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Surgical MCQs > Acne scar revision > Flashcards

Acne scar revision Flashcards

1
Q

Ice pick scars are less than 2mm in diameter

A

T

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2
Q

Boxcar scars extend 1mm into dermis

A

F

0.1–0.5 mm

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3
Q

The 3 methods for treating acne scars are to
Alter the colour
Induce or reduce collagen
Fill the scar

A

T

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4
Q

Rolling scars may be >5mm in diameter

A

T

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5
Q

Icepick scars do not extend into subcutaneous layer

A

F

can do

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6
Q

Post inflammatory hyperpigmentation (PIH) can respond to bleaching agents, light chemical peels, pigment lasers, light sources and fractionated lasers

A

T

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7
Q

Hyperpigmentation is more difficult to treat than hypopigmentation

A

F

Hypopigmentation is most difficult

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8
Q

Erythematous scars may improve with time

A

T

also skincare and vascular laser or IPL

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9
Q

altering the colour is the most common approach to acne scar teratment

A

F

altering the collagen is

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10
Q

medium and deep chemical peels stimulate collagen while superficial peels reduce pigmentation

A

T

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11
Q

There are 3 grades of acne scarring severity

A

F

4 grades

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12
Q

If scars dissappear with stretching the skin is an important discriminator in assessinfg acne scar severity

A

T
important for atrophic scars especially
If they dissappear its grade 3 if not is grade 4

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13
Q

Discolouration with no textural change is characteristic of Grade 2 acne scarring

A

F
Grade 1 =
Erythematous, hyper- or hypopigmented flat marks visible to patient or observer at any distance

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14
Q

Grade 4 acne scarring includes atrophy or hypertrophy that is obvious at social distances of ≥50 cm and is not covered easily by make-up, the normal shadow of shaved beard hair in males or body hair, if extra-facial, but flattens by manual stretching of the skin

A

F
this is Grade 3
Grade 4 is the same but Manual skin stretching cannot flatten it

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15
Q

Grade 1 acne scarring is Mild atrophy or hypertrophy that may not be obvious at social distances of ≥50 cm and may be adequately camouflaged with make-up, the normal shadow of a shaved beard in males or normal body hair if extra-facial

A

F

this is grade 2

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16
Q

Hypeprigmented scars mainly seen in dark skin types

A

T

Must advise sun block

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17
Q

Needling devices can penetrate up to 3mm

A

T

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18
Q

shallow depth needle treatments can do at home without anaesthetic

A

T

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19
Q

25g needles are used for acne scar needling treatments

A

F

30g

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20
Q

Dermapen is a vibrating, stamping needle device

A

T

vibrations make it much less painful

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21
Q

Prophylaxis for herpes simplex is not required for needling procedures

A

F

Prophylactic antivirals should be used for pts w/ Hx of herpes simplex (Acyclovir 400mg TDS for 5 days)

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22
Q

Needling sessions can be repeated 2 weeks apart

A

T

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23
Q

Chemica peels are 2nd line to laser techniques

A

T

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24
Q

TCA CROSS stands for TCA Chemical Reconstruction Of Skin Scars

A

T
Use 60-100% TCA +/- other techniques (subcision etc) to raise depressed scars
Then often followed by CO2 or Er:YAG laser resurfacing

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25
Q

1927nm non-ablative fractional thalium laser resurfacing can help hypopigmentation

A

T

or the 1550nm Fractionated non-ablative diode-pumped erbium laser (fraxel SR)

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26
Q

bleaching agents cannot help hypopigmentation

A

F

use on the normal skin to reduce the contrast

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27
Q

Pigment transfer procedures include minigrafting and epidermal suspensions

A

T

28
Q

1550nm Fractionated non-ablative diode-pumped erbium laser (fraxel SR) can be used for macular erythematou scars (grade 1 scarring)

A

T

29
Q

moderate (grade 3) rolling scars should be treated with non-ablative resurfacing, microdermabrasion or needling or Dermal or superficial dermal fillers

A 
F
this for grade 2 mild rolling scars
For grade 3/4 rolling scars use;
ablative or non-ablative resurfacing
Medical skin rolling
Plasma skin resurfacing
Dermabrasion
Chemical peel
Focal dermal filler if localized
If extensive- volumetric deeply placed HA, hydoxyapatite or stimulatory agents
Subcision
BoTox
30
Q

Fine wire diathermy can be used to treat small papular scars of grade 2 acne

A

T

also intralesional 5FU

31
Q

Vascular lasers are mainly used for erythematous scars but may have a positive effect on other atrophic and hypertrophic scar types if they are also present

A

T

32
Q

Options for mild-mod hypertrophy (papular) scars include ILCS and/or 5FU and/or silicon sheeting or vascular laser

A

T

same options for major hypertrophy/keloids

33
Q

Subcision is treatment of choice for Deep box car scars or Ice pick scars

A

F
TCA CROSS
Punch excision
Punch elevation if base skin okay

34
Q

Bridge or tunnel dystrophic scars can be treated with ablative laser

A

F

excision

35
Q

Sagging and redundancy due to scar tissue can be treated with rhytidectomy

A

T

36
Q

BoTox + fillers are useful for grade 4 atrophic or hypertrophic scars esp in lower face

A

T

37
Q

Non-ablative lasers have a less pronounced healing phase at microscopic level

A

F

more pronounced than ablative lasers

38
Q

Non-ablative laser thermally denatures the treated skin – pronounced healing phase during which remodelling occurs

A

T
1540nm Er:glass
1550nm diode-pumped erbium laser (fraxel SR)
1927nm thallium

39
Q

Ablative lasers have higher risk of erythema and hyperpigmentation

A

T

40
Q

Non-ablative Non-fractional resurfacing is comonly used for acne scarring

A

F
rarely used now
Modest results
Can be used for mild (grad II) rolling scars

41
Q

Fractional ablative resurfacing good for older pts esp if photodamage and tightening of skin also required – good for all scar types including hypertrophic/keloids

A

T

42
Q

Fractional non-ablative laser good for younger pts or where less downtime is required esp boxcar and rolling scars

A

T

43
Q

Fractional radiofrequency treatment is radiowaves delivered into skin

A

T

44
Q

Fractional radiofrequency treatment can be used for all hypertrophic scars

A

F

For all atrophic scars - ice pick, boxcar and rolling scars

45
Q

Fractional radiofrequency treatment has a similar Rx regime and response to fractional ablative (CO2) laser resurfacing

A

T

causes collagen and elastin formation and remodelling

46
Q

Microdermabrasion is the technique with the highest risk of hyperpigmentation

A

F

dermabrasion is

47
Q

Plasma skin resurfacing is thought to be similar to CO2 fractional resurfacing in efficacy and downtime

A

T

48
Q

Dermal Fillers restore volume, firmness, density, elasticity and shape to tissue

A

T

49
Q

antegrade injection is typically performed when injecting dermal fillers

A

F
retrograde injection for isolated atrophic scars (boxcar or rolling) – insert needle at 90 degrees to skin and inject as you withdraw to lift the scar (can use after subcision)

50
Q

Autologous filler means injecting the patients own fat

A

T
fat recommended for severely atrophic disease
Cheap, readily available, no risk of rejection or allergy

51
Q 
non-autologous fillers include
Purified bovine dermal collagen
Hyaluronic acid (HA) 
Freeze-dried irradiated human cadaveric fascia lata
Polyacrylamide
A

T

Polyacrylamide not recommended as prone to biofilms and late infection

52
Q

Hyaluronic acid (HA) is a long term filler

A

F

53
Q

Hyaluronic acid (HA) causes more sensitization and foreign body reaction than collagen

A

F

Less

54
Q

Keloids on the face should be treated initially with kenacort A40

A

F

start with A10

55
Q

Intralesional 5FU for hypertrophic/Keloid scars is used at 50mg/ml used neat or diluted 80:20 w/ low strength steroid

A

T
Use 1ml per session of 5FU and repeat every 2 weeks
May only need 0.1-0.3mls per scar per Rx

56
Q

Botox is used for ‘movement quiesence’

A

T
to relax puckered scars in areas subject to a lot of movement
esp on forehead, glabella or chin/lower jaw area e.g. marionette lines, chin
these can become more pronounced with age
Temporary improvement
Works well combined with dermal fillers

57
Q

Punch excision is used mainly for ice pick or boxcar type ‘punched out’ scars esp if white base, dystrophic or in bearded area

A

T

58
Q

For punch excision the punch size must be slightly smaller than scar

A

F

size must be slightly larger than scar

59
Q

Punch elevation of depressed scars is contraindicated if if the scar base is poor or the scar is in a bearded area

A

T

60
Q

Punch grafting involves replacing punched out scar with a slightly larger non scarred punch from good skin, usually postauricular

A

T
usually perform laser resurfacing 4-8 wks later
excellent result

61
Q

In Punch elevation/float – scar is punched but not removed and pts serum injected into base to float the scar up to the level of the surrounding skin

A

T

usually perform laser resurfacing 4-8 wks later (or dermabrasion)

62
Q

excision +/- flap repair may be considered for large areas of severely atrophic facial scars

A

T

63
Q

It is not necessary to completely remove all underlying cystic tissue when excising large areas of severely atrophic facial scars

A

F
Be sure to completely remove all underlying cystic tissue which can have wide extensions
Excision can cause cyst reactivation

64
Q

Subcision results in permanent improvement of rolling scars

A

T

Several treatments needed; 1-3 months in between sessions

65
Q

Overpromising results is a pitfall in acne scar treatment

A

T
Tell pts scars are not removable only improvable
Ensure pts are aware the multiple treatments are often needed and final results cannot be seen for many months

66
Q

Post op infection after resurfacing is a preventable and problematic pitfall

A

T
Always think of HSV infection when swelling occurs
Be liberal with antiviral prophylaxis

67
Q

Must do punch excision, graft and elevation just outside the scar or on the edge

A

F

Just outside the scar not inside or on the edge

Surgical MCQs (44 decks)

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