Laser Review Flashcards
Signs of BDD? What should you do if your upset pt has BDD?
- Has inspo pictures of Hollywood stars
- Worries about their appearance > 1 hour a day
- No longer has friends or social life
- Directs the Dr or esthetician on how to do procedure
- Has edited pictures of how they want to look
- Knows exactly hoe to solve the problem
- Concerns are difficult for others to see
- Pt tends to be unhappy with results
- Threat of legal action
- Threat of bodily harm to technician, physician, or aesthetician
- Notify doctor
How do you treat BDD?
therapy and/or meds
General characteristics of acne
- Can be disfiguring, cause redness, pustules, and scarring
- Not contagious or life threatening but can affect self esteem
- One of the primary concerns of aesthetic clients
What are the causes of acne?
- Not to do with cleanliness; is hereditary or hormonal
- Hereditary factors known as retention hyperkeratosis = dead skin (keratinocytes) doesn’t shed off the surface of the corneum and instead build up in the follicle (tendency for heavy sebum or oily skin is also hereditary); Sebum waxes over cell build up and causes irritation and inflammation of the follicle = acne
How does oil make you acne prone?
- Oiliness can cause enlarged pores
- Oil and build up can plug pores
What bacteria is responsible for acne and what does it feed on?
- P acnes (propionibacterium acnes)
- It can’t survive w oxygen
- in normal skin oxygen is present and kills p acnes; in acne prone skin oxygen is blocked and allows p acnes to thrive off of sebum
What are comedones? Types?
- non inflammatory acne lesions
- open and closed
What is the difference between open and closed comedones?
- closed are whiteheads
- open are blackheads
What is inflammatory acne/ acne papule? What causes it?
- Acne characterized by redness and inflammation
- pressure builds on the follicle walls and the wall ruptures –> spread of bacteria, sebum, and debris –> debris is detected by the dermal immune system –> skin around the lesion and follicle become red and inflamed as WBC are recruited
- in acne, pus rises, forming a clump at the top of the follicle = pustule
Difference between papule and pustule?
- Papule is a red, inflamed lesion without a white center
- Pustule is a raised, red lesion with a white center
What is a nodule?
- deeper lesion that can be felt and moved around easily under the skin
- too deep for surface treatments
What is a cyst? how is it formed? What can happen as a result?
- deep pockets of infection with large amounts of pus
- formed when the skin forms hardened tissue around infection to try to stop the spread
- can destroy dermal cells causing depressed or raised scars
- too deep for surface treatments
What are sebaceous filaments? where are they usually found? how to treat?
- clogged pores/small impacted follicles
- found in T zone
- responds well to peels
How is acne related to hormones in teens?
- Androgens (DHT) stimulate sebaceous glands –> increase sebum production –> increased follicle inflammation and causes follicle wall to stretch
- starts with puberty (11-12 yrs); nose, then forehead, then chin
- follicles in children are hard to see and become more visible with puberty
- Teen acne is moe prominent in males
How is acne related to hormones in adults?
- females more likely to get adult acne d/t hormonal fluctuations (birth control, pregnancy, lactation, menopause, HRT)
- Premenstrual acne (8-10 days prior to period) = increased sebum production = perifollicular inflammation
- Large sore papules around jawline, chin, and neck, and other areas
Other factors that affect acne?
- Diet: food has little to do with acne; there is no scientific evidence to back it up
- Stress: adrenal gland responds to stress by releasing adrenaline which helps people cope with stressful events. Follicles become inflamed with the overproduction of sebum
What are two treatments for acne?
Accutane and photodynamic therapy
What is accutane? How does it work? how long do results last?
- Oral retinoid used to treat severe inflammatory and cystic acne
- Only drug that causes sebaceous glands to shrink and normalize
- Normalizes the hyperkeratosis (thickening) of the follicle
- Mode of action: increases lipids in the blood
thus Patients must have liver and kidney function monitored regularly
-After stopping Accutane the results last for several months; skin will become less dry and some sebum production will resume
What are the medical and aesthetic side effects of accutane?
- bone and tendon calcification
- Severe birth defects therefore women of childbearing age have to also use birth control
- Mental disturbance with an increased suicide risk (mostly concerning teens)
- Aesthetic side effects = red, sensitive, and dry skin; dehydration and flaking
What specific products should those on accutane be using?
- mild, nonfragranced, non exfoliating, nonfoaming/low foaming cleanser
- Nonalcoholic, hydrating toner
- Hydrating, nonfragranced and noncomedogenic moisturizer
- Nonfragranced, noncomedogenic, alcohol free SPF 30 (min)
- Azulene and green tea extract reduces redness and soothes skin
Instructions for those on accutane
- Clients on Accutane should stop all exfoliating and keratolytic products (anything that peels the top layer of the skin) — benzoyl peroxide, sulpha, salicylic acid, retinol, AHA, etc
- Wait 12 months before resuming any treatment (confirm with dermatologist)
- Resume treatment with extreme caution
What is photodynamic therapy? what are the indications? Benefits?
-Treatment performed with Levulan (5-aminolevulinic acid), a photosynthesizing agent, activated with the correct wavelength of light
- Indications: acne, rosacea, sun damage, pigmentation, fine lines
(ARSPF)
- Attacks acne bacteria, minimizes pores and acne scarring, reduces oil glands, removes sun damaged precancerous areas and actinic keratoses
What are the contraindications to PDT?
- Those with hx of cold sores should start antiviral treatment a day before
- Avoid acid topical treatments or facials for 5 days prior to treatment
- Must be off oral abx for 1 week prior to
- Cant be pregnant or breastfeeding
- Okay to do on a mild tan
What is the post treatment for PDT?
- For discomfort and swelling —> ice packs
- For cooling (decrease burning sensation) —> vinegar compress (1 tsp to 1 cup cold water for 20 min q 4-6h - ice can be applied over the vinegar soak), Pat dry after vinegar soak and apply 1% hydrocortisone
- Stay inside for at least 24h after
- Advil/Tylenol may be taken as needed
- Photosensitivity to sun is usually gone 24h after but can last up to 40h
- Skin may appear red with some peeling for 2 days after treatment; temporary swelling of lips and eyes; area may be red for 4-6 weeks post treatment
PDT protocol
- Cleanse skin
- Apply acetone (4 swipes w gauze)
- Break 2 glass ampules in Levulan stick - shake for 2 min
- Apply solution on entire area (at least 2 coats); important to get to the eyes as it will be apparent that they were not treated
- Allow it to incubate for 30-60 min
- Activate w Blu-U light for 8 min to start
- Wash face well with soap and water to remove residual Levulan
- If little reaction noted on first treatment, increase incubation for next treatment
- Advise patient to come prepared with hat, scarf, and sunglasses as this must be worn when leaving the office
- Photography should be done prior to every treatment
- safe for all; be cautious for 4-6
Where does melanoma show up usually?
tongue, palms, soles
What increases your risk of melanoma?
- one bad sunburn before 18yrs, fair skin and red hair, > 50 moles, immunosuppression, fam history of skin cancer
What is law in Australia
to send children to school with sunscreen
What is UV divided into?
UVC (100-280 nm) = short wavelength; most damaging; completely filtered by the atmosphere and doesn’t reach earth
UVB (280 - 315 nm) = medium wavelength; can’t go past superficial skin layers; responsible for delayed tanning and burning; enhances aging and promotes skin cancer; most is filtered
UVA (315-400 nm) = longest wavelength; 95% of radiation that reaches earth; can penetrate into the deeper layers of the skin and is responsible for immediate tanning; also contributes to aging and skin cancer development
Why do Canadians still have such a high skin cancer rate?
people only use sunscreen with intense exposure
What is UV index? Daily UV forecast?
- Measure of the intensity of the suns rays
- Scale runs from 1-11 in Canada, but can reach 14 in the US and tropics
- Daily UV index forecast = prediction of max UV strength (usually peaks early afternoon)
What is the most common type of skin cancer in Canada? most or least dangerous?
basal cell carcinoma
- least dangerous
Where does BCC appear? What are the EWS?
- Usually appears on sun exposed skin (face, neck, trunk legs); appearance can vary
- Early Warning Signs = small red (d/t small blood vessels), scaly patch; any sore that doesn’t heal within 4 weeks; a firm, flesh coloured or slightly reddish bump with a pearly border; a sore/pimple like growth that bleeds, crusts over, the reappears
What causes BCC? and who’s at risk?
- UV radiation form the sun is the main cause; frequent severe sunburns and intense sun exposure in childhood increase risk
Who’s at risk?
- Fair skin with blonde or red hair, skin that usually burns, older age (> 50), more men than women, those who’ve already had it, immunocompromised
How is BCC treated?
- Can be surgical excision, curettage, electrodesiccation and cautery, laser, photodynamic therapy and immune modulating creams are on the horizon
- For large tutors and those near important structures, Mohs surgery is indicated (removes just the tumour and spares normal skin)
How do you check for moles?
A: Asymmetry
Compare one half of the growth to the other. Unequal or asymmetric are sus
B: Border
Moles should be round or oval. If irregular/indistinct this is sus
C: Colour
Moles should be one colour. Variations and mixtures of colours are sus. Different shades of browns, blues, reds, whites, and black are concerning. A black mole, even one colour, is concerning
D: Diameter
Any mole larger than 6 mm or pencil eraser is sus
E: Elevation or Evolving
Elevated/raised from the skin is sus
Other dangerous signs = changing colour, size, shape, elevation, surface texture, surrounding skin, sensation
What are antioxidants? What is considered an antioxidant?
vital phytochemicals/vitamins that prevent/slow oxidative damage (from sun, stress, pollution, metabolic byproduct, and can cause cancer, aging, other disease)
Vit A, C, E, beta carotene
veggies, fruits and nuts, herbs
What is laser safety? Why is it needed? What was put in place to regulate them?
- Laser safety = safe design, use, and implementation of lasers to minimize risk of laser accidents
- Moderate and high power lasers are potentially hazardous as they can burn the retina or skin. Some are so powerful that even the reflection from a surface can be hazardous to the eye (The coherence of laser light and the focusing mechanism of the eye = concentration of laser light into a small spot on the retina). Infrared lasers are particularly hazardous, since the body’s protective blink reflex is only triggered by visible light (eg. Nd:YAG emits 1064 nm invisible radiation so there is no immediate pain or damage noticed; a pop or click from the eye may be the only indication that damage has occurred)
- To control injury risk, various specifications define classes (4) of laser depending on their wavelength and ability to cause harm
These regulations also have required safety measures
What is MPE? how is it measured?
- maximum permissible exposure (MPE) is the highest power or energy density (J/cm square) of a light source that is considered safe
- Measured at the cornea of the human eye or at the skin, for a given wavelength and exposure time
which lasers transmit to the retina and which don’t?
- Lasers that dont transmit to the retina are CO2, ER:Yag, Ho:Yag; but they can
- All of the visibly coloured lasers and most infrared will transmit back to the retina (Ruby, Alex, Nd:Yag, IPL)
What PPE should be worn with lasers? Precautions?
- Protective goggles with appropriate filtering optics for technician and pt
- Also consider: clothing, surfaces/windows/mirrors, calibration, maintenance, manufacturer’s instructions
- don’t stare into laser beam, don’t take deep breath of laser plume
- don’t perform in a room with mirror, remove jewelry near the treatment area, a laser sign must be outside room, laser key must be removed from machine after use
What is laser? purpose?
- light amplification by the stimulated emission of radiation
- direct beam of light
- cut, vaporize, coagulation, ablation
Frequency
the numbers of waves to pass a single point
