Electroquatery in Dermatology

Most Common Uses for Electroquatery in Dermatology

The same principles that apply to any electroquatery procedure apply to electroquatery for dermatology.  The device cuts, desiccates (dries the area), coagulates (forms blood clots) and fulgurates (destroys and removes) tissue.

There are so many dermatology procedures that respond well to electroquatery that dermatologists generally use it every day.  The benefits of the procedure are numerous.  Procedures are performed under local anesthesia, often without the need of an assistant.  The use of electroquatery has been tied to less bleeding during the procedure which reduces complications, promotes rapid healing and minimal scarring.

A few of the most common electrosurgical dermatology procedures include the following:

Removal of skin lesions

• Non-cancerous moles (Electrosurgery is not used for excision of suspected or confirmed melanomas)

• Common skin tags

• Warts

• Small basal cell carcinomas less than 0.2 inches in diameter

• Squamous cell carcinoma that is in situ

• Other miscellaneous lesions

• Seborrheic keratoses

Treatment of angiomas and pyogenic granulomas

Electrosurgery for dermatology procedures is the ideal method for removal of hemangiomas and pyogenic granulomas due to their vascular nature and tendency to bleed.  With electrosurgery, the elevated portions of the lesions are shaved off and the area electrocoagulated.  With this procedure, if there is any blood loss at all, it is minimal.

Electrosurgery for acne

Electrosurgery for dermatology is used to treat some types of acne.  For example, there are several remedies available for comedonal acne, which involves blackheads and whiteheads located primarily on the forehead and chin.  If other treatments fail and the condition persists, electrosurgery is recommended.

Scar revision is another use of electrosurgery for dermatology

The advantage of electrosurgery for scar revision is the ease with which the unwanted tissue is removed without the dermatologist having to put pressure on the skin.  The area is simultaneously coagulated to reduce bleeding.  The device can be directed so that surrounding tissue is not damaged.

Fractional CO2 Laser

What is Fractional CO2 Laser

Indications 

• Acne Scar

• Comedonal Acne

• Wart removal

• Seborrheic keratosis

• Xanthelasma removal

• Skin tag removal, Milia removal

• Molluscum Removal

• Antiageing

• Syringomas

How does it work?

Co2 laser basically works on 3 main principals

• Incision

• Vaporisation

• Coagulation

It works on 10600 nm wavelength. Intracellular water is the chromophore of the co2 laser. With Fractional co2 laser, multiple micro ablative channels are created into the skin which involved both the epidermis and the dermis which are surrounded by normal undamaged skin so that reepithelization could be achieved in 2–3 days, and wound healing could occur more rapidly under the protection of the new skin. This helps in collagen remodulation & improving structural irregularities in the skin like open pores, acne scars, antiageing. This treatment can be combined with PRP to get best results for skin rejuvenation & acne scars.

In the treatment of various skin lesions: Like xanthelasma, syringoma, milia, molluscum contagiosum.

After local injection anesthesia, the CO2 laser is used to incise the skin lesion, then that lesion gets vapourised & cut the lesion, Then with the defocus mode, we can cauterize the lesion, this helps to avoid bleeding after the procedure.

• Seborrheic keratosis:

With co2 laser, it can be selectively and precisely vaporized to remove the melanotic cornification of this type of lesion in controlled layers. This procedure is done under topical anesthesia to avoid pain.

• Skin Tag:

With co2 laser, under local anesthesia, (lidocaine).  In the CO2 treatment of skin tags traction is applied to the tag and the precisely focused beam of the CO2 laser is used to excise the lesion at its base.

During treatment, a wooden stick is placed at the back of the tissue being excised to act as a backstop. If spotty bleeding occurs, the blood is wiped off with dry gauze and the area painted with the defocused CO2 beam to achieve hemostasis.

• Syringomas and Xanthelasma: 

Can also be removed under topical anesthesia with CO2 laser treatment.

• Warts

The common wart, verruca vulgaris, is a viral infection of the skin, which usually appear on the face, fingers, and toes, particularly of children. A warty skin lesion is vascular &having blood supply at the dermo-epidermal junction. Removal of the wart with incision may lead to spreading of infection to other healthy areas of skin.

Cryotherapy [Liquid Nitrogen therapy ] can be used but this takes multiple sessions for complete removal & healing time is more. 

Wart removal with a co2 laser is most advanced laser treatment which cuts and vaporize the central portion of the wart till normal tissue architecture is seen.The co2 beam can be defocused to achieve immediate coagulation of the blood on the area.This is the fastest method of wart removal.

Advantages of co2 over other machines: minimized charring with faster healing which increases patients compliance for treatment.

Precautions:

Extensive ablation may result in scarring. Treatment has to be done under the supervision of experienced dermatologist only in order to get best possible results.

Role of the Fractional co2 laser

• In Antiaging:  

Skin rejuvenation has recently become a hot topic. Everybody dreams to have rejuvenated skin. The fractional Co2 laser acts as a bridge between fully ablative & non-ablative lasers. It helps to stimulate new collagen beneath the skin layers. This helps to reduce fine lines, wrinkles on the skin. This procedure can be combined with PRP to get best possible results.

• In Acne Scars:–

Fractional co2 laser work well in treating Box scars, rolling acne scars. The individual scar can be targeted using this method of scar resurfacing.

With Fractional co2 laser, multiple micro ablative channels are created into the skin which involved both the epidermis and the dermis which are surrounded by normal undamaged skin. This laser helps to break collagen bands beneath the fibrous tissue of the scar & helps to form new collagen in order to lift the scar. This treatment can be combined with Subcision [ Treatment in which collagen bands beneath the scar tissue are manually broken with the help of needle ] to get better results.

Post-treatment:-

Redness, swelling, inflammation may occur on the skin, which gets settle down in 6 to 8 days. Strict photoprotection is advised in order to avoid PIH after the treatment.

Disadvantages:-

• Chances of getting PIH are more if proper precautions are not taken after treatment.

• Precautions need to be taken in darker skin type patient.