CLINICAL STUDY
1) In summary, what is the statistical incidence of complications reported in the survey?
Five patients suffered from the complications of light-based hair removal, three suffered from NPO administered microdermabrasion and tattoo removal, one patient suffered from a three-inch round skin abrasion on her right cheek and one patient suffered from a fever of 102.5 F on tattoo removal making the total complications ten incidences.
2) Why do you think there was a high incidence of complications in rosacea patients and discuss why non-physicians should not attempt to diagnose skin diseases.
The high prevalence of the complications is due to the delayed treatments and the misdiagnosis, especially by the non-physicians. Non-physicians shouldn’t diagnose the skin diseases because they give misdiagnosis, they carry out their operations outside the hospital where they may not have the necessary equipment to use, they are also so bogus in their operations that even the traditionally simple medical procedures are being the cause of hypopigmentation, scars and permanent burns.
3) From the patient complications outlined in table 1, how do you think the NPO contributed to these complications?
They carry out the treatment formulae based on a misdiagnosis, some may not be having the wherewithal to use the medical machinery( the laser machines )and thereby end up exposing undue radiations to the patients which grossly affects them, some with respect to the nurses had barely had the training to offer such treatment and therefore offered the treatment based on meagre knowledge on the same and some conducted the procedures to earn money at the expense of the patients safety as evidenced by the complications caused by the product sellers.
4) How do you think this NPOs could have responded to their complications?
The NPOs would have responded to the complications by referring the affected patients to the professional practitioners and desist from conducting such treatment in the future, the salon owners would have employed the professional therapist to forestall such avoidable complications and carrying out the treatment, if they must, under the supervision of a therapist.
5) How is the cosmetic medicine portrayed by media in this article?
The cosmetic medicine is portrayed as: unscrupulous where anybody could practice it intent on earning with minimal concern for patients’ safety, the one full of impunity where rogue practitioners perform the treatment, causing complications on the patients and going scot free, irresponsible where patients go down with serious complications and the one having no legal requirements which open the floodgates to the NPOs.
6) How can the NPOs establish more credibility within the cosmetic medical profession?
They should perform the procedure in the presence of medical technicians. They should also employ the trained therapists. Furthermore, they should undergo the relevant training in order to provide safe treatments. Performing such procedures in registered health institutions will also increase the credibility of their practice.
7) Please discuss your experiences of the NPO. For example, have you had any patients requesting treatment of adverse reactions due to inappropriate treatment with other providers?
I have had many such cases of the NPOs in my in-tray. First off, a lady ended up having a disfigured face after a banged procedure. The cream used- Lecithin was mismatched with wrong skin type and as such ended up backfiring. Based on my research, the patient’s skin type was IV which does not respond to the used cream but only responds positively to the demagogical cream (Berlin, 2012)
CLINICAL STUDY TWO
1) Fill in the table below.
| Grade | Characteristics | Treatment |
| I | Appearance of blackheads | Using product with salicylic acid and steaming |
| II | Presence of papules and pustules | Applying the topical treatments |
| III | Acne scarring | Application of topical treatments and oral antibiotics |
| IV | Cysts and nodules | Injection of Corticosteroids directly into the cysts and nodules |
2) What do you think the e confounding variable is within this study and how do you think it may affect the study’s result?
The confounding variable is the patient who never got cured of their acne III conditions, this would affect the result since anyone reading such results may question the efficacy of the treatment modality used, which would render the entire research null and void as it were.
3) What was the protocol used for the MDA treatment?
The protocol used was: the candidates for the treatment were aged between 6-19 years and were under the dermatological care, it was ensured that they all received oral treatment; those who were pregnant by then and those who had been on isotretinoin were excluded from the treatment, in intervals of 7-10 days the treatment was performed, the post-treatment photographs were taken two weeks after the treatment.
4) What results were obtained after the MDA session?
The results were, twenty-seven patients completed the treatment and one patient was withdrawn from the study after having completed four rounds of the treatment to start the isotretinoin treatment. The results on the success of the treatment were as follows: 38% of the patients obtained excellent outcomes, 34% achieved good outcomes, 17% had average results and 12 % had negative results (Murad, 2011).
5) What was the average pressure used in Kpa.
The therapist normally moves the hand piece meticulously on the skin on a three- pass pattern to avert streaking. In addition, especially for the case of comedo, they apply for a supplementary pass with a foot pedal. The pedal has an average pressure of -156.41 kpa.
6) How would you advise a patient on the efficacy of MDA treatment for acne based on this study?
The MDA treatment is effective as seen when 92 % of the patients reported positive changes on their skin and 96 % of them would even recommend the treatment to others. Moreover, as it has been noted in the article, this treatment is nonsurgical, nonchemical, and noninvasive and has a high patient approval reports procedure that could be done by some trained personnel.
CLINICAL STUDY THREE
- What was the protocol of the MDA treatment?
Honesty was applied in seeking the consent of the patients. The therapist also applied a professional image by doing commendable treatments on the patients. In addition, they cleaned and greased the skin of the patients before the treatment. Lastly, the seven passes of the MDA unit were done on the patient skin.
- How did the authors measure statistical differences in biopsy results and discuss the importance of statistically significant results?
This was done through the comparative analysis of the biopsy specimen of the treated and control areas. In addition, the authors ensured that the research was carried in two distinct areas with a defined setting (the control and treatment areas). The statistically significant results are used in estimation models to make predictions.
- This text discusses/changes between the control and treatment areas. Produce that demonstrates these differences in detail.
| CONTROL AREAS | TREATED AREAS |
| There were constant mitotic figures | There were increased mitotic figures |
| There was no evidence for the basal processes in the cell | There were increased basal processes in the cell |
| No elastic fibers in the cells | High density of elastic fibers |
| Constant levels of inflammatory processes | Increased levels of inflammatory processes |
| Non-conspicuous and small fibroblasts | Large and conspicuous fibroblasts |
| Constant epidermal thickness | Increased epidermal thickness |
- What is the role of dermal inflammation in the clinical changes seen with MDA treatments?
- The dermal inflammation causes epidermal and thermal thickening
- The dermal inflammation is responsible deposition of new collagen fibers in the papillary dermis
- The dermal inflammation is the cradle of the formation of fibroblasts in the dermis
- The dermal inflammation eventuates in the blood flow in the dermis (Acton, 2012).
CLINICAL STUDY FOUR
1) Explain the physiological effects of a superficial peeling.
Some of the effects of the procedure are: increased production of the type one keratin which is more of a mucosal activity than it is a fiber production activity, increased glycosaminoglycan in the spaces between the cells, increased epidermal thickness during the first year of usage, increased count of fibroblasts which by now seems to be producing pink collagen fibrils and the papillary dermis and improved skin blood circulation.
2) List the disadvantages of the deeper chemical peeling and discuss why non-physicians should use only perform very superficial and superficial peels.
Disadvantages include: the process may eventuate in the chronic scarring of the skin, it may result in the skin infection, leads to herpes simplex infection of the skin and it may cause emotional and physical discomfort.
The non-physicians should only perform superficial peeling since it less expensive with minimal side effects, conditions as furrows, folds, and scars only respond to superficial peeling and it is not dependent on concentrations.
3) This article identifies 4 indications for the use of superficial peeling. Briefly describe the effects of superficial peeling on each of these indications.
- Acne; light peeling is an effective option against acne because it provides a solution for scarring acne and improves on the complexity.
- Fine wrinkling: the light peeling stimulates pigmentary changes which reduces the wrinkles.
- Weathering of the skin: the deposition of collagen curbs this indication.
- Poikilodermatous changes which include minimized pores
The superficial peeling enhances the dilation of vessels and angiogenesis which increases the pore count
4) In what circumstances, would you increase or decrease the number of days between superficial peeling treatments.
The period variation during the treatment procedures largely depend on: the concentration of the chemical; with a strong concentration, the period between treatments will be longer, the type of the chemical also affects the period between treatments whereby the retinoic acid has the shortest periods between the treatments (daily) and finally is the occurrence of a complication mainly due to skin sensitivity where the intervals will be longer than usual.
5) What substances are used for degreasing the skin prior to peeling and why is this important
There are various substances used in the degreasing of the skin, this may include alcohol and acetone among others. There are two reasons for the degreasing process: to measure the content of the oil that needs to be removed from the epidermis and to maintain a clean epidermis for easier absorption of the chemicals to be used.
6) Why do you think people with fair skin have high sensitivity in some segments of their face?
People with fair have been seen to have small doses of collagen fibers which increases the skin dryness increasing the sensitivity. In addition, the long exposure time they could be subjected to sun in their regions and the regular day to day application of the topical treatment procedures may also be the reasons their skins are sensitive.
7) In addition to concentration, PH and exposure time, what other factors mentioned in the article may cause increased sensitivity and what method can be adopted to increase peel depth.
Some of the factors that cause skin sensitivity may include: skin dryness, use of topical treatments on a daily basis, extreme exposure to the sun and the hormonal imbalances related to the menstrual cycle. The depth of the skin may be increased by skin stretching, skin rubbing, apply more moist gauze, excessive coating and introducing closer treatment intervals.
8) The author has recommended the rinsing off the TCA after one minute for patients first peel. How does this method of application differ to the method discussed in the lecture material and do you view as the safer method?
The two methods differ in: Jessenia’s method is only applicable on the face of the patients, with TCA the deepening of the skin is achieved by increasing the concentration of the solution while with the Jessenia’s method it is done through rubbing the skin and for TCA washing is essential but for the Jessenia’s method it is not.
The Jessenia’s formula is more effective because its concentration has no effect on the patient.
9) Why are Jessenia’s peels limited to small areas?
The application of the Jessenia’s is only limited to some body parts for two reasons: to rule out the possible toxicity from the poisonous resorcinol and to circumvent the inherent resorcinol membrane which may clog the pores and restrict the free movement of the body.
10) Why would use Jessenia’s solution on a patient rather the TCA?
I would use the Jessenia’s solution because: the TCA has possible toxicity due to the resorcinol in it, the Jessenia’s solution does not require washing, the deepening process is not dependent on concentration which would otherwise not auger well especially with type I and II of the skin, the solution also poses no threats to the skin health of a patient and the solution does not require time duration during the applications.
11) Discuss the importance of skin preparation at least two weeks prior to the treatment and list three ingredients suitable for skin preparation.
The importance of skin preparations includes: removes the subcutaneous oil, introduces a clean skin easing the chemical absorption, helps the physician know the type of skin they are handling for better treatment and attainment of healthy results and finally it helps the therapists know the sensitive parts of the skin at hand and decide on what concentrations to use.
The Key ingredients used are water alcohol and acetone (Rawlings, 2007).
CLINICAL STUDY FIVE
1) What are the main benefits of skin needling over the other dermal therapies?
Advantages include: the epidermis is never negatively affected unlike in other treatments, the skin retains its natural complexion, the skin becomes thicker with more collagen and elastin metrics, it stimulates the revascularization and the depigmentation of the stretch marks, it is safe and recommendable for all patients, it is less expensive, the process uses easy- to -master equipment and finally it is fast in healing.
2) With reference to how the skin heals, discuss why it is necessary to puncture the blood vessels in order to achieve a clinical result.
The skin needling procedure stimulate healing in three phases: phase 1: here the platelets are stimulated via releasing the chemotactic material, phase 2: monocytes comes in in the place of the neutrophils and leads to the releasing of transforming growth factors, phase 3: this is where the remodeling of the tissues actually takes place. (Acton, 2012).
3) Describe the histological and visual changes noted after the two needling sessions
There are various changes observed here; first off is the fact that the skin remains as natural as before the session. Secondly, the severity of acne is reduced in the patient and there was an overall improvement on the aesthetic value of the patient. Finally, there was no any observable signs of the procedure and hyperpigmentation.
4) What would be the course of action to be taken in the event of a needle stick injury and how can you prevent any potential cross-contamination associated with skin needling?
The emergency procedure is: The affected area should be cleaned thoroughly with disinfectants, the case should be reported immediately, the therapist should fill in the incident report form and the therapist should ensure finally that the patient is treated right.
If any blood gets on the skin of a person other than the patient irrespective of whether or the person has cuts on the skin, the area should be screened for any infections.
References
Ashton Acton (2012). Issues in Dermatology and Cosmetic Medicine: 2011 Edition. Scholarly Editions.
David J Goldberg, Alexander Berlin (2012). Acne and Rosacea: Epidemiology, Diagnosis and Treatment. CRC Press, Pg. 77.
Guy F. Webster, Anthony V. Rawlings (2007). Acne and Its Therapy. CRC Press.
Murad Allam (2011). Evidence-Based Procedural Dermatology. Springer Science & Business Media.