Microdermabrasion

Microdermabrasion Treatment

Exfoliation or superficial removal of the outer surface of the epidermis and superficial dermis by gentle mechanical abrasion is called microdermabrasion treatment. This skin rejuvenation procedure was popular even in ancient Egypt. In 1500s the physicians used a type of sandpaper to treat scars. In the early 1900s, modern dermabraon was developed by Kromayer in Germany, who used human powered rotation wheels and rasps to treat scars, keratoses and hyperpigmentation. However, it was not very popular until mid-1950s, when Kurtin, Burks, and others began using motorized wire brushes. Dermabrasion, however, had its own risks. There was increased downtime, pain, risk of scarring. Keeping in mind the risks of dermabrasion Dr. Matiolli and Brutto developed the first microdermabrasion machine in 1985 in Italy. This first machine was a “closed-loop” system, which meant that the abraded skin was returned to a “dirty” container in the machine instead of being aerosolized. 

Microdermabrasion machines got introduced in America by Mattioli Engineering in the late 1990s, and since then the production of microdermabrasion machines has exploded. Modern microdermabrasion uses refined abrasive elements such as diamond tipped heads or constant flow of aluminum oxide crystals to remove the stratum corneum. Crystal free devices are becoming more popular due to the lack of dust and hence minimal risk of triggering asthma and ocular injuries.

 Principle of microdermabrasion treatment

 The principle of MDA is based on wound healing. Removal of superficial skin in a controlled manner stimulates cell renewal with regeneration of epidermis and upper part of dermis. Multiple sittings are required to see a visible change. After microdermabrasion, histologically the skin shows thickening of the epidermis and dermis, flattening of the rete pegs, vascular ectasia and perivascular inflammation, and hyalinization of the papillary dermis with newly deposited collagen and elastic fibers.

Clinically the improvement is seen in the form of smoothening of skin and decrease in hyperpigmentation. Some studies show improvement in acne scars, fine liIndications

• Dull, sallow skin

• Superficial scars

• Rough texture

• Enhanced penetration of chemical peels

• Enlarged pores

• Photoaging

• Hyperpigmentation (Solar lentigenes,melasma, PIH)

• Fine lines

• Acne grade I—white and black comedones Contraindications

• Sun burns

• Patient on oral isotretinoin therapy and within 3 months of completing the therapy

• Active rosacea (especially with crystal MDA)

• Papulopustular acne (especially with crystal MDA)

• Very thin skin or excessive laxity and skin folds

• Burn and trauma scars, which are atrophic

• Active herpetic, bacterial, viral infection (verrucae)

• Hypersensitivity to aluminium oxide crystals

• Keloidal tendencynes, and pore size.

Complications

 Superficial abrasion Pain or temporary discomfort Pruritus Immediate erythema Edema Persistent erythema Postinflammatory hyperpigmentation Activation of Herpes simplex infection Bacterial infection Fungal infection Ocular injuries Urticaria (with crystal MDA) A remote possibility of scarring (with crystal MDA).

 CRYOTHERAPY

Cryotherapy is controlled destruction of tissues by the application of substances at freezing temperatures.The mechanism is by heat transfer, inflammation, and immunomodulation. It is indicated in the management of variety of benign and malignant lesions. Contraindicated in patients with blood dyscrasia and lesions where histopathology is required. Cryotherapy (derived from kyros meaning “icycold” in Greek) is a form of treatment that entails controlled destruction of tissues by the application of substances at freezing temperatures. It is known by various synonyms such as cryosurgery, cryocautery, cryocongelation, and so on. It is an inexpensive, easy, and safe procedure and can be performed in an office. The cosmetic results are also good with minimal or no scarring.

HISTORY OF MICRODERMABRASION TREATMENT

For thousands of years, the benefits of cold have been utilized by mankind for palliative purposes. The ancient Egyptians, and later Hippocrates, knew of the analgesic and anti-inflammatory properties of cold. Over the years, cold treatment has evolved from generalized application such as hydrotherapy to the recent specific, focal destruction of tissue—cryosurgery. Campbell White, of New York, was the first person to employ refrigerants for medical use in 1899. Liquid air (78% nitrogen, 21% oxygen, 1% argon, and traces of other rare gases),1 liquid oxygen, and carbon dioxide snow were initially used for cryotherapy. Allington is believed to have first usediquid nitrogen in 1950.

 Cryogen Boiling point (°C)

Liquid nitrogen −196

Liquid oxygen −183

Nitrous oxide −89

CO2 snow −78

Fluorocarbons −30

Dimethyl ether −24

 Mechanism of action Steps 

1. Direct tissue injury Heat transfer, cell injury, and inflammation

2. Indirect tissue injury Vascular stasis and tissue hypoxia

3. Immunomodulation Exposure of viral particles to immune system

INDICATIONS

 Cryotherapy has been found to be useful in a variety of lesions, showing satisfactory to very good results. They can be classified as follows:

1. Viral infections: Common warts, condyloma acuminata, molluscum contagiosum

 2. Vascular lesions: Hemangiomas, angiokeratomas, cherry angiomas, pyogenic granulomas

 3. Benign tumors: Skin tags, dermatosis papulosa nigra, syringomas, milia, keloids, acne keloidalis, xanthelasma, nodular acne, verrucous epidermal nevus, seborrheic keratosis

4. Premalignant lesions: Bowen’s disease, actinic keratosis, basal cell epitheliomas, leucoplakia, erythroplasia of Queyrat

5. Malignant lesions: Squamous cell carcinoma (SCC), basal cell carcinoma (BCC), lentigo maligna, malignant melanoma

 6. Miscellaneous: Postherpetic neuralgia, cutaneous leishmaniasis, granuloma annulare, hypertrophic lichen planus, prurigo nodularis, cutaneous larva migrans.6–11

 CONTRAINDICATIONS

Absolute contraindications Relative contraindications

Blood dyscrasias

Cold urticaria

Lesions for which tissue pathology is required

Lesion in an area with compromised circulation

Proven sensitivity or adverse reaction to cryosurgery

Sclerosing BCC or recurrent BCC or SCC, particularly when located in a high-risk area such as temple or nasolabial fold

 Keloidal tendency

Pyoderma gangrenosum

Cold intolerance

Collagen vascular disease

Cryoglobulinemia

Raynaud’s disease

Multiple myeloma

Sensory loss at lesional site

Lesions located in pretibial areas, eyelid margins,nasolabial fold, ala nasi, and hair-bearing areas

Concurrent treatment with immunosuppressive drugs

Very dark individuals

Immediate Complications

1. Edema and blister formation

2. Pain during and immediately after the procedure

3. Headache on freezing lesions on head and neck areas

4. Vasovagal attack in overanxious patients

5. Rarely, bleeding can occur at treatment site

Delayed Complications

 1. Hemorrhagic necrotic blister formation 

2. Wound infection

3. Delayed wound healing

4. Rarely, scar hypertrophy

 Protracted Complications

 1. Hypopigmentation at the site of treatment due to destruction of melanocytes

2. Atrophy

3. Cicatricial alopecia

4. Milia formation

5. Hypoesthesia (usually temporary) in lesions close to superficial nerves