A18 Concern about appearance (ICD-10:F45.2)

Introduction

Concern about appearance refers to a patient’s distress or dissatisfaction with their physical appearance. This can be related to various factors, including body image issues, skin conditions, hair loss, or other cosmetic concerns^[1][2]. The aim of this guide is to provide a comprehensive overview of the diagnostic steps, possible interventions, and lifestyle modifications that can help address concerns about appearance.

Codes

• ICPC-2 Code: A18 Concern about appearance
• ICD-10 Code: F45.2 Hypochondriacal disorder

Symptoms

• Changes in skin texture or color
• Excessive hair loss or thinning
• Visible signs of aging (wrinkles, sagging skin)
• Scarring or blemishes on the skin
• Body dysmorphic thoughts or preoccupation with perceived flaws^[3][4]

Causes

• Genetic factors^[5]
• Hormonal imbalances
• Skin conditions (acne, eczema, psoriasis)
• Aging
• Trauma or injury
• Psychological factors (body dysmorphic disorder)^[6]

Diagnostic Steps

Medical History

• Gather information about the patient’s concerns and specific areas of dissatisfaction
• Identify any underlying medical conditions or risk factors that may contribute to appearance concerns
• Assess the patient’s psychological well-being and screen for body dysmorphic disorder or other mental health conditions^[7]

Physical Examination

• Examine the skin, hair, and nails for any visible abnormalities or signs of underlying conditions
• Assess the patient’s overall appearance, including body shape and symmetry
• Evaluate the patient’s facial features, including the presence of wrinkles, sagging skin, or other signs of aging^[8]

Laboratory Tests

• Blood tests: Evaluate hormone levels, nutritional deficiencies, or underlying medical conditions that may contribute to appearance concerns
• Allergy tests: Determine if any allergies or sensitivities are causing skin reactions or other appearance-related issues
• Skin biopsy: In cases of suspected skin conditions or abnormalities, a small sample of skin may be taken for further analysis^[9]

Diagnostic Imaging

• Dermoscopy: A non-invasive imaging technique used to examine the skin and identify any abnormalities or changes in pigmentation
• Ultrasound: Can be used to assess the underlying structures of the skin, such as the presence of cysts or tumors
• MRI or CT scan: These imaging modalities may be used to evaluate the underlying structures and identify any abnormalities that may contribute to appearance concerns^[10]

Other Tests

• Psychological assessment: If body dysmorphic disorder or other mental health conditions are suspected, a psychological evaluation may be necessary
• Consultation with specialists: Depending on the specific concerns, a referral to a dermatologist, plastic surgeon, or other specialists may be recommended

Follow-up and Patient Education

• Provide the patient with a clear understanding of the diagnostic findings and their implications
• Discuss the available treatment options and their potential benefits and risks
• Address any concerns or questions the patient may have
• Schedule follow-up appointments to monitor progress and adjust treatment plans as needed

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for concerns about appearance:

1. Topical retinoids (e.g., Tretinoin, Adapalene):
   • Cost: $10-$100 per tube
   • Contraindications: Pregnancy, breastfeeding, hypersensitivity to retinoids
   • Side effects: Skin irritation, dryness, redness
   • Severe side effects: Severe skin reactions, allergic reactions
   • Drug interactions: None significant
   • Warning: Avoid sun exposure and use sunscreen
2. Topical corticosteroids (e.g., Hydrocortisone, Betamethasone):
   • Cost: $10-$50 per tube
   • Contraindications: Skin infections, hypersensitivity to corticosteroids
   • Side effects: Skin thinning, discoloration, acne
   • Severe side effects: Adrenal suppression, allergic reactions
   • Drug interactions: None significant
   • Warning: Avoid long-term use and use as directed
3. Oral antibiotics (e.g., Doxycycline, Minocycline):
   • Cost: $10-$100 per month
   • Contraindications: Pregnancy, breastfeeding, hypersensitivity to antibiotics
   • Side effects: Upset stomach, diarrhea, photosensitivity
   • Severe side effects: Severe allergic reactions, liver toxicity
   • Drug interactions: Oral contraceptives, antacids
   • Warning: Use with caution in children and avoid sun exposure
4. Antifungal medications (e.g., Clotrimazole, Terbinafine):
   • Cost: $10-$50 per tube
   • Contraindications: Hypersensitivity to antifungals
   • Side effects: Skin irritation, burning, itching
   • Severe side effects: Severe allergic reactions
   • Drug interactions: None significant
   • Warning: Use as directed and complete the full course of treatment
5. Hormonal therapy (e.g., Oral contraceptives, Spironolactone):
   • Cost: $10-$50 per month
   • Contraindications: Pregnancy, breastfeeding, history of blood clots
   • Side effects: Nausea, breast tenderness, mood changes
   • Severe side effects: Blood clots, liver problems
   • Drug interactions: Antibiotics, antifungals
   • Warning: Regular monitoring of blood pressure and hormonal levels

Alternative Drugs:

• Antioxidant supplements (e.g., Vitamin C, Vitamin E): Can help improve skin health and reduce signs of aging. Cost: $10-$30 per bottle.
• Hair growth supplements (e.g., Biotin, Saw palmetto): May promote hair growth and reduce hair loss. Cost: $10-$50 per bottle.
• Skin lightening creams (e.g., Hydroquinone, Kojic acid): Can help reduce hyperpigmentation and improve skin tone. Cost: $10-$50 per tube.
• Anti-aging creams (e.g., Retinol, Peptides): May help reduce wrinkles and improve skin elasticity. Cost: $10-$100 per jar.
• Oral collagen supplements: Can help improve skin elasticity and reduce signs of aging. Cost: $20-$50 per bottle.

Surgical Procedures:

• Cosmetic surgery: Various procedures, such as facelifts, breast augmentation, or liposuction, can address specific appearance concerns. Cost: Varies depending on the procedure, ranging from $3,000 to $15,000 or more.
• Hair transplant: In cases of significant hair loss, hair transplantation can restore hair growth. Cost: $4,000 to $15,000 or more.

Alternative Interventions

• Acupuncture: May help improve blood flow and reduce pain. Cost: $60-$120 per session.
• Chelation therapy: Controversial treatment involving the administration of chelating agents to remove heavy metals from the body. Cost: $75-$150 per session.
• Hyperbaric oxygen therapy: Involves breathing pure oxygen in a pressurized chamber to increase oxygen delivery to tissues. Cost: $200-$300 per session.
• Herbal supplements: Some herbs, such as garlic and ginkgo biloba, may have potential benefits for improving skin health. Cost: Varies depending on the specific supplement.
• Microneedling: A procedure that uses small needles to stimulate collagen production and improve skin texture. Cost: $100-$500 per session.

Lifestyle Interventions

• Healthy diet: Consuming a balanced diet rich in fruits, vegetables, and lean proteins can promote overall skin health. Cost: Varies depending on dietary choices.
• Regular exercise: Engaging in regular physical activity can improve blood circulation and contribute to a healthy appearance. Cost: Varies depending on the chosen exercise regimen.
• Adequate sleep: Getting enough sleep can help rejuvenate the skin and reduce signs of fatigue. Cost: None.
• Stress management: Practicing stress-reducing techniques, such as meditation or yoga, can improve overall well-being and contribute to a healthier appearance. Cost: Varies depending on chosen methods.
• Sun protection: Using sunscreen and avoiding excessive sun exposure can help prevent skin damage and premature aging. Cost: Varies depending on the chosen sunscreen product.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions. It is recommended to consult with healthcare professionals for personalized advice and cost estimates.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Concern about appearance effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Concern about appearance. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Phillips, K. A. (2005). The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. Oxford University Press.
2. Gupta, M. A., & Gupta, A. K. (2013). Evaluation of cutaneous body image dissatisfaction in the dermatology patient. Clinics in Dermatology, 31(1), 72-79.
3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
4. Veale, D., & Neziroglu, F. (2010). Body Dysmorphic Disorder: A Treatment Manual. John Wiley & Sons.
5. Monzani, B., Rijsdijk, F., Anson, M., Iervolino, A. C., Cherkas, L., Spector, T., & Mataix-Cols, D. (2012). A twin study of body dysmorphic concerns. Psychological Medicine, 42(9), 1949-1955.
6. Wilhelm, S., Phillips, K. A., & Steketee, G. (2013). A Cognitive-Behavioral Treatment Manual for Body Dysmorphic Disorder. Guilford Press.
7. Dufresne, R. G., Phillips, K. A., Vittorio, C. C., & Wilkel, C. S. (2001). A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice. Dermatologic Surgery, 27(5), 457-462.
8. Sarwer, D. B., & Spitzer, J. C. (2012). Body image dysmorphic disorder in persons who undergo aesthetic medical treatments. Aesthetic Surgery Journal, 32(8), 999-1009.
9. Gupta, M. A., & Gupta, A. K. (2013). Evaluation of cutaneous body image dissatisfaction in the dermatology patient. Clinics in Dermatology, 31(1), 72-79.
10. Gentile, B., Weaver, A., Knutson, K. L., & Kales, H. C. (2017). A review of neuroimaging studies of body dysmorphic disorder. International Review of Psychiatry, 29(2), 162-171.