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Cucumber
Cucumis sativus is a member of the Cucurbitaceae family, which also includes pumpkin, zucchini, watermelon, and squash. Found growing wild in the Himalayan region and commonly referred to as cucumber in English, khira in Hindi, and sakusa in Sanskrit, the plant is cultivated throughout India and China, in particular, as well as in Europe and the United States (J. Young. Pharm. 2010;2:365-8).
It is grown as a food crop, with its fruit (the cucumber) found in many cuisines as well as a component in traditional medicine and folk cosmetics (Planta. Med. 2008;74:1785-8). Headache was one traditional indication; the fruit juice was used as a demulcent in antiacne lotions and the seeds were noted for their cooling and diuretic effects (J. Young. Pharm. 2010;2:365-8). In traditional Chinese medicine, the leaves, roots, and stems of the plant have been used to detoxify as well as to treat diarrhea and gonorrhea (Planta. Med. 2008;74:1785-8). Popularly, the application of cucumber slices to ameliorate swelling or dark circles under the eyes has long been accepted throughout the world as an effective treatment.
Antioxidant Activity
In 2002, Villaseñor and coinvestigators assessed the comparative effectiveness of sugar beet roots, cucumber fruits, New Zealand spinach leaves, and turmeric rhizomes against dimethylbenz[a]anthracene-initiated and croton oil–promoted skin tumors in a Swiss Webster albino mouse model using three different protocols. The four species were selected based on prior findings of antioxidant activity and effectiveness in preventing skin tumors induced in laboratory settings. All four displayed antioxidant activity, and all were found to be effective in lowering skin tumor incidence and the number of skin tumors as well as delaying the onset of skin tumor formation, compared with the control, with turmeric exhibiting the greatest potency (Nutr. Cancer. 2002;44:66-70).
Melanin Suppressing Properties
In 2008, Kai and coinvestigators assessed six plant parts of C. sativus to compare their inhibitory effects on melanogenesis. They found that methanol extracts of the leaves and stems suppressed melanin production in cultured B16 mouse melanoma cells. Although they did not alter mushroom tyrosinase activity or crude enzyme lysate activity in these cells, the methanol extracts did reduce tyrosinase expression at the protein level. The researchers suggested that these findings indicate that the depigmenting activity of C. sativus extracts is associated with tyrosinase expression. They also found that lutein, of eight compounds isolated from the leaves, inhibited melanogenesis, significantly lowering tyrosinase expression. The investigators concluded that the leaves, and lutein in particular, of C. sativus effectively suppress tyrosinase expression and warrant consideration as a skin-whitening agent (Planta. Med. 2008;74:1785-8). Tyrosinase-inhibitory activity exhibited by cucumber extracts had also been previously attributed to enzymes found in cucumber skin (J. Agric. Food. Chem. 2003;51:7764-9).
In 2010, Kumar and coinvestigators evaluated the aqueous fruit extract of C. sativus for free radical scavenging and analgesic activities using in vitro and in vivo models. Preliminary phytochemical screening indicated that cucumber contains various classes of compounds known to exert antioxidant as well as analgesic activity, including flavonoids and tannins. The investigators found that the fruit extract showed maximum antioxidant and analgesic effect at 500 mcg/mL and 500 mg/kg, respectively, although the exact constituents of C. sativus fruits responsible for the promising effects were not elucidated by the study (J. Young. Pharm. 2010;2:365-8).
Research on Skin Care Properties
Early in 2011, Akhtar and coinvestigators reported on their efforts to formulate a topical water in oil (without) emulsion of 3% cucumber extracts, and to assess it according to multiple parameters, compared with its base (lacking cucumber ingredients) as a control, in 21 healthy volunteers over 4 weeks. The cucumber formulation demonstrated statistically significant reductions in sebum, as well as a decline in melanin content that was not statistically significant. Transepidermal water loss and erythema were elevated by the test formulation, but these changes were also not statistically significant. While identifying the need for more research, the authors concluded that their findings point to the potential for cucumber extracts to be effective ingredients in skin care agents for medical and cosmetic purposes (African J. Biotechnol. 2011;10:1206-16).
Later in 2011, Nema and coinvestigators subjected the lyophilized juice of C. sativus fruit to 1,1-diphenyl-2-picrylhydrazyl and superoxide radical scavenging assays in reference to butylated hydroxytoluene, and hyaluronoidase and elastase inhibitory assays in reference to oleanolic acid. The cucumber juice, rich in ascorbic acid, was found to exhibit significant free radical scavenging activity as well as potent antihyaluronidase and antielastase activity. The researchers concluded that C. sativus warrants consideration for its potential used as an antiwrinkle ingredient in cosmetic formulations (Arch. Dermatol. Res. 2011;303;247-52).
Cucumber extracts can currently be found in a wide range of over-the-counter skin care creams and eye gels.
Conclusion
Cucumber has captured the popular imagination as an effective, temporary agent for the relief of swollen eyes, or dark circles under the eyes. It has developed an anecdotal reputation as a diuretic that systemically and topically acts against water retention, thus ameliorating burns, dermatitis, and swollen eyes. This folk medicine success or popularity has, perhaps, spurred the inclusion of C. sativa in various skin care products. There is a dearth of research on the dermatologic benefits of the plant, however, as well as its usefulness in skin care products. That said, some emerging evidence regarding its inhibitory effect on melanin production bears watching. Much more research is necessary to determine the appropriate role of cucumber in dermatology.
Dr. Baumann is in private practice in Miami Beach. She did not disclose any conflicts of interest.
Cucumis sativus is a member of the Cucurbitaceae family, which also includes pumpkin, zucchini, watermelon, and squash. Found growing wild in the Himalayan region and commonly referred to as cucumber in English, khira in Hindi, and sakusa in Sanskrit, the plant is cultivated throughout India and China, in particular, as well as in Europe and the United States (J. Young. Pharm. 2010;2:365-8).
It is grown as a food crop, with its fruit (the cucumber) found in many cuisines as well as a component in traditional medicine and folk cosmetics (Planta. Med. 2008;74:1785-8). Headache was one traditional indication; the fruit juice was used as a demulcent in antiacne lotions and the seeds were noted for their cooling and diuretic effects (J. Young. Pharm. 2010;2:365-8). In traditional Chinese medicine, the leaves, roots, and stems of the plant have been used to detoxify as well as to treat diarrhea and gonorrhea (Planta. Med. 2008;74:1785-8). Popularly, the application of cucumber slices to ameliorate swelling or dark circles under the eyes has long been accepted throughout the world as an effective treatment.
Antioxidant Activity
In 2002, Villaseñor and coinvestigators assessed the comparative effectiveness of sugar beet roots, cucumber fruits, New Zealand spinach leaves, and turmeric rhizomes against dimethylbenz[a]anthracene-initiated and croton oil–promoted skin tumors in a Swiss Webster albino mouse model using three different protocols. The four species were selected based on prior findings of antioxidant activity and effectiveness in preventing skin tumors induced in laboratory settings. All four displayed antioxidant activity, and all were found to be effective in lowering skin tumor incidence and the number of skin tumors as well as delaying the onset of skin tumor formation, compared with the control, with turmeric exhibiting the greatest potency (Nutr. Cancer. 2002;44:66-70).
Melanin Suppressing Properties
In 2008, Kai and coinvestigators assessed six plant parts of C. sativus to compare their inhibitory effects on melanogenesis. They found that methanol extracts of the leaves and stems suppressed melanin production in cultured B16 mouse melanoma cells. Although they did not alter mushroom tyrosinase activity or crude enzyme lysate activity in these cells, the methanol extracts did reduce tyrosinase expression at the protein level. The researchers suggested that these findings indicate that the depigmenting activity of C. sativus extracts is associated with tyrosinase expression. They also found that lutein, of eight compounds isolated from the leaves, inhibited melanogenesis, significantly lowering tyrosinase expression. The investigators concluded that the leaves, and lutein in particular, of C. sativus effectively suppress tyrosinase expression and warrant consideration as a skin-whitening agent (Planta. Med. 2008;74:1785-8). Tyrosinase-inhibitory activity exhibited by cucumber extracts had also been previously attributed to enzymes found in cucumber skin (J. Agric. Food. Chem. 2003;51:7764-9).
In 2010, Kumar and coinvestigators evaluated the aqueous fruit extract of C. sativus for free radical scavenging and analgesic activities using in vitro and in vivo models. Preliminary phytochemical screening indicated that cucumber contains various classes of compounds known to exert antioxidant as well as analgesic activity, including flavonoids and tannins. The investigators found that the fruit extract showed maximum antioxidant and analgesic effect at 500 mcg/mL and 500 mg/kg, respectively, although the exact constituents of C. sativus fruits responsible for the promising effects were not elucidated by the study (J. Young. Pharm. 2010;2:365-8).
Research on Skin Care Properties
Early in 2011, Akhtar and coinvestigators reported on their efforts to formulate a topical water in oil (without) emulsion of 3% cucumber extracts, and to assess it according to multiple parameters, compared with its base (lacking cucumber ingredients) as a control, in 21 healthy volunteers over 4 weeks. The cucumber formulation demonstrated statistically significant reductions in sebum, as well as a decline in melanin content that was not statistically significant. Transepidermal water loss and erythema were elevated by the test formulation, but these changes were also not statistically significant. While identifying the need for more research, the authors concluded that their findings point to the potential for cucumber extracts to be effective ingredients in skin care agents for medical and cosmetic purposes (African J. Biotechnol. 2011;10:1206-16).
Later in 2011, Nema and coinvestigators subjected the lyophilized juice of C. sativus fruit to 1,1-diphenyl-2-picrylhydrazyl and superoxide radical scavenging assays in reference to butylated hydroxytoluene, and hyaluronoidase and elastase inhibitory assays in reference to oleanolic acid. The cucumber juice, rich in ascorbic acid, was found to exhibit significant free radical scavenging activity as well as potent antihyaluronidase and antielastase activity. The researchers concluded that C. sativus warrants consideration for its potential used as an antiwrinkle ingredient in cosmetic formulations (Arch. Dermatol. Res. 2011;303;247-52).
Cucumber extracts can currently be found in a wide range of over-the-counter skin care creams and eye gels.
Conclusion
Cucumber has captured the popular imagination as an effective, temporary agent for the relief of swollen eyes, or dark circles under the eyes. It has developed an anecdotal reputation as a diuretic that systemically and topically acts against water retention, thus ameliorating burns, dermatitis, and swollen eyes. This folk medicine success or popularity has, perhaps, spurred the inclusion of C. sativa in various skin care products. There is a dearth of research on the dermatologic benefits of the plant, however, as well as its usefulness in skin care products. That said, some emerging evidence regarding its inhibitory effect on melanin production bears watching. Much more research is necessary to determine the appropriate role of cucumber in dermatology.
Dr. Baumann is in private practice in Miami Beach. She did not disclose any conflicts of interest.
Cucumis sativus is a member of the Cucurbitaceae family, which also includes pumpkin, zucchini, watermelon, and squash. Found growing wild in the Himalayan region and commonly referred to as cucumber in English, khira in Hindi, and sakusa in Sanskrit, the plant is cultivated throughout India and China, in particular, as well as in Europe and the United States (J. Young. Pharm. 2010;2:365-8).
It is grown as a food crop, with its fruit (the cucumber) found in many cuisines as well as a component in traditional medicine and folk cosmetics (Planta. Med. 2008;74:1785-8). Headache was one traditional indication; the fruit juice was used as a demulcent in antiacne lotions and the seeds were noted for their cooling and diuretic effects (J. Young. Pharm. 2010;2:365-8). In traditional Chinese medicine, the leaves, roots, and stems of the plant have been used to detoxify as well as to treat diarrhea and gonorrhea (Planta. Med. 2008;74:1785-8). Popularly, the application of cucumber slices to ameliorate swelling or dark circles under the eyes has long been accepted throughout the world as an effective treatment.
Antioxidant Activity
In 2002, Villaseñor and coinvestigators assessed the comparative effectiveness of sugar beet roots, cucumber fruits, New Zealand spinach leaves, and turmeric rhizomes against dimethylbenz[a]anthracene-initiated and croton oil–promoted skin tumors in a Swiss Webster albino mouse model using three different protocols. The four species were selected based on prior findings of antioxidant activity and effectiveness in preventing skin tumors induced in laboratory settings. All four displayed antioxidant activity, and all were found to be effective in lowering skin tumor incidence and the number of skin tumors as well as delaying the onset of skin tumor formation, compared with the control, with turmeric exhibiting the greatest potency (Nutr. Cancer. 2002;44:66-70).
Melanin Suppressing Properties
In 2008, Kai and coinvestigators assessed six plant parts of C. sativus to compare their inhibitory effects on melanogenesis. They found that methanol extracts of the leaves and stems suppressed melanin production in cultured B16 mouse melanoma cells. Although they did not alter mushroom tyrosinase activity or crude enzyme lysate activity in these cells, the methanol extracts did reduce tyrosinase expression at the protein level. The researchers suggested that these findings indicate that the depigmenting activity of C. sativus extracts is associated with tyrosinase expression. They also found that lutein, of eight compounds isolated from the leaves, inhibited melanogenesis, significantly lowering tyrosinase expression. The investigators concluded that the leaves, and lutein in particular, of C. sativus effectively suppress tyrosinase expression and warrant consideration as a skin-whitening agent (Planta. Med. 2008;74:1785-8). Tyrosinase-inhibitory activity exhibited by cucumber extracts had also been previously attributed to enzymes found in cucumber skin (J. Agric. Food. Chem. 2003;51:7764-9).
In 2010, Kumar and coinvestigators evaluated the aqueous fruit extract of C. sativus for free radical scavenging and analgesic activities using in vitro and in vivo models. Preliminary phytochemical screening indicated that cucumber contains various classes of compounds known to exert antioxidant as well as analgesic activity, including flavonoids and tannins. The investigators found that the fruit extract showed maximum antioxidant and analgesic effect at 500 mcg/mL and 500 mg/kg, respectively, although the exact constituents of C. sativus fruits responsible for the promising effects were not elucidated by the study (J. Young. Pharm. 2010;2:365-8).
Research on Skin Care Properties
Early in 2011, Akhtar and coinvestigators reported on their efforts to formulate a topical water in oil (without) emulsion of 3% cucumber extracts, and to assess it according to multiple parameters, compared with its base (lacking cucumber ingredients) as a control, in 21 healthy volunteers over 4 weeks. The cucumber formulation demonstrated statistically significant reductions in sebum, as well as a decline in melanin content that was not statistically significant. Transepidermal water loss and erythema were elevated by the test formulation, but these changes were also not statistically significant. While identifying the need for more research, the authors concluded that their findings point to the potential for cucumber extracts to be effective ingredients in skin care agents for medical and cosmetic purposes (African J. Biotechnol. 2011;10:1206-16).
Later in 2011, Nema and coinvestigators subjected the lyophilized juice of C. sativus fruit to 1,1-diphenyl-2-picrylhydrazyl and superoxide radical scavenging assays in reference to butylated hydroxytoluene, and hyaluronoidase and elastase inhibitory assays in reference to oleanolic acid. The cucumber juice, rich in ascorbic acid, was found to exhibit significant free radical scavenging activity as well as potent antihyaluronidase and antielastase activity. The researchers concluded that C. sativus warrants consideration for its potential used as an antiwrinkle ingredient in cosmetic formulations (Arch. Dermatol. Res. 2011;303;247-52).
Cucumber extracts can currently be found in a wide range of over-the-counter skin care creams and eye gels.
Conclusion
Cucumber has captured the popular imagination as an effective, temporary agent for the relief of swollen eyes, or dark circles under the eyes. It has developed an anecdotal reputation as a diuretic that systemically and topically acts against water retention, thus ameliorating burns, dermatitis, and swollen eyes. This folk medicine success or popularity has, perhaps, spurred the inclusion of C. sativa in various skin care products. There is a dearth of research on the dermatologic benefits of the plant, however, as well as its usefulness in skin care products. That said, some emerging evidence regarding its inhibitory effect on melanin production bears watching. Much more research is necessary to determine the appropriate role of cucumber in dermatology.
Dr. Baumann is in private practice in Miami Beach. She did not disclose any conflicts of interest.
Sleep Quality May Impact Skin Health
A recent article in the New York Times ("How Well you Sleep May Hinge on Race," Aug. 20, 2012), discussed a link between ethnicity and quality of sleep. According to the story, non-Hispanic white patients sleep longer with less interruption than people of other ethnicities. Black patients are also most likely to get shorter, more restless sleep, according to the article.
Poor sleep quality has been associated with high blood pressure, obesity, and insulin resistance, which might help explain why people in some minority groups experience higher rates of chronic health conditions.
The article highlighted racial disparity evidence presented at the annual Associated Professional Sleep Societies meeting in Boston in June. White patients from the Chicago area were found to get an average of 7.4 hours of sleep per night; Hispanic and Asian patients averaged 6.9 hours; and black patients averaged 6.8 hours. Sleep quality – defined as ease in falling asleep and length of uninterrupted sleep – was also higher for white patients than for black patients. Even after adjusting for cardiovascular disease, sleep apnea, and obesity, black patients and other ethnic minorities still got less, and more disruptive, sleep than white patients.
Could differences in quality of sleep also be associated with dermatologic conditions that occur at a higher rate in certain ethnic groups?
A study, published earlier this year, found that sleep disturbance correlated with immune system dysregulation (Am. J. Geriatr. Psychiatry 2012 Feb. 10 [epub ahead of print]), which could help explain why atopic dermatitis is seem more frequently in children of Asian and African-American descent?
Interestingly, there have been reports of sleep disturbances in both infants and older children with atopic dermatitis (Asian Pac. J. Allergy Immunol. 2012;30:26-31). But is it the atopic dermatitis that causes poor sleep or the poor sleep that exacerbates the atopic dermatitis?
I think there is probably a relationship in both directions. It would be interesting to study whether socioeconomic and living conditions, regardless of race and ethnicity, are contributing factors. Insights into sleep quality and ethnic disparities may also offer further information on the same disparities seen in skin conditions.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to sknews@elsevier.com.
A recent article in the New York Times ("How Well you Sleep May Hinge on Race," Aug. 20, 2012), discussed a link between ethnicity and quality of sleep. According to the story, non-Hispanic white patients sleep longer with less interruption than people of other ethnicities. Black patients are also most likely to get shorter, more restless sleep, according to the article.
Poor sleep quality has been associated with high blood pressure, obesity, and insulin resistance, which might help explain why people in some minority groups experience higher rates of chronic health conditions.
The article highlighted racial disparity evidence presented at the annual Associated Professional Sleep Societies meeting in Boston in June. White patients from the Chicago area were found to get an average of 7.4 hours of sleep per night; Hispanic and Asian patients averaged 6.9 hours; and black patients averaged 6.8 hours. Sleep quality – defined as ease in falling asleep and length of uninterrupted sleep – was also higher for white patients than for black patients. Even after adjusting for cardiovascular disease, sleep apnea, and obesity, black patients and other ethnic minorities still got less, and more disruptive, sleep than white patients.
Could differences in quality of sleep also be associated with dermatologic conditions that occur at a higher rate in certain ethnic groups?
A study, published earlier this year, found that sleep disturbance correlated with immune system dysregulation (Am. J. Geriatr. Psychiatry 2012 Feb. 10 [epub ahead of print]), which could help explain why atopic dermatitis is seem more frequently in children of Asian and African-American descent?
Interestingly, there have been reports of sleep disturbances in both infants and older children with atopic dermatitis (Asian Pac. J. Allergy Immunol. 2012;30:26-31). But is it the atopic dermatitis that causes poor sleep or the poor sleep that exacerbates the atopic dermatitis?
I think there is probably a relationship in both directions. It would be interesting to study whether socioeconomic and living conditions, regardless of race and ethnicity, are contributing factors. Insights into sleep quality and ethnic disparities may also offer further information on the same disparities seen in skin conditions.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to sknews@elsevier.com.
A recent article in the New York Times ("How Well you Sleep May Hinge on Race," Aug. 20, 2012), discussed a link between ethnicity and quality of sleep. According to the story, non-Hispanic white patients sleep longer with less interruption than people of other ethnicities. Black patients are also most likely to get shorter, more restless sleep, according to the article.
Poor sleep quality has been associated with high blood pressure, obesity, and insulin resistance, which might help explain why people in some minority groups experience higher rates of chronic health conditions.
The article highlighted racial disparity evidence presented at the annual Associated Professional Sleep Societies meeting in Boston in June. White patients from the Chicago area were found to get an average of 7.4 hours of sleep per night; Hispanic and Asian patients averaged 6.9 hours; and black patients averaged 6.8 hours. Sleep quality – defined as ease in falling asleep and length of uninterrupted sleep – was also higher for white patients than for black patients. Even after adjusting for cardiovascular disease, sleep apnea, and obesity, black patients and other ethnic minorities still got less, and more disruptive, sleep than white patients.
Could differences in quality of sleep also be associated with dermatologic conditions that occur at a higher rate in certain ethnic groups?
A study, published earlier this year, found that sleep disturbance correlated with immune system dysregulation (Am. J. Geriatr. Psychiatry 2012 Feb. 10 [epub ahead of print]), which could help explain why atopic dermatitis is seem more frequently in children of Asian and African-American descent?
Interestingly, there have been reports of sleep disturbances in both infants and older children with atopic dermatitis (Asian Pac. J. Allergy Immunol. 2012;30:26-31). But is it the atopic dermatitis that causes poor sleep or the poor sleep that exacerbates the atopic dermatitis?
I think there is probably a relationship in both directions. It would be interesting to study whether socioeconomic and living conditions, regardless of race and ethnicity, are contributing factors. Insights into sleep quality and ethnic disparities may also offer further information on the same disparities seen in skin conditions.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to sknews@elsevier.com.
Photoprotection for Preventing Skin Cancer and Premature Skin Aging
Dr. Hale discusses how regular sunscreen use can diminish the chances of developing future skin cancers and can slow the process of premature skin aging. For more information, read Dr. Hale's article in the May 2012 issue, "Sunscreens and Photoaging: An Update."
Dr. Hale discusses how regular sunscreen use can diminish the chances of developing future skin cancers and can slow the process of premature skin aging. For more information, read Dr. Hale's article in the May 2012 issue, "Sunscreens and Photoaging: An Update."
Dr. Hale discusses how regular sunscreen use can diminish the chances of developing future skin cancers and can slow the process of premature skin aging. For more information, read Dr. Hale's article in the May 2012 issue, "Sunscreens and Photoaging: An Update."
Let Lip Defect Size Drive Treatment
SAN DIEGO – Principles for lip repair are based on size and location of the defect, etiology of the lesions, and patient age and gender, said Dr. Michael A. Keefe.
Surgical goals of lip reconstruction are to cover the skin and oral lining, leave a semblance of a vermilion and an adequate stomal diameter, make sure sensation is intact, and ensure that the patient has a competent oral sphincter. "The vermilion is the most visible component of the lips, and it’s also the sensory unit of the lip," Dr. Keefe said at a meeting on superficial anatomy and cutaneous surgery. The meeting was sponsored by the University of California, San Diego, School of Medicine and the Scripps Clinic.
"Scars are very well hidden at the vermilion-cutaneous border. If you have to cross the vermilion-cutaneous junction, cross at 90 degrees."
Lower Lip
The lower vermilion is the most affected target of solar radiation injury. In cases of premalignant lesions such as actinic cheilitis or leukoplakia, Dr. Keefe, a plastic surgeon with the division of head and neck surgery at Sharp Rees-Stealy Medical Group in San Diego, said he often performs a total vermilionectomy (lip shave). This involves resection from the white roll to the contact area with opposite lip. "Primary closure is possible," he said. "You can get tension and dehiscence and flattening of the lip, but generally it heals up pretty well. An option for vermilion reconstruction of larger defects is the buccal mucosal advancement flap, which involves elevating the mucosa deep to salivary glands and superficial to the orbicularis oris muscle."
An advantage of treating the lower lip is that there is increased soft tissue laxity and there is no Cupid’s bow, philtrum, or nose, "so it’s nice that there are no dominant central structures," he said. "The downside is that you have to be mindful of the effect of gravity on the repair, so there is a greater need for tone to prevent drooling and incompetence."
He recommends a staged approach based on the extent of the defect and the age of the patient. For small defects (those less than one-third of the lip size) he uses primary closure. Options for medium defects (those that involve one-third to two-thirds of the lip size) include the Estlander flap, the Abbe flap, Bernard Burow’s procedure, the Karapandzic flap, and the stairstep repair, while the options for large defects (those that involve more than two-thirds of the lip size) include Bernard Burow’s procedure, the Karapandzic flap, and the free flap. "You have a lot of tools, depending on what you feel comfortable with," Dr. Keefe said.
Upper Lip
Cancerous tumors of the upper lip are less common, "but there are some unique structures to pay attention to, including the nose, columella, Cupid’s bow, and the philtrum," he said. "In men there’s a hair-bearing skin issue, but scars can be disguised in a mustache."
The aesthetic subunits to keep in mind, he continued, are the medial subunit, which is one-half of the philtrum, and the lateral subunit, which consists of the philtral column, the nostril sill, the alar base, and the nasolabial crease. Primary closure is used for upper lip defects that involve less than one-third of the lip size. "You can make some perialar crescentic skin excisions, which can help advance things," Dr. Keefe said.
For centrally located medium-sized defects of the upper lip, he often uses primary closure with perialar crescentic skin excisions. "If it’s greater than one-half of the lip size, you can add an Abbe flap," he said. "That’s nice because that recreates the philtrum area."
For medially located medium-sized defects of the upper lip, "you can use the Abbe flap if the commissure is not involved and the Estlander flap if the commissure is involved."
Options for cases with large defects and adequate cheek tissue, he said, include the reverse Karapandzic flap, the reverse fan flap, inverted Bernard Burow’s procedure, superiorly based cheek flaps, and the bilateral levator anguli oris flap combined with the Abbe flap. Options for cases with inadequate cheek tissue include the distal pedicle flap and the free flap.
Repair Risks
A lot of these patients have medical problems," he said. "When you do your first injection to resect the tumor or put the lip back together, make sure you don’t cause a myocardial infarction. Generally you should be comfortable with patients who have an INR [International Normalized Ratio] of 2.5 and below."
For patients with large cancerous tumors of the lip, be mindful of lymphatic drainage, because larger tumors have an increased risk of metastases, said Dr. Keefe. For tumors larger than 2 cm in length or 6 mm in spread, or if there is perineural spread, the patient should be referred for radiation therapy.
Dr. Keefe said that he had no relevant financial conflicts to disclose.
SAN DIEGO – Principles for lip repair are based on size and location of the defect, etiology of the lesions, and patient age and gender, said Dr. Michael A. Keefe.
Surgical goals of lip reconstruction are to cover the skin and oral lining, leave a semblance of a vermilion and an adequate stomal diameter, make sure sensation is intact, and ensure that the patient has a competent oral sphincter. "The vermilion is the most visible component of the lips, and it’s also the sensory unit of the lip," Dr. Keefe said at a meeting on superficial anatomy and cutaneous surgery. The meeting was sponsored by the University of California, San Diego, School of Medicine and the Scripps Clinic.
"Scars are very well hidden at the vermilion-cutaneous border. If you have to cross the vermilion-cutaneous junction, cross at 90 degrees."
Lower Lip
The lower vermilion is the most affected target of solar radiation injury. In cases of premalignant lesions such as actinic cheilitis or leukoplakia, Dr. Keefe, a plastic surgeon with the division of head and neck surgery at Sharp Rees-Stealy Medical Group in San Diego, said he often performs a total vermilionectomy (lip shave). This involves resection from the white roll to the contact area with opposite lip. "Primary closure is possible," he said. "You can get tension and dehiscence and flattening of the lip, but generally it heals up pretty well. An option for vermilion reconstruction of larger defects is the buccal mucosal advancement flap, which involves elevating the mucosa deep to salivary glands and superficial to the orbicularis oris muscle."
An advantage of treating the lower lip is that there is increased soft tissue laxity and there is no Cupid’s bow, philtrum, or nose, "so it’s nice that there are no dominant central structures," he said. "The downside is that you have to be mindful of the effect of gravity on the repair, so there is a greater need for tone to prevent drooling and incompetence."
He recommends a staged approach based on the extent of the defect and the age of the patient. For small defects (those less than one-third of the lip size) he uses primary closure. Options for medium defects (those that involve one-third to two-thirds of the lip size) include the Estlander flap, the Abbe flap, Bernard Burow’s procedure, the Karapandzic flap, and the stairstep repair, while the options for large defects (those that involve more than two-thirds of the lip size) include Bernard Burow’s procedure, the Karapandzic flap, and the free flap. "You have a lot of tools, depending on what you feel comfortable with," Dr. Keefe said.
Upper Lip
Cancerous tumors of the upper lip are less common, "but there are some unique structures to pay attention to, including the nose, columella, Cupid’s bow, and the philtrum," he said. "In men there’s a hair-bearing skin issue, but scars can be disguised in a mustache."
The aesthetic subunits to keep in mind, he continued, are the medial subunit, which is one-half of the philtrum, and the lateral subunit, which consists of the philtral column, the nostril sill, the alar base, and the nasolabial crease. Primary closure is used for upper lip defects that involve less than one-third of the lip size. "You can make some perialar crescentic skin excisions, which can help advance things," Dr. Keefe said.
For centrally located medium-sized defects of the upper lip, he often uses primary closure with perialar crescentic skin excisions. "If it’s greater than one-half of the lip size, you can add an Abbe flap," he said. "That’s nice because that recreates the philtrum area."
For medially located medium-sized defects of the upper lip, "you can use the Abbe flap if the commissure is not involved and the Estlander flap if the commissure is involved."
Options for cases with large defects and adequate cheek tissue, he said, include the reverse Karapandzic flap, the reverse fan flap, inverted Bernard Burow’s procedure, superiorly based cheek flaps, and the bilateral levator anguli oris flap combined with the Abbe flap. Options for cases with inadequate cheek tissue include the distal pedicle flap and the free flap.
Repair Risks
A lot of these patients have medical problems," he said. "When you do your first injection to resect the tumor or put the lip back together, make sure you don’t cause a myocardial infarction. Generally you should be comfortable with patients who have an INR [International Normalized Ratio] of 2.5 and below."
For patients with large cancerous tumors of the lip, be mindful of lymphatic drainage, because larger tumors have an increased risk of metastases, said Dr. Keefe. For tumors larger than 2 cm in length or 6 mm in spread, or if there is perineural spread, the patient should be referred for radiation therapy.
Dr. Keefe said that he had no relevant financial conflicts to disclose.
SAN DIEGO – Principles for lip repair are based on size and location of the defect, etiology of the lesions, and patient age and gender, said Dr. Michael A. Keefe.
Surgical goals of lip reconstruction are to cover the skin and oral lining, leave a semblance of a vermilion and an adequate stomal diameter, make sure sensation is intact, and ensure that the patient has a competent oral sphincter. "The vermilion is the most visible component of the lips, and it’s also the sensory unit of the lip," Dr. Keefe said at a meeting on superficial anatomy and cutaneous surgery. The meeting was sponsored by the University of California, San Diego, School of Medicine and the Scripps Clinic.
"Scars are very well hidden at the vermilion-cutaneous border. If you have to cross the vermilion-cutaneous junction, cross at 90 degrees."
Lower Lip
The lower vermilion is the most affected target of solar radiation injury. In cases of premalignant lesions such as actinic cheilitis or leukoplakia, Dr. Keefe, a plastic surgeon with the division of head and neck surgery at Sharp Rees-Stealy Medical Group in San Diego, said he often performs a total vermilionectomy (lip shave). This involves resection from the white roll to the contact area with opposite lip. "Primary closure is possible," he said. "You can get tension and dehiscence and flattening of the lip, but generally it heals up pretty well. An option for vermilion reconstruction of larger defects is the buccal mucosal advancement flap, which involves elevating the mucosa deep to salivary glands and superficial to the orbicularis oris muscle."
An advantage of treating the lower lip is that there is increased soft tissue laxity and there is no Cupid’s bow, philtrum, or nose, "so it’s nice that there are no dominant central structures," he said. "The downside is that you have to be mindful of the effect of gravity on the repair, so there is a greater need for tone to prevent drooling and incompetence."
He recommends a staged approach based on the extent of the defect and the age of the patient. For small defects (those less than one-third of the lip size) he uses primary closure. Options for medium defects (those that involve one-third to two-thirds of the lip size) include the Estlander flap, the Abbe flap, Bernard Burow’s procedure, the Karapandzic flap, and the stairstep repair, while the options for large defects (those that involve more than two-thirds of the lip size) include Bernard Burow’s procedure, the Karapandzic flap, and the free flap. "You have a lot of tools, depending on what you feel comfortable with," Dr. Keefe said.
Upper Lip
Cancerous tumors of the upper lip are less common, "but there are some unique structures to pay attention to, including the nose, columella, Cupid’s bow, and the philtrum," he said. "In men there’s a hair-bearing skin issue, but scars can be disguised in a mustache."
The aesthetic subunits to keep in mind, he continued, are the medial subunit, which is one-half of the philtrum, and the lateral subunit, which consists of the philtral column, the nostril sill, the alar base, and the nasolabial crease. Primary closure is used for upper lip defects that involve less than one-third of the lip size. "You can make some perialar crescentic skin excisions, which can help advance things," Dr. Keefe said.
For centrally located medium-sized defects of the upper lip, he often uses primary closure with perialar crescentic skin excisions. "If it’s greater than one-half of the lip size, you can add an Abbe flap," he said. "That’s nice because that recreates the philtrum area."
For medially located medium-sized defects of the upper lip, "you can use the Abbe flap if the commissure is not involved and the Estlander flap if the commissure is involved."
Options for cases with large defects and adequate cheek tissue, he said, include the reverse Karapandzic flap, the reverse fan flap, inverted Bernard Burow’s procedure, superiorly based cheek flaps, and the bilateral levator anguli oris flap combined with the Abbe flap. Options for cases with inadequate cheek tissue include the distal pedicle flap and the free flap.
Repair Risks
A lot of these patients have medical problems," he said. "When you do your first injection to resect the tumor or put the lip back together, make sure you don’t cause a myocardial infarction. Generally you should be comfortable with patients who have an INR [International Normalized Ratio] of 2.5 and below."
For patients with large cancerous tumors of the lip, be mindful of lymphatic drainage, because larger tumors have an increased risk of metastases, said Dr. Keefe. For tumors larger than 2 cm in length or 6 mm in spread, or if there is perineural spread, the patient should be referred for radiation therapy.
Dr. Keefe said that he had no relevant financial conflicts to disclose.
AT A MEETING ON SUPERFICIAL ANATOMY AND CUTANEOUS SURGERY
Argan Oil for Dry Hair
We were recently asked by a reader if there is any scientific evidence on the benefits of using argan oil to treat dry hair and scalp.
Argan oil is native to Morocco and has been used for centuries in foods and topical preparations. It is a plant oil produced from the argan tree (Argania Spinosa L). Studies have found that the oil has cardioprotective and anti-thrombotic effects when ingested.
Over the past several years, it has become popular in hair care products. While the benefits of consumption of argan oil have been well-studied, its use for hair has not been documented in peer-reviewed literature.
Argan oil may be used on any hair type. It is available in shampoos, conditioners, and leave-in products. I have found that argan oil is beneficial for patients with curly hair, particularly those of African or African-American descent, because it helps to reduce frizz and adds shine. A small amount may be applied to the scalp if dry.
In patients with fine hair, too much oil can be greasy and may weigh curls down. In those cases, small amounts of the oil may be more beneficial. If too much product is used, clarifying shampoos may help remove excess oil.
The number of personal care products on the U.S. market with argan oil as an ingredient increased from just 2 in 2007 to over 100 in 2011. There are many hair care brands that contain argan oil including Moroccanoil, DermOrganic, Josie Maran, One 'N Only, and Organix, among others.
There has been one report of anaphylaxis to argan oil in the literature (Allergy 2010;65:662–3). Studies must be done to assess its actual efficacy for dermatologic scalp conditions and use for ethnic hair.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to sknews@elsevier.com.
We were recently asked by a reader if there is any scientific evidence on the benefits of using argan oil to treat dry hair and scalp.
Argan oil is native to Morocco and has been used for centuries in foods and topical preparations. It is a plant oil produced from the argan tree (Argania Spinosa L). Studies have found that the oil has cardioprotective and anti-thrombotic effects when ingested.
Over the past several years, it has become popular in hair care products. While the benefits of consumption of argan oil have been well-studied, its use for hair has not been documented in peer-reviewed literature.
Argan oil may be used on any hair type. It is available in shampoos, conditioners, and leave-in products. I have found that argan oil is beneficial for patients with curly hair, particularly those of African or African-American descent, because it helps to reduce frizz and adds shine. A small amount may be applied to the scalp if dry.
In patients with fine hair, too much oil can be greasy and may weigh curls down. In those cases, small amounts of the oil may be more beneficial. If too much product is used, clarifying shampoos may help remove excess oil.
The number of personal care products on the U.S. market with argan oil as an ingredient increased from just 2 in 2007 to over 100 in 2011. There are many hair care brands that contain argan oil including Moroccanoil, DermOrganic, Josie Maran, One 'N Only, and Organix, among others.
There has been one report of anaphylaxis to argan oil in the literature (Allergy 2010;65:662–3). Studies must be done to assess its actual efficacy for dermatologic scalp conditions and use for ethnic hair.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to sknews@elsevier.com.
We were recently asked by a reader if there is any scientific evidence on the benefits of using argan oil to treat dry hair and scalp.
Argan oil is native to Morocco and has been used for centuries in foods and topical preparations. It is a plant oil produced from the argan tree (Argania Spinosa L). Studies have found that the oil has cardioprotective and anti-thrombotic effects when ingested.
Over the past several years, it has become popular in hair care products. While the benefits of consumption of argan oil have been well-studied, its use for hair has not been documented in peer-reviewed literature.
Argan oil may be used on any hair type. It is available in shampoos, conditioners, and leave-in products. I have found that argan oil is beneficial for patients with curly hair, particularly those of African or African-American descent, because it helps to reduce frizz and adds shine. A small amount may be applied to the scalp if dry.
In patients with fine hair, too much oil can be greasy and may weigh curls down. In those cases, small amounts of the oil may be more beneficial. If too much product is used, clarifying shampoos may help remove excess oil.
The number of personal care products on the U.S. market with argan oil as an ingredient increased from just 2 in 2007 to over 100 in 2011. There are many hair care brands that contain argan oil including Moroccanoil, DermOrganic, Josie Maran, One 'N Only, and Organix, among others.
There has been one report of anaphylaxis to argan oil in the literature (Allergy 2010;65:662–3). Studies must be done to assess its actual efficacy for dermatologic scalp conditions and use for ethnic hair.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to sknews@elsevier.com.
