Answers to Questions on MDA Treatment and Skin Diseases

In Summary, what is the statistical incidence of complications reported in the survey?

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The survey reported that 111 dermatologic surgeons recorded cases of patients exposed to third-degree burns, permanent nerve damage and scaring. Ninety-five surgeons recorded cases of complication in the treatment and diagnosis of rosacea and delayed treatment. Another ninety ASDS members reported to have witnessed cases of chemical peeling procedures to have been performed by inexperienced physicians. 78 surgeons treated complications after microdermabrasion techniques. 44 dermatologic surgeons reported to have witnessed cases of non-ablative skin rejuvenation while another 68 members reported to have witnessed various treatments such as sclerotherapy, botulinum, inappropriate skin cancer, and fungal disorders.

Why do you think there was high incidence of complications experienced by rosacea patients and discuss why the non-physician should not attempt to diagnose skin diseases?

Most people confuse between beauty and medicine. The survey recorded high rate of rosacea diagnosis because many non-physician operators cannot distinguish between beauty and medicine. This confusion makes them think that they can diagnose rosacea because it is a skin disease. Most of the people who perform cosmetic surgery believe that they can as well perform any skin related complication. As mentioned in the case study, most of the NPOs confuse the two fields of study for either of the other; one thinks that if he/she can perform a cosmetic surgery then he/she also has the necessary qualifications to perform medical surgery especially on skin related complications (P. 323).

From the patient complications outlined in table 1, how do you think the NPO contributed to these complications?

NPO contributed to these complications in various ways; for example, some of the NPO are still in training process but they use the little skills they have learned to operate on patients. For instance, an exemplary situation given in the case study 1 about nurse who was still taking classes and decided to treat a patient with blisters and hypertrophic scars can explain the NPO who use the skills they have learned to operate on patients. Again, other NPO confuse between medicine and other fields such as cosmetic. The think that they can apply the same concepts learned in cosmetic in medicine.

How do you think these NPOs could have more effectively responded to their complications?

Every profession has its code of conduct in which its members are bound to practice. Therefore, when someone goes against these codes of conducts, he/she is considered to have violated the ethical principles of the profession. The NPOs could have responded to their complications in various ways; for instance, seek professional help from the physicians who have trained on the field. A cosmetic surgeon will be violating the code of conduct of both cosmetic surgery and also medicine when he/she moves from cosmetic surgeon to becoming a medical surgeon. This might expose the patient to a greater health and safety risks which violates both cosmetic and medicine code of conducts of practice.

How is cosmetic/aesthetic medicine portrayed by the media in this article?

Cosmetic/aesthetic medicine has been portrayed with ambiguity as most of the cosmetic medicine confuses the consumers on the cosmetic nature of the products. As stated in the case study, the marketing strategies that the cosmetic companies use to market their services confuse the consumers in the marketplace. As a result, they promise consumers with the offer of high medial technology at low prices (P. 323). Since most of the consumers are driven by the prices of products and services, they find themselves in these institutions.

How can the NPO establish more credibility within the cosmetic medical profession?

NPOs are not bound not to practice cosmetic medical profession especially those who have gone through the training session and successfully completed their courses. However, to reduce tragic cases of patients getting misdiagnosed or delayed treatments as illustrated in the case study material, NPO need to collaborate with the professional physicians and legislators who supervise any form of medical practice. Therefore, collaborating with the physicians will give them the chance to consult where they do not know or refer the patient to a trained physician where it is beyond their capacity.

Please discuss the experiences of the NPO.

Cases of NPO have recently increased. I recently witnessed a case when I went for medical check-up in a nearest healthcare institution where a patient was suffering from infection but she thought that it was allergy. Therefore, she went to a nearest medicine store house and the store keeper diagnosed her with allergy and provided her with some medicine to help her eliminate the scars. She went home and taken the medications as prescribed by the NPO at the store but she condition only got worse. So she came to the hospital after she had already consumed the wrong medication for the wrong purpose.

Case Study 2

Using a table clarify the difference between grades I-IV Acne, including characteristics and all suitable treatments

Acne Grade Characteristics Treatments

Grade I Existence of blackheads on the nose and few papules (Amer et al, (1982). Again, manifestation of read breakouts mostly on the cheeks Administration of the European Deep Cleanse Facial therapy which removes the bacteria.

Grade II Manifested through blackheads, whiteheads, inflammation, redness, papules and pustules on the cheeks, nose and chin (Amer et al., 1982). Administration of skin care therapy such as correcting facials one per week for eight weeks. This will bring the skin oil level back to normal level.

Grade III This is almost the same to grade II; however, it only has swelling and increased number of pustules and papules found on the neck and face. Administration of both aesthetician therapy and medical therapy. Medical therapists will prevent the frequent breakouts through medication while aesthetician therapist will engage in de-sensitizing and correcting the facials through aesthetic extractions

Grade IV Manifested through increased number of pustules and swelling (Amer et al., 1982). Although very rare but very severe than the other three grades. Administration of dermatologic medical therapy.

Table 1.0: Difference between Acne Grade I-IV

What do you think the main confounding variable is within this and how do you think it may affect the studys result?

The main confounding variable for this study include exposure to isotretinoin therapy. Exposure to isotretinoin therapy can influence the results of the study. Subjects exposed to this therapy are most likely to recorded excellent results because of the effects of isotretinoin. Subjects may record high power average which could not have been the case in a normal situation.

What was the protocol used for each MDA treatments?

The patients were administered to oral antibiotic as a tropical therapy. 95% of the subjects used in the study were given tropical retinoid. The treatments were adjusted to obtain different variations and results. However, patients who had been exposed to other therapy sessions such as isotretinoid were excluded from the study. The care providers administered the eight microdermabrasion treatments on both patients with acne grade II and III.

What results were achieved after the MDA sessions?

After the MDA sessions, the results obtained were different for different categories of subjects; for example, out of the 24 patients who participated in the study, 9 patients achieved excellent results, 8 patients achieved good results, 4 patients achieved fair results and 3 patients achieved poor results. One patient was excluded for having involved in isotretinoid therapy which was in violation of the study protocols.

What was the average negative pressure used? Please then convert this to Kilopascals (kPa) using you MDA units of measurement handout?

The treatment power average began at 26.67cmHg; however, after an increase of treatment continued, the treatment power also increased. The final treatment power used was 41.11cmHg.

Conversion: 1cmHg = 1.3332287kPa

Therefore, 26.67 X 1.3332287 = 35.55720943kPa

How would you advise a patient of the efficacy of MDA treatments for acne based on this study?

Acne problem is treatable and a patient should not fear going for medical care. Base on this study, I would advise a patient with acne that there are various MDA treatments that can be administered such as glycolic, salicylic and the most recently discovered microdermabrasion treatment. Therefore, acne victims should stay with the problem because it can affect their future health life if not properly controlled at the early stages.

Case Study 3

What protocol did they use for each MDA treatment?

All the MDA treatments followed a specific protocol including cleaning and degreasing the skin. After the cleaning, the treatment follows by five to seven passes of hand piece of MDA to a vacuum with a pressure of 50cmHg. The patients are then taken through a series consisting of six stages of microdermabrasion treatment between 7 to 10 days.

How did the authors measure statistical differences in the biopsy results and discuss the importance of achieving statistically significant results?

The authors measured each of the biopsy specimens by cutting the specimen in a 4mm and fixed them in 10% buffered solution of formaldehyde. One author reviewed each of the microscopic slides. Each of the slides was then examined using a micrometer at 10X magnification and the results plotted against time. The authors used a pair of t-test to identify the statistical differences in the thickness between treatment periods (P. 1032). Achieving statistically significant results is important to the researcher. To the researcher, it helps to prove the hypothesis of the research that helps to reject the null hypotheses (Simmons & Nelson, 2011). The researcher can only reject the null hypotheses when the p-value of study is less than the predetermined significance level.

This text discusses the results/changes between the control and treatment areas. Produce a table that demonstrates these differences in detail.

Treatment Area Thickness before treatment Thickness after treatment

After three microdermabrasion for the epidermal treatments 45 +/-4mm 62 +/-10mm

After six microdermabrasion for the epidermal treatments 62 +/- 10mm 65 +/- 7mm

After three microdermabrasion treatments for papillary dermal 81 +/- 8mm 108 +/- 11mm

After six microdermabrasion treatment for papillary dermal 108 +/- 11mm 114 +/-9mm

Table 2.0: Control Treatment differences

What is the role of dermal inflammation in the clinical changes seen with MDA treatments?

The dermal inflammatory responses proved to be significant in the MDA treatments. The dermal inflammation produced the treatment effects that facilitated the microdermabrasion treatment. By increasing the blood flow in the dermis, the dermal inflammatory process enhanced the treatment by thickening the papillary and epidermal sizes.

Case study 4

Explain the physiological (cellular) effect of superficial peeling?

Superficial peeling has been found to be useful in the treatment of skin complications such as acne. The treatment is brought about by the effects of superficial peeling which include skin rejuvenation. Rejuvenation is the process whereby the cosmetic medications are administered to the victim to eliminate the wrinkling on the face. Superficial peeling also causes skin freshening especially with the effects of the application of retinoic acid on the face.

List the disadvantages of deeper chemical peeling and discuss why non-physicians should onl...