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Alpha-Hydroxy acid

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81. Seborrheic Keratosis (Diagnosis)

. Evaluation of ammonium lactate in the treatment of seborrheic keratoses. J Am Acad Dermatol . 1990 Feb. 22(2 Pt 1):199-203. . Van Scott EJ, Yu RJ. Alpha hydroxy acids: procedures for use in clinical practice. Cutis . 1989 Mar. 43(3):222-8. . Herron MD, Bowen AR, Krueger GG. Seborrheic keratoses: a study comparing the standard cryosurgery with topical calcipotriene, topical tazarotene, and topical imiquimod. Int J Dermatol . 2004 Apr. 43(4):300-2. . Eskata (hydrogen peroxide) topical solution prescribing

2014 eMedicine.com

82. Dermal Fillers (Overview)

Agent Contents Method of Action Indications Injection Duration Limits Sculptra Synthetic, biodegradable, biocompatible, immunologically inert polymer from the alpha-hydroxy-acid family; must be reconstituted with at least 3-5 mL of sterile water for injection; must stand for at least 2 hours to ensure hydration prior to treatment. Particles of poly-L-lactic acid stimulate formation of new collagen (collagen neosynthesis) in the skin, adding volume over time. Intended for restoration (...) not established. Table 8. Poly-L-Lactic Acid Agent Contents Method of Action Indications Injection Duration Limits Sculptra Synthetic, biodegradable, biocompatible, immunologically inert polymer from the alpha-hydroxy-acid family; must be reconstituted with at least 3-5 mL of sterile water for injection; must stand for at least 2 hours to ensure hydration prior to treatment. Particles of poly-L-lactic acid stimulate formation of new collagen (collagen neosynthesis) in the skin, adding volume over time

2014 eMedicine.com

83. Corns (Treatment)

relieves pain, especially with helomas. Lesions may be maintained in this state if the patient uses short soaks and pumice stone debridement at home. Debridement may be enhanced with the use of keratolytic agents, such as ureas, alpha-hydroxy acid (eg, glycolic, malic, or lactic acid), or beta-hydroxy acid (eg, salicylic acid). [ ] Garlic extracts have also been described as being helpful. [ ] Self-adhesive pads are most effective for reducing thick lesions, whereas lotions, creams, and medicaments (...) of ulceration and, consequently, the need for surgical intervention. [ ] The use of orthotics and conservative footwear with extra toe space are often beneficial. When all else fails, surgery may be performed. If abnormal dermatoglyphics or pinpoint bleeding is seen, wart therapy is initiated. If normal dermatoglyphics are noted, salicylic acid compounds and orthotics may be beneficial. Relief of symptoms may be achieved by thinning and cushioning of the involved lesions. Paring of the lesions immediately

2014 eMedicine.com

84. Dermal Fillers (Treatment)

Agent Contents Method of Action Indications Injection Duration Limits Sculptra Synthetic, biodegradable, biocompatible, immunologically inert polymer from the alpha-hydroxy-acid family; must be reconstituted with at least 3-5 mL of sterile water for injection; must stand for at least 2 hours to ensure hydration prior to treatment. Particles of poly-L-lactic acid stimulate formation of new collagen (collagen neosynthesis) in the skin, adding volume over time. Intended for restoration (...) not established. Table 8. Poly-L-Lactic Acid Agent Contents Method of Action Indications Injection Duration Limits Sculptra Synthetic, biodegradable, biocompatible, immunologically inert polymer from the alpha-hydroxy-acid family; must be reconstituted with at least 3-5 mL of sterile water for injection; must stand for at least 2 hours to ensure hydration prior to treatment. Particles of poly-L-lactic acid stimulate formation of new collagen (collagen neosynthesis) in the skin, adding volume over time

2014 eMedicine.com

85. Chemical Peels (Overview)

likely. Penetration into the reticular dermis entails a very high risk of scarring. The weaker agents (eg, alpha-hydroxy acids) change the pH sufficiently to cause a superficial shock to the cells and, depending on many variables, cell injury or death. When used with a moisturizer, the acid acts simply to cause cellular and intercellular swelling and plumping, leading to a transient increase in cell and matrix size and lessening of fine lines and rhytides. Sequential treatments lead to exfoliation (...) . This process decreases solar elastosis and replaces and reorients the new dermal connective tissue. The result is an improved clinical appearance of the skin, with fewer rhytides and decreased pigmentary dyschromia, and a more youthful appearance. The images below depict a patient during and after a salicylic acid peel. Men also request chemical peeling. This 56-year-old man is in the process of a salicylic acid peel. Same patient as shown above following a successful chemical peeling. In recent years

2014 eMedicine.com

86. Seborrheic Keratosis (Overview)

. Evaluation of ammonium lactate in the treatment of seborrheic keratoses. J Am Acad Dermatol . 1990 Feb. 22(2 Pt 1):199-203. . Van Scott EJ, Yu RJ. Alpha hydroxy acids: procedures for use in clinical practice. Cutis . 1989 Mar. 43(3):222-8. . Herron MD, Bowen AR, Krueger GG. Seborrheic keratoses: a study comparing the standard cryosurgery with topical calcipotriene, topical tazarotene, and topical imiquimod. Int J Dermatol . 2004 Apr. 43(4):300-2. . Eskata (hydrogen peroxide) topical solution prescribing

2014 eMedicine.com

87. Botanical Dermatology (Overview)

is converted to tulipalin A, the allergen, by means of acidic hydrolysis. Tuliposide B, the alpha-hydroxy derivative of tuliposide A, and the hydrolytic product tulipalin B are commonly found in tulips; they are much weaker sensitizers than tulipalin A. Alstroemeriaceae The family Alstroemeriaceae includes the Peruvian lily. Florists often develop erythema, fissures, vesicles, hyperkeratosis, and exfoliation of the fingertips, which often affects their dominant hand. The allergen can pass through vinyl (eg (...) soldiers who were stationed in India during World War II had adverse reactions to their marked garments. Plant identification - Cross-reacting species from other families The Ginkgo tree ( Ginkgo biloba ) is widely grown in suburban areas in North America and Europe because of its beauty, size, and pollution resistance. Allergic reactions are mediated by anacardic acid, which is present in the seed pulp. The unique fan-shaped leaves, shown below, are easily recognizable. Mature gingko tree, Ginkgo

2014 eMedicine.com

88. Botanical Dermatology (Treatment)

is converted to tulipalin A, the allergen, by means of acidic hydrolysis. Tuliposide B, the alpha-hydroxy derivative of tuliposide A, and the hydrolytic product tulipalin B are commonly found in tulips; they are much weaker sensitizers than tulipalin A. Alstroemeriaceae The family Alstroemeriaceae includes the Peruvian lily. Florists often develop erythema, fissures, vesicles, hyperkeratosis, and exfoliation of the fingertips, which often affects their dominant hand. The allergen can pass through vinyl (eg (...) soldiers who were stationed in India during World War II had adverse reactions to their marked garments. Plant identification - Cross-reacting species from other families The Ginkgo tree ( Ginkgo biloba ) is widely grown in suburban areas in North America and Europe because of its beauty, size, and pollution resistance. Allergic reactions are mediated by anacardic acid, which is present in the seed pulp. The unique fan-shaped leaves, shown below, are easily recognizable. Mature gingko tree, Ginkgo

2014 eMedicine.com

89. Acne Keloidalis Nuchae (Treatment)

or chlorhexidine can help prevent secondary infection. [ ] Tar shampoos may provide an effective alternative. In addition, mild keratolytic agents containing alpha-hydroxy acids or topical retinoids may help soften the coarse hairs. Patients should discontinue hair greases or pomades, which can interfere with hair growth. [ ] Early, mild papular disease may respond to potent or superpotent topical steroids with or without the use of topical retinoids. This latter combination seems to be somewhat more effective (...) sutures may be used to re-approximate the skin as they cause less of an inflammatory response than nylon sutures. Instruct patients to clean the postoperative area 3 times a day with a mild cleanser, followed by application of a topical antibiotic ointment. The sutures should be removed in 7-10 days, and the patient should then begin a twice-daily topical retinoic acid/corticosteroid regimen for 4-6 weeks. The preferred method of excision for larger linear lesions (1 cm or less in diameter

2014 eMedicine.com

90. Erythrokeratodermia Variabilis (Treatment)

usually is very low. The use of topical agents in the management depends on the symptoms and focuses on hydration, lubrication, and keratolysis. Therapy may include the use of emollients and keratolytics, such as urea, alpha-hydroxy acids, propylene glycol, salicylic acid, and topical vitamin D analogs and retinoid preparations. Newer synthetic retinoids, such as short-contact topical tazarotene, combined with moisturizers seem promising. [ ] Masking the erythematous lesions of uncovered skin

2014 eMedicine.com

91. Laser Tissue Resurfacing (Treatment)

of retinoic acid, hydroquinone, alpha-hydroxy acids, and sunblock. Previous Next: Intraoperative Details Laser tissue interaction Carbon dioxide laser emits light at a wavelength of 10,600 nm, which is strongly absorbed by water (the primary chromophore for carbon dioxide light that is abundant in the skin). [ ] Although approximately 90% of the carbon dioxide laser energy is absorbed by the initial 20-30 µm of skin, traditional, continuous wave lasers leave a zone of thermal damage measuring 0.2-1 mm (...) in the course. [ ] Recovery is dependent on the depth of ablation. During the first week, patients experience variable degrees of oozing and crusting. Dressings should be applied until complete reepithelialization takes place; the patient can start applying a light water-based moisturizer for the next 2-3 weeks. Postprocedure skin reconditioning should begin early during the healing process. Hydroquinone and retinoic acid can be reintroduced 3-4 weeks postoperatively. Alpha-hydroxy acids should be avoided

2014 eMedicine.com

92. Paraneoplastic Diseases (Treatment)

of AI includes hydration of the skin and prevention of evaporation. This is achieved through the topical application of alpha-hydroxy acids (eg, lactic, glycolic, and pyruvic acids) and emollients (eg, urea creams, propylene glycol). Topical corticosteroids are not useful. Acrokeratosis paraneoplastica (Bazex syndrome) In 1965, Bazex described the development of eczematous or psoriasiform plaques on acral surfaces in association with an underlying cancer. The clinical features of Bazex syndrome (...) of the lung, and positive anti-HU antibody titer. (a) Peripheral nerve in longitudinal section stained with Luxol fast blue-periodic acid-Schiff (PAS) showing scattered wallerian degeneration (arrowheads). (b) Low-power view of a paravertebral sympathetic ganglion stained with hematoxylin and eosin (H&E). Arrowhead indicates perivascular mononuclear infiltrates. (c) High-power view of the same sympathetic ganglion showing degenerating neurons (single arrowheads) and mononuclear infiltrates (double

2014 eMedicine.com

93. Pachyonychia Congenita (Treatment)

, salicylic acid, alpha-hydroxy acid). [ ] Treatment of hyperhidrosis, which is a bothersome and common feature of pachyonychia congenita, appears to be helpful in decreasing blistering and pain and has been achieved with agents such as aluminum chloride or plantar injections of botulinum toxin. [ , , ] Pharmaceutical treatment of pachyonychia congenita includes systemic retinoids, such as isotretinoin [ ] and etretinate. [ ] The retinoids may be successful in reducing the follicular keratoses (...) or a wheelchair may be helpful or even necessary for pain management and healing. [ ] Mechanical thinning of keratotic nails and calluses with a variety of tools such as pumice stones, emery boards, rasps, and files may be helpful. Some patients have reported the successful use of electrical tools, such as grinders, polishers, and sanders, to reduce thickened nails. [ ] Softening of the nails and calluses can also be achieved with water, humectants (eg, urea, propylene glycol), and weak organic acids (eg

2014 eMedicine.com

94. Keratosis Pilaris (Treatment)

pilaris may be improved with basic lubrication using over-the-counter moisturizer lotions such as Cetaphil, Purpose, or Lubriderm. Additional available therapeutic options for more involved cases of keratosis pilaris include lactic acid lotions (AmLactin, Lac-Hydrin), alpha hydroxy acid lotions (glycolic body lotions, urea cream (Carmol 10, Carmol 20, Carmol 40, Urix 40), salicylic acid (Salex lotion), and topical steroid creams (triamcinolone 0.1%, Locoid Lipocream), retinoic acid products (...) such as tretinoin (Retin-A), tazarotene (Tazorac), and adapalene (Differin). Specially mixed “designer” compound creams with multiple different combined ingredients can also be prescribed by physicians. Chlorine dioxide complex cleanser has been reported as effective. [ ] The affected area may be washed once or twice a day with a gentle cleanser such as Dove. Acne-prone skin may benefit from more therapeutic cleansers such as salicylic acid, or benzoyl peroxide. Lotions should be gently massaged

2014 eMedicine.com

95. Ichthyosis Vulgaris, Hereditary and Acquired (Treatment)

systemic condition. The main approach to treatment of both conditions includes hydration of the skin and application of an ointment to prevent evaporation. Hydration promotes desquamation by increasing hydrolytic enzyme activity and the susceptibility to mechanical forces. Pliability of the stratum corneum is also improved. Note the following: Topical retinoids are helpful for some patients. Alpha-hydroxy acids (eg, lactic, glycolic, or pyruvic acids) are effective for hydrating the skin. They work (...) by causing disaggregation of corneocytes in the lower levels of the newly forming stratum corneum. Lactic acid is available as a 12% ammonium lactate lotion, or it can be compounded by prescription in a concentration of 5-10% in a suitable vehicle. Twice-daily applications have shown to be superior to petrolatum-based creams for controlling of ichthyosis vulgaris. Removal of scales can be aided by keratolytics (eg, salicylic acid), which induce corneocyte disaggregation in the upper stratum corneum

2014 eMedicine.com

96. Paraneoplastic Diseases (Overview)

of AI includes hydration of the skin and prevention of evaporation. This is achieved through the topical application of alpha-hydroxy acids (eg, lactic, glycolic, and pyruvic acids) and emollients (eg, urea creams, propylene glycol). Topical corticosteroids are not useful. Acrokeratosis paraneoplastica (Bazex syndrome) In 1965, Bazex described the development of eczematous or psoriasiform plaques on acral surfaces in association with an underlying cancer. The clinical features of Bazex syndrome (...) of the lung, and positive anti-HU antibody titer. (a) Peripheral nerve in longitudinal section stained with Luxol fast blue-periodic acid-Schiff (PAS) showing scattered wallerian degeneration (arrowheads). (b) Low-power view of a paravertebral sympathetic ganglion stained with hematoxylin and eosin (H&E). Arrowhead indicates perivascular mononuclear infiltrates. (c) High-power view of the same sympathetic ganglion showing degenerating neurons (single arrowheads) and mononuclear infiltrates (double

2014 eMedicine.com

97. Seborrheic Keratosis (Treatment)

> Seborrheic Keratosis Treatment & Management Updated: Oct 30, 2018 Author: Arthur K Balin, MD, PhD, FACP; Chief Editor: William D James, MD Share Email Print Feedback Close Sections Sections Seborrheic Keratosis Treatment Medical Care Ammonium lactate and alpha hydroxy acids have been reported to reduce the height of seborrheic keratoses. [ , ] Superficial lesions can be treated by carefully applying pure trichloroacetic acid and repeating if the full thickness is not removed on the first treatment (...) , Russell TJ, Krochmal L. Evaluation of ammonium lactate in the treatment of seborrheic keratoses. J Am Acad Dermatol . 1990 Feb. 22(2 Pt 1):199-203. . Van Scott EJ, Yu RJ. Alpha hydroxy acids: procedures for use in clinical practice. Cutis . 1989 Mar. 43(3):222-8. . Herron MD, Bowen AR, Krueger GG. Seborrheic keratoses: a study comparing the standard cryosurgery with topical calcipotriene, topical tazarotene, and topical imiquimod. Int J Dermatol . 2004 Apr. 43(4):300-2. . Eskata (hydrogen peroxide

2014 eMedicine.com

98. Pachyonychia Congenita (Follow-up)

, salicylic acid, alpha-hydroxy acid). [ ] Treatment of hyperhidrosis, which is a bothersome and common feature of pachyonychia congenita, appears to be helpful in decreasing blistering and pain and has been achieved with agents such as aluminum chloride or plantar injections of botulinum toxin. [ , , ] Pharmaceutical treatment of pachyonychia congenita includes systemic retinoids, such as isotretinoin [ ] and etretinate. [ ] The retinoids may be successful in reducing the follicular keratoses (...) or a wheelchair may be helpful or even necessary for pain management and healing. [ ] Mechanical thinning of keratotic nails and calluses with a variety of tools such as pumice stones, emery boards, rasps, and files may be helpful. Some patients have reported the successful use of electrical tools, such as grinders, polishers, and sanders, to reduce thickened nails. [ ] Softening of the nails and calluses can also be achieved with water, humectants (eg, urea, propylene glycol), and weak organic acids (eg

2014 eMedicine.com

99. Paraneoplastic Diseases (Follow-up)

of AI includes hydration of the skin and prevention of evaporation. This is achieved through the topical application of alpha-hydroxy acids (eg, lactic, glycolic, and pyruvic acids) and emollients (eg, urea creams, propylene glycol). Topical corticosteroids are not useful. Acrokeratosis paraneoplastica (Bazex syndrome) In 1965, Bazex described the development of eczematous or psoriasiform plaques on acral surfaces in association with an underlying cancer. The clinical features of Bazex syndrome (...) of the lung, and positive anti-HU antibody titer. (a) Peripheral nerve in longitudinal section stained with Luxol fast blue-periodic acid-Schiff (PAS) showing scattered wallerian degeneration (arrowheads). (b) Low-power view of a paravertebral sympathetic ganglion stained with hematoxylin and eosin (H&E). Arrowhead indicates perivascular mononuclear infiltrates. (c) High-power view of the same sympathetic ganglion showing degenerating neurons (single arrowheads) and mononuclear infiltrates (double

2014 eMedicine.com

100. Kallmann Syndrome and Idiopathic Hypogonadotropic Hypogonadism (Follow-up)

of this review. Patients with ichthyosis are treated with alpha-hydroxy acids, such as glycolic acid or lactic acid. Next: Further Inpatient Care Admit patient for diagnostic testing and surgery as needed. Previous Next: Inpatient & Outpatient Medications Medications include gonadal steroid replacement (testosterone in males and estrogen-progestin in females) in postpubertal-aged patients. Male and female patients with KS or IHH who desire fertility may choose between pulsatile gonadorelin (GnRH) infusion (...) and mineralocorticoid replacement therapy. Antiepileptic medications are needed in patients with seizures. Patients with congenital heart disease may need pharmacologic therapy as well. Details of these therapies are beyond the scope of this review. Patients with ichthyosis are treated with alpha-hydroxy acids, such as glycolic acid or lactic acid. Previous Next: Transfer Transfer may be indicated for specific diagnostic testing or surgery. Previous Next: Deterrence/Prevention Patients at risk of osteoporosis

2014 eMedicine.com

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