This letter is a reflection that arose from the lecture given by Professor Fatimata Ly, from University Cheikh Diop in Dakar (Africa) in the latest Congress of the European Academy of Dermatology and Venereology in Paris. Professor F. Ly gave the lecture "Depigmentation: when, where and how”. An even skin tone is one of the criteria for beauty. This letter does not concern those patients that come to our practices and are carefully followed and monitored by thorough dermatologists. She wants to raise attention to those that do not come to our practices, that use prescriptions given to acquaintances, or that use a dermatologist prescription indefinitely, after a single consultation. I was recently part of "discussion” forums over the internet, anonymously, of lay people on melasma. The intensity and speed of sharing of what they recommend using are impressive. They are very creative suggesting the use of products that could cause harm. Among the most used lightening products are steroids, hydroquinone, mercury and acids. There must be an awareness campaign to warn the population regarding the dangers of using skin depigmenting agents without a specific indication by the dermatologist.

Keywords: Hyperpigmentation; Melanosis; Skin Care; Skin Pigmentation; hidroquinones

The application of botulinum toxin to patients with sequelae of Bell's palsy is a beneficial adjuvant therapy for the reduction of synkinesia and facial asymmetries. Bell's palsy is the most common cause of facial nerve paralysis.After the paralysis phase of the facial muscles, the condition may evolve with facial asymmetry and synkinesia. In the treatment of synkinesia, punctual injections into the orbicularis and platysma muscles relieve the spasms. Selective application to the unaffected hemiface aims to reduce facial asymmetry and its negative social impact, with improved quality of life.

Keywords: Facial paralysis; Bell palsy; Botulinum toxins, type A; Rehabilitation; Quality of life

INTRODUCTION: Patients often request anti-aging treatments of the perioral and periorbital regions. Most of the time, it is necessary to use a combination of procedures, so the result meets the patient’s expectations.
OBJECTIVE: This is a prospective, single-center, and comparative study assessing the rejuvenation of the perioral and periorbital regions after treatment with medium depth chemical peel using phenol 88% with or without the previous application of botulinum toxin.
METHODS: Sixteen patients underwent regional peel with phenol 88%; eight received botulinum toxin application two weeks before. The assessment was conducted using standard photographs and evaluation scales by doctors and patients.
RESULTS: The overall evaluation by doctors and patients on the 45th day was considered excellent or good for all patients, with little advantage for combined treatment in the periorbital region.
CONCLUSION: Combining these two relatively low-cost procedures, often overlooked by dermatologists, resulted in a significant improvement in the changes related to aging in these areas.

Keywords: Botulinum toxins type A; Chemexfoliation; Phenol; Rejuvenation

Atrophic acne scars are persistent and undesirable sequelae that have a negative cosmetic and psychosocial impact on patients. This issue becomes more delicate when such scars are located in the presternal region due to the risk of hypertrophic scars appearing when performing these procedures in the area. The literature has long recognized the role of insulin in promoting protein and fat synthesis. Insulin properties as a growth factor to treat these sequelae seems logical and has proved cosmetically satisfying, with quality of life improvement.

Keywords: Acne Vulgaris; Atrophy; Scar; Wound healing; Injections, subcutaneous; Insulin; Ambulatory surgical procedures; Quality of life; Tissue therapy

INTRODUCTION: Rosacea is a chronic inflammatory skin disease. The intradermal application of botulinum toxin (BT) has been studied as a therapeutic option for patients who struggle to manage flushing and/or persistent facial erythema. There is no standard protocol for TB application in rosacea.
OBJECTIVE: To evaluate the effectiveness of botulinum toxin application on erythematotelangiectatic rosacea.
METHODS: Pilot study with case series. We applied intradermal TB in 10 patients with a diagnosis of rosacea and symptoms of persistent erythema and/or facial flushing. Patients received 10 to 15 injections per hemiface (1 unit of onabotulinum TB per injection) and 0 to 5 injections in the nasal region, totaling 25 to 35 units per patient.
RESULTS: Seventy-five percent of the patients presented a reduction in flush and erythema intensity. The follow-up time was three months, and no serious adverse events were observed.
CONCLUSIONS: The therapeutic arsenal to control erythema and facial flushing of rosacea, especially refractory to the usual treatment, should consider the intradermal application of TB type A.

Keywords: Erythema; Rosacea; Flushing; Botulinum toxins

BACKGROUND: The increased demand for cosmetic facial treatments is a universal reality, with Brazil being the second country in the world that performs them the most. Quality of life questionnaires can help assess results more objectively and reveal data not yet explored in the scientific literature. For this, the process of translation, adaptation and validation of questionnaires is necessary for the universalization of data.
OBJECTIVE: To translate, adapt and validate a specific questionnaire for the assessment of facial cosmetics procedures into the Portuguese language spoken in Brazil.
METHODS: After choosing the SROE (Skin Rejuvenation Outcome Evaluation) questionnaire, the translation process started. A literal translation was performed, with subsequent synthesis of the versions. After, reverse translation and final validation by a team of experts were carried out. The data obtained were statistically analyzed for validation.
RESULTS: The final version was called "Avaliação dos Resultados de Rejuvenescimento da Pele" (ARRP). The Cronbachs a resulted in values above 0.70, showing good internal consistency. The Intraclass Correlation Coefficient was 0.995 (p<0.001).
CONCLUSIONS: The values obtained validate the ARRP questionnaire, translated into Brazilian language and culture, which aims to evaluate the results and impact on the quality of life of facial cosmetics procedures.

Keywords: Cross-cultural comparison; Patient health questionnaire; Quality of life

Hormonal changes added to extrinsic exposure factors, including socio-environmental and lifestyle factors, affect the quality of life of climacteric women. Symptoms during the climacteric are variable, and most women are not aware that menopause affects the skin. Among the perceived changes, there is an increase in dryness, roughness, sagging, and atrophied skin. This article reviews the relationship between exposure and menopause, focusing on helping dermatologists to guide patients on preventive care and treatments to improve skin and quality of life in menopause.

Keywords: Menopause; Perimenopause; Postmenopause; Climacteric; Exposome; Skin aging