Mosmuller, D.G.M. (David G. M.)

Nipshagen, M.D. (Martine D.)

Velthuis, P.J. (Peter)

English

Erasmus University Digital Repository

T H E R A P E U T I C HO T L I N E : L E T T E RPeriorbital postinflammatory hyperpigmentation afterplasma exeresisDear EditorPostinflammatory hyperpigmentation (PIH) developing after cos-metic procedures, such as chemical peeling and laser therapies arealways a concern, has not been reported with plasma exeresis(PlexR).Plasma exeresis is considered to be a safe method suitable for allskin types, because of the minimal dermal damage according to themanufacturer and as shown in research.1-3 It is an effective non-surgical treatment as an alternative for surgical upper and lowerblepharoplasty. Plasma is formed by this device through the ioniza-tion of atmospheric gas. The amount of plasma generated dependson which of the three Plexr devices is used. The white device has0.7-W power and creates points on the skin with a diameter of0.5 mm, the green device has 1-W power and creates 1 mm points,and the red device is the strongest with 2-W power and 2 mmpoints, respectively. This series of minuscule dots on the skin causesan instant tightening and contraction of the skin fibers subsequentlyleading to remodeling, lifting, and rejuvenating effects. After thetreatment, a crust on the treated part will form that falls off in abouta week, leaving no bruising or scarring.Over the last 4 years (March 2016 through February 2020), wehave performed 164 nonsurgical upper and lower blepharoplastiesusing plasma exeresis in 106 patients in our clinic. Sixty-fourpatients had a single treatment, 31 patients had 2 treatments,6 patients had 3 treatments, 1 patient had 4 treatments, and4 patients had 5 treatments. The average time between the treat-ments was 6 months. Recently, we have had two patients, a37-year-old woman with Fitzpatrick skin type II (patient 1) and a61-year-old woman with Fitzpatrick skin type IV (patient 2), whoexperienced periorbital/periocular PIH after their first plasmaexeresis treatment using the red device. In both cases, the brown-colored pigmentation occurred bilaterally after aesthetic plasmaexeresis treatment involving the lower periorbital region. Itappeared after the natural release of the crust in patient 1 after6 days and patient 2, respectively, after 9 days. Both patients hadno history of allergy as in atopic or allergic contact dermatitis, norhad other dermatological conditions (eg, lichen planus pigmentosus)and did not use any drugs. They applied daily SPF 50 and had noexcessive exposure to the sun, nor used a tanning bed.We have prescribed both patients hydroquinone 5% (HQ) in com-bination with tretinoin 0.05% for bleaching of their hyperpigmentedskin after which a mild-to-moderate improvement was reached inboth patients. After 4 months, patient 1 was successfully treated witha superficial herbal peel (Green Peel by Dr. Schrammek) and the pig-mentation did not re-occur (Figure 1).F IGURE 1 A, 1 day after treatment. B, 6 weeks aftertreatment. C, 4 months after treatmentReceived: 4 March 2020 Accepted: 6 April 2020DOI: 10.1111/dth.13404This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in anymedium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.© 2020 The Authors. Dermatologic Therapy published by Wiley Periodicals LLC.Dermatologic Therapy. 2020;e13404. wileyonlinelibrary.com/journal/dth 1 of 2https://doi.org/10.1111/dth.13404Patient 2 was treated after 2 months with also the same superfi-cial herbal peel with only minor improvement. Two weeks later, a gly-colic acid peeling (Neostrata, 20% glycolic acid) was performed withlittle further improvement. After this, patients 2 was treated fourtimes with thermomechanical ablation (Tixel on mode 10/500) whichresulted in the result as shown in Figure 2C after 9 months. Tixel is anonlaser fractional treatment technology that transfers thermalenergy to the skin through a matrix of tiny pyramid-shaped pins madeof biocompatible materials covering a treatment area of 1 cm2.PIH can occur as a side effect of a plasma exeresis treatment inany skin type. Our advice to practitioners is to have their patientsapply topical hydroquinone 5% cream each day for 4 weeks prior toplasma exeresis treatment to prevent PIH. Since we have adopted thisnew protocol, no new cases of PIH after plasma exeresis treatmenthave occurred.CONFLICT OF INTERESTAll authors have no conflict of interest.Martine D. Nipshagen1Peter J. Velthuis2David G. M. Mosmuller1,31Doctors At Soap, Private Cosmetic Clinic, Amsterdam, The Netherlands2Erasmus Medical Center, Department of Dermatology, Rotterdam,The Netherlands3Department of Plastic, Reconstructive and Hand surgery, UniversityMedical Center Amsterdam, Amsterdam, The NetherlandsCorrespondenceDavid G. M. Mosmuller, Department of Plastic, Reconstructive andHand surgery, De Boelelaan 1117, 1081 HV Amsterdam,The Netherlands.Email: davidmosmuller@gmail.comORCIDPeter J. Velthuis https://orcid.org/0000-0002-9449-0068David G. M. Mosmuller https://orcid.org/0000-0002-9764-0930REFERENCES1. Sotiris T, Nikolaos G, Irini G. New treatment with plasma Exeresis fornon-surgical blepharoplasty. EC Opthalmology. 2017;5(4):156-159.2. Rossi E, Farnetani F, Trakatelli M, Ciardo S, Pellacani G. Clinical andconfocal microscopy study of plasma Exeresis for nonsurgical blepha-roplasty of the upper eyelid: a pilot study. Dermatol Surg. 2018;44(2):283-290.3. Tsioumas GS, Georgiadis N, Georgiadou I. The gas ionization by plasmatechnology for noninvasive techniques in oculoplastic. JOJ Ophthal.2017;2(2):555-584.F IGURE 2 A, Directly after treatment. B, 1 month aftertreatment. C, 9 months after treatment2 of 2 THERAPEUTIC HOTLINE: LETTER

Periorbital postinflammatory hyperpigmentation after plasma exeresis

https://repub.eur.nl/pub/126627/Repub_126627_O-A.pdf

Periorbital postinflammatory hyperpigmentation after plasma exeresis

Abstract

Similar works

Full text

Available Versions

Erasmus University Digital Repository