Introduction: Needle infi ltration of local anesthetic is a painful procedure, thus, a topical anesthetic is a comfortable alternative; however, it is difficult to deliver transcutaneous polar drugs. Iontophoresis is a noninvasive technique that uses electrical current for releasing electrically charged drugs through biological membranes. Objective: To evaluate the anesthesia induced by iontophoresis of lidocaine for a standardized painful stimulus. Material and methods: Randomized, controlled, double-blind study, involving 10 volunteers under the anesthetic effects of topical application of lidocaine gel 2% and noradrenaline 1:50,000, with or without iontophoresis of 1.85 milliamps for 13 minutes. Pain sensitivity was evaluated by the prick of a 21G needle in the arms posterior region, using a visual numerical scale. Results: Patients mean age was 50.8 ± 11.4 years. Nine of them were women. All had previously received infi ltrative anesthesia. Iontophoresis was well tolerated by volunteers. The median pain scores were 0 and 3 for the arm that received the iontophoresis and for the one that did not receive, respectively (p < 0.01). Conclusion: The anesthetic effect in the region subjected to iontophoresis suggests an effi cient and comfortable method for promoting local anesthesia in the surgical approach of pediatric, hyperalgic, or needlephobic patients.

Keywords: ANESTHESIA, LIDOCAINE, AMBULATORY SURGICAL PROCEDURES, IONTOPHORESIS

Although treating contagious molluscum with 5% potassium hydroxide solution is common, some studies challenge its efficacy. Ten patients (aged 4-13) with a total of 141 lesions were evaluated. After 28 days of treatment there were 105 lesions (75% of the initial amount), none of which achieved total resolution. Persistent lesions were curetted in up to two sessions; 28 of the 105 lesions remained after treatment. The percentages of reduced or completely resolved lesions were higher for curettage than potassium hydroxide (71% x 9%, p = 0 .01 vs. 80% x 0%, p = 0.02).

Keywords: MOLLUSCUM CONTAGIOSUM, THERAPEUTICS, CURETTAGE

Introduction: The use of exogenous pigmentation as an adjuvant therapy to Intense Pulsed Light in the treatment of melanoses is routine, nevertheless there is an absence of published comparative studies. Objective: To compare Intense Pulsed Light therapy in isolation, or combined with exogenous pigmentation in the treatment of solar lentigines on the dorsum of the hands. Methods: Twenty women (mean age = 56.5 years) with skin types from I to III, underwent three sessions of Intense Pulsed Light, with a brown makeup pencil pigment reinforcement being applied to the lesions on the right hand. The patients were queried about the degree of discomfort, swelling, crusting, and improvement experienced, their treatment of preference and which they felt provided greater effectiveness, and the incidence of side effects. Results: When assessing all three of the treatment sessions together, the median discomfort score, as well as the degree of inflammation and crusting (p < 0.01), were higher on the right hand. Regarding the subjective impression of the final result, 15 in 20 patients preferred the technique applied on the right hand, considering it more effective (p < 0.01). Eleven in 20 patients reported fewer side effects in the un-pigmented side (p = 0.12). The degree of discomfort did not correlate significantly with the preferred technique (p = 0.67). Conclusions: In this sample, there was a preference for the method with the adjuvant use of exogenous pigmentation, however the incidence of pain and side effects was higher in this group.

Keywords: MELANOSIS, HAND, PIGMENTATION, LIGHT

Introdução: actinic melanosis is a pigmentation disorder caused by the cumulative action of sunlight on the skin and its incidence increases with advancing age. Objective: Considering the lack of studies comparing agents with the same concentration, however in different vehicles, the authors compared the clinical effects of chemical peelings performed with 20% trichloroacetic acid (ATA) paste or solution in the treatment of actinic melanoses in the back of the hands. Methods: A prospective, controlled, randomized study was carried out with 15 patients bearers of bilateral actinic melanoses on the back of the hands. Three monthly sessions with 20% ATA peelings were performed with paste in one hand and solution in the other. The degree of whitening was evaluated by 13 blinded dermatologists, and patients were asked about the satisfaction and preferred method. Results: There was no preference for any of the methods used (p = 0.41), however, according to the medical evaluation, there was greater whitening with the paste (p = 0.01). Only the paste caused significant adverse effects, affecting 4/15 patients. Conclusions: Compared to the solution, when applied for two minutes in the treatment of actinic melanosis, the 20% ATA paste had greater whitening capacity, however demonstrated a tendency to cause more local adverse effects.

Keywords: TRICHLOROACETIC ACID; MELANOSIS; HAND; CHEMEXFOLIATION; SKIN PIGMENTATION

Introduction: The application of botulinum toxin in the perioral region is a minimally invasive procedure that leads to substantial improvement in the signs of aging in addition to increasing the volume of the lips. However literature on this procedure is still scarce.
Objective: To evaluate changes in shape and volume of the lips, as well as the patients' satisfaction after the application of botulinum toxin in perioral lines.
Methods: Nineteen patients underwent evaluation, photographic record and measurements following the application of botulinum toxin in the perioral region, being subsequently assessed for changes in the lips and satisfaction.
Results: Most of the patients rated their lips as moderately or significantly more attractive after the application of botulinum toxin (p = 0.039). Fifteen women deemed the changes in the lips as a major factor in the overall improvement of their faces.
Conclusions: The use of botulinum toxin in the perioral region leads to the elevation of the upper lip, causing the shortening of the philtrum and the extension of the vermilion. The application of botulinum toxin in the vermilion's border leads to the relaxation of the orbicularis muscle, favoring a more intense tonus effect arising from the upper lip lifting muscles. The patients' satisfaction with the appearance of their lips was evaluated by four additional questions (linked to the lip's shape, volume, attraction and beauty), receiving positive answers. Side effects were minimal.

Keywords: LIP; BOTULINUM TOXINS, TYPE A; BOTULINUM TOXINS

INTRODUCTION: Melasma is frequent among women, and it is associated with a significant psychosocial impact. The facial expressions recognition is a cognitive process directly related to our emotional and psychosocial status.
OBJECTIVES: This study evaluates the melasma patients' ability and healthy controls in identifying facial expressions reflecting six main emotions.
METHODS: This is a cross-sectional study, including 24 melasma patients and 24 healthy controls, matched for age. We collected demographic data, dermatology life quality index (DLQI), Hospital Anxiety and Depression Scale (HADS), and Social Phobia Inventory (SPIN). Also, we conducted a computerized facial emotion recognition test using 56 images.
RESULTS: The participants had a mean age of 39.8 (sd: 8.1), and the melasma patients reported a median of 84 months (p25-p75: 48-144) duration of the dermatosis and a median DLQI of 6 (2-10). Patients with melasma presented higher anxiety scores (9.4 [4] x 6.7 [4.3]; p=0.03) and showed higher accuracy in identifying emotions due to their greater success in recognizing fear (35 [13-52] x 13 [3-25]; p=0.03). The non-biased right answers' difference remained significant after multivariate analysis adjusted for the anxiety scores (p<0.01).
CONCLUSIONS: Women with melasma presented a higher accuracy in recognizing facial expressions of fear, suggesting differentiated brain processing of emotions in this population.

Keywords: Anxiety; Emotions; Melanosis

INTRODUCTION AND OBJECTIVE: The Campanha Nacional de Prevenção ao Câncer de Pele (National Skin Cancer Prevention Campaign), promoted by SBD, is an annual event to inform about the early diagnosis and prevention of skin cancer. Considering the participants’ profile, composed mostly of older adults, and the campaign educational goals, it's opportune to identify the proportion of people with cognitive impairment to improve communication.
METHODS: We perform a cognitive screening of 2018 Campaign participants using a "10-point cognitive screener" score. The participants included were ≥ 60 years. We excluded those who were unable to communicate or denied consenting.
RESULTS: The study interviewed 66 participants. The median age was 68 years (p25-p75:63-73), and 42 (64%) were women. Twenty-four participants (36%) had some elementary school, and 13 (20%) had a neurological or psychiatric disease. The crude and adjusted by schooling 10-CS scores had a median of 8 (6-9). Twenty-five of the interviewed patients (38%) had adjusted score below eight, indicating cognitive impairment, and six (9%) had a probable impairment. The cognitive deficit was associated with a history of neurological disease and low schooling.
CONCLUSIONS: Despite covering all ages, the campaign prioritizes the risk population, including older adults. Therefore, campaign volunteers should adapt the communication to participants’ profile.

Keywords: Dermatology; Skin Neoplasms; Disease Prevention; Mild Cognitive Impairment; Epidemiology; Early Detection of Cancer

INTRODUCTION: With the advancement of digital image analysis, predictive analysis, and machine learning methods, studies have emerged regarding the use of artificial intelligence in imaging tests such as dermoscopy.
OBJECTIVE: Construction, testing, and implementation of an artificial neural network based on characteristics of dermoscopic images.
METHODS: 1949 images of melanocytic nevi and melanomas were included, both from the authors’ files and from dermoscopic image banks available on the internet, and routines and plugins were developed to extract 58 features applied to a multilayered neural network construction algorithm. Also, 52 dermatologists assessed 40 random images and compared the results compared.
RESULTS: The training and testing of the neural network obtained a correct percentage of classification of 78.5% and 79.1%, respectively, with a ROC curve covering 86.5% of the area. The sensitivity and specificity of dermatologists were 71.8% and 52%. For the same images and a cutoff point of 0.4 (40%) of the output value, the application obtained 62% and 56% values, respectively.
CONCLUSIONS: Multilayer neural network models can assist in the dermoscopic evaluation of melanocytic nevi and melanomas regarding the differential diagnosis between them.

Keywords: Artificial intelligence; Diagnosis; Melanoma; Nevus

INTRODUCTION: Actinic keratoses are premalignant lesions with a risk of transformation to invasive squamous cell carcinoma. There is no identified correlation between clinical classification and histological grade of these lesions.
OBJECTIVES: To correlate the clinical characteristics of actinic keratoses of the forearms and back of the hands with the degree of histological atypia (Keratinocyte Intraepidermal Neoplasia); to develop and validate a clinical severity scale correlated with the histological grade of actinic keratoses.
METHODS: Cross-sectional study with 162 actinic keratoses clinically evaluated for diameter, erythema, infiltration, hyperkeratosis, and exulceration and 34 lesions with different patterns were biopsied. Clinical features were correlated with the degree of histological atypia and p53 and Ki-67 expression.
RESULTS: Only the diameter of the lesions was significantly correlated with the degree of atypia (p=0.04), and only the erythema, hyperkeratosis, and the diameter linked with the immunohistochemical markings. A clinical score including diameter, hyperkeratosis, and exulceration was developed, which associated significantly with the degree of atypia (Spearman’s Rho=0.43; p=0.01).
CONCLUSIONS: A score composed of diameter, hyperkeratosis, and exulceration correlated with the histological grade of actinic keratoses of the upper limbs was developed.

Keywords: Carcinoma in situ; Carcinoma squamous cell; Keratosis actinic; Skin diseases