AVOID TRIGGERS

Overheating: keep bathing temperature warm rather than hot and avoid overheating in bed and in clothing.

Abrasive surfaces: ensure clothing and bedding are smooth and unlikely to irritate the skin.

Avoid environmental irritants where possible e.g. dust, grass, sandpits, chlorine pools, sweat. This is difficult in children and patients exercising so pre-treating with moisturisers prior to exposure and showering and reapplying moisturisers soon after helps manage this situation.

Avoid detergents, soap, solvents as they irritate the skin.

MOISTURISERS (EMOLLIENTS)

Substitute a soap free cleanser or wash with sorbolene cream in the shower and avoid soap. There are many brands available from chemists and supermarkets.

Avoid perfumed products.

If using a bath substitute a bath oil or cleanser for soap.

Use a moisturiser liberally and often, particularly after bathing and after washing your hands if you have hand dermatitis.

Moisturisers come in different forms. Creams are generally white and rub into your skin and ointments are often clear and feel greasy. Ointments sit on your skin for a longer period of time but are often more effective when managing eczema. Patients may choose to use a combination of moisturisers as creams may be suitable before and during work and ointments more beneficial after work or on weekends when greasy skin is more acceptable. I can suggest some brands if required.

When applying moisturisers the application should be in the direction of hair growth rather than against it. This helps to prevent inflamed hair follicles.

Topical steroids will sometimes be prescribed but it is important to always follow these baseline instructions even when your eczema is not active. Keeping your skin in good condition by following these guidelines will help to improve your eczema and sometimes prevent exacerbations.

If you have any questions or problems during the course of your treatment please call:
Adelaide Skin & Eye Centre 8211 0000 (Monday to Friday 9am to 5pm)

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BEFORE THE PROCEDURE:

Please wear sunscreen every day, treatment may be cancelled if there is marked tanning or sunburn. Darker skin may benefit from using a bleaching cream nightly for 2 weeks before the procedure. If you have had cold sores, please tell me as preventive treatment may be required, starting the night before and continuing 2 x daily for a few days. A prescribed anaesthetic cream is sometimes used, please discuss with me. If so, apply a maximum of 5mls to clean, dry skin 45 minutes beforehand and extending 1cm outside the area to be treated.

THE PROCEDURE:

Please come without makeup or sunscreen. Photos will be taken. Your skin is cleansed with alcohol and protective eye patches are applied. The TCA is applied to each scar and causes some stinging. Most people do not need any anaesthetic. The treatment will take 15-30 minutes. A white frosting of the skin occurs immediately. Antibiotic ointment or Vaseline is applied.

POST OPERATIVE COURSE:

The white frost lasts up to 12 hours and is followed by 1-2 days of redness and soreness. After 2-3 days, a small scab develops and should be allowed to fall off by itself after 3-7 days WITHOUT PICKING. Subsequent redness takes up to a few weeks to settle. Darker skin often develops brown discolouration which may take several weeks to months to resolve and is treated with sun avoidance, sunblock and bleaching cream (Superfade or similar).

Cleanse your skin 2 x daily (Aveeno positively radiant or QV face gentle cleanser), gently pat dry and apply antibiotic ointment or Vaseline until the scabs come off. After this, sunscreen must be applied daily throughout the course of treatment and for 3 months afterwards to prevent pigmentation. Darker skin should have bleaching cream applied nightly.

Treatments are repeated every 4-8 weeks. Usually, 2-3 treatments are needed but 1-2 extra treatments are needed in darker skin as lower strength TCA is used. Improvement is a gradual process due to the body’s formation of collagen over the three months following the last treatment.

COMPLICATIONS:

Some scars are resistant to treatment and may require a greater number of treatments or a change in the type of treatment. Complications are uncommon but may include prolonged irritation and redness, changes in colour (brownish discolouration is usually temporary but lightening may be permanent), permanent hair loss in the treated area, worsening of acne, infection and scarring, including joining together of adjacent scars to form larger ones.

If you have any questions or problems during the course of your treatment please call:
Adelaide Skin & Eye Centre 8211 0000 (Monday to Friday 9am to 5pm)

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Rhinophyma is a type of acne rosacea in which there is a slow increase in the size of the end of the nose. This is often associated with redness, broken blood vessels and pustular lesions. The cause is unknown and contrary to popular opinion, the enlarging red nose has nothing to do with alcohol intake.

Creams and tablets may be helpful in stopping the pustules and reducing the redness.

Rhinophyma treatment permanently reduces the size of the nose, using a combination of surgery and laser reshaping and sculpting.

After reshaping the nose, IPL or the Nd YAG laser may be used to treat broken blood vessels.

BEFORE THE PROCEDURE:

If you are taking blood thinning medications such as Aspirin which increase bleeding, please let me know as we may need to cease these before the procedure. Please let me know if you have had cold sores on the nose as anti-viral medication needs to be started the evening before the procedure and continued 2 x daily for a few days.

PROCEDURE:

Your nose will be photographed and injected with local anaesthetic. Your eyes will be covered to protect them.

First, excess tissue is removed then the laser is used to shape the nose. A smoke evacuator is used to remove fumes – this sounds like a vacuum cleaner. The nose usually bleeds during the procedure, please don’t be worried by this. The procedure itself takes about one hour. Once it is over the nurse will apply a large dressing to the nose.

POSTOPERATIVE CARE:

The treated area will look red and raw, rather like a grazed knee. Vaseline or antibiotic ointment and a dressing will be applied. When the anaesthetic wears off, Panadol and/or Ibuprofen may be used. Swelling around the nose and the eyes may be quite marked and is worst at 2-3 days after surgery. Please apply ice packs (e.g. packet of frozen peas in a clean tea towel) hourly for 10-15 minutes on the day of surgery to reduce swelling. If the nose is oozing, apply the cold pack firmly and continuously (no peeking) for 20 minutes.

Starting the day after surgery, go into the shower, get the dressing wet and remove it. The treated area should be dressed daily as follows:

1. Use gauze or cotton buds with hydrogen peroxide or saline to remove all crusts, and then dry gently with gauze. Do not get peroxide in the eyes.
2. Apply Vaseline generously.
3. Apply 2 layers of Hypafix tape. Areas such as the nostrils where a dressing cannot be applied, should have Vaseline applied every 2 hours.

The wound will be reviewed in the first few days. The dressings will need to continue for approximately 10-14 days until healing is complete. The nose will remain pink for a further 2 to 3 months and must be protected with sunscreen everyday for 3 months. Use a flesh coloured zinc stick sunblock and a hat if outside. Once the nose has healed, it usually has a smoother, slightly shiny surface and is somewhat lighter in colour than previously. Most people will still have a large nose after the treatment but it will have a better shape.

COMPLICATIONS:

Scarring and an uneven surface (due to underlying cysts falling out during the procedure) are rare complications. Other rare complications include infection, prolonged redness and hyperpigmentation (brown patches). Hyperpigmentation is more common in olive or darker skin and sunscreen is essential for prevention. It is very rare for regrowth of the nose to occur but treatment may be repeated if needed in the future.

If you have any questions or problems during the course of your treatment please call: Adelaide Skin & Eye Centre 8211 0000 (Monday to Friday 9am to 5pm).

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