ARTICLE | RADIOFREQUENCY | Radiofrequency surgery for
the treatment of PPP is a convenient and moderately easy to perform method of treatment.
tissue and unaffected surrounding tissue, therefore
unwanted papules can be ablated without much sacrifice to the surrounding normal tissue.
Materials and methods Before undertaking radiofrequency surgery, a correct diagnosis of PPP is made based on patient medical history and a physical examination. The patient medical history is reviewed to make sure that he has no contraindications to the procedure, such as a history of keloids and hypertrophic scars, uncontrolled diabetes, or a history of poor healing. His medical history is also reviewed to make sure he has not used Accutane (isotretinoin) for the 6 months prior to treatment. Isotretinoin is used to treat recalcitrant cystic acne, and is well known for impairing the skin healing mechanism, contributing to exaggerated scar formation for up to 6 months after its use.
Prior to surgery, lidocaine (LipoThene) 20% ointment
is applied to the treatment area under an occlusive dressing 40 minutes before treatment. After application, the treatment area is cleaned and prepped with a povidoneÐ iodine solution, and a surgical field is draped accordingly. The author uses a Dento-Surg 90 F.F.P. radiofrequency surgical instrument (Ellman
International, Inc.). The
instrumentÕs power control dial is set at 7, and diamond and loop-shaped electrodes are used depending on the location, density and size of the papules. All lesions are removed using a very gentle gliding,
Figure 2 The patient immediately following treatment with a radiofrequency surgical device
swiping or scraping action with a pinpoint motion. A binocular headband magnifier can be used for better visualisation of the surgical field. This procedure is operator-dependent and requires advanced skills in order to avoid the removal of tissue beyond the papules. During the procedures, patients have reported no sensation of pain and are able to observe treatment in comfort. The author has experienced no blood loss in patients while using this technique. Following the procedure, petrolatum ointment and a
loose sterile dressing is applied to the treatment area. The patient is instructed on how to care for the affected area, including correct sterilisation and dressing application. Restriction in sexual activity is advised for approximately 10 days, or until healing is complete. Figures 1–3 illustrate the effectiveness of the
radiofrequency surgical technique on a patient who underwent just one treatment. The patient was a 37-year-old male, with Fitzpatrick skin type IV and without a significant past medical history, who presented with PPP as diagnosed by another physician (Figure 1). In the authorÕs experience, there are no restrictions to the skin types that can be treated using this methodology. The patient reported an approximate 20-year history
48 ❚
of papules that developed on his penis during his late teenage years. The patient reported that his lesions did not cause any itching, pain or progressive growth since their first emergence, but he did complain of significant psychological discomfort owing to the cosmetic
July/August 2012 |
prime-journal.com
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