Introduction: The photodynamic therapy (PDT), using 5-aminolevulinic acid (ALA) associated to IPL has become an issue of great interest to treat photodamaged skin with AKs. Objective: To determine the long term efficacy of 5-ALA+IPL in the treatment of the photodamaged skin with AKs, comparing to IPL alone. Material and methods: Nine patients with photodamaged facial skin were enrolled in this study. Two sessions of ALA-IPL were done on a split face and IPL alone on the other side, with a month interval. Results: AK lesions clearance was observed only on the area treated with ALAIPL (62.9%) after 3 months supervision. Recurrence of the improved lesions (70.6%) was observed in 12 month follow up. Improvement of melanoses, telangiectasia and wrinkles were observed on both sides, but more evident on the side treated with ALA-IPL. Conclusion: ALA-IPL brings improvement in photodamaged skin, including in AK lesions, what was not observed with IPL alone. Nevertheless, a long time of supervision is necessary to confirm the efficacy of the therapy.

Keywords: PHOTOCYNAMIC THERAPY, AMINOLEVULINIC ACID, REJUVENATION

Introduction: Melasma is an acquired and progressive hyperpigmentation of photoexposed areas. For being a recurrent and refractory dermatosis, its treatment continues to be a challenge.Objective: To evaluate the efficacy and security of the Skin Whitening Complex in the treatment of the facial melasma,and to compare it to the hydroquinone. Materials and methods: Double-blind Comparative study of 13 women bearers of melasma. All received two different formulations, labelled as “right side of the face" and left "side of the face". The formulations were applied twice a day for 90 consecutive days. Only the pharmacist responsible for the formulations had knowledge of their content. The tests of Wilcoxon and 2 of McNemar-Bowker were employed in the statistical analysis. Results: Ten of the 13 patients presented the global clinical improvement of the melasma. Four patients presented total improvement and six (p = 0004) presented partial improvement in the hemiface treated with hydroquinone 4%. In the hemiface treated with Skin Whitening Complex 5%, the improvement was total in two patients, and partial in six (p = 0007).There were no statistically significant differences between the two treatments (p = 0223). Conclusions: Although the treatment with hydroquinone 4% presents better clinical results, there were no statistically significant differences between the two treatments. Skin Whitening Complex 5% has shown efficient and safe in the treatment of the melasma.

Keywords: MELANOSIS/THERAPY, HYPERPIGMENTATION, HYDROQUINONES

Topical photodynamic therapy is an established method of treating some types of non-melanoma skin cancers. Modifications to the standard protocol have recently been adopted that increase its therapeutic efficacy. This case study describes two female patients with multiple actinic keratoses who were simultaneously treated with the standard and modified protocols for methyl aminolevulinate and fractional radiofrequency combined with ultrasound in two different, symmetrically located, affected areas. This study’s objective is to evaluate the effectiveness of the transepidermal application of drugs in photodynamic therapy combined with new methods such as the proposed treatment.

Keywords: PHOTOCHEMOTHERAPY, AMINOLEVULINIC ACID , KERATOSIS ACTINIC, ABLATION TECHNIQUES

Introduction: Gynoid lipodystrophy may affect up to 95% of post-pubertal women. Treatments are aimed at improving the skin's appearance. Invasive procedures have long recovery times and may cause complications. Non-invasive methods, such as radiofrequency, are increasingly becoming popular. Objective: To evaluate unipolar radiofrequency's safety and efficacy in the treatment of gynoid lipodystrophy. Methods: Eight women with gynoid lipodystrophy grades II and III, in the gluteus region and thighs, underwent treatment with four sessions of unipolar radiofrequency at fortnightly intervals. Clinical-photographic, laboratory, and ultrasound evaluations of the patients were performed before, during, and 30 days after the end of the last session. Results: Improvement in the sagging of the skin was clinically observed in all treated patients. Four patients also had improvement in morphology. The ultrasound evaluation showed a statistically significant increase (p <0. 05%) in dermal thickness after the treatment in seven of eight patients. There were no laboratory abnormalities. Conclusions: Unipolar radiofrequency is an effective and safe method in the treatment of gynoid lipodystrophy in the gluteus region and thighs.

Keywords: CELLULITIS, ULTRASONOGRAPHY,TREATMENT OUTCOME

Topical photodynamic therapy (TPT) is a well-established therapeutic modality in the treatment of non-melanoma skin cancer. It is based on light-activated chemical reaction in the presence of oxygen. In recent years, this therapy has been used in cosmiatric dermatology, and studies on the mechanisms of TPT action in dermal remodeling of the photodamaged skin have been reported. This review addresses procedures with different light sources and photosensitizers, as well as clinical and collateral effects of this therapy in the treatment of photoaging.

Keywords: PHOTODYNAMIC THERAPY, PHOTOSENSITIZER, PHOTOAGING, REJUVENATION, COLLAGEN, DERMIS

Conventional Photodynamic Therapy (c-PDT), approved in Brazil since 2006 for non-melanoma skin cancer, is a well-established treatment worldwide. The evolution of PDT, in the last 10 years, includes its use in other indications, its association with techniques that promote increased photosensitizer permeation and use of daylight instead of artificial light. This new method, which uses daylight, was approved in Brazil in 2014 for the treatment of actinic keratosis and field cancerization, with the benefit of maintaining c-PDT's efficacy without adverse events.

Keywords: PHOTOCHEMOTHERAPY; LIGHT; SKIN NEOPLASMS; KERATOSIS, ACTINIC

Introduction: Daylight photodynamic therapy (PDT) is a recent therapeutic modality for actinic keratoses and field cancerization. The association of techniques to PDT for transepidermal delivery of the photosensitizer is a new option for the treatment of photodamaged skin with actinic keratosis.
Objective: To evaluate the clinical efficacy and the adverse events of photodamaged skin treatment through the transepidermal drug delivery and daylight-PDT.
Methods: Seven patients with phototype II and III, aged 60-73 years, with photodamaged skin, with and without actinic keratoses, were submitted to the association of methods (CO₂ laser, micro-abrasion or microneedling) and daylight-PDT. Two sessions were performed with two weeks intervals. MAL was applied after micro-abrasion and after CO₂ laser, but before the micro-needling. All patients were exposed to daylight for a period of 2 hours. Clinical evaluations were performed before, 15 days and three months after treatment.
Results: CO₂ laser associated with daylight-PDT was more effective in overall improvement of the skin (texture, pigmentation and wrinkles). Microneedling associated with daylight-PDT was effective in improving texture and pigmentation. Micro-abrasion proved to be effective when combined with microneedling. Excellent improvement of actinic keratosis lesions was achieved with all associations of techniques. Adverse events were transient and more intense with the association of CO₂ Laser.
Conclusion: Association of TDD with daylight-PDT was effective in the treatment of photodamaged skin and safe in all protocols.

Keywords: PHOTODYNAMIC THERAPY, PHOTOSENSITIZER, LIGHT, ACTINIC KERATOSIS, PHOTOAGING.

Herpes zoster outbreaks following minor procedures have been documented recently in literature. Since the use of botulinum toxin is nowadays spread in several medical areas for different purposes, it is crucial to study its side effects and complications. Literature review revealed 65 cases of zoster reactivation following minor procedures, and three cases related to BTA injections (two for facial lines treatment and one for chronic migraine). In our case, a 43 year old healthy woman had herpes zoster on the face and scalp after receiving BTA injections for cosmetic purpose, with complete recovery after anti-viral treatment.

Keywords: HERPES ZOSTER OPHTHALMICUS; HERPES ZOSTER; BOTULINUM TOXINS, TYPE A; DERMATOLOGIC SURGICAL PROCEDURES

Introduction: Photoaging and melasma are frequent dermatological complaints. Confocal reflectance microscopy (CRM) is a recent technique that can be used for diagnostic evaluation of these dermatoses.
Objectives: To evaluate the characteristics of the epidermis and dermis containing pigmentary alterations caused by photodamage and melasma with the assistance of CRM, and compare the findings linked to these changes with the perilesional region.
Methods: A pilot study was conducted with eight female individuals (aged 38 to 50 years, Fitzpatrick phototypes from II to IV) with clinical diagnoses of photodamage (n = 4) and melasma (n = 4) in the facial malar region. The perilesional and lesional regions were compared regarding the thickness of the stratum corneum and viable epidermis, the depth of the interpapillary crests, and the presence of hyper-refractive structures.
Results: The pigmentary alterations in the photodamaged skin revealed a morphological pattern — such as an increase in the depth of the interpapillary ridges in the lesion region — typical of solar lentigo. In the lesional region of volunteers bearing melasma, it was possible to observe the presence of dendritic cells in the epidermis and melanophages in the dermis. All volunteers had hyper-refractive keratinocytes in the lesional epidermis region.
Conclusions: Considering the number of patients evaluated, it was possible to characterize and compare cutaneous pigmentary alterations caused by photodamage to those cause by melasma.

Keywords: Aging; Microscopy, confocal; Diagnosis

Nevus lipomatosus cutaneous superficialis is an uncommon dermatosis in which the adipose tissue is present ectopically in the dermis.This condition is clinically divided into two variants: classical and solitary.The first is characterized by soft, pedunculated, cerebriform, skin-colored or yellowish papules or nodules, mainly involving the pelvic region.The latter is observed as a solitary or sessile papule. Treatment with surgical excision is usually enough. Nevus lipomatosus cutaneous superficialis may be associated with other conditions such as multiple lipomas, as in our case.

Keywords: Nevus; Dermis;Adipocytes; Lipoma