Birthmarks, port-wine marks, and other pigmentary conditions may be entirely or partly removed from the skin of the face, according to the size of the area treated and the nature of the case. For this purpose the single needle attached to the negative pole is hardly sufficient, unless the spot is exceedingly small, therefore a bunch needle electrode is used. This electrode has a number of fine steel needles set into it, as shown in [Fig. 519].
Fig. 519.—Multiple Needle Electrode.
In this treatment the needles are made to puncture the skin at right angles to them to a depth corresponding to the papillary layer. These pigments lie above that, so that it is not necessary to include the derma. At each point of puncture a white spot will appear which soon turns red. In a day’s time a number of fine scabs, or a single scab, will form over the parts treated, which fall away in about five days eventually, leaving the parts paler than before, owing to a number of minute punctate scars.
The amount of treatment given in each case varies with the extent of the lesion. If the result from the first sitting has not accomplished as much as desired, it can be repeated over and over until the parts assume a normal tint. There may be more or less bleeding following the treatment; this is easily checked by pressure. If the part worked on is quite large, dry aristol dressing should be used to avoid infection. The scab should not be picked off by the patient, but allowed to fall off.
REMOVAL OF TATTOO MARKS
The best method of removing such pigmentations of the skin is to remove them with the knife when possible, and to cover the wound by sliding flaps made by subcutaneous dissection at either side of the wound, as in the Celsus method. Some authorities advocate their re-tattooing with papoid solution, while others prefer caustic agents, with the object of destroying the pigmented area. These methods are not to be preferred, since they leave unsightly burn scars.
Electrolytic needling may be tried and is quite successful when the marks are very small, but, as with gun-powder stains, they are best removed by punching, or cutting out, a little cone of skin containing the pigment. The secondary wounds thus made leave only very small punctate scars that are hardly noticeable. Of course a number of such removals would not be advisable.
Where the pigmentation is very pale, recourse may be had to the peeling method, as will be later described.