Rhinophyma is a rare clinical condition that is characterized by the proliferation of sebaceous glands and underlying connective tissue of the nose. There is no standard method for the treatment of this benign condition as several techniques have been proven effective. The patient is a 79-year-old male that presents with a large rhinophyma and left-sided alar mass. He was treated operatively with the use of electrocautery dermabrasion and sharp excision. Pre-operative, intra-operative, and post-operative images were obtained and depict a desirable cosmetic outcome. Although they are among many effective therapies for the management of rhinophyma, electrocautery dermabrasion and sharp excision remain viable and successful options for the treatment of this condition.

Thesis (Ph.D.)--Bioengineering program, Georgia Institute of Technology, 2008. / Committee Chair: Dr. Mark R. Prausnitz; Committee Co-Chair: Dr. Mark Feinberg; Committee Member: Dr. Mark Allen; Committee Member: Dr. Niren Murthy; Committee Member: Dr. Peter Hesketh; Committee Member: Dr. Robert Swerlick

Atualmente existem vários tratamentos para melhorar a aparência da pele com fotoenvelhecimento. A quimioabrasão é uma dessas técnicas, consiste na associação de esfoliação química com ácido tricloroacético a 35%, seguida por dermabrasão. O ácido tricloroacético facilita a dermabrasão por promover coagulação das proteínas da pele, tornando-a mais friável. Além disto, produz um branqueamento na pele que está relacionado ao seu grau de penetração, auxiliando a uniformização da profundidade atingida com a dermabrasão. A técnica de dermabrasão utilizada neste estudo, foi manual com lixas d?água, por ser indicada para tratamento de regiões da face, como a perioral, pois não evidencia os limites entre as regiões tratadas ou não. Trata-se de um lixamento graduável, sendo mais profundo sobre as rítides e mais superficial na periferia da região tratada. Foram estudadas 12 pacientes submetidas à quimioabrasão para o tratamento de rítides periorais. Após 30 dias, observou-se atenuação das rugas e melhora da textura da pele, em todas as pacientes. Após um ano, os resultados se mantiveram ou ficaram clinicamente melhores. Foi realizado um estudo comparativo da quantificação das células de Langerhans e expressões da molécula de adesão intercelular-1, do antígeno da classe II do complexo principal de histocompatibilidade (HLA-DR), dos linfócitos CD4+ e CD8+ na pele, antes e 30 dias após a realização da quimioabrasão. Todas as pacientes apresentaram redução da quantidade das células de Langerhans, após 30 dias (p=0,002). Não se observou diferença estatisticamente significante para os outros elementos celulares estudados. A diminuição da quantidade das células de Langerhans justificaria o desenvolvimento de infecção por herpes simples, em três pacientes, mesmo sem apresentarem antecedente pessoal para a doença. Este trabalho mostra que as células de Langerhans, mesmo com a reepitelização completa da pele, mantêm-se em menor número, 30 dias após a realização de quimioabrasão. / At the latest years, the interest in improving the appearance of the photoaged skin has increased considerably. Chemabrasion is an effective procedure that alleviates many facial cutaneous disorders like photodamage and wrinkled skin. This is a combined procedure of 35% trichoroacetic acid chemical peel associated with manual dermabrasion with drywall sanding screen. The trichoroacetic acid coagulates skin proteins and promotes a more uniform depth of the dermabrasion. The technique of manual dermasanding takes little skill factor, causes no splatter, provides uniformly pleasant results, and leaves no sharp lines of demarcation. It is indicated for the treatment of subunits of the face. Twelve patients with actinic damage of the perioral skin have undergone chemabrasion. Improvement in rhytides and skin texture were observed in all patients after 30 days and one year. This study also evaluated the expression of CD1-a positive Langerhans cells, ICAM-1, HLA-DR and CD4+ and CD8+ cells, before and one month after the surgery. Significant difference in the expression of anti-CD1a was detected between the two comparison groups, before and after chemabrasion. After 30 days, the Langerhans cells were reduced in all patients (p=0,002). The results of the expression of HLA-DR, ICAM-1, CD4+ and CD8+ cells before and after the surgery had no statistically different significance. After chemabrasion, three patients had herpes virus infection. The resurfacing techniques can cause immunological impairment, which justifies the high incidence of bacterial and virus infections in the skin, after these treatments.

The major hurdle in the development of transdermal route as a versatile drug delivery method is the formidable transport barrier provided by the stratum corneum. Despite decades of research to overcome the stratum corneum barrier, limited success has been achieved. The objectives of this research were to develop and characterize two different strategies to overcome the stratum corneum barrier for transdermal delivery of biopharmaceuticals and vaccines. In the first strategy, coated microneedles (sharp-tipped, micron-sized structures) were developed to enable delivery of drugs directly into the skin by bypassing the stratum corneum barrier. In the second strategy, instead of bypassing the barrier, microdermabrasion was used to selectively abrade stratum corneum with sharp microparticles for topical drug application. Coated microneedles For developing painless microneedles, the first detailed study was performed to characterize the effect of microneedle geometry on pain caused by microneedle insertions in human volunteers. This study demonstrated that microneedles are significantly less painful than a 26-gage hypodermic needle and that decreasing microneedle length and numbers reduces pain. Next, the first in-depth study of microneedle coating methods and formulations was performed to (i) develop a novel micron-scale dip-coating process, (ii) test the breadth of compounds that can be coated onto microneedles, and (iii) develop a rational basis to design novel coating formulations based on the physics of dip-coating. Finally, a plasmid DNA-vaccine was coated onto microneedles to immunize mice, to provide the first evidence that microneedle-based skin immunization can generate a robust in vivo antigen-specific cytotoxic-T-lymphocyte response using similar, or lower, DNA doses on microneedles as when using the gene gun or intramuscular injection. Microdermabrasion We demonstrated for the first time that microdermabrasion in monkeys and humans can selectively, yet completely remove the stratum corneum layer. Using a mobile mode of microdermabrasion, an increase in the number of treatment passes led to greater tissue removal. Furthermore, topical application of Modified Vaccinia Ankara virus after microdermabrasion induced virus-specific antibodies in monkeys. In conclusion, both coated microneedles and microdermabrasion were developed to enable delivery of biomolecules into the skin, indicating their potential for transdermal delivery of a wide range of biopharmaceuticals and vaccines.

Atualmente existem vários tratamentos para melhorar a aparência da pele com fotoenvelhecimento. A quimioabrasão é uma dessas técnicas, consiste na associação de esfoliação química com ácido tricloroacético a 35%, seguida por dermabrasão. O ácido tricloroacético facilita a dermabrasão por promover coagulação das proteínas da pele, tornando-a mais friável. Além disto, produz um branqueamento na pele que está relacionado ao seu grau de penetração, auxiliando a uniformização da profundidade atingida com a dermabrasão. A técnica de dermabrasão utilizada neste estudo, foi manual com lixas d?água, por ser indicada para tratamento de regiões da face, como a perioral, pois não evidencia os limites entre as regiões tratadas ou não. Trata-se de um lixamento graduável, sendo mais profundo sobre as rítides e mais superficial na periferia da região tratada. Foram estudadas 12 pacientes submetidas à quimioabrasão para o tratamento de rítides periorais. Após 30 dias, observou-se atenuação das rugas e melhora da textura da pele, em todas as pacientes. Após um ano, os resultados se mantiveram ou ficaram clinicamente melhores. Foi realizado um estudo comparativo da quantificação das células de Langerhans e expressões da molécula de adesão intercelular-1, do antígeno da classe II do complexo principal de histocompatibilidade (HLA-DR), dos linfócitos CD4+ e CD8+ na pele, antes e 30 dias após a realização da quimioabrasão. Todas as pacientes apresentaram redução da quantidade das células de Langerhans, após 30 dias (p=0,002). Não se observou diferença estatisticamente significante para os outros elementos celulares estudados. A diminuição da quantidade das células de Langerhans justificaria o desenvolvimento de infecção por herpes simples, em três pacientes, mesmo sem apresentarem antecedente pessoal para a doença. Este trabalho mostra que as células de Langerhans, mesmo com a reepitelização completa da pele, mantêm-se em menor número, 30 dias após a realização de quimioabrasão. / At the latest years, the interest in improving the appearance of the photoaged skin has increased considerably. Chemabrasion is an effective procedure that alleviates many facial cutaneous disorders like photodamage and wrinkled skin. This is a combined procedure of 35% trichoroacetic acid chemical peel associated with manual dermabrasion with drywall sanding screen. The trichoroacetic acid coagulates skin proteins and promotes a more uniform depth of the dermabrasion. The technique of manual dermasanding takes little skill factor, causes no splatter, provides uniformly pleasant results, and leaves no sharp lines of demarcation. It is indicated for the treatment of subunits of the face. Twelve patients with actinic damage of the perioral skin have undergone chemabrasion. Improvement in rhytides and skin texture were observed in all patients after 30 days and one year. This study also evaluated the expression of CD1-a positive Langerhans cells, ICAM-1, HLA-DR and CD4+ and CD8+ cells, before and one month after the surgery. Significant difference in the expression of anti-CD1a was detected between the two comparison groups, before and after chemabrasion. After 30 days, the Langerhans cells were reduced in all patients (p=0,002). The results of the expression of HLA-DR, ICAM-1, CD4+ and CD8+ cells before and after the surgery had no statistically different significance. After chemabrasion, three patients had herpes virus infection. The resurfacing techniques can cause immunological impairment, which justifies the high incidence of bacterial and virus infections in the skin, after these treatments.