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IMCAS Alert - Challenging cases: injectables, clinical dermatology & lasers - (under an educational grant from Aerolase)

Partner of the session

ESCAD

European Society for Cosmetic and Aesthetic Dermatology

International

Partner of the session

ESDV

The Egyptian Society of Dermatology and Venereology

Egypt

Focus program

Room: Webinar
Date: Wednesday 10 March 2021 at 11:00 to 12:30
Format: CLINICAL CASE STUDY > study of unusual or difficult patient cases to assess various treatment plans and discuss patient care

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
11:00	Dominique DU CREST	Introduction		109049
11:05	Dr Ronald FEINER	Challenging case with injectables	View	108900
11:15	Prof Berthold RZANY	Challenging case with injectables	View	108901
11:25	Dr Ahmed SADEK	Challenging case with clinical dermatology		108904
11:35	Dr Anthony ROSSI	Challenging case with clinical dermatology	View	108905
11:45	Dr Muriel CREUSOT	Challenging case with lasers	View	108902
11:55	Dr Nabil FAKIH	Aggressive rosacea: clearance using a combination of 650-microsecond non-ablative and 300-microsecond ablative laser	View	108987
12:07	Prof Ashraf BADAWI	Challenging case with lasers	View	108903
12:17		Discussion and Q&A with the audience		109031

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Dominique DU CREST

Industry Representative

France

Other author(s) :

Introduction

Dr Ronald FEINER

Australia

Other author(s) :

Challenging case with injectables

Objectives: 1. Consideration of optimal and safe filler injections in the temporal fossa for correction of hollowing with particular reference to the minimisation of vasculo-occlusive risk.
2. The necessity for injectors to form a thorough appreciation of the complex nature of temporal fossa anatomy.

Introduction: In the past the temple region was regarded by some injectors as a rather easy region for filler injection.
This is clearly not the case as the anatomy is rather complex with many vessels coursing and weaving through various tissue and fascial planes, rendering the region relatively hazardous for filler malplacement and/or potentially alarming inadvertent vasculo-occlusive events.

Materials / method: CASE SUBMISSION TO IMCAS ALERT:
A complication is explored in a case of a 38 year old female patient that was recently submitted by a colleague to IMCAS ALERT concerning a vascular traumatic event, secondary to injection of HA filler for correction of temple hollowing.

Results: The case raises many interesting questions for debate:
• Is the complication a bleed/haematoma or a vasculo-occlusive event?
• What is the appropriate treatment?
• Which plane is the safest to inject?
• What is safer- cannula or needles?
• What size of needle or canula?
• Which plane of injection is most effective?
• What is the ideal filler rheology for each intended plane?

Conclusion: Avoidance of vascular hazards and sub-optimal outcomes, injectable filler correction of temple hollowing should be approached with great caution with due respect for the complex anatomy of the temporal fossa.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Prof Berthold RZANY

Dermatologist

Austria

Other author(s) :

Challenging case with injectables

Objectives: To describe a case published on IMCAS Alert. The case published is: 'periorbital stiff edema'

Introduction: IMCAS alert gives colleagues the chance to submit challenging cases and have them discussed

Materials / method: The patient with ‘periorbital still edema’ was reported on 8th November 2020 by an anonymous colleague. The colleague described a 71year old female patient with a stiff erythematous edema subocularly. The patient had been treated one year ago with a polyacrylamid filler (Activegel). The patient developed the stiff edema. It is not mentioned when the edema developed. The diagnosis of an adverse reaction to a permanent filler was made and the colleague started an oral antibiotic treatment with clarithromycin and injected steroids with only temporary improvement.

Results: The colleagues posted the case with the question of the most appropriate treatment. The discussion of the colleagues focused on surgical and well as medical options. Different opinions were presented. Among the options three times an immunmodulating therapy with methotrexate was mentioned. For this intervention several case reports/case series have been published.
The colleague presented the options to the patient. As the patient did not favored as surgical approach the colleague started a weekly methotrexate therapy.

Conclusion: Permanent fillers pose permanent challenges. The treatment with methotrexate is still not widely used and should be considered in patients with adverse reactions to permanent injectable fillers.

Based on this and similar cases one might question for permanent injectable fillers at all.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Ahmed SADEK

Dermatologist

Egypt

Other author(s) :

Challenging case with clinical dermatology

Dr Anthony ROSSI

Dermatologist

United States

Other author(s) :

Challenging case with clinical dermatology

Objectives: Lentigo maligna (LM): melanoma in situ occurring on chronically sun-damaged skin, often on head/neck
Diagnostically challenging due to overlapping features with benign pigmented lesions (BPL).
Benign lentigines present in ~90% lighter phototype individuals over age 601
Common cosmetic concern -> elective treatment

It is unknown if prior cosmetic treatment of lesions later identified as LM portend worse outcomes

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Muriel CREUSOT

Dermatologist

Belgium

Other author(s) :

Challenging case with lasers

Objectives: Vitiligo is an acquired depigmentation disorder resulting from progressive destruction of epidermal melanocytes.
The question arises on what to do about laser hair removal in a patient with vitiligo.

Laser hair removal applies the principle of selective photothermolysis ; melanin in the hair follicule (bulge and bulb) is the target but epidermal melanin is also the chromophore responsible of side effects.

The question arises on what to do about laser hair removal in a patient with vitiligo.
Can it be treated? If so, under what conditions? What is the most appropriate wavelength? In the case

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Nabil FAKIH

Facial Plastic Surgeon

Lebanon

Other author(s) : Nabil Fakih-Gomez

Aggressive rosacea: clearance using a combination of 650-microsecond non-ablative and 300-microsecond ablative laser

Objectives: Share our experience in aggressive rosacea treatment

Introduction: Rosacea is a highly prevalent, chronic inflammatory disease. The treatment of aggressive rosacea remains a challenge to dermatologists. Therapies include skin care, medications, lasers, and various combinations of these modalities. The appropriate treatment depends on clinical types and patient's various clinical symptoms. Currently, various vascular lasers are used for treatment, and among
them, Nd:YAG.

Materials / method: We present a case of aggressive rosacea in a 35 years old patient that failed several modalities of treatment. We proceed with a 650-microsecond Nd:YAG technology after several sessions followed by 300 microsecond Erb:YAG technology to control and treat the patient.

Results: Successful clearance of redness and acne breakouts in our case study

Conclusion: Both Nd:YAG and Erb:YAG are effective in treating aggressive rosacea.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No
Please specify entities (individual, company, society): Aerolase

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): Aerolase

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Aerolase

Prof Ashraf BADAWI

Dermatologist

Canada

Other author(s) :

Challenging case with lasers

Objectives: Realizing the causes Scarring after Nd:Yag laser treatment for facial telangiectasia

Introduction: Scarring after Nd:Yag laser treatment for facial telangiectasia is not an uncommon complication. Realizing the causes and the ways to avoid it is crucial for the patients safety.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Discussion and Q&A with the audience

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IMCAS Academy International Program

IMCAS Alert - Challenging cases: injectables, clinical dermatology & lasers - (*under an educational grant from Aerolase*)

Lectures of the session

IMCAS Academy International
Program

IMCAS Alert - Challenging cases: injectables, clinical dermatology & lasers - (under an educational grant from Aerolase)