Jana Dib El Jalbout

Phenol peel is a deep peel used to treat conditions involving the reticular dermis such as scars, deep wrinkles, and lentigos and is an attractive alternative to surgical interventions for the rejuvenation of the eyelids and face. Patients who wish to undergo this procedure should be screened for the presence of any contraindications and should be counseled on the possible complications, which include arrhythmia, skin atrophy, scarring, acne eruption, and infection. We describe the cases of four women who underwent deep phenol peeling for the improvement of wrinkles and aging features around the eyelid area as a conservative alternative to surgical blepharoplasty. Patients were previously healthy with no absolute contraindication for the procedure. They were instructed to use the Kligman formula for 1 month prior to peeling. A nonsteroidal anti‐inflammatory medication was given to the patient 30 mins before starting the procedure. The skin was cleansed with urea foam for 1 min, and excess product was removed with a dry and then a moistened gauze until the skin was clean. A 70% alcohol solution was then used to clean the skin area in which the peeling was desired. Phenol concentrated at 88% was applied using a damp cotton swab over multiple layers, until peeling was achieved. At the end of the procedure, a plastic occlusive mask was used to seal the area, and a postphenol occlusive ointment was applied over the periorbital region. Patients were instructed not to wash the area for 7–10 days and were prescribed Hyabak eye drops for dryness as well as oral analgesics as needed. No complications were reported in all cases. Phenol peeling is an easy, relatively safe and effective deep peeling technique that can be used to achieve the desired aesthetic outcomes in patients who wish to improve aging features and minimize the appearance of deep wrinkles without undergoing surgical intervention.

Morgellons disease is characterized by the persistent delusion of skin infestation, ultimately inflicting wounds and impairing quality of life. There is insufficient and conflicting research pertaining to this condition, imposing challenges on clinicians in understanding, diagnosing, and treating it. In this review, we summarize the available literature on Morgellons disease including its historical evolution, epidemiology, proposed pathophysiology, underlying structural and functional brain pathologies, typical and atypical clinical presentations, diagnosis, and treatment. A comprehensive review of the literature was conducted on PubMed, Embase, and Scopus using specified keywords. Selected articles were screened by two independent reviewers based on set inclusion and exclusion criteria. Conflicts were resolved by a third reviewer as needed. No limit to the date of selected articles was set due to the scarce literature available on the subject. Morgellons disease is an underdiagnosed entity, owing mostly to the lack of an established pathophysiology and treatment guidelines. While many authors classify it as a type of delusional infestation (DI), others correlate MD with an underlying spirochetal infection, namely Lyme disease. Neuroimaging studies have revealed abnormalities in the “fronto-striato-thalamo-parietal network”, a finding common to patients with DI, in addition to alterations in structures related to the “Itch Processing Pathway”. Patients tend to extract fibers from their skin lesions and place them in a match box hence the term “match box sign”. The diagnosis is that of exclusion, requiring extensive work up to rule out secondary causes and differential diagnoses. Treatment is largely based on the use of antipsychotics, with or without cognitive behavioral therapy. Despite being a diagnosis of exclusion, clinicians must be aware of this entity and have a profound understanding of the pathogenesis underlying it. Upon clinical suspicion, secondary Morgellons should always be ruled out through a thorough history taking, physical examination, and laboratory exams. Despite the challenges brought by the heterogeneous presentation of the condition and the paucity of research revolving around it, the great impact that Morgellons disease has on patients’ quality of life forms a pressing need for its adequate detection, diagnosis, and treatment.