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34 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Which collagen ratio changes during skin aging? |
Decreased ratio of type I/type III collagen in addition to a thinner dermis & epidermis |
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Which Fitzpatrick skin type Burns moderately; tans moderately? |
Fitzpatrick type III (6 types total) |
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How does facial resurfacing affect the layers of the skin? |
Cause dermal collagen reorganization and new collagen deposition |
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CO2 laser: 1. Target wavelength? 2. Target chromophore? 3. Which zone of the skin is targeted? 4. Time to re-epithelialization? 5. How long does erythema last? 6. Most common adverse reaction? |
The wavelength is 10,600 nm. ▀The target chromophore is water. ▀Depth of ablation depends on the number of passes and amount of cooling time allowed between passes The greatest effect is in the papillary dermis 8.5 days 3-6 months Hypopigmentation is most common adverse reaction. |
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Which treatment for facial aging increases dermal collagen? |
Tretinoin therapy |
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Which fillers can be injected with steroid to reduce lumps? |
lumps caused by poly-L-lactic acid or polymethyl methacrylate respond well to intralesional steroids, these are not as effective in treating lumps caused by calcium hydroxylapatite |
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Which chemical peel has the following: rapid breathing, tinnitus, hearing loss, dizziness, abdominal cramps and central nervous system reactions. |
Salicylic acid |
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An otherwise healthy 46-year-old woman undergoes botulinum toxin type A (Botox) treatment for severe glabellar lines. Twelve units of Botox is administered into each corrugator muscle. Eight days later, the patient comes to the office because of ptosis of the right eyelid. Which of the following muscles is most likely inadvertently affected in this patient? |
Levator palpebrae superioris |
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Which muscle is the primary upper eyelid elevator? Which CN is it innervated by? |
Levator palpebrae superioris is the primary upper eyelid elevator and is innervated by the third cranial nerve
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How is Muller's muscle innervated? How much eyelid excursion does it provide? |
Müller's muscle is an accessory eyelid elevator and lies deep to the levator. It is innervated by the sympathetic nervous system. Contraction of this muscle (such as with pharmacologic stimulation) contributes about 2 mm to lid retraction. |
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Mechanism of action of retinoic acid? |
Topical retinoids act by decreasing corneocyte adhesion in the stratum corneum, resulting in reduced follicular occlusion and comedone formation. In addition to acne treatments, topical retinoids also improve fine rhytides, correct mild hyperpigmentation changes, and create smoother skin. |
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Place the following in order for depth of peel, starting with the lightest: Glycolic acid 50 to 70% Jessner solution Phenol-croton oil Salicylic acid 20 to 30% Trichloroacetic acid 35 to 50% |
Salicylic acid 20 to 30% depth is less than 100 µm, which is classified as superficial-very light Both glycolic acid 50 to 70% and the Jessner solution penetrate to a depth of 100 µm, which is considered superficial-light. A medium-depth peel extends 200 µm, penetrates through the epidermis and papillary dermis to the upper reticular dermis, and results in increased collagen production. Trichloroacetic acid solution 35 to 50% would penetrate to medium-depth Phenol-croton oil is deep & will penetrate to the reticular dermis |
The result is decreased formation of melanin and increased degradation of melanosomes. |
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Mechanism of action of tretinoin? |
Tretinoin results in a 70% inhibition of AP-1 transcription factor binding to DNA and a significant reduction in protease activity. Long-term use of tretinoin is associated with improved skin texture, decreased sallowness, a reduction in fine rhytides and actinic keratosis, fading of pigmented macules, and an overall improvement in skin appearance. Histologic effects of tretinoin include increased epidermal and granular layer thickness; elimination of dysplasia, atypia, and microscopic actinic keratoses; uniform dispersion of melanin granules; increased collagen and glycosaminoglycan deposition in the papillary dermis; and diminished dermal elastosis, angiogenesis, and compaction/thinning of the stratum corneum. |
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Which medication does the following: impairs sebaceous gland activity, impairs epithelialization, and thins the stratum corneum |
Isotretinoin (13-cis retinoic acid; Accutane) |
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Which medication impairs the conversion of dopamine to melanin? |
Hydroquinone |
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Injection of Botox into the cervicomental junction might cause? |
dysphagia and voice changes 3 days after undergoing injection of 50 units botulinum toxin type A because of platysmal bandin |
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Best injectable to treat thin lips with rhytids? |
Hyaluronic acid injectable products, such as Juvéderm, Restylane, or Perlane, are the best treatment available to improve fullness of the nasolabial fold and lip area. |
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What is one of the problems with Bovine collagen (Zyplast) ? |
Hypersensitivity reactions with soft-tissue fillers are relatively uncommon. Local reactions can occur with any of the fillers, but most reactions likely stem from local irritation associated with the technique of injection or quantity injected versus a true allergic reaction. In the case of Zyplast, approximately 3% of patients will exhibit a hypersensitivity reaction caused by a preexisting allergy to bovine collagen. Thus, for the bovine collagen products (Zyderm I and II; Zyplast), a skin test should be performed prior to use. |
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A patient with facial hyperkinesia comes to the office for treatment with botulinum toxin type A for temporary improvement in the appearance of moderate to severe glabellar facial lines. How many units of botulinum toxin type A should be administered to this patient, according to the Food and Drug Administration? |
20 units |
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Which medication is used to treat levator ptosis caused by Botox injection? Mechanism of action? |
Apraclonidine is an alpha-adrenergic agonist and as such stimulates the Müller muscle to contract. This contraction may elevate the eyelid 1 to 3 mm and lessen the amount of ptosis to varying degrees in order to make the overall appearance of the eyelids more tolerable to the patient until the effects of botulinum toxin type A wear off on their own and levator function naturally returns. The most common dose of apraclonidine is 1 to 2 drops three times daily until ptosis resolves |
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A 45-year-old woman comes to the office because of deep rhytides caused by photoaging. Topical application of 35% trichloroacetic acid in combination with Jessner solution is planned. Which of the following best describes the clinical endpoint during application of this chemical peel? A) Dark firm eschar B) Grey hue C) Hypopigmentation D) Transparent frost with a pink background E) Uniform deep white frost
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The correct response is Option E. Uniform deep white frost |
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An otherwise healthy 54-year-old woman with Fitzpatrick Type II skin undergoes full-face carbon dioxide laser resurfacing. She received acyclovir for 3 days before the procedure. She is treated with a closed dressing regimen. On postoperative day 2, the patient has onset of facial pain and pruritus. Physical examination shows marked diffuse erythema and edema. Which of the following is the most likely diagnosis? A) Allergic reaction B) Bacterial infection C) Fungal infection D) Herpes simplex virus E) Normal healing
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The correct response is Option E. |
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3 FDA approved treatment areas for Botox cosmetic? How many units per site? |
Dosing Glabellar lines: Inject 4 units (0.1 mL) into each of 5 sites, 2 in each corrugator muscle and 1 in procerus muscle for a total dose of 20 units Canthal lines: Inject 4 units (0.1 mL) into 3 sites per side (6 total injection points) in the lateral orbicularis oculi muscle for a total of 24 units/0.6 mL (12 units per side) Forehead lines: Inject 4 units (0.1 mL) into each of 5 forehead line sites (20 units); treat in conjunction with glabellar lines with 0.1 mL (4 units) into each of 5 glabellar line sites (20 units), for a recommended total of 40 units |
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In a patient who presents with dysphagia or vocal changes after treatment of platysmal banding with neuromodulator, an orally active agent like ______ may be useful to counteract some of the effects until the agent wears off. |
In a patient who presents with dysphagia or vocal changes after treatment of platysmal banding with neuromodulator, a reversible orally active anticholinesterase agent like pyridostigmine may be useful to counteract some of the effects until the agent wears off. |
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Which injectable is contraindicated in patients allergic to milk? |
Dysport is contraindicated for individuals who have an allergy to cow’s milk protein. /p> |
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Which blood pressure medication and antibiotic classes are known to potentiate Botox cosmetic? |
The following medications are known to potentiate the effects of BOTOX Cosmetic: penicillamine, quinine, calcium-channel blockers, and aminoglycosides |
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Accidental injection of hyaluronic acid filler into which area is most likely to cause blindness by retrograde occlusion of the central retinal artery? |
Dorsum of the nose: dorsal nasal artery is a distal continuation of the ophthalmic artery from the internal carotid artery |
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A 67-year-old woman with Fitzpatrick Type I skin comes to the office because of deep rhytides and signs of photoaging. Which of the following chemical peels will penetrate to the reticular dermis? A) Alpha-hydroxy acid B) Beta-hydroxy acid C) Jessner solution D) Phenol-croton oil E) 20% Trichloroacetic acid |
Croton oil is mixed with phenol to create a deeper peel. These are part of the ingredients in the Baker-Gordon and Hetter solutions. Hetter’s studies demonstrated that it was the croton oil that controlled the depth of the peel. |
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Which peel will penetrate to the upper reticular dermis? A) Glycolic acid 50 to 70% B) Jessner solution C) Salicylic acid 20 to 30% D) Tretinoin E) Trichloroacetic acid 35 to 50% |
E) Trichloroacetic acid 35 to 50% Salicylic acid 20 to 30% would cause injury to the stratum corneum and possibly the stratum granulosum with exfoliation. The depth is less than 100 µm, which is classified as superficial-very light. Both glycolic acid 50 to 70% and the Jessner solution penetrate to a depth of 100 µm, which is considered superficial-light. These agents cause necrosis of the entire epidermis down to the basal layer and stimulate regeneration of new epithelium. A medium-depth peel extends 200 µm, penetrates through the epidermis and papillary dermis to the upper reticular dermis, and results in increased collagen production. Trichloroacetic acid solution 35 to 50% would penetrate to medium-depth. A deep peel penetrates to deeper than 400 µm and causes necrosis to part or all of the mid reticular dermis.
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Use of Botox: good evidence for use in which upper limb problem? Neck? Face other than cosmetic? |
Botulinum toxin type A has good evidence demonstrating efficacy for the treatment of blepharospasms, hemifacial dyskinesia, cervical dystonia, post-stroke upper limb spasticity (not from paroxysmal dyskinesia—see below). |
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Which chemical peel does sodium bicarbonate neutralize? |
Glycolic acid |
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Which chemical peel does sodium bicarbonate neutralize? |
Glycolic acid |
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What can be used to neutralize TCA peel? |
TCA penetrates deep to the dermal-epidermal junction and is counteracted by dilution with saline |
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Which muscle contributes to horizontal glabellar rhytides? What about vertical glabellar rhytides? |
The procerus stretches from the nasal bones to the dermis of the glabella, and contraction promotes horizontal rhytides in the glabellar region. The corrugator supercilii is more likely to promote vertical rhytides in the glabella |
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