Dermatology Online Journal

Alternative uses of a curette
Chung-Yin Stanley Chan MD, Rosella D Creed MD, John C Browning MD, Sylvia Hsu MD
Dermatology Online Journal 13 (3): 7

Department of Dermatology, Baylor College of Medicine, Houston, Texas

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The Use of a non-disposable curette to extract milia

Milia are very common, often located around the eyelids and cheeks, and create cosmetic concern for patients. Milia can be treated by destruction or surgical evacuation. Destructive techniques include laser ablation, electrocautery, and very low current electrodesiccation [1, 2]. These techniques can be time consuming, cumbersome, and expensive for the patient. Milia can also be treated by incising the overlying epidermis with a needle, scalpel, or lancet and expressing the cyst contents with a comedone extractor [3, 4]. This method is satisfactory, however, comedone extractors are not always readily available. We suggest a technique for the treatment of milia that is efficient and the tools readily available.

We use an 18-gauge sterile, hypodermic needle and the backside of a non-disposable curette to treat milia. The needle is used to make a superficial epidermal defect over the lesion and the backside of a steel curette is then used to apply mild, lateral pressure to the milium. As the curette is drawn across the milium, the keratin core is easily expressed through the epidermal defect. (Fig. 1) The curette is then cleaned and autoclaved before the next use.

Milia can be treated effectively and safely using the backside of a curette. Curettes are a basic a surgical instrument in the dermatologist's office and are readily available. They are a familiar tool, facilitating the efficient removal of milia. They eliminate the risk of scalpel blades in evacuating milia. Furthermore, milia can be easily treated at the same time as other dermatologic procedures requiring a curette.

Figure 1	Figure 2
Figure 1. Back side of curette being used to extract a milium Figure 2. Blunt stainless steel curette being used to obtain fungal scraping

The use of a non-disposable curette in obtaining scale for KOH examination in a patient with suspected dermatophyte infection

Dermatophyte infections of the skin, nails, or hair are frequently encountered in the dermatology clinic and can sometimes be difficult to differentiate from other skin conditions with epidermal scale. KOH microscopy is often used in the clinic to aid in the diagnosis. It is popular because of its reliability, convenience, and cost-effectiveness. However, one drawback of the procedure is that a scalpel blade or razor blade is typically used to obtain the scale. This poses a risk of laceration to patients, particularly with children and anxious patients. Alternative ways of obtaining samples, such as vinyl adhesive tape, have been studied, [5] but scraping continues to be a widely used method because of its simplicity. One alternative to the traditional scalpel blade used in scrapings is the blunt non-disposable curette, which is available in most dermatology clinics. Curettes are commonly used during skin procedures, but non-disposable curettes become difficult to use with time because they are often dull. Ideally, they should be re-sharpened once a year, [6] but rarely does this occur in most clinics. In our clinic we use the dull stainless steel curettes to obtain fungal scrapings from patients with suspected dermatophyte infections without the risk of laceration that the traditional scalpel blades pose.

In our clinic a blunt, reusable stainless steel curette is used. We scrape the suspicious skin lesion several times with the curette on to a glass slide, just as we would do with a traditional blade, to obtain the scale for KOH microscopy (Fig. 2). The curette is then cleaned and autoclaved before the next use.

Besides the ease in obtaining scale that this technique provides, we also find that it relieves anxiety in patients who might otherwise become concerned at the sight of a scalpel blade. This technique is also useful in children who may move during the procedure and possibly suffer a laceration if a traditional blade is being used. In using this technique, we make use of the curettes in our clinic that are no longer suitable to be used for standard curettage.

The use of a disposable curette to obtain a skin specimen in tight spaces

Despite using a curved razor blade, it is often difficult to perform a shave biopsy in small spaces, such as the outer ear canal, the umbilicus, and the medial canthus. In our practice, we find that a sharp disposable curette works very well in getting into those small spaces to perform a skin biopsy.

References

1. Leshin B and Whitaker DC. Epidermal tumors. In: R.K. Roenigk and H.H. Roenigk's Jr., editors. Roenigk and Roenigk's dermatologic surgery: principles and practice. New York: Marcel Dekker, 1989. pp. 551-559.

2. Parlette HL. Management of cutaneous cysts. In: R.G. Wheeland, editor, Cutaneous surgery. Philadelphia: Saunders, 1994. pp. 651-652.

3. Thami GP, Kaur S, Kanwar AJ. Surgical Pearl: Enucleation of milia with a disposable hypodermic needle. J Am Acad Dermatol. 2002 Oct;47(4):602-3. PubMed

4. Bhawan J and McGillis ST. Cysts of epithelial adnexal origin. In: Arndt KA, Leboit PE, Robinson JK, Wintroub BU, eds. Cutaneous Medicine and Surgery. Philadelphia: W.B. Saunders Company, 1996. pp 1450-1463.

5. Miranda MF, Silva AJ. New uses of vinyl tape for reliable collection and diagnosis of common superficial mycoses. Skinmed. 2003; 2:156-8. PubMed

6. Bennett RG. Fundamentals of Cutaneous Surgery. St. Louis: CV Mosby; 1988. 532-3.

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