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Surgical Pearl: Versatile paper clip comedo extractor for acne surgery
PEARLS Stuart J. Salasche, MD Feature Editor
Surgical Pearl: Versatile paper clip comedo extractor for acne surgery Maj Joseph L. Cvancara, USAF, MC, and Lt Col Jeffrey J. Meffert, USAF, MC Fort Sam Houston, Texas
Since the 1870s when Dr Henry Piffard first devised an acne instrument, comedo extractors have been used in physicians’ offices. Contemporaries Jay Frank Schamberg and Paul Gerson Unna improved on Piffard’s instrument, modifications that are still used.1 Today, many designs and prices exist, ranging from disposable $3 to reusable $40 instruments.2 We report an effective and simple comedo extractor design utilizing ordinary paper clips. Several steel wire large (jumbo) and regular (No. 1) paper clips can be packaged and autoclaved for convenient use. Autoclaving does not rust or affect the ductile nature of the paper clip, but depending on the brand, may tarnish the wire. When a patient has a comedo or cyst that needs expression, a paper clip is easily bent and sized to From the Department of Dermatology, Brooke Army Medical Center. Reprints are not available from the authors. J Am Acad Dermatol 1999;40:477-8. 16/74/93802
Fig 1. Numerous configurations demonstrating the versatility of the paper clip.
be slightly larger than the lesion (Figs 1 and 2). Direct vertical pressure is exerted by this instrument circumferentially around the follicular opening or cystic lesion, increasing the forces within the dermis, resulting in extrusion of contents onto the skin surface (Fig 3). For closed comedones and cysts, the top of the lesion is gently nicked with a
Fig 2. Cyst and paper clip comedo extractor before expression.
Fig 3. Cyst and paper clip comedo extractor during expression.
477
Journal of the American Academy of Dermatology March 1999
478 Pearls No. 11 blade or 18-gauge needle before pressure extraction. Because open comedones do not have an epidermal covering, no additional tissue manipulation is required. This versatile disposable instrument is economical and convenient, especially for those physicians who are involved in various satellite clinic visits, humanitarian work, or military deployments.
REFERENCES 1. Parish LC. Historical aspects of cutaneous surgery. In: Wheeland RG, editor. Cutaneous surgery. Philadelphia: WB Saunders; 1994. p. 4-5. 2. Dermatologic buying guide. Council Bluffs (IA): Dermatologic Lab & Supply, Inc (Delasco); 1998. p. 91, 117.
Direct all submissions to Dr Stuart J. Salasche, 5300 N Montezuma Trail, Tucson, AZ 85750.
IOTADERMA #62 What causes acquired distal trichorrexis nodosa? Jeffrey D. Bernhard, MD Answer will appear in the April issue of the Journal.
FEBRUARY IOTADERMA (#61) Many people think Napoleon had scabies. Reuben Friedman developed a rather convincing argument that the emperor always had his hand up his shirt because of a different dermatologic disorder. What was it? Answer: Dermatitis herpetiformis. REFERENCES Friedman R. The emperor’s itch. New York: Froben Press; 1940.
Surgical Pearl: Versatile paper clip comedo extractor for acne surgery Maj Joseph L. Cvancara, USAF, MC, and Lt Col Jeffrey J. Meffert, USAF, MC Fort Sam Houston, Texas
Since the 1870s when Dr Henry Piffard first devised an acne instrument, comedo extractors have been used in physicians’ offices. Contemporaries Jay Frank Schamberg and Paul Gerson Unna improved on Piffard’s instrument, modifications that are still used.1 Today, many designs and prices exist, ranging from disposable $3 to reusable $40 instruments.2 We report an effective and simple comedo extractor design utilizing ordinary paper clips. Several steel wire large (jumbo) and regular (No. 1) paper clips can be packaged and autoclaved for convenient use. Autoclaving does not rust or affect the ductile nature of the paper clip, but depending on the brand, may tarnish the wire. When a patient has a comedo or cyst that needs expression, a paper clip is easily bent and sized to From the Department of Dermatology, Brooke Army Medical Center. Reprints are not available from the authors. J Am Acad Dermatol 1999;40:477-8. 16/74/93802
Fig 1. Numerous configurations demonstrating the versatility of the paper clip.
be slightly larger than the lesion (Figs 1 and 2). Direct vertical pressure is exerted by this instrument circumferentially around the follicular opening or cystic lesion, increasing the forces within the dermis, resulting in extrusion of contents onto the skin surface (Fig 3). For closed comedones and cysts, the top of the lesion is gently nicked with a
Fig 2. Cyst and paper clip comedo extractor before expression.
Fig 3. Cyst and paper clip comedo extractor during expression.
477
Journal of the American Academy of Dermatology March 1999
478 Pearls No. 11 blade or 18-gauge needle before pressure extraction. Because open comedones do not have an epidermal covering, no additional tissue manipulation is required. This versatile disposable instrument is economical and convenient, especially for those physicians who are involved in various satellite clinic visits, humanitarian work, or military deployments.
REFERENCES 1. Parish LC. Historical aspects of cutaneous surgery. In: Wheeland RG, editor. Cutaneous surgery. Philadelphia: WB Saunders; 1994. p. 4-5. 2. Dermatologic buying guide. Council Bluffs (IA): Dermatologic Lab & Supply, Inc (Delasco); 1998. p. 91, 117.
Direct all submissions to Dr Stuart J. Salasche, 5300 N Montezuma Trail, Tucson, AZ 85750.
IOTADERMA #62 What causes acquired distal trichorrexis nodosa? Jeffrey D. Bernhard, MD Answer will appear in the April issue of the Journal.
FEBRUARY IOTADERMA (#61) Many people think Napoleon had scabies. Reuben Friedman developed a rather convincing argument that the emperor always had his hand up his shirt because of a different dermatologic disorder. What was it? Answer: Dermatitis herpetiformis. REFERENCES Friedman R. The emperor’s itch. New York: Froben Press; 1940.