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Part 2 book “Color atlas of cosmetic dermatology” has contents: Cherry and spider angiomas, granuloma faciale, granuloma faciale, pyogenic granuloma, keratosis pilaris atrophicans, infantile hemangioma, basal cell carcinoma, striae distensae, squamous cell carcinoma, dermatosis papulosa nigra,… and other contents.
S IX Vasc u l a r A l te rat i o n s 68 I Color Atlas of Cosmetic Dermatology CHAPT E R 29 Angio ke rato m a Angioke ratomas a re te la ngiectasias with keratotic ele ments They present i n d i ffe rent c l i n ical scena rios i n c l u d i n g ( a ) solitary or m u lt i p l e a ngioke ratomas occ urring p red o m i n a ntly on lower extre m ities; ( b) a ngiokeratoma of Fordyce affecti n g the sc rotu m a n d the vu lva ; ( c ) a ngiok e ratom a of M i be l l i , a n a utoso m a l d o m i n a nt d isorder affecti n g d o rs u m of h a n d s a n d feet, e l bows, a n d knees; (d) a ngiokerato ma corporis d iffus u m associated with Fa bry's d isease, an X- l i n ked recessive d isord e r c h a rac terized by a.-ga lactosidase-A d eficie ncy and affecting the lowe r a bd o m e n , buttoc ks, a n d ge n ita l ia ; a n d ( e ) a ngioke ratoma c i rc u mscri ptu m usua l ly grou ped on one extre m ity E P I D E M I O LOGY Age: solita ry o r m u ltiple a ngiokeratomas u s u a l l y affect you n g a d u lts , a ngiokeratomas of Fordyce affect m i d d le aged and elderly i n d ivid u a l s Angioke ratoma of M i be l l i a n d a ngioke rato ma c i rc u msc r i ptu m a re u s u a l l y d iag n osed in c h i l d h ood Sex: a ngiokeratoma of M i be l l i a nd a ngioke ratoma c i r c u mscri pt u m exh i bit fem a l e pred o m i na nce Otherwise, there is no sex pred is position PHYS I CAL EXAM I NAT I O N R ed t o violaceous, we l l - c i rc u m sc r i bed hyperke ratotic pa p u les a n d p l a q ue s A D I F F E R E N T I A L D I AG N OS ES Sol ita ry lesions ca n be m ista ken for mela noma , a cq u i red hemangioma, lym p ngio m a , seborrheic ke ratos is, a n d wa rts LABORATORY DATA • D e r m atopat h o l ogy M a rked d i lated , t h i n -wa l l ed blood vesse ls in the pa p i l l a ry d e r m i s , associated with an overlying acanthotic hyperker atotic epidermis COU RS E MANAG E M ENT B M a nagement o f a ngiokeratomas rema i ns a c h a l lenge Figure 29 (A) Angiokeratomas on the abdomen of a young patient M a n y m od a l ities have been reported i n the l iterature with (B) Angiokeratoma imaged through an epiluminescence microscope va riable s uccess Treatment m od a l ities i n c l u d e (DermLite) Sect i o n : Va sc u l a r A l te rat i o n s • I 69 Lasers : a ngiokeratomas have occasionally been treated successfu lly with lasers - The p u lsed dye laser ( P OL) is an effective d evice for the i m provement of the vasc u l a r component of a ngiokeratomas, but freq uently some keratosis rema i n s The target c h romophore is hemogl o b i n P O L has proven successful a t 595 n m , 5-to-7- m m spot, t o 1 J/c m , O C O 30/20 Cove ring the a ngiok e rato m a with a glass s l i d e , that is, d iascopy, is h e l p fu l The end point is lesional p u r p u H ea l i ng occ u rs in more than 10 to 14 days M u lt i p l e treatments may be req u i red ( Fig 29 ) - Res u rfacing lasers s u c h as C0 and Er:YAG lasers ca n be uti l ized for lesiona l va porizatio n Patients genera l ly req u i re local i nfi ltration with % l id oca i n e with or with out epinephrine prior to treatment The U ltra Pu lse C0 ( Lu men is, Sa nta Clara, CAl is employed using a 3-m m col l i mated hand piece, with an energy of 300 to 500 mJ with nonoverlapping pu lses The va rious sca n ned C0 lasers such as the Sharplan FeatherTouch a re Figure 29.2 Angiokeratoma on the left thigh resistant to m ultiple treat ments with pulsed dye laser em ployed using the 25-m m hand piece, 3-m m sca n size at 14 to 40 W The treatment end point is a blation to achieve lesional flattening and opalescence Treatment sites should be clea nsed with sa l i ne soa ked ga uze between laser passes Postoperative care req u i res twice d a i ly wash i ng with soa p and water a n d a ppl ication o f a n a nti biotic oi ntment Hea l ing occ u rs i n more t h a n t o weeks A s with a l l a blative proced u res, sca rring may be observed - Other lasers that have been used i n the past with va riable success i n c l u d e potass i u m -tita nyl-phosphate laser, a rgon laser, a n d copper va por lase r Long pu lsed N d : YAG ( , 064 n m ) laser has been shown to be effective in i m prov i n g a ngioke ratomas d u e to its selectivity a nd its deeper penetration i nto the ski n Successfu l treatment with a d ua l -wave length laser A system (595 a n d reported , 064 n m ) has been rece ntly ( Cynergy with M u lti plex™ , Cynosu re, Westford , MA, U S A ) • O t h e r s u rgical treatments i n c l u d e excision , electro ca utery, electrofu lgu ratio n , or c ryosu rgery P I T FALLS TO AVO I D • Patients s h o u l d be advised that the P O L treatment wi l l cause o bvious b r u i s i n g for u p t o 14 days • Keratotic featu res may persist after treatment I m provement is often el usive B I B L I OG RAPHY Gorse SJ , J a mes W , M u rison M S S u ccessful treatment of a ngioke ratoma with potass i u m tita nyl phosphate laser Br J Dermatol 2004; 50 ( ) : 620-622 B Figure 29.3 (A) Biopsy-proven angiokeratoma on the thigh of a young child (B) Some resolution after one treatment with pulsed dye laser at a wavelength of 595 nm with a 0-mm spot, pulse duration of ms, a fluence of J/cm2 , and DCD 30120 70 I Color Atlas of Cosmetic Dermatology La pi ns J , Emtesta m L, M a rcusson J A Angiokeratomas i n Fa bry's d isease a n d Fordyce's d i sease : Successful treat ment with copper va pour laser Acta Derm Venereal 993; 73 ( ) : 33- Occella C , B l e i d l D , R a m p i n i P, Schiazza L, R a m p i n i E Argon laser treatment of c uta neous m u lt i p l e a ngioker atomas Dermatol Surg 1995;2 ( ) : 70- Ozd e m i r M , Baysa l I , Engi n B , Ozd e m i r S Treatment of a ngiokeratoma of Fordyce with long- p u lse neodym i u m d o ped ytt r i u m a l u m i n i u m garnet laser Dermatol Surg 2009;35( ) : 92-97 Pfi rrma n n G , R a u l i n C , Ka rsa i S Angioke rato ma o f the lower extre m ities: Successfu l treatment with a d ua l wavele ngth laser system ( 595 a n d 064 n m ) Eur Acad Dermatol Venereal 2009;23( ) : 86- 187 Sommer S , M e rc h a nt WJ , Shee h a n - Da re R Severe p re d o m i n a ntly acra l va riant of angiokeratoma of M i be l l i : Response t o long-pu lse N d : YAG ( 064 n m ) laser treat ment JAmAcad Dermatol 200 ;45 ( ) : 764-766 CHAPT E R Che r ry a nd Spid e r Angio mas Cherry a ngiomas, a lso known a s r u by spots, se n i l e hema ngiomas, a cq u i red ca p i l lary hemangioma, and Ca m p bell d e Morga n spots a re very c o m m o n benign vas c u l a r lesions that pred o m i n a ntly affect the tru n k Spider a ngiomas, a lso known as nevus a n eus, spider telangiec tasia, a rteri a l spid er, and vasc u l a r spid er, re present loca l ized telangiectasias rad iating from centra l feed ing a rterioles They a re common vasc u l a r lesions that pre d o m i n a ntly affect the face, u pper tru n k , a rms, and hands EPI OEM I O LOGY Incidence: very common Age: cherry a ngiomas-m i d d l e-aged a n d elderly peo ple; s p i d e r a ngiomas-a l l ages Sex: more common in fema les Precipitating factors: cherry a ngiomas can e r u pt d u ri n g p regnancy or w i t h h e patic d i sease S pider a ngiomas a re strongly associated with pregna n cy, i nta ke of ora l contra ceptive p i l ls, a n d h e patoce l l u l a r d isease PATHOG EN ES I S U n known for both Assoc iation with pregna n cy, o l con traceptive use, a n d l iver d isease suggest a hormona l ly med iated a ngioge n i c mecha n is m Sect i o n 6: Va sc u l a r A l te rat i o n s I 171 PHYS I CAL EXAM I NAT I O N Cherry a ngioma prese nts as a -to-3-m m bright red to violaceous, s mooth , d o m e-sha ped pa p u l e Spider a ngioma d is plays a network o f d i l ated ca p i l l a ries rad iati ng from a ce ntra l vessel B oth may bleed when tra u matized PATHOLOGY Che rry a ngiomas show loss of rete ridges as we l l as con gested and ectatic ca p i l l a ries a n d postca p i l l a ry ven u les in the pa p i l la ry dermis S p i d e r a ngiomas revea l a centra l asce n d i ng a rte riole that b nc hes a n d co m m u n icates with m u lt i p l e d i lated c a p i l l a ries D I F F E R E N T I AL D I AG N OS ES Cherry a ngiomas ca n be m ista ken for angiokerato m a , glomeruloid hema ngioma , pyoge n i c gra n u l o m a , and n od u l a r mela noma S p i d e r a ngiomas can be m i sta ken for genera l i zed essentia l te langi ectasias a n d h ered ita ry h em orrhagic tela ngiectasia CO U RS E Che rry a nd spider a ngiomas a ri s i n g d u ri n g pregnancy may regress postpa rt u m S p i d e r a ngiomas a rising i n c h i l d hood m a y a lso resolve sponta neous ly Otherwise, both lesions ten d to persist A MANAG E M ENT Although med ica l l y i nsign ifica nt, c h e rry a n d spider a ngiomas a re freq u e ntly treated for cosmetic p u r poses M u ltiple effective s u rgica l treatment o ptions exist Depend i ng on the proced u re selected , the cost to the patient may va ry sign ificantly Che rry and spider a ngiomas that present d u ri ng pregnancy s h o u l d n ot be treated u ntil seve l months after d e l ivery as they may resolve on their own • El ectrosu rgery - El ectrod essication with coagulation ( monopolar set ti ng, 1-2 W fol l owed by gentle c u rettage with end point of lesional flatte n i ng a n d h em ostas is) has been the trad itiona l treatment m od a l ity for th ese lesions - I t is effective and easi l y a ccess i b l e - The potential f o r sca r formation m ust b e considered • Laser su rgery : d ifferent lasers have been used su ccess fu l ly in treatment of c h e rry a n d spider angiomas B - P u l sed dye laser ( P OL) is the treatm e nt of c h oice A Figure 30 (A) Spider angioma, right nose (B) Full resolution of spider angioma after a single pulsed dye laser treatment to central vessel and surrounding skin s pot size s h o u l d be selected that matc h es d ia meter of the a ngioma With spider a ngiomas, the ce ntra l 72 I Color Atlas of Cosmetic Dermatology feed i n g vessel as we l l as the s u r ro u n d i n g vessels s h o u l d be treated It is best to com press the lesion with a m i c roscope s l i d e to b l a n c h all but the centra l fee d i n g vesse l A p u r p u r i c laser pu lse s h o u l d be d e l ivered The m i c roscope s l i d e shou ld be rem oved to a l low for coo l i n g of the a rea S u bseq uently, a p u r p u r i c laser p u lse ca n be e m p l oyed to target the te la ngiectasias rad iating from the feed i n g vesse l The p u r p u ric treatment end point re presents coagu lation of the targeted vessels ( Figs 30 and ) - The potass i u m -tita nyl-phosphate ( KT P ) 532-n m laser prod u ces a favora b l e res ponse S pot size s h o u l d match the lesion d i a m eter The vessels shou l d b e traced out c o m p l etely for m ost effective treatment Treatment end point is lesional cleara nce or su perfi c i a l white n i ng E rythema ca n be expected posttreat ment, last i n g 24 to 48 h o u rs A - Ca rbon d ioxid e laser ( U itra P u lse 3-m m co l l i m ated h a n d piece, 300-400 mJ/pu lse, nonoverlapping p u l ses; Sharplan FeatherTou ch 25- m m h a n d piece, 14-40 W, 3-mm sca n size, nonoverla p p i n g p u lses) has been e m p l oyed as secon d-l i n e thera py with su ccess Treatment e n d po i n t is lesional flatte n i n g Potentia l sca r formation m ust be consid ered • Light thera py - I ntense p u l sed l ight ( I P L) has a lso been e m p l oyed with some su ccess As coagu lation is needed fo r lesional reso l ut i o n , h igher fluences may be req u i red for treatm ent efficacy • S u rgical exc ision - Excision should be reserved for lesions that a re resis ta nt to other treatments A posto perative sca r is expected w h i c h may be less cosmetically pleasing t h a n the a ngioma P I T FALLS TO AVO I D • B Figure 30.2 (A) Cherry angiomas on the trunk in a middle-aged female (B) The appropriate endpoint is purpura obtained after pulsed dye laser treatment (wavelength of 595 nm, 7-mm spot 5-ms pulse duration, f/uence of J/cm , DCD 30120) Patie nts need to be cou nseled as to the l i ke l i h ood of o bvious p u r p u fo l l owi n g treatment with P D L that may persist for to 14 d ays , espec i a l l y off the face Lesions a re less l i kely to be com pletely treated at s u b p u r p u ric fluences • S i m ple electrocautery may be j u st as effective as P D L at a red uced cost t o t h e patient • Com press i n g the lesion with a glass slide d u ri n g PDL o r K T P treatment is h e l pful t o m i n i mize its s i z e a n d a l low i ng for greate r laser penetrati o n This red u ces the tota l energy needed for coagu lation a n d i n c reases the treat ment success rate • M u lt i p l e treatme nts may be req u i red , in pa rti c u l a r for la rge spider a ngiomas A Figure 30.3 (A) Cherry angioma, chest Sect i o n : Va sc u l a r A l te rat i o n s I 73 B I B L I OG RAPHY Dawn G , G u pta G Com pa rison o f potass i u m tita nyl p h os p hate vasc u l a r laser a n d hyfrecato r in the treatment of vasc u l a r spiders and che rry a ngiomas Clin Exp Dermatol 2003 ; 28(6) : 58 -583 Fod or L, R a m o n Y, Fodo r A, Ca r m i N , Peled I J , U l l ma n n Y A side- by-side pros pective study o f i ntense p u l sed l ight and N d : YAG laser treatment fo r vasc u l a r lesions Ann Plast Surg 2006; 56(2 } : 64- 70 B c D Figure 30.3 (ContinuedJ (B) Pulsed dye laser treatment to cherry angioma utilizing diascopy (C) Purpura immediately post pulsed dye laser treat ment (D) Complete resolution of cherry angioma after one pulsed dye laser treatment 74 I Color Atlas of Cosmetic Dermatology CHAPT E R G nu l o m a Facia l e G n u loma fac i a l e ( G F ) was fi rst d escri bed by Wigley i n 945 w h o la beled t h e d i sease "eos i n o p h i l ic gra n u l o ma " P i n kus re n a m ed this d isorder gra n u loma fac i a l e i n 1952 G F is a n i d i o pathic c h ro n i c c uta neous d isorder that usu a l ly i nvolves the face, pa rt i c u l a rly the nose It ca n prese nt with a si ngle lesion or m u ltiple lesions E P I D E M I O LOGY Incidence: u n c o m m o n Age: 30 t o 50 yea rs Race: pri m a ri ly seen in Caucasians Sex: ma les > fem a l es Figure Granuloma faciale on the scalp PATH OG E N ES I S U n k nown , but may b e mediated b y i m m u ne c o m p lex d e position PHYS I CAL EXAM I NAT I O N Si ngle i n d u rated facial brown ish-red pa pule o r plaque Some lesions may have telangiectasia M u ltiple lesions may be present Extrafacial sites rarely observed Lesions may vary in size from m i l l i meters to centimeters ( Fig ) D I FFERENTIAL D I AG N OS ES Cutaneous l u pus erythematos us, sa rco idosis, lym p h o m a , pseudolym phoma , c uta neous T-ce l l lym p h o m a , fixed d ru g e r u pti o n , rosacea D E R M ATOPATHOLOGY Dense, polymorphous i nflam matory cell i nfi ltrate i n the u pper two-t h i rds of the dermis The i nfi ltrate is com posed of n u merous eosinoph i ls, neutrophi ls, lym phocytes, a n d h istiocytes A pro m i nent grenz zone is c h a racteristica lly present Leu kocytoclastic vasc u l itis is freq uently observed CO U RS E The lesions of G F a re usua l ly c h ro n i c a n d o n l y occasion a l ly resolve s ponta neously Sect i o n : Va sc u l a r A l te rat i o n s I 75 MANAG E M ENT Difficu lt t o treat with a ny modal ity A n y s uccessfu l treat ment often leaves sca rring • To p i c a l Treat m e n t • Corticosteroids: topica l , i ntra lesio n a l • Tac ro l i m u s o i ntment (0 % ) • Syste m i c Treat m e n t • Da psone • Anti m a l a ri a l s • Colc h ic i n e • Cl ofaz i m i n e • G o l d i nj ecti ons A S U RG I CAL TREAT M E N T • C ryos u rgery: m u ltiple reports i n d icati ng su ccessful c l ea n c e Resu lts a re u n pred icta ble ( Fig ) • S u rgical excision • Derm a b rasion • El ectrosu rgery • L i g h t Treat m e n t • Topica l psora len a n d u l traviolet A ( P UVA) rad iation thera py • Laser thera py: d ifferent lasers have been used in the treatment of GF with p ro m i s in g resu lts, either as an a b lative thera py with ca rbon d i oxid e laser o r as a selec tive thera py ta rget i n g the prom i n ent vasc u latu re in G F lesions using the Q-switc hed a rgon laser, p u lsed dye, d i ode laser, and potass i u m tita nyl phosphate ( KT P ) 532-nm l a s e r ( F ig 3 ) P I T FALLS T O AVO I D • G F is often reca lc itra nt to thera py Patie nts s h o u l d be cou nseled that successfu l treatment is often el usive B I B L I OG RAPHY A m m i rati CT, H ruza GJ Treatment o f gra n u l o m a fac i a l e w i t h the 585- n m p u l sed d y e laser Arch Dermatol 999; 135(8) :903-905 Apfel berg DB, Dru ker D , Maser M R , Las h H, S pence B J r, Denea u D G n u l o m a fac i a l e Treatment with the a rgon laser Arch Dermatol 983 ; 1 ( ) : 573-576 B Figure (A) Multiple lesions of granuloma faciale on the face (8) No significant improvement detected after one treatment with cryotherapy on a 4-month follow-up visit 76 I Color Atlas of Cosmetic Dermatology Chatrath V, R o h rer TE G n u loma fac i a l e successfu l l y treated w i t h long-pu lsed t u n a b l e d y e laser Dermatol Surg 2002 ;28( ) : 527-529 Elston O M Treatment of gra n u loma fac i a l e with the p u l sed dye laser Cutis 2000;65(2 ) : 7-98 Khaled A , J ones M, Zerma n i R, et a l G n u loma fac i a l e Pathologica 2007 ;99( ) : 306-308 M a i l l a rd H, G rogna rd C , Toled a n o C, J a n V, Mac het L, Va i l la nt L G n u l o m a fac i a l e : Efficacy of c ryosu rgery i n cases Ann Dermatol Venereal 2000; ) : 77-79 To mson N , Ste rl i ng J C , Sa lva ry I G n u loma fac i a l e treated successfu l l y w i t h topica l tac ro l i m us Clin Exp Dermatol 2009;34(3) :424-42 Wheela nd R G , Ash l ey J R , S m ith O A , E l l i s O L, Wheela n d O N Ca rbon d ioxid e l a s e r treatment o f gra n u loma fac i a l e J Dermatol Surg Oneal 984; ( ) : 730-733 A B Figure 3 (A) Indurated brownish-red plaque on the left cheek of a middle-aged female with granuloma facia/e (B) Two-year follow-up show ing resolution of granuloma faciale after m ultiple pulsed dye laser treat ments 31 I Color Atlas of Cosmetic Dermatology A c Figure 64.3 One stage preauricular flap to repair earlobe deformities INDEX N ote : I n this i ndex, the letters "f" and "t" denote figu res and ta bles, respectively pathogenesis, 72 1, 450-nm diode laser, 82, 82f, 83f physical exa m i nation, 72 5-a m inolevu l i n i c acid (5-ALA), 75, 254 5-fl uorouraci l , 207, 224, 229 Acq u i red ca p i l l a ry hema ngioma, 70-1 73 1320-nm N d : YAG laser, 1 450- n m diode laser, , 74 Acra l amela notic melanoma, 206 Acti n i c c h e i l itis, 248 Actinic keratosis (AK), 248 consu ltative q uestions, 249 A cou rse, 249 Ablative fractional laser resu rfaci ng, 39, 57 dermatopathology, 248 adva ntages of, 57 ind ications, 58 d ifferential d iagnosis, 248 epidemiology, 248 laser safety, 59 ma nagement, 249 adverse side effects, 60, 601 pathoge nesis, 248 fol low- u p , 59-60, 59f physical exa m i nation, 248 i nfectio n , 60, 1 pitfa l l s , 250-2 nonfacial skin, 60-6 postoperative care, 57f, 58f, 59 treatment, 249-250 Acti n i c keratoses vs wa rts, 206 preoperative eva l uation, 58 Acyclovir, 32, 46, 54 prophylaxis/a nesth esia, 58-59 Ablative laser res u rfacing, 11, 52 Ada palene, 9, 73 a bsol ute contra i nd ications, 45 Adatosil 5000, 14t, 5t a n esthesi a , 46-47 for Becker's nevus, Adenoma sebaceu m , 2 Affirm , 440 n m N d : YAG laser, 56, 56t for epidermal nevus, 224 Age-related textural cha nges, 2t ideal laser candidate, 45 Agi ng, i n d ications, 44 Aging face and non-facial regions, a na lysis of less than ideal laser cand idate, 45 a natomic consid erations, 2-3 , 2t mecha n ism of action, 43 ca rbon d i oxide laser, 43, 43f, 44f preoperative eva l uation, ca rti lage, bony structures, and s u p portive structures, Er:YAG, 43, 45f cha nges in, medications, 46 facial m uscu lature cha nges, for m i l ia , 230 G l oga u Photoaging Classification, 2f, 3-4, 3f, 4f, 5f postoperative care, 49, 501, 1 pigmenta ry cha nges, 4, 6f preoperative eva l uation, 44-45 proced ure, 48-49, 49f su bcuta neous fat atrophy, AK See Acti nic keratosis relative contra ind ications, 45-46 A LA See 5-a m i n olevu l i n i c acid safety mea s u res, 47-48 Alca i ne See Topica l proparaca ine for seborrheic keratosis, 236 Alcon, 28 treatment pearls, 50 ACE i n h i bito rs See Angiotensi n-converting enzyme (ACE) i n h i bitors Alcon La bs, 5t Al lerga n , 4t, 5t, 1 Aceta m i nophen, 58 Allergic reactions Acetone, 48 to sclerothera py, 20 Al loderm , 14t Acne scars, 290, 293 Aloe vera , 10 physica l lesions, 293-295 treatment, 295 Acne vu lga ris, 72, 76, 00 Aloesi n , 9t, 10 a-hyd roxy acid, 32 lotions, 182 vs angiofi broma, 2 for posti nfl a m matory hyperpigmentation, 60 cou rse, 73 d ifferential d iagnosis, 72 peels, epidemiology, 72 A l u m i n u m c h l oride hexa hydrate, la boratory data dermatopathology, 73 A m b u latory phle bectomy, 202 American Academy of Dermatology, endocrine stud ies, 72-73 Amoxici l l i n , 73 ma nagement, 73 Amyotro phic latera l sclerosis, 22 l ight treatment, 72f, 73f, 74-75, 75f Anesthesia , 88 s u rgica l treatment, 74 for a blative fractional laser resu rfaci ng, systemic treatment, 73-74 topical treatment, 73 58-59 for a blative laser resu rfaci ng, 46-47 31 31 I I ndex for a ngiofi broma, for l i poma treatment, 227 for neurofi broma, 236 for nonablative fractional laser resu rfaci ng, 54 for nonablative laser resu rfa c i ng, 40 m i d - i nfrared lasers, 40f, for soft tissue augmentation, 6f, for wa rt remova l , 207t, 208 Angiofi broma, 2-2 consu ltative q uestions, cou rse, , 3f de rmatopathology, 2 d ifferenti a l d iagnosis, 2 epidemiology, 2 laboratory data , ma nagement, 3-2 14, 4f, 5f pathogenesis, 2 physical exa m i nation, 2 , 2f pitfa l l s , Angiokeratoma, 68 vs angiomas, cou rse ma nagement, 68-1 69, 69f de rmatopathology, 68 differentia l d i agnoses, 68 epidemiology, 68 physical exa m i nation, 68 pitfa l l s to avo i d , 69 Angio l i poma, 226 Angiomas, cherry and spider, 170 cou rse, differentia l d i agnoses, epidemiology, 70 ma nagement, - pathogenesis, 70 pathology, physical exa m i nation, pitfa l l s to avo i d , Angiotensi n-converti ng enzyme (ACE) i n h i bitors, 89 Anth l i n , 224 Anti bacterial agents, 73 Anti bacteria l thera py, 46, 53 Anti biotics, 73 Antima la ria ls, 75 Antioxida nts, Anti pers p i nt, 89 Antivira l med ications, 49 Antivira l thera py, 46, 54 Apraclo n i d i n e hydrochloride, 28 Aq ua m i d , 4t Aquaphor H ea l ing O i ntment, 49 Arbuti n , 9t, Artefi l l , 4t Arterial spider, 70- 73 Ascorbic acid , 9t, 1 B B l u pu s m i l iaris d isse m i natus faciei, 76 B - H C G See � - H u m a n chorionic gonadotropin B a n naya n-Zonana synd rome, 226 Basa l cell carci noma ( BCC), 81, 252-254 epidermal nevus a n d , 222, 223 consu ltative q uestions, 253 cou rse, 253 de rmatopathology, 252 d ifferential d iagnoses, 252 epidemiology, 252 la boratory data, 253 ma nagement, 253-254, 253f, 254f, 255f pathogenesis, 252 physical exa m i nation, 252, 252f pitfa l l s , 254 B ea rberry, B ecker's nevus, consu ltative q uestions, cou rse, d ifferential d iagnosis, epidemiology, la boratory exa m i nation, ma nagement, 7-2 18, 7f pathogenesis, pathology, physical exa m i nation, 6, 6f pitfa l l s , B e l otero Basic, 4t B e l otero Soft, 14t Benign growths a ngiofi broma, 2-2 Becker's nevus, epidermal i nclusion cyst, 9-22 epidermal nevus, 222-225 Benzoyl peroxide, 73 �- H u ma n chorionic gonadotropin ( B- H C G ) Betaca ine Enha nced Gel, B etaca ine P l u s , B io-Aica m i d , 14t B i oform M e d i ca l , 5t B iomatrix I nc , 5t B i o psies epidermal i nclusion cysts, 220 epidermal nevus a n d , 223 l i poma, 227 neurofi broma, 232 seborrheic keratosis, 235 B i otech I n d u stry, 5t B laschke, l i nes of, 222 B leac h i n g crea ms, 46 B l e p h a rochalasis, 64 B loom's synd rome, 67, 136 Bornaprine, 87 Ash leaf macule, 2, 3f Botox, 89 See also Botu l i n u m toxin A Aspergillus, AstraZeneca , Botu l i n u m toxin Botox Cosmetic, 1! Ataxiatela ngiectasia, 67 com pl ications, 27 Ativa n , 58 contra i n d ications Atro p h i c scars, 294-295 Atrophoderma verm iculatu m (AV), a bsol ute, 22 relative, 22 Avila , Avobenzone, 7t d i l ution, 22 Azelaic a c i d , 9t, 10, 73, 77, , , 60 m uscle gro u ps, 22f, 23 Azit h romyc i n , 46, 73 mecha nism of action, 21 forehea d , 22f, 23-24, 23f I n d ex gla bellar com plex, 24, 24f Cavernous hemangioma, 77-1 80 nasolabial fol d , 25 6, 27f Cel l u l ite, 276-279, 276f neck, 26-27, 28f consu ltative q uestions, 277 periora l region, 26, 27f, 28f periorbital regio n , 24-25, 25f course, 276 u pper nasal root, 25, 26f epidemiology, 276 la boratory exa m i nation, 276 pharmacology, , ! ma nagement, 277 postoperative considerations, 27 physical lesions, 276 preoperative eva l uatio n , 22 pitfa l l s , 278 279 lower eyelid snap back test, 22-23 prepa rations, lt treatments, 277-278, 277f proced u re, 23 Centrofacial te la ngiectasias, 194f Chem ical peels, 30, 74, treatment benefits, 27 compl ications, , 38f treatment pearls, 28 contra i n d ications, 1-32 B otu l i n u m toxin A ( BTX-Al , , 22, 87, 88, 88f a n esthesi a , 88 antipers p i nt, 89 ideal ca n d i d ate, less ideal ca n d idate, med ications, 32 Botox, 89 peel types, 33 hyperh i d rosis, mechanism of action i n , 88f postoperative care, 34 i njection sites of, 88f, 89f proced ure, 33-34, 36f, 37f med ications, 89 treatment pearls, 34-35 su rgery, 89 treatment, 88-89, 88f, 89f wou n d depth, 32 Chem ical su nscreen, 7-8, 7t Botu l i n u m toxin B ( BTX- B l , Cherry a ngiomas, 70 73 , 72f B otu l i n u m toxin E ( BTX-E), Cinoxate, 7t B r i n d is, 14t C i p rofloxa c i n , 46 Broussonetia papyrifera, C l i ndamyc i n , 73 B ucci nator, , 27f, 28f Clofazimine, c C02 l a s e r a b lation, 82 C02 resu rfacing See Carbon d ioxide (C02 ) laser Coenzyme Q10, Clostridium botulinum, Cafe au lait macu les (CALMs), 136 vs B ecker's nevus, consu ltative q uestions, 137 Colchicine, cou rse, 137 Col lagen, i n a ngiofi broma, 2 Col lagenase, d ifferential d iagnosis, 136 Comedone extractio n , 74 epidemiology, 136 Common wa rts, 206-209 la boratory exa m i nation, 136 laser treatment, 37-138 Compression stocki ngs, 200 ma nagement, 137 Complete tea rs, 308 vs neurofi bromas, 232 Congen ital ad renal hyperplasia, 92 Congen ita l hema ngiomas, 7 pathogenesis, 136 Congen ita l nevus, pathology, 136 Contu I nternationa l , 4t physica l lesions, 136 pitfa l ls, 138 Cooltouch I n c , topical treatment, 138 Corrugator s u perc i l i i , 24, 24f Corticosteroids, 64, 75 Calci potriol, 224 Corrective h a i r transplant su rgery, 10, 1 0t Campbell de Morga n spots, 70 73 for epidermal nevi , 224 Candela Corp , for epidermal i ncl usion cysts, 22 Canderm, Canderm Pharma, I n c , 4t Ca n i n us, 26, 27f, 28f for m i l ia , 229 Cosmod ermrM , 14t Cantharone, 207 Cosmoplas(TM , 14t Cross-hatch ing, 18 Ca p i l l a ry, 77 Cryogen spray coo l i n g (CSC ) , 185 Ca ptiq uerM , 4t Cryosu rgery, 175 Carbon d ioxide (C02 ) laser, 43, 43f, 48, 49, 57, , 239 Carbon d ioxide laser resu rfacing Cryothera py for a ngiofi broma, 213, 4-2 5f for a ngiomas, 72 for de rmatosis pa pu losa n igra , 242 for ephelides, 142 for epidermal nevus, 224 for basa l cell ca rcinoma, 254 for lentigines, 146 for epidermal nevus, 224 for neu rofi broma, 232 for sebaceous hyperplasia, 83 for seborrheic keratosis, 236 for sq uamous cell carcinoma, 258 for sq uamous cell carcinoma, 258 for venous la kes, 208 for venous lakes, 204 for wart remova l , 209 for wa rts, 207t, 208 for seborrheic keratosis, 236, 237, 237f for seborrheic keratosis, 236 I 313 314 I I ndex C u rettage Dyschromia for epidermal nevus, 224 for wa rt remova l , 209 from wart remova l , 207t, 208, 209 Dysport, lt Cushi ng's d isease, 92, 285 Cutting tool , 44 Cymetra Life Cell Corp., 14t E Cynosure, 56, 56t Ea r piercing, 298 Cyproterone acetate, 28 Cysts consu ltative q uestions, 298 ma nagement, 298, 298f epidermal incl usion cysts, 9-2 physical exa m i nation, 298 h o r n , 235 m i l i a , 229-230 pitfa l l s , 299, 299f pilar cysts, 220 treatment, 298 Ectopic ad renocorticotropic hormone prod uction, 92 Electroca utery, 239 for epidermal nevus, 224 Electrodesiccation, 83 D for a ngiofi bromas, DAO See Depressor angu l i oris for seborrheic keratoses, 236 Dapsone, 75 Deep-depth strength peels, 30t, 33 Electrolysis, 94, Electrosection, 7 Deep hema ngioma ( D H ) , 7 Electrosu rgery, 76f, 7 , 77f, , Deep vei n throm bosis, 198 for venous lakes, 204 Demodex fol l ic u l o ru m , 77 El l i ptical excision, , 9f, 227, 132 Depilation, 94 El l i ptical strip h a rvesti ng, 06 Depressor angu l i oris ( DAO), 26, 27f, 28f Derc u m 's d i sease, 226 vs fol l i c u l a r unit extraction ( F U E) , 107, 107t E l l m a n S u rgitro n , 78 Derma brasion , 75 Em bol ization, 180 for epidermal nevus, 224 for a ngiofi broma, Endermologie for cel l u l ite, 277-278 Derm a l melasma, 149 Endocrine stud ies, of acne v ulgaris, 72-73 Dermatochalasis, 64 consu ltative q uestions, 65 Endocrinology, consu ltation with, 93 End osco pic/classic sym pathectomy, 88 cou rse, 65 Eosi noph i l ic gra n u loma, 74 de rmatopathology, 65 Ephelides, 139 differentia l d iagnosis, 64 consu ltative q uestions, 40 epidemiology, 64 course, 140 ma nagement, 65 pathogenesis, 64 d ifferential d iagnosis, 40 epidemiology, 39 physical exa m i nation, 64 la boratory exa m i nation, 140 pitfa l ls, 65-66 ma nagement, 140 treatment, 65 Dermatosis pa pu losa n i gra ( D P N s ) , pathogenesis, 139 pathology, 140 24 , 24lf consu ltative q uestions, 242 physical lesions, 140 vs solar lentigo, 45t cou rse, 24 treatments differentia l d iagnosis, 241 chemical peels, 14 1-142 epidemiology, 241 cryothera py, 42 laboratory exa m i nation, 241 laser thera py, 42- 143 laser treatments, 242-243 ma nagement, 242 pitfa l l s to avoid/com plications/ma nagement, 143 topical treatment, 40- pathogenesis, 241 E p i d e r m a l acanthosis, , pathology, 24 E p i d e r m a l inclusion cysts ( EI C ) , 9-22 physical lesions, 241 consu ltative q uestions, 220 pitfa l ls, 243 cou rse, 220 Derm ik, 5t Destructive modal ities, 83 of sebaceous hyperplasia Diazepa m , 17 d ifferential d iagnosis, 220 epidemiology, la boratory data, 220 ma nagement, 220 Dicloxa c i l l i n , 46 pathogenesis, Diode laser treatments pathology, for Becker's nevus, for venous la kes, 204 Dioxybenzone, 7t physical exa m i nation, 9, 19f pitfa l l s , 22 treatment, 220-22 , 9f, 220f Dow-Corn ing, 4t Epidermal melasma, 32f, 49 Doxycyc l i ne, 73, 77 Epidermal nevus ( E N ) , 222 D P N s See Dermatosis pa pu losa n igra vs Becker's nevus, I n d ex consu ltative q uestions, 223 medical thera py, 27-1 28 course, 223 non-FDA a p p roved medications, 28 d ifferentia l d iagnosis, 223 pathogenesis, 26 epidemiology, 222 la boratory data, 223 physical exa m i nation, 26, 28-129 su rgery, 128 pathogenesis, 222 Female s u rgica l pla n n i ng, 129 pathology, 222 postoperative i n structions, 130 physica l exa m i nation, 223 postoperative period , 130- pitfa l ls, 225 vs seborrheic keratosis, 223, 235 treatment, 224-225 Epidermis a n d epidermal i n c l usion cysts, preoperative i n structions, Fern d a l e La bs, Fi brous pa pu les, 2 F i l iform wa rts, 206 F i l lers permanent, 282-283 i n l i poma, 226 Epidermoid cyst, E pi l u m i nescence microscopy ( E L M ) , 203 Epinephrine, 59 tem porary, 282 Finasteride, 104, 104t, 28, 33 Fitzpatrick skin phototype, Er:YAG See Erbi u m : Yttr i u m-Al u m i n u m Ga rnet Laser Fitzpatrick's classificatio n , of skin types, 4t Erbi u m ablative resu rfacing lasers, 57 Flash l a m p , 78f, 79, 79f, 801 Erbi u m : Yttriu m-Ai u m i n u m Garnet ( Er:YAG) laser treatment, 193 and a blative laser resu rfacing, 43, 451, 48, 49 Flavonoids, 9t a n d epidermal nevus, 224 and seborrheic keratos is, 236 Foam sclerothera py, 199-200 Follicular i nfu n d i b u l u m , Erythematotela ngiectatic rosacea See Vasc u l a r rosacea Follicular u n it extraction ( FU El , 06t, , 08! vs e l l i ptica l strip rvesting, 07t Eryth romyc i n , 73 Eutectic m i xture of loca l a n esthetic (EM LA), 17, 40 Fo l l i c u l itis, 00 Exci mer laser, 65, 287 Forehea d , 22f, 23-24, 24f Excision su rgica l , 253, 257, 29 , 29 11 Eye i nj u ries m i l i a , 229-230 Fractional photothermolysis ( F P ) and lasers, 981 Fractional res u rfaci ng, 11, 152, 53f Fraxel Restore, 56, 56! Freckles See Ephel ides Fronta l i s m u scle, 221, 23-24, 23f F Facial age-related conto u r changes, 2t Fronta l i s m u scles, 24, 24f F U E See Follicular u n it extraction Facia l m uscu lature changes, Facial telangiectasias, 192, 192f cou rse, 192 dermatopathology, 192 G epidemiology, 192 Gelatinase, ma nagement, 192-194 physica l exa m i nation, 192 Genita l wa rts, 206-209 Gentisic acid , 9t pitfa l l s to avo i d , 194 G l a be l l a r com p l ex, 24, 24f prior to long p u l se-d u ration pu lsed dye laser G la brid i n , treatment, 951 prior to p u l sed dye laser treatment, 931 Fa n n i ng, 18 Fascia B iomateria ls, 5t Fascia n, 5t Fat accu m u lation treatment of, 283 G l oga u Photoaging Classification, 2f, -4 , 3f, 4f, 51 G lycolic acid , 9t, 30! G lycolic acid pee l , 32, 331, 74, 60 and e p h i l ides, and melasma, , t G lycopyrro n i u m bromide, G/ycyrrhiza g/abra linneva, F DA-a pproved med ications, for male pattern h a i r loss, 104, 04t G o l d i njections, Female pattern h a i r loss, 126, 26f See also M a l e pattern hair loss c h i ef com pla i nt, G rafts, s k i n , 2251 G n u loma faciale, 74, 741, 76f consult, 1-132 cou rse, 74 consu ltative q u estions, 26 de rmatopathology, 17 course, 126 d ifferential d iagnoses, 74 d ifferentia l d iagnosis, epidemiology, 74 epidemiology, 26 female hair transplantation, l ight treatment, 75 ma nagement, 175 t o correct a ltered tem pora l h a i r l i ne, from l ifting proced u re, female surgica l pla n n i ng, 129 postoperative i n structions, 130 postoperative period , 130- preoperative i n structions, 30 vs male pattern h a i r loss, 29, 29t, 1 m u ltiple lesions of, 75f pathogenesis, 74 physical exa m i nation, 74 pitfa l l s to avoid, syste m i c treatment, 75 topical treatment, I 31 31 I I ndex G n u loma gravida r u m , 88- botu l i n u m toxin A, 88, 88f G n u loma tela ngiectaticu m , 188- anesthesi a , 88 G n u lomatous rosacea , antipers p i nt, 89 Gynecomastia, 72-275, 272f consu ltative q u estions, 273 botox, 89 medications, 89 cou rse, 273 su rgery, 89 differentia l d iagnosis, 272 treatment, 88-89, 88f, 89f epidemiology, 272 consu ltative q uestions, 87 laboratory exa m i nation, 272-273 cou rse, 86 ma nagement, 273 pathogenesis, 272 de rmatopathology, 86 d ifferential d iagnosis, 86 physical lesions, 272 epidemiology, 86 pitfa l ls/com p l ications/outcome expectations, 274-275 la boratory exa m i nation, 86, 86f treatment, 273-274 ma nagement, 87, 87f ora l med ications, 87 pathogenesis, 86 physica l fi ndi ngs, 86 H H a i r loss See Female pattern h a i r loss; M a l e pattern h a i r loss H a i r remova l , H a i r tra nspla ntation, 04-1 05 H a i r l i n e design , 08 H a rn a rto rna , 16, 222 Hemangioma, segmenta l , 80f Hemangioma, u l cerated , 79f Herna ngiornas, 7 H i bernoma, 226 H i biclens, 48 H i rsutism, 92 consu ltative q u estions, 93 cou rse, 93 differentia l d iagnosis, 92-93 epidern iology, 92 laboratory tests, 93 ma nagement, 93 electrolysis, 94 endocrinology, consultation with , 93 j ust prior to treatment, 96 laser h a i r remova l tech n i q ue, 95, 96-98 non laser thera p ies, 93-94 patient consu ltation, 95-96 posttreatment i n structions to patient, 98 physical exa m i nation, 92 pitfa l l s , 89-90 su rgery, 88 topical med ications, 87 Hyperh i d rosis sites of, 90f treatment d iagra m , 87f Hyperpigrnentation a n d cryotherapy, 209 and post-sclerothera py, 200 Hype rsensitive rea ctions, of soft tissue augmentation , 18 Hypertonic sa l i n e , 199, 200t, 201t Hypertrichosis, 6, Hypertrophic sca rs, 290 c l i n ical experience, 293 d ifferential d iagnosis, 290 vs keloids, 290! la boratory exa m i nation, 290 laser, 29lf, 292, 292f ma nagement, 291 physica l exa m i nation, 290 pu I sed dye laser, 292t stud ies, 292 Hypopigmentation, 67, 187f and cryothera py, 209 , 236 and laser treatments, pitfa l l s , 94f, 98-99 H IV l i podystrophy/facial l i poatrophy, 280-284 consu ltative q u estions, 281 cou rse, 28 Ice-Pick/Boxcar Sca r dermatopathol ogy, 280 differentia l d iagnosis, 281 lcod i n , 58 l d e benone, epidemiology, 280 l m i q u imod , 79 , 207, 29 , 29 T laboratory exa m i nation, 281 l named Corp, 14t ma nagement, 281-282 l named Corp , 5t pathogenesis, 280 physical lesions, 280-281 I nfa nti le hemangioma ( I H ) , 7 , 7f, 78f pitfa l ls, 283-284 a n c i l l a ry tests, 78 com pl ications, 78 prec i pitating factors, 280 course, 78 prevention, 28 de rmatopathology, 7 treatments, 282-283 Homosalate, 7t Hormones, 73 d ifferential d iagnoses, 7 epidem i ology, 7 H u ma n pa pil lomavirus ( H PV), 206-209 la boratory tests, 77 ma nagement, 78-180 Hya l u ronidase, 47 physical exa m i nation, 7 Hyd roq u i none, , 9t, 13, 140, 146, 15 1!, 160, Hyd roxy acid, 73 Hyd roxycou marins, 9t Hylaform ® , 5t Hyperhid rosis, 86 pitfa l l s t o avo i d , 180 I ntense pu lsed l ight lasers for pseudofo l l i c u l itis, 1 for Becker's nevus, for cherry and spider a ngiomas, 72 I n d ex for port-wine sta i ns, 185 and h i rsutism , 95 for postsclerothera py hyperpigmentatio n , 201-202, 20lf, 202f and pseudofolliculitis, 001, 1 , l f for venous lakes, 204 tech niq ue, 9&-98 I nterferon-a, 179 Laser l ight firing, 93f I nterlocking Ls repa ir, 308 l ntra lesional 5-fl uoro u racil (5-FU ) , 29 , 29 lt Laser safety, 97f l ntra lesional steroid i njection, 74 nona b lative laser resu rfaci ng, 41 for a blative fractional laser resurfaci ng, 59 l ntra lesional tria mcinolone acetonides, 29 , 29 lt adve rse side effects, 60, 601 l o p i d i n e , 28 fol low- u p , 59-60, 59f I PL See I ntense pulsed l ight i nfection, 60, f I psen L i mited, t lsolage n , 5t nonfacial ski n, 60-6 Isopropyl a lcohol , 48 lsotreti n o i n , 40, 58, 74, 77 I postoperative care, 57f, 58f, 59 Laser thera py for d ermatochalasis, 65 for gra n u loma faciale, 75 for Poiki loderma of Civatte, 68, 68f J for sebaceous hyperplasia, 82 83, 82f, 83f J essner, 30t, 35f Laser-assisted photodynamic thera py, 82 J essner peels, 14 , 160 Lasers, 74 J uvedermrM , 5t Lecithins, 9t Lentigines, 144 chem ical peels, 146 consu ltative q uestions, 45-146 K Keflex, , 46 Keloids d ifferential d iagnosis, 290 vs hypertrophic scars, 29ot vs keloids, 290t laboratory exa m i nation, 290 laser, 29lf, 292, 292f ma nagement, 29 physica l exa m i nation, 290 pulsed dye laser, 292t stud ies, 292 Keratinocytes, 40, 222 Keratolytic agents, 73 Keratoses seborrheic, 223 Keratosis fol liculari s s p i n u losa deca lva ns ( KFSD), Keratosis p i l a r i s atroph ica ns ( KPA), , 8lf, 82f cou rse, dermatopathology, d ifferential d iagnosis, epidemiology, ma nagement, pathogenesis, physica l exa m i nation, pitfa l l s t o avoid , 182 Keratosis pila ris atroph ica ns faciei ( KPA F ) , 181 Keratoses actinic, 206 seborrheic, 206, 234-237 Kindler synd rome, 67 Koenen's tumor, 2 Koj ic acid , 9t, , KTP laser See Potass i u m -tita nyl-phosphate laser cou rse, 45 cryothera py, 146 d ifferential d iagnosis, 145 epidemiology, 144 la boratory exa m i nation, 145 laser and l ight sou rce treatment, 146-147 ma nagement, 45 pathogenesis, 44 pathology, 144 physical lesions, 144 pitfa l l s to avoid/co m p l ications/ma nagement/outcome expectations, 147-148 vs seborrheic keratosis, 235 topical med ications, 45-146 Lentigo sim plex, 144 LEOPA R D synd rome, 44 Lichen planus ( L P ) , 262-264 course, 263, 264f de rmatopathology, 262 d ifferential d iagnosis, 262 epidemiology, 262 la boratory data , 262 ma nagement, 263 pathogenesis, 262 physical exa m i nation, 262, 262f, 263f Lichen striatus, 223 Licorice extract, 9t, 10 Lidoca i ne, 47, 59, 107 for wart removal , 208 Life Cell Corp , 4t Light treatment, of acne vu lgaris, 72f, 73f, 74-75, 75f Light cryothera py, 82 Linear foca l elastosis Linear th readi ng, Linoleic acid, 9t L L- M -X-4 a n d 5, Li pectomy, 283 Lipoma, 22&-228 consu ltative q uestions, 227 Lactic acid, 182 cou rse, 227 Lactic acid, 9t d ifferentia l d iagnosis, 226 epidemiology, 226 LAM B synd rome, 44 La nzhou I nstitute of B iologica l Prod ucts, 1t Laser h a i r remova l la boratory data , 227 pathology, 226 31 31 I I ndex physical exa m i nation, 226, 226f, 227f, 228f pitfa l l s , 228 treatment, 227-228, 227f, 228f Melanin i n post-sclerothera py hyperpigmentation , 200 in seborrheic keratosis, 236 Li posa rcom a , 226 M ela nocyte cytotoxic agents, 9t Li posucti o n , 88 for cel l u l ite, 277 Melanoma Melanocyte tra nsfer i n h i bition, 9t for gynecomasti a , 274 vs seborrheic keratosis, 235 for HIV l i podystrophy/facial l i poatrophy, 283 venous la kes a n d , 203 for l i poma, 227 warts a n d , 206 Liver s pots See Solar lentigos M elanophages, 44 LLLT See Low level l ight laser therapy Lob u l a r ca p i l l a ry hemangioma, 188 M elasma, , 49f a blative laser, 152 Long- p u lsed alexa nd rite laser, 1 chemical peels, 1- 152 Long- p ulsed N d : YAG laser, 1 consu ltative q uestions, 50 Low level l ight laser thera py ( LLLT), 33, 33f, 34f cou rse, 50 de rmatopathology, 149 mecha nism of action , 133 pea rls of wisd o m , 33 use of, 33 d ifferential d iagnosis, 50 epidemiology, 149 Lower extremity telangiectasias, 198 202 fractional resu rfaci ng, 52 , 53f Lower eye l i d snap back test, 22-23 la boratory exa m i nation, 50 Lower face, ma nagement, 50, 50f, 11, 52f Lower lid horizonta l laxity, 64 LP See Lichen planus pathogenesis, 49 Lux , 540 n m laser, 56, 56t pitfa l l s , 52-153 physical lesions, 149 Q-switched laser, 52 topical treatment, , lt M M EN D See M icroscopic epidermal necrotic debris Macu les, 6, 223 Madelu ng's d i sease, 226 M enta l i s m uscle, 26, 27f, 28f Male pattern hair loss, 03 See also Female M eq u i n o l , 9t pattern hair l oss consult, 105 d ifferential d iagnosis, 03 Mentor Corporation, 5t M e rz Pharma, 4t, lt M esothera py for cel l u l ite, 278 epidemiology, 03 vs fem a l e pattern h a i r loss, 129, 29t, 1 M ethanthel i u m bromide, 87 h a i r transpla ntation, 04- 05 M ethyl a nthra n i late, 7t laboratory exa m i nation, 104 M etron idazole, 77 M exoryl SX, 7t medica l thera py, 04, 04t M ethyl a m i nolevu l i nic acid ( MAL), 254 natural progression, 03 M exoryl XL, 7t pathogenesis, 103 physical exa m i nation, 03 , 03f, 05f M icroderma brasion, 74, 229, 287 s u rgica l proced u re M icroth ermal treatment zones ( MTZs ) , 52 M icrosco pic epidermal necrotic debris ( M E N D ) , 52 corrective h a i r transplant su rgery, 10, 10t M idface, day of proced u re, 06 M id-i nfrared lasers, 401, donor h a rvesti ng tec h n i q ues, 06, 06f, 106t, 107t M i ld atrophy, 67 donor regi o n , a n esthesia i n , 06 fol l i c u l a r unit extraction ( F U E) , 107, 107t M i l i a , 229-230 consu ltative q uestions, 230 graft creation, 107 cou rse, 230 graft placement, 108 09, 13f epidemiology, 229 h a i r l i n e design , 08 pathogenesis, 229 post h a i r tra n splant side effects, 109 pathology, 229 postoperative period , 109 postsu rgica l period after sutu res/sta ples physica l exa m i nation, 229, 229f, 2301 removed , 09-1 treatment, 230, 2301 preoperative i n structions, 06 pitfa l l s , 230 M i n i m a l erythema d ose ( M ED ) , re side effects, 09 M i nocyc l i ne, 73, 77 reci pient region, anesthesia i n , 08 M i noxid i l , 104, 04t, 7-1 28, 7t, , 133 reci pient site creation, 08, 12f McCune-A l bright syndrome, 136 M c G h a n Medica l , 5t M ixed dermal melasma, 149 M ixed su perficial a n d deep hema ngioma ( M H ) , 177 Mohs microgra p h i c surgery, 254, 257-258 M ED See M i n i m a l erythema d ose M onobenzone, 9t Medial orbicularis ocu l i , 24, 24f Morphea, 265 267 M ed icis, 5t cou rse, 266 Medicis Esthetics, l t M ed i u m -d e pth pee l , 30t, 3 , 34f, 35f de rmatopathology, 266 M edy-Tox, Inc, l t epidemiology, 265 d ifferential d iagnosis, 265 I n d ex la boratory data, 265-266 med ications, 53-54 ma nagement, 266, 266f postoperative care, 55 pathogenesis, 265 preoperative eva l uation, 52-53, 53f, 54f physica l exa m i nation, 265, 265f pitfa l l , 267 preoperative pre paratio n , 54 M TZs See M icrothermal treatment zones proced ura l tips, 54-55 treatment pearls, 55-56 M u l berry extract, 9t Nonablative fractional lasers, 57 M uscle grou ps, 23 Nonablative fractional resu rfacing, 39, 60 forehea d , 23-24 Nonablative laser resurfaci ng, 39, 39f glabellar com p l ex, 24, 24f nasola bial fol d , 25-26, 27f adve rse side effects, 4, f l neck, 26-27 , 28f postoperative care, -42 i n d ications, 40 periora l region, 26, 27f, 28f laser safety, periorbita l regio n , 24-25, 25f preoperative eva l uation, 40 u pper nasal root, 25, 26f prophylaxis/a nesthesia , 40 M yasthenia gravis, 22 Myobloc, l t m i d - i nfra red lasers, 40f, N onfacial s k i n , 60 N o n - F DA approved med ications, for fe male pattern h a i r loss, 128 Non-hypersensitive reactions, of soft tissue augmentation, 18-19 N Non laser thera py, 93 N A F R See Nona blative fractional laser res u rfacing Nasal sebaceous hyperp lasia See R h i nophyma Nasolabial fol d , 25-26, 27f N d :YAG laser, 99, 93 for seborrheic keratosis, 236 depi lati o n , 94 topical eflorn ith i n e , 94 Norwood classification, 103f N eck, 26-27 , 28f N e u rofi bromas ( N F) , 23 1-234 Octocrylene, 7t consu ltative q uestions, 232 cou rse, 232 d ifferential d iagnosis, 23 epidemiology, la boratory data, 232 Octyl methoxycinna mate, 7t Octyl sa l i cylate, 7t Ocular rosacea , 76 Oral medications i n hyperh i d rosis, 87 ma nagement, 232 Oral thera py, 65 pathogenesis, 231 Orbicularis ocu l i , 24-25, 25f pathology, 23 physica l exa m i nation, 23 , 23lf pitfa l ls, 223-224 Orbicularis ocu l i tone, 64 Orbicularis oris, 26, 27f, 28f Oxybenzone, 7t treatment, 232-233, 232f N e u rofi bromatosis, 136 N e u ronox, l t N e v u s a neus, 70- 73 N evus, Becker's, 6-2 N evus, epiderma l , 222-225, 235 p rf>3 tumor suppressor gene, 252 PABA See Pa ra-a m i n o benzoic acid Padi mate 0, 7t Nevus fuscoceruleus ophtha l momaxilla ris, 54 Palmoplanta r warts , 206-209 Nevus of Ota , 54 Palomar Medical Tec h nologies, 56, 56t, 79 Paper m u l berry, consu ltative q uestions, 55 cou rse, 155 d ifferential d iagnosis, 54 epidemiology, 54 la boratory exa m i nation, 155 ma nagement, 55 pathogenesis, 54 pathology, 54 physical lesions, 54 pitfa l ls, 57 topical treatment, 155 treatment, 55- 56 Papu les in angiofi bromas, 2 i n epidermal nevus, 223 i n warts, 206 Papu lopustular rosacea, 76 Pa ra-a m i n o benzoic acid ( PABA), 7t Partial tears, 308 Patient consu ltation, 95 prior to treatment, 95-96 P D L See Pu lsed d ye laser P DT See Photodyna mic thera py Nevus sebaceous, 223 Pearly pen ile pa p u l es, 2 N ia c i n a m i d e , 9t, 10 Nonablative fractional laser resu rfacing ( N A F R ) Peel types, 33 and c l i n ica l i n d ications, 30t a n esthesia, 54 Pee l i ng agent characteristics, 30t contra i n d i cations, 53 dermatopathology, 52, 52f Penici l l i u m , Perifo l l i c u l a r erythema, cha racteristic posttreatment, 93f devices, 56, 56t Periora l dermatitis, 76 i n d ications, 52 mecha nism of action, 52, 52f Periorbita l region, 24-25, 25f, 26, 27f, 28f Periorbita I rhyti d es, 55f I 31 320 I I ndex Peri u ngua l fibromas, 2 pathogenesis, 58 Perlane, 5t physica l lesions, 58 Perla ne LrM , 5t pitfa l l s to avoid/co m p l ications/ma nagem ent/outcome Peutz-Jeghers syndrome, 144 P H A G E synd rome, 78 Phenol, 30! expectations, s u n p rotection, 59 topical treatment, 60 Phenyl benz i m i d azole su lfonic acid , 7t Postsclerotherapy hyperpigmentation ( P S H ) , 200 Photodyn a m i c thera py ( P DT ) , 75 Potass i u m -tita nyl-phosphate laser, 79, 193 Photodyn a m i c thera py, 254, 258, 269 Pred nisone, 130, 79 Photothera py, 75, 65 P hymatous rosacea See Sebaceous hyperplasia Pregna ncy P hysical screen , 8, 8t and telangiectasias, 98, 201 Pregna ncy-ind uced hypertension ( P I H ) , 60 Pigmentary cha nges, i n face, 4, 6f Prevelle s i l k , 5t P I H See Posti nflam matory hyperpigmentati o n ; Pregna ncy-ind uced hypertension Primary and rogen-prod ucing neoplasms, 92 Procerus, 24, 24f Pilar cysts, 220, 226 P i mecro l i m u s, 64 Propanth e l i ne, 87 Prophylactic anti biotics, 49 , 53 P ityros poru m ova l e , Propranolol, 79 P l a n e warts, 206 209 Prosigne , ! Pla ntar wa rts, 206 Prostate cancer Plaques in a ngiofi broma, 2 i n Becker's nevus, i n seborrheic keratosis, 235 P latysma m uscle co m p l ex, 26 27, 28f prophylaxis in, 273 Proteus syn d rome, 226 Pseudofollicul itis, 99 course, 100 de rmatopathology, 100 POC See Poiki loderma of Civatte d ifferentia l d iagnosis, 00 Podophyl l i n , 224 epidemiology, 99 Podophyllotox i n , 207 Poiki loderma of Civatte ( POC), 67 la boratory exa m i nation, 100 ma nagement, 00 consu ltative q uestions, 68 pathogenesis, 99 course, 68 physical lesions, 100 de rmato pathology, 67 pitfa l l s , 1-102, 11, 02f differentia l d iagnosis, 67 epidemiology, 67 treatment ma nagement, 68 laser hair remova l , lOOt, 1 , 1 shaving cessation, 100 pathogenesis, 67 shaving tech n i q ue , mod ification of, 10(}- 1 physical exa m i nation, 67, 67f, 68f topical treatment, 1 pitfa l ls, 68-69, 69f pretreatment, 68f treatment, 68, 68f Pseudofo l l i c u l itis, a n d etrology, 1 Pseudogynecomasti a , 272 Polidoca n o l , 199, 200, 200! Pseudo-och ronosis, 34, 59f Psora len a n d ultraviolet A ( P UVA ) , 65, 75 Poly-L-Iactic acid, Psoriasis, 267-270, 267f, 268f Pontoca i n e See Topica l tetraca ine Port-wine sta i n s ( PWS), 83 , 84f, 85f, 86f ancil lary tests, 83 course, 183 course, 268 d ifferential d iagnosis, 268 epidemiology, 267 dermatopathology, 183 la boratory data, 268 ma nagement, 268-269, 269f differentia l d iagnosis, 83 pathogenesis, 268 epidemiology, 183 physica l exa m i nation, 268 ma nagement, 83 physical exa m i nation, 83 pitfa l l s to avo i d , 183 Post hair tra nsplant side effects, 109 Post i nfla m matory erythema a n d cu rettage, 237f Post i nfla mmatory hyperpigmentation ( P I H ) , 58, 58f chemical peels, 6(}- consu ltative q uestions, 59 pitfa l l s , 270 Psuedogynecomastia, 274 P u l sed carbon d i oxide laser, 250 Pu lsed dye laser ( P OL) for acne vulga ris, 75 for a ngiofi broma, for a ngiokeratomas, 69 for cherry and spider a ngiomas, for facial telangiectasia, 203, 203f, 205f course, 59 for facial tela ngiectasias, 192 dermato pathology, 58 for hypertrophic scars/ke loids, 292t differentia l d iagnosis, 58 for i nfa ntile hema ngiomas, 79 epidemiology, 58 for keratosis pila ris atrophicans, 182 laboratory exa m i nation, 58 lasers, for m orphea , 266 for Poiki loderma of Civatte, 68 treatment, 18, 233 ma nagement, 59 for port-wine sta ins, 185 for psorias, 269 I n d ex for pyogenic gra n u lo m a , 189 Rete ridges in epidermal nevus, 222 for rosacea , 78 for sebacious hyperplasia, 82 for striae d i ste nsae, 287 for telangiectasias, 201 Reticular veins, 198-202 Reticulated hyperpigmentation , 67 for venous la kes, 203, 205f Reti n-A, 82 Reti naldehyde, 8, for warts, 206f, 208, 208f, 209f Reti noic acid, 8-9, 9t, 10, chemical structu res of, Sf for warts, 208 P u n c h excision, Reti noids, 73, , , 1!, 60, 182 Pu rpura, 204, 208 PUVA See Psora len a n d u ltraviolet A Reti n o l , Pyogenic gra n u loma ( PG ) , 88, 188f, 89f I Retinyl esters, R F technology See Radiofreq uency ( R F) tech nology biopsy-proven , l f R h i nophyma, 76, 76f, 77-78 cou rse, 188 R hytides, 58 dermatopathology, 88 R osacea , 76 cou rse, 77 de rmatopathology, 77 d ifferential d iagnoses, 88 epidemiology, 188 laser treatment, 89 d ifferential d iagnosis, 76 ma nagement, 89 epidemiology, 76 pathogenesis, 88 ma nagement, 77 physica l exa m i nation, 88 surgica l thera py, 77-79 pitfa l l s to avo i d , 189 s u rgica l treatment, 189 systemic thera py, 77 topical thera py, 77 pathogenesis, 76 vs venous la kes, 203 physical exa m i nation, 76 Roth m u nd-Thomson synd rome, 67 Q R u by spot, 70-1 73 See also Cherry a ngiomas Q-M ed AB, 5t Q-switched lasers, 52 R ussell-Silver synd rome, 36 alexa nd rite for Becker's nevus, 7, 8f s for cafe au Ia it macules, , 138 Sa l icyl ic acid , 73, 207 for dermatosis pa pu losa n igra , 242 for epidermal nevus, 225 Sa l i n e for nevus of Ota , 55, 56 for seborrheic keratosis, 236 a rgon and gra n u loma faciale, 75 N d :YAG for Becker's nevus, 7, 8f a n d warts, , 208 and tela ngiectasias, 201 Scarring from a n giofi broma treatment, from surgica l i ncision, 224, 228 from wart remova l , 207t, 208, 209 for cafe au Ia it macules, , 138 SCC See Squamous cell carcinoma Sclerothera py, 199-20 , 98f, 99f, 200f, 200t, 201t, 204 a n d e p h i l ides, 142 Scoliosis, 232 a n d lentigines, 46 Sc u l ptra TM , 5t for nevus of Ota , 155 Se baceo us cyst, 19 for tattoo remova l , 300!, 302 r u by for Becker's nevus, 7, 8f Se baceo us hyperplasia, 76, 77, , 8lf consu ltative q uestions, 81 cou rse, for dermatosis pa p u l osa n igra , 242 d ifferential d iagnosis, for e p h i l ides, 42 epidemiology, for lentigines, 46, 47 for seborrheic keratosis, 236f for nevus of Ota , 155 for seborrheic keratosis, 236 for tattoo remova l , 300!, 302t la boratory exa m i nation, 81 ma nagement, 82 pathogenesis, 81 pathology, R Rad iation dermatitis, 67 Rad iation thera py, 54 Radiesse TM , 5t physical lesions, pitfa l l s , 83 treatments, 82 destructive modal ities, 82 laser thera py, 82-83, 82f, 83f Radiofreq uency ( R F) tech nology, 62 Seborrheic dermatitis, 76 Rad iothera py, 258 Seborrheic keratosis, 234 37 See also Dermatosis pa pulosa n igra R e-epithe l i a l ization, 49 consu ltative q uestions, 235 Relaxi n , ! cou rse, 235 Renova , R estylane, 5t d ifferential d iagnosis, 235 epidemiology, 234 R estyla ne-L, 5t vs epidermal nevus, 223, 235 32 322 I I ndex ma nagement, 235-236 de rmatopathology, 257 pathology, 235 d ifferential d iagnosis, 256, 257f physical exa m i nation, 235 epidemiology, 256 pitfa l l s , 237 treatment, 236 vs epidermal nevus, 223 la boratory data , 257 vs wa rts, 206 ma nagement, 257-258, 258f, 259f Segmenta l hemangioma, 1801 pathogenesis, 256 Senile hema ngiomas, 70-1 73 physical exa m i nation, 256, 256f Seria l p u n ctu re, 18 pitfa l l s , 258 Seria l sa l icylic acid peels, 74 Sharplan FeatherTouch, 69 vs seborrheic keratosis, 235 Shave biopsies a n d excisions vs wa rts, 206, 207 Sta rch-iod ine test, 88 for a ngiofi bromas, Sta rlux Lux G hand piece, 79 for epidermal nevus, 224 Steroid rosacea , 76 for l i poma, 227, 227f Stockings, elastic com pression, 200 for n e u rofi bromas, 236 for seborrheic keratosis, 236 Strawberry, 77- 80 Stretch marks See Striae d i stensae Shaving cessation, 100 Stria a l ba , 287 Shaving tech n i q u e , mod ification of, 00-1 Stria ru bra , 286-287, 287f Short-pu lsed erbi u m , 287 Striae d i stensae, 285, 285f S i l icone, 18 consu ltative q uestions, 286 S i l icone sheeti ng, 29 , 29 lt S i l i kone- 000, 5t cou rse, 286 d ifferential d iagnosis, 286 Skin grafts, 225f epidemiology, 285 Skin l ightening agents, 9-1 la boratory exa m i nation, 286 Skin testi ng, ma nagement, 286 Skin turnover acceleration, 9t m icroderma brasion , 287 Skin types a n d Becker's nevus, pathogenesis, 285 pathology, 285 Smooth bea m , physica l lesions, 285 SNAP-25, pitfa l l s , 288 Sod i u m morrh uate, 199 topical treatment, 287 Sod i u m sulfaceta mide, 73, 77 Sod i u m tetradecyl su lfate, 199, 200t, 20lt Soft tissue a ugmentation adve rse reactions treatment, 286-287 Stromelysi n , Stu rge-Weber syndrome (SWS) , 184 S u bcision, 278 hypersensitive, 18 Su bcuta neous fat, i n l i poma, 226 non-hypersensitive, 8- Su bcuta neous fat, 5t tec h n i q u e compl ications, a n esthesia, 6f, Su bcuta neous fat atro phy, Su lfu r, 73 degree o f correction, S u l isobenzone, 7t d u ration o f correction, 18 S u n expos ure ideal fil ler, 14, 14t- 5t i njection tech n i q ue, 18, 8f, 19f level of i njection, 7- 18, 7f, 18f mecha n ism of action , 14 and sclerothera py, 200 and venous lakes, 203 Sun protective factor ( S P F ) , Su nscreen , 7-8, 7f, 7t preoperative eva l uation, 5- Su perficial hemangioma ( S H ) , 77 , 79 proced ura l medications, Su perficial pee l , 30t, 32f, 33, 33f skin testi ng, Su rgery treatment pearls, 19 Softform, 5t Solar le ntigo vs ephel i d , 145t Solar le ntigos, 144 in hyperhidrosis, 88 S u rgica l excision, 75 S u rgica l proced u re, for hair tra nsplantation corrective hair tra nsplant su rgery, 10, 10t Solta Medica l , I n c , 56, 56t day of proced u re, 06 Soltice Neu rosciences, lt donor h a rvesti ng tec h n i q ues, 06, 06f, 106t, 107t Sotradechol, 200 donor region, a nesthesia i n , 06 Soy, Soybea n/m i l k extracts, 9t fol l i c u l a r u n it extraction ( F U E) , 107, 107t graft creation, 107 S P F See S u n protective factor graft placement, 108-1 09, 1 3f Spider a ngiomas, 70-173, 11 hairline design , 08 Spider tela ngiectasia, 70-1 73 post h a i r tra n s plant side effects, 109 S p i n a l dysra p h i s m , 227 postoperative period , 109 Spi ronolactone, 73, 28 Squamous cell carcinoma (SCC), 256-258 postsu rgica l period after sutu res/sta ples removed , 09-1 consu ltative q uestions, 257 preoperative i n structions, 06 cou rse, 257 rare side effects, 09 I n d ex checkl ist, 62-63 side effects, 63 S u rgica l thera py of acne vu lgaris, 74 for Dermatochalasis, 64f, 65 Topica l 5-fl uorou raci l , 254 Topica l eflorn ith ine, 94 Topica l i m iq u i m od , 254 Topica l med ications, in hyperh i d rosis, 87 for epidermal i ncl usion cysts, 220 Topica l proparaca ine, 47, 59 for epidermal nevus , 224 Topica l retinoic acid , 32 for l i poma, 227, 227f, 228f Topica l tetraca ine, 47, 59 Topica l thera py for neu rofi broma, 232-233, 232f of Rosacea , 76f, 77-79 , 79f, 80f of acne vu lgaris, 73 for venous lakes, 204 for dermatochalasis, 65 for wa rt remova l , 207-209 for Poiki loderma of Civatte, 68 of pseudofo l l i c u l itis, 1 Syri ngoma, 238, 238f consu ltative q uestions, 239 cou rse, 239 o f Rosacea , 77 Topica l treatment options d ifferential d iagnosis, 238 a p p l ication tec h n i q ues, 1- epidemiology, 238 com pl ications, laboratory exa m i nation, 238 contra i n d icatio ns, 1 ma nagement, 239 ideal ca ndidate, 1 pathogenesis, 238 pathology, 238 i nd ications, 1 less than ideal ca ndidate, 1 physica l lesions, 238, 238f mecha nism of action , 7-1 pitfa l ls, 239f, 240, 240f posttreatment care, treatment, 239-240 System i c l u pus erythematosus, 76 System i c thera py of acne vu lgaris, 73-74 323 proced ure, 62 reci pient region, a nesthesia i n , 08 reci pient site creation, 08, 12f for a ngiofi broma, for Becker's nevus, I pretreatment eva l uation, 1 treatment pearls, 12-13 Topica l treti n o i n , 46, 146 Torn earlobe, 308 of Rosacea , 77 key consu ltative q uestions, 308 ma nagement, 308 pitfa l l s to avoid/co m p l ications/ma nagement/outcome expectations, 309 T Tacro l i m us, 64 treatments, 308-309, 308f, 309f, 0f Trad ition a l P D L, 78 Tacro l i m u s oi ntment, 75 Trad ition a l resu rfaci ng, 39 Ta l kesthesia, Tretinoi n , 9, 46, 54, 73 Ta p water iontophoresis, 87 and epidermal nevus, 224 Tattoo remova l , 300, 300f and m i l i u m , 230 adverse effects/preca utions, 303, 304f, 305f, 306, 307f consu ltative q uestions, 300-301 TriActive Laserd ermology, 278 Tria mci nolone aceton ide, 79 laser thera py, 300t Triangula ris m uscles, 26, 27f, 28f ma nagement, 301 Trich l o racetic acid (TCA) peels, 301, 74 pitfa l ls, 303-304 for wart removal , 207 posttreatment care, 302 Tri l u ma , 46 pretreatment assessment, 30 tattoo treatment, 302, 302t, 303f, 304f Trola m i n e sa l i cylate, 7t TS H See Thyroid-sti m u lating hormone treatment, 30 1-302, 303f Tu berous sclerosis, 136 Tazarotene, 9, 73, 82 Tu berous sclerosis, 213, 3f TCA peels See Trichloroacetic acid peels Tu rnors, 220 Telangiectases, 67 Tylenol, 109 Tela ngiectasias, 78-79, 78f, 79f, 80f lower extremity, 198-202 Tyrosinase, Tyrosi nase i n h i b itors, 9t epidemiology, 198 laboratory data, 198 ma nagement, 199-202, 98f, 99f, 200f pathophysiology, 198 physical exa m i nati o n , 198 Telangiectatic matting rM , 201 u U l cerated hemangioma, 79f U ltra , 5t U ltra P l u s , 5t Telogen effl uvi u m , 29, 130-13 U ltra P l u s XC, 5t Tetracycl i ne, 73, 77 U ltra XC, 5t T h ro m boph lebitis, 198 U ltrasou n d , 198 U ltraviolet A ( U VA), 67 Thyroid-sti m u lating hormone (TS H ) , 63 Tissue tighte n i ng, 62 ca n d idate selection, 62 c l i n ical pea rls, 63 mecha n ism of action, 62 U ltraviolet B ( U V B ) , 67 U p per a n d m idfacial m uscu latu re, a natom ical i l l u stration of, 22f U p per face, 2-3 324 I I ndex U p per nasal root, 25, 26f la boratory exa m i nation, 63 U S Food a n d Drug Ad m i n istration, 94 laser thera py exci mer laser, 65 UVA See U ltraviolet A UVB exposu re, ma nagement, 64 U V B See U ltraviolet B oral thera py, 65 pathoge nesis, 63 v physical lesions, 63 photothera py, 165 pitfa l l s to avoid/co m p l ications/managem ent! Valacyclovir, 46 outcome expectations, 66 Valacyclovir, 54 preventi o n , 64 s u rgica l treatments, 65 Valtrex, , 32 Va n iqa See Topica l eflorn ith i n e topical treatment, 64 Va porizi ng tool , 44 Variable-pu lse P D L, 78 Varicose veins, 198-202 Vascular a lterations lower extremity telangiectasias, 198-202 reticular and va ricose veins, 198-202 w Warts, 206-209 cou rse, 207 venous lakes, 203-205 de rmatopathology, 206 warts, 206-209 differentia l d iagnosis, 206 epidemiology, 206 Vascular a lterations pathogenesis, 206 venous lakes, 203-205 physica l exa m i nation, 206 warts, 206-209 Vasc u l a r ectasia, 77 pitfa l l s , 209 treatment, 207-209, 206f, 207f, 205f, 209f Vascular lasers, 39 Vascular rosa cea , 76 Vascular spid er, 70- 73 Watson's syndrome, 136 Westerhof's syndrome, 136 Vaseli ne, 34 Wickha m 's striae, 262 Vei ns, reticular a n d varicose, 198-202 VelaSmooth system , 278 Wood's l a m p eva l uation, , 1, 63 Wydase See Hya l u ron idase Venous lakes, 203-205 cou rse, 203 de rmato pathology, 203 d ifferenti a l d iagnosis, 203 epidemiology, 203 e p i l u m i n escence m i c roscopy ( EL M ) , 203 X Xa nthelasma pa l pebraru m See Xa nthelasrnas Xa nthelasmas, 243 cou rse, 244 ma nagement, 203-204, 203f, 204f, 205f de rmatopathology, 244 physical exa m i nation, 203 differentia l d iagnosis, 244 pitfa l ls, 204 epidemiology, 243 ma nagement, 244 Venous o bstruction, 198 Venous va lvular incom petence, 198 Verruca , 223, 235 pathoge nesis, 243 physica l exa m i nation, 244 Vincristine, 79 Vita m i n C, Vita m i n E, pitfa l l s , 244 Xeom i n , ! Vitiligo, 63 consu ltative q uestions, 64 cou rse, 63-1 64 dermato pat hology, 63 z d ifferential d iagnosis, 63 Z-plasty repa i r, 308 Zyd erm ® , 5t epidemiology, 63 Zyplast® , 5t ... at a wavelength of 595 nm with a 0-mm spot, pulse duration of ms, a fluence of J/cm2 , and DCD 30 120 70 I Color Atlas of Cosmetic Dermatology La pi ns J , Emtesta m L, M a rcusson J A Angiokeratomas... u n a b l e d y e laser Dermatol Surg 20 02 ;28 ( ) : 527 - 529 Elston O M Treatment of gra n u loma fac i a l e with the p u l sed dye laser Cutis 20 00;65 (2 ) : 7-98 Khaled A , J ones M, Zerma... Dermatol 20 05 ; 52( 3): 480-490 Figure 34.5 Hypopigmentation, which can be permanen t, after aggres sive treatment of a PWS in an A frican-American patient 88 I Color Atlas of Cosmetic Dermatology