Introduction: Stretch marks occur due to the rapid stretching of the skin, which is typical in pregnancy. Several topical treatments to prevent them have been studied.
Objective: To evaluate the effectiveness of a topical formulation (lactic acid and sodium lactate in an emulsion with caprylic and capric acids’ triglycerides) in the prevention of stretch marks.
Methods: Seventy-five pregnant women aged 18-40 were assessed. The treated area was the abdomen and the control area was the inner forearm, with and without the application of the tested product. Softness, hydration, and elasticity – and biophysical measurements for hydration and elasticity – were evaluated.
Results: Of the 52 women who completed the study, 9.6% presented stretch marks in the treated abdominal area. There was a significant improvement in all clinical parameters assessed (p < 0.001). There was a significant improvement – compared the control area – in the instrumental measurements of hydration and elasticity in the abdomen. A significant improvement was also verified in the treated forearm area compared to the untreated forearm area for both parameters evaluated (p = 0.001).
Conclusions: The formulation improved the skin’s elasticity and hydration, reducing the striae incidence more than previously reported in the literature.

Keywords: STRIAE DISTENSAE; PREGNANCY; RELAXIN.

Pyogenic granuloma is a common vascular proliferation that can be found on skin and mucous membranes. Its clinical presentation is that of a nodular, friable and erythematous lesion, with fast growth history. The nail bed pyogenic granuloma is generally related to onychocryptosis and trauma, being very painful in that site. There are several treatment options, including surgical excision, cryotherapy, electrocautery, curettage, lasers, application of trichloroacetic acid, imiquimod and microembolization. The present study reports a case of bilateral pyogenic granuloma in the halluces with exuberant growth, leading to the occlusion of the nail plate. The surgical excision of the lesion was performed with good cosmetic results.

Keywords: PYOGENIC GRANULOMA, SURGERY, TRICHLOROACETC ACID, CRYOTHERAPY.

Neurofibromatosis type 1, also known as von Recklinghausen neurofibromatosis, is an autosomal dominant disorder that affects 1 in 3,000 newborns. Approximately 50% of neurofibromatosis type 1 patients have no family history of the disease. The tongue, the alveolar ridge of the buccal mucosa, gums, lips, palate, floor of the mouth, and pharyngomaxillary fossa can be affected by tumors associated with this condition; the tongue is the most common site. We report the case of a 29-year-old female patient with neurofibroma in the tongue, highlighting the possibility of disease manifestations in the oral cavity and differential diagnoses.

Keywords: NEUROFIBROMATOSIS 1; NEUROFIBROMA, PLEXIFORM; NEUROFIBROMA; TONGUE NEOPLASMS.

Summary: Multiple cutaneous miliary osteoma is a rare condition characterized by ectopic bone tissue in the dermis and/or hypodermis. It usually occurs on the face, in individuals of 17 to 79 years old. Its etiology is still unknown. The present article reports the case of a female patient affected by a hardened, poorly delimited, papular plaque of dark brown hue and irregular surface, affecting the malar and mentonian regions. The patient sought medical care two years before the publication of this study, describing untreated acne since the age of 16. The papular plaque was composed of hyperchromic papular nodular lesions – some with white-yellowish hue. The diagnosis was confirmed histopathologically. Satisfactory therapeutic results were achieved with the use of 0.1% tretinoin cream.

Keywords: OSTEOMA; DECALCIFICATION, PATHOLOGIC; OSSIFICATION, HETEROTOPIC.

Introduction: In vivo confocal microscopy is an auxiliary non-invasive diagnostic method used in the diagnosis of hyperpigmented lesions in scars. Objectives: To evaluate hyperpigmentation in the scars of benign and malignant melanocytic lesions through confocal microscopy examination. Methods: Clinical, dermoscopic, and confocal microscopy images of fourteen patients with hyperpigmentation in adequately treated melanoma scars and in excised melanocytic nevi, were evaluated. Results: Among the eight patients with hyperpigmentation in melanoma scars, four showed no suspicious structures after confocal microscopy examination and four showed suspicious structures. Among the six patients with hyperpigmentation in areas where melanocytic nevi had been excised, three had atypical structures, such as dendritic cells and non demarcated papillae. Patients with suspicious structures underwent histological examination, with one case of hyperpigmentation in a lentigo maligna scar evidencing recurrence. Conclusions: The examination method allowed for the avoiding of biopsy in confirming the diagnosis in six of the fourteen patients. The finding of cells with dendritic or pagetoid pattern in the confocal microscopy examination means a diagnostic challenge, for it can indicate melanocytes or Langerhans cells in the spinous layer. Therefore, lesions that have such structures must be removed for histology and differential diagnosis.

Keywords: MELANOMA, NEVUS, DERMOSCOPY, CONFOCAL MICROSCOPY.

Introduction: The beauty industry in Brazil ranks third in the world by size, second only to those of the U.S. and Japan. Paradoxically, the vast majority of studies on aesthetic treatments for the skin do not demonstrate a corresponding knowledge of the industry by the relevant population. Contemporary women, with their increasingly strong role in society, are the engine that drives the growth of the beauty and aesthetics industry. Objectives: To obtain data related to the population's knowledge of cosmetic dermatology treatments. Methods: A descriptive, multicentric study was carried out in the Brazilian states of São Paulo, Rio de Janeiro, and Santa Catarina with 600 women between the ages of 18 and 70 years old. Results: The majority of the target population wants to correct skin imperfections, however there is great suspicion about the effectiveness of the treatments available. The dermatologist's practice is not the main source of information for the interested audience. Conclusions: The consumer profile in the beauty market undergoes constant changes and to understand the public's knowledge, concerns, and challenges linked to these issues is key to allowing discussion with, and educating patients about the ever-expanding cosmetic dermatology field.

Keywords: ESTHETICS, BEAUTY CULTURE, LASERS, BOTULINUM TOXINS, SKIN CREAM.

Introduction The pigment mainly responsible for the color of the skin, melanin is directly influenced by exposure to sunlight. Objective: The present study assessed the effects of solar radiation on the levels of melanin in areas exposed and not exposed to the sun, taking into consideration the seasonality of exposure. Methods: Melanin levels were evaluated on the forehead, sacral region, and forearm, in the post-summer and post-winter periods, using spectrophotometry. Results: The levels of melanin after winter were lower than those after summer in the forehead (168.1 vs. 177.0), sacral region (132.0 vs. 140.4), and forearm (218.7 vs. 260. 4), with a statistically significant reduction only in the forearm (p<0.0001).Additionally, erythema was significantly less intense in the forearm and forehead (p<0.0001 and p=0.002) after winter than after summer. Conclusion: The significant reduction of melanin levels in the forearm after winter reinforces the influence of seasonality on skin pigmentation changes to body areas exposed to the sun without protection.The small variation in the levels of melanin found in the unexposed area (sacrum) confirms that the effect of exposure to the sun on the levels of melanin is predominantly local. Increased production of melanin is directly related to local exposure to UV rays.

Keywords: MELANINS; ERYTHEMA;SOLAR RADIATION; PIGMENTATION.

Introduction: Acne is one of the most prevalent skin conditions, representing a constant challenge to dermatologists, especially in severe cases as nodulocystic acne, which can be resistant to medicament based treatment. Traditional therapy includes topical and oral drugs that are not always effective and often lead to bacterial resistance and side effects. The use of lasers in the treatment of inflammatory acne has increased lately due to the ease, clinical efficacy, and minimal side effects of this type of therapy. Objective: To evaluate the effects of fractional laser in patients with nodulocystic acne resistant to treatment with isotretinoin. Methods: Application of laser therapy sessions with Nd:YAP in 9 patients. Assessment of the degree of patient satisfaction and comparison of photographs taken before and after treatment by dermatologists not linked to the study. Results: Average reduction of 65% in inflammatory lesions, satisfaction of all patients who underwent treatment, and approval in the assessment carried out by dermatologists. Conclusions: The fractional Nd:YAP laser was proven effective in the treatment of inflammatory acne and may represent a new therapeutic option for this pathology, especially for patients who do not respond to conventional treatment.

Keywords: ACNE VULGARIS; LASERS; LASER THERAPY.

Extramammary Paget's disease is a rare cutaneous neoplasm typically occurring in the vulva of Caucasian women after menopause. Clinically, the most common symptom is pruritus, when an erythematous, desquamative and eczematous lesion can be observed. Due to the rarity and nonspecific appearance of the disease, it can be confused with other dermatological conditions, delaying diagnosis. The present case demonstrates a form of vulvar extramammary unilateral Paget's disease confirmed by anatomical pathologic and immunohistochemical study. The standard treatment used for the disease in this case was surgical and the patient underwent complete excision of the lesion, with continued monitoring every six months.

Keywords: GENITAL NEOPLASMS, FEMALE; VULGAR NEOPLASMS; VULVAR DISEASES; PAGET DISEASE, EXTRAMAMMARY.

True gynecomastia is a benign proliferation of the glandular tissue of the male breast. In general, management is conservative, however if there is development of fibrosis after the inflammatory phase, surgery is recommended. The present article describes a case of true gynecomastia with symmetrical enlargement of the breasts since adolescence. In light of this diagnosis, corrective surgery was performed with tumescent anesthesia and exeresis in block of the mammary gland.

Keywords: GYNECOMASTIA; AMBULATORY SURGICAL PROCEDURES; DERMATOLOGY; ANESTHESIA, LOCAL.

Introduction: The skin is the largest organ of the human body and constitutes a covering layer that has many essential functions such as defense, sensorial, thermoregulatory, and aesthetic. Therefore, maintaining its integrity is extremely important for the homeostasis of the organism. Objective: To evaluate the efficacy and safety of a cutaneous moisturizer that, in addition to traditional substances, contains in its composition other ingredients capable of stimulating the function of the aquaporins. Methods: One hundred volunteers were clinically evaluated through medical examination and subjective self-evaluation, regarding the efficacy and safety of the product. Of these, 30 also underwent instrumental analysis through corneometry (assessment of the skin's hydration), pH metry (measurement of the skin's pH) and TEWLmetry (assessment of TransEpidermal Water Loss). Results: During a 90-day study, all efficacy variables subjectively analyzed showed clinical improvement (dryness, hydration, softness, desquamation, and itching). In the analysis of objective variables, it was observed that the corneometry measurements showed a significant increase in skin hydration. Conclusion: With the present study's clinical outcomes, the test product was proven effective for having significantly increased skin hydration (according to corneometry) and extremely efficient for its action on the signs and symptoms of skin xerosis (according to theassessment of the physiciansand volunteers).

Keywords: HYDRATION, DESICCATION, AQUAPORINS.

Ascher syndrome (AS) is a rare disorder of unknown etiology characterized by the presence of double upper lip, blepharochalasis and nontoxic goiter (complete AS). The nontoxic goiter is present in 10-50% of cases (incomplete AS). Trauma, hormonal dysfunction, autosomal dominant inheritance, defects in elastic fibers and allergy are possible causes. Surgery is indicated due to the compromise of facial aesthetics, trauma, or visual difficulty, and to restore the patient's quality of life. The present article reports the case of a patient with a double and blepharochalasis lip, diagnosed as a bearer of the incomplete Ascher syndrome, and describes the adopted conduct.

Keywords: BLEPHAROPLASTY ; BLEPHAROPTOSIS; LIP

Introduction: The dorsum of the hands is a visible part of the body and needs special attention regarding rejuvenation treatments. The combination of different techniques in this area is important to increase the effectiveness of the treatments.
Objective: This study was aimed to evaluate the clinical efficacy of a fractional non-ablative laser (1,340nm Nd:YAP) combined with intense pulsed light (IPL) for rejuvenating the hands.
Methods: A prospective comparative study evaluated 11 patients complaining of aging on hands, for 90 days. Two sessions were carried out with a two-week interval using IPL and 1,340nm Nd:YAP laser. The left hand was treated with 1,340nm Nd:YAP laser associated with IPL and the right hand with isolated IPL. The improvement was rated using scores from 1 to 4, evaluating the parameters: wrinkles, pigmentation, brightness, keratosis and overall rejuvenation observing the elasticity and filling of visible structures such as bones, tendons and vessels.
Results: By analyzing the frequencies of the categories of the variables, it was possible to observe that there was a higher frequency of improvement in the left hand. For the comparative analysis of the studied variables, the mean value of each variable computed for each hand, evidenciated that the variable overall rejuvenation and the left hand showed more marked improvements for the studied characteristics. Ten among 11 patients had a higher satisfaction degree with the combined treatment, with absence of significant adverse effects.
Conclusion: The association of 1,340nm laser to the IPL was shown to be safe and more effective than isolated intense pulsed light in the rejuvenation of the hands.

Keywords: LASERS; REJUVENATION; HAND

Introduction: Cryosurgery is a safe and effective treatment modality that uses liquid nitrogen for tissue destruction.
Objective: To demonstrate the effectiveness of cryosurgery in the treatment of hypertrophic granulation tissue in cutaneous wounds.
Methods: Cutaneous wounds with hypertrophic granulation tissue were treated with the nitrogen spray applied from a distance of 5cm from the area to be treated, at a 90º angle. The freezing time was two 5-second cycles and the number of sessions ranged from 1 to 3. The assessments of results were based on weekly clinical and photographic comparisons, as well on the measurement of the wound's and hypertrophic granulation tissue's areas using a planimeter, up until the healing process was completed. The results were statistically analyzed.
Results: Twenty patients with cutaneous wounds located on the head, trunk and limbs were treated. The average weekly percentage reduction compared to the baseline area was 32.5%. The results were statistically significant.
Conclusions: Cryosurgery is a practical, cost effective and non-invasive method and can be indicated for the treatment of hypertrophic granulation tissue in cutaneous wounds.

Keywords: GRANULATION TISSUE; CRYOSURGERY; THERAPEUTICS

INTRODUCTION: Vitiligo is a hypopigmented disorder characterized by irregular loss of of the skin pigmentation. Current therapeutic modalities focus on increasing melanin production and modulating immune system responses. The use of some combined topical agents, in appropriate concentrations, is a possibility for the treatment of such hypopigmentation disorders.
OBJECTIVE: To follow-up patients who used a combination of creams in the experimental times of 6 and 14 months and to determine the effectiveness of the formulation.
METHODS: Forty-one patients with generalized stable vitiligo participated in the study. Patients applied a cream containing acetyl hexapeptide-1, mometazone furoate and dihydroxyacetone. The sites of the lesions included eyelids, forehead, face, neck, fingertips, hands, feet and legs. The variations in the treated patches were evaluated by dermatologists at each experimental visit. The percentage of repigmentation was evaluated after 6 months.
RESULTS: After 6 months of treatment, 8 patients (19.51%) had an excellent response to treatment, while a good response was observed in 19 patients (46.34%), moderate response in 10 (24.39%), and unsatisfactory in 4 (9.75%). Eyelids, face and forehead presented the best rate of repigmentation, while fingertips response was generally unsatisfactory.
CONCLUSIONS: The data support the efficacy of the new cream evaluated by the present study.

Keywords: Skin Pigmentation; Skin Cream; Vitiligo

Onychomatricoma is a tumor of the nail matrix with well-known clinical features; however, sometimes underdiagnosed. It is often mistaken for onychomycosis due to thickening of the nail plate. dermoscopy of the plate and its free margin allows the visualization of important features for the diagnosis, many times not seen with the naked eye.

Keywords: Dermoscopy; Nail Diseases; Nails/Pathology; Neoplasms

The preservation of the surgical margins marking is essential during Mohs micrographic surgery. However, skin degermation during antisepsis and the use of gauze during local anesthesia often remove these markings. The use of the protective film Cavilon^® 3M to fix the marking pen ink was effective in preserving the surgical map, allowing an accurate removal of the surgical specimen.

Keywords: Mohs surgery; Carcinoma, Basal cell; Carcinoma, Squamous cell; Excision Margins

Extramammary Paget’s disease (EMPD) is a rare malignancy and is quite difficult to diagnose. We report a case of a 51-year-old female patient with perianal EMPD. Because experience with this disease is still very limited, we searched international databases for similar publications. After consultation with an oncologist, the treatment was wide excision without adjuvant therapy. This treatment option was curative.

Keywords: Paget Disease, Extramammary; Surgery, Plastic; Anal Gland Neoplasms.

Esthetic dermatology is a growing field, and different noninvasive therapies are gaining attention. The objective of this narrative review was to update current evidence-based knowledge about recombinant enzymes. The PubMed, SciELO, Cochrane Central, and Imbiomed databases were searched for meta-analyses, systematic reviews, randomized controlled clinical trials, observational registries, and preclinical data published in English, Spanish, and Portuguese. Effectivity, safety, and tolerability of recombinant hyaluronidases, lyases, collagenases, and lipases, including their combinations, were evaluated and confirmed in diverse indications. Further research could increase current knowledge on this constantly developing and promising therapeutic area.

Keywords: Liases; Colagenase microbiana; Hialuronoglucosaminidase; Lipase.

The clinical use of combined technologies has been increasing to address the effects of skin aging on the face and other areas of the body. Poly-L-lactic acid is a biocompatible, semipermanent synthetic filler used for volume enhancement through neocollagenesis induction by fibroblast activation. Similarly, energy-based technologies, such as high-intensity focused ultrasound and microneedling radiofrequency devices, promote fat reduction and collagen contraction by heating the deep dermis. This article presents expert panel recommendations and a literature review on the topic.

Keywords: Polylactic Acid-Polyglycolic Acid Copolymer; Radiofrequency Therapy; Collagen Type I; Collagen Type III; Adipose Tissue.