Another IMPOSSIBLE case of persistent nodular cystic acne

We have a case here of a patient with one of the worst case of nodular cystic acne. The left side had a huge nodular cystic collection that has been constantly flaring up over the past year. When I first saw him, it was actually his mother that was more bothered about his face than the son himself!
Glad he was convinced to come down anyway and finally receive treatment.

 

These are the pictures when I first saw him. All pictures posted here are posted with full consent of the patient. He has gladly allowed me to share his journey on how I treat a case of severe pimples or acne vulgaris.

What we are seeing here is evidence of massive nodular cystic acne on both sides of the cheeks. Also presence of multiple papules. If he doesn't receive prompt treatment, I am worried that either the acne may develop into a cheek abscess or he will be left with terrible scaring when it finally resolves by itself. Cheek abscesses can sometimes spread to the inner cheeks as well and may result in full facial infection or cellulitis if this is left untreated.

 

The nodule on the left side was so big that it required a small incision to drain out all the pus and necrotic debris. A tiny stab incision was made after injection of local anaesthesia and this allowed the rapid drainage of the pus to be expressed.

 

The wound was packed with gauze and required alternate day dressing. This particular abscess was eventually closed with interrupted stitches. It was a difficult journey that time with every alternate day dressing, but he could come to the clinic after school for a relatively quick procedure. After the wound showed more signs of healing, it was closed with interrupted stitches and for the wound to finally heal.

 

He was subsequently put on 3 round of AGNES treatment, Q-switch laser and V-beam laser treatment. This helped to resolve most of his other stubborn acne throughout the rest of the face and also with the laser treatment to resolve the scarring and also to suppress any active acne and inflammation. This continued for the next 5 months for him, seeing him at regular intervals.

 

It is an absolutely pleasure for me to report how happy he is that he has agreed to allow me to use his pictures to document his remarkable journey. With repeated AGNES treatment for permanent control for his acne and using a unique Q-switch protocol developed by myself combined with the V-beam laser.

 The most important aspect is also the prevention of depressed scars. The ice-picks and boxscar scars are very difficult to treat and I am glad early treatment of this case of nodular cystic Acne Vulgaris has resulted in an excellent result.

Lesson to learn. Early visit to the doctor can prevent future scaring, help achieve excellent outcomes for the skin and early resolution of even the most severe cases of acne or pimples.

Is there a permanent cure for Keloid Scars?

Kleoid scaring can be disfiguring and a very prominent keloid scar can cause a lot of distress. Keloids apart from looking aesthetically unacceptable, it also causes itch, pain and some discomfort during the day and sometimes even at night.
A true definition of a keloid scar is a scar that is not only raised but also horizontally larger. They are often also erythematous or pink in appearance. These scars form because of excess collagen growth in that particular area. Hence these keloid scars represent excess tissue growth beyond the orginal margins of theh wound.
Traditional treatment of these keloid scars have always been through steroid injections. This is still the mainstay of the treatment but recently there has been a lot of work done on various lasers that were previously not available or not thought to help these very stubborn scars but now shown to be incredibly effective.

I shall be mainly talking about 2 new lasers that are now available at my practice that can improve any stubborn keloid scars that were previously very stubborn to treat. These lasers can be commenced as early as the first few weeks after injury and also as late as several years post injury.

Before and After Steroid injections and V-beam

Facial Plast Surg 2012;28:518–524.
Sepehr Oliaei, John Stuart Nelson, Richard Fitzpatrick, Brian Wong Laser Treatment of Scars Facial Plast Surg 2012;28:518–524 Laser Treatment of Scars


Vbeam
The V beam laser or Pulse Dye Laser has been shown to improve scaring by destroying blood supply at the level of the dermis, hence stopping the formation of these keloid scars.
Futhermore, V beam laser has also been shown to disrupt the growth cycle of the cells, hence stopping the growth of these keloid scars. This methods of treating the keloid scars were previously not available before the introduction of the V beam.

The V beam laser works on the concept of selective photothermolysis. That means that it selectively breaks down specific particles in the skin. With a wavelength of 595nm, this particle happens to fall across the haemoglobin spectrum. Hence its main indication is treatment of pathologies of the vascular wavelength. Examples of this would be cherry haemangioma, telangiectasia and port wine stains.

Picture of a cherry haemangioma

Picture of telangiectasia over the nose

Picture of a baby with port-wine statins

This makes the V beam also a very good laser for the treatment of red raised and angry looking keloid scars. The V beam hence is able to improve not only the colour but also the bulk of the of the scar tissue.


Fraxel
The use of the Fraxel complements the V beam by induction of collegen remodelling of the scar tissue to improve the appearance of the keloid scar. This works by delivering controlled fractional doses of thermal energy to the keloid scar in controlled pulses and intervals, sufficient to induce collagen remodelling and allows for good contour changes in the scar

Summary
Keloids have always been difficult to treat. Surgical excision of these scars were previously performed but the tendency for them to return is higih. With the combination of these 2 new lasers in the market, I am now finally hopeful that there can be a permanent cure for the most stubborn pathologies that have long plagued doctors.

Click here to find out more
http://www.cliffordclinic.com/vbeam-laser-treatment/

Infini Microneedle Fractional Radiofrequency - The treatment for acne scars

 

We all know our local Mediacorp Artist Mark Lee. Having depressed acne scars since he was young, he was teased and made fun off during his early days of his acting. Having personally treated him for a good couple of years, I have to say that his results are truly good especially with the duel effects of scar improvement and skin tightening, allowing regrowth of collagen for a tighter smoother skin.

 

  

Infini uses Microneedle that punctures into the skin at a controlled depth, breaking up scar fibres deep beneath the skin. It also delivers radiofrequency at specific energies including the duration of energy to be supplied. This allows very specific collagen growth remodelling and when done in experienced hands have next to no side effects.

 

1) Why choose Infini as compared to other laser resurfacing?
One huge advantage of this procedure is the ability to get huge dramatic results without the need for laser resurfacing, hence avoiding the need for a long down time yet still getting the results they desire

2) Is there any risk of fat atrophy?
Although there has been some reports of this, I personally have not had any patients with this particular side effect. The Infini microneedles are of a variable depth, hence allowing the user to select which depth the energy should be supplied. This microneedle should never be placed in the fatty laser of the skin, hence there should not be any risk of fat atrophy in an experienced user

3) How is Edge Fractional CO2 laser different?
Edge Fractional CO2 is an ablative laser that allows for controlled micro-thermal damage allowing for collagen stimulation and hence scar improvement. It uses a different technology as compared to Infini

4) Any risk of Infini?
The risk of post-inflammatory hyperpigmentation is always there, but this risk can be reduced and eliminated completely if your doctor understands the machine well.



The procedure isn't as scary as you think! Will be happy to see anyone who is keen to do this procedure for improvement in depressed acne scars and also for skin tightening.