Keywords: REJUVENATION; SKIN; FACIAL MUSCLES.

In search of a perfect aesthetic, facial filling procedures have been widely used. The presence of animal proteins or synthetic substances in some cutaneous fillers can cause serious allergic reactions, especially when performed by untrained professionals. There are not ideal, pure and free of side effects substances available in the marketplace. The present article is aimed at reporting a case where a facial filling was performed by a non-medical professional, resulting in foreign body reaction and severe skin infection, leading to deformities caused by the procedure carried out. The complications entailed invasive procedures for removal of the material used, and treatment with corticosteroids.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; NOSE NEOPLASMS; SURGICAL FLAPS; NASAL CARTILAGES

W-plasty is a commonly used technique in facial cosmetic surgery to camouflage the straight line of a scar into a regularly irregular pattern. It consists of excising a series of consecutive small triangles of skin on each side of the scar, and imbricating the resultant triangular flaps, producing a "zig-zag" effect. This procedure is particularly useful on long, wide, curved, contracted, or anti-tension line scars of the forehead, cheeks, chin, and nose. We report the usefulness of this technique in an unaesthetic postsurgical facial scar.

Keywords: CICATRIX; DERMATOLOGIC SURGICAL PROCEDURES; SURGICAL FLAPS; RECONSTRUCTIVE SURGICAL PROCEDURES

Introduction: Microneedling has been performed in several areas of Dermatology, including the treatment of androgenetic alopecia. However, one of its major limitations is pain, which occurs both with the use of rollers with multiple fine needles and with motorized devices equipped with microneedles.
Objective: To describe a new technique aimed at minimizing pain during the microneedling in the scalp.
Methods: An observational, prospective and comparative study of the microneedling effects was performed with a motorized device, with and without folding the skin by using the thumb and index finger of the surgeon’s non-dominant hand. This procedure was termed “pinch technique” by the authors. The pain was assessed by the patient based on a visual analogue scale, and the data analyzed with the Student’s t-test, in order to verify the existence of statistical difference between the data sets.
Results: Fourteen patients bearers of androgenetic alopecia (13 men and 1 woman) were treated. The analysis of the data on the pain reported by the patients suggested that the arithmetic mean of the data obtained from the areas where the technique was not applied was greater than that obtained in areas where the technique was employed.
Conclusions: The described technique was proven effective in reducing pain during the microneedling procedure. That outcome resulted from the alteration of the perception of pain due to the tactile stimulus and the increase in the distance of the needles regarding the galea, which is richly innervated.

Keywords: AMBULATORY SURGICAL PROCEDURES; ALOPECIA; NEEDLES

Introduction: Acne is a multifactorial disease where inflammatory lesions usually appear as papules, pustules and comedones. It is more common in people aged between 11 and 30 years, and occurs in various body sites where there are high concentrations of pilosebaceous glands. Acne has different classifications and treatments. More recently, platelet growth factors have been used as an alternative therapy for acne scars.
Objective: The present study is aimed at describing a case of nodule-cystic acne and acne scars Grades 1, 2 and 3b treated with platelet rich plasma and highlighting the effectiveness of the treatment.
Methods: Platelet rich plasma was applied for three months in the left side of the face of a patient bearing acne.
Results: In the clinical and photographic evaluations, there was improvement in the skin appearance and quality, less number of lesions and decrease of pain.
Conclusions: The present study has demonstrated the effectiveness of platelet rich plasma as a treatment for acne and resulting scars.

Keywords: PLATELET-RICH PLASMA; ACNE VULGARIS; CICATRIX

The treatment of acne scars — a common dermatological complaint and cause of anxiety for patients — is challenging, usually consisting of multiple serial methods. The authors of the present article describe a case where hyaluronic acid cutaneous filling and fractional CO2 laser were indicated, with an unusual complication occurring due to the short time interval between the applications of the techniques. The article discuses the need for a close and frank physician / patient relationship aimed at containing patient anxiety as well as studies determining the optimal time interval between therapeutic approaches in the treatment of acne scars.

Keywords: ACNE VULGARIS; LASER THERAPY; PHYSICIAN-PATIENT RELATIONS; HYALURONIC ACID; FOLLOW-UP STUDIES

Introduction: Microneedling, also known as percutaneous collagen induction therapy, is a safe and effective procedure, mostly used for rejuvenation, treatment of scars, melasma, alopecia, and other conditions, as well as for drug delivery. Despite the safety and benefits of this technique, the control of pain during the procedure is its major limiting factor.
Objectives: To assess whether the drug delivery system for topical anesthesia immediately before a microneedling session is capable of reducing the pain.
Methods: A split-face pilot study was carried out with nine consecutive cases of microneedling that had been indicated for the treatment of acne scars, rejuvenation and collagen induction. All patients underwent cleansing of the skin followed by the application of topical anesthetics on the entire face, and drug delivery with a 0.5mm roller only on the left hand side of the face. Next, all anesthetics were removed and microneedling with a 1.0mm roller was performed on both sides of the face
Results: There was a significant reduction of the pain on the left hand side of the face, where the drug delivery was carried out (p <0.01), with a mean value of 3.33 (± 1.49) on the Visual Analogue Scale as compared to the right hand side, which yielded a mean value of 5.22 (± 1.74).
Conclusion: The topical anesthetic drug delivery technique was effective and successful in reducing the pain during microneedling procedures carried out in the study’s patients group.

Keywords: anesthesics, local; collagen; scars

The dermatologist's clinical practice is based on the analysis of cutaneous lesions that is carried out mainly by clinical observation, and currently supplemented with tests such as dermoscopy and confocal microscopy. Despite its low cost, the Wood's lamp has been decreasingly used as an auxiliary diagnostic method. The authors of the present study describe several cases of use of the Wood's lamp where it provided valuable assistance to the dermatologist, aiming at encouraging the use of this device in the daily practice.

Keywords: fluorescence; diagnosis; malassezia; propionibacterium acnes; porphyrias; vitiligo; melanosis; erythrasma; corynebacterium; tinea capitis

Acne is a common condition that often results in scarring. We propose a novel treatment of acne scarring using: 1- chemical reconstruction of skin scars (CROSS), mainly with carbolic acid, 2- blunt bi-level cannula subcision, and 3- microneedling. A total of 139 patients were treated from 2017- 2018, of which 89 (64%) were Fitzpatrick Skin Types IV-VI. This triple approach to treating acne scars resulted in consistent high satisfaction from patients and photographic evidence of improvement. A combination of CROSS (to stimulate neocollagenesis), subcision (to release dermal connective tissue tethering), and microneedling (to stimulate neocollagenesis) is effective for acne scar treatment.

Keywords: Acne vulgaris; Acne keloid; Cicatrix; Cosmetic techniques

INTRODUCTION: Vitiligo is a pigmentation disorder characterized by white spots on the skin and mucous membranes. Wnt1 protein belongs to the Wnt signaling pathway. Wnt1 induction is linked with melanocyte stem cell differentiation in hair follicles on lentigo solaris, which is a hyperpigmentation skin disorder in sun-exposed area. This assumes the possibility of Wnt1 induction with NB-UVB therapy, which causes perifollicular repigmentation on vitiligo.
OBJECTIVES: To compare Wnt1 expressions in vitiligo repigmentation after NB-UVB treatment and to identify the relationship between Wnt1 expressions and vitiligo repigmentation area.
MATERIALS AND METHODS: The subjects of the study were 18 vitiligo patients. Immunohistochemical examination was conducted on vitiligo skin tissues pre- and post-phototherapy treatment twice a week for two months.
RESULTS: There were significant differences in the vitiligo lesion area between pre and post-therapy. Also, there were significant differences in Wnt1 expressions between pre and post-therapy. There was a correlation between the post-therapy Wnt1 expressions and the post-therapy vitiligo lesion area.
CONCLUSIONS: Wnt1 induction occurs in hair follicles post-NB-UVB therapy, causing pigmentation around hair follicles. Further studies are needed on the Wnt1 protein mechanism resulting in pigmentation around hair follicles.

Keywords: Hair Follicle; Melanocytes; Ultraviolet Therapy; Wnt1 Protein; Phototherapy; Vitiligo

INTRODUCTION: The inflammation may play a critical role in the development of facial acne. Pro-inflammatory mediators, such as prostaglandins and leukotriene, have been implicated in the initiation of acne.
OBJECTIVE: This study aimed to evaluate the clinical efficacy and safety of 1% diclofenac gel compare with a placebo gel in the treatment of mild to moderate acne patients in 12 weeks. Methods: A 12 weeks, randomizing, double-blind, individual and split-face comparative trial was conducted in 24 volunteers. Patients with mild to moderate acne vulgaris, aged 18 to 30 years were enrolled. They received 2.5% benzoyl peroxide with 1% diclofenac gel and 2.5% benzoyl peroxide with placebo gel apply regularly at each side of the face.
RESULTS: 24 participants with mean (SD) age of 25.92 years were enrolled in the study. Statistically significant decrease in mean of comedone lesions was observed in 1% diclofenac gel group by acne lesion count at week 12 (P <0.05) superior than placebo gel. Moreover, post inflammatory hyperpigmentation also had statistically significant decrease superior to placebo group at week 4.
CONCLUSIONS: The 1% diclofenac gel topical treatment has shown good clinical efficacy and safety in decreasing facial comedones at week 12 and post-inflammatory hyperpigmentation in 4 weeks.

Keywords: Acne vulgaris; Diclofenac; Inflammation; Hyperpigmentation

INTRODUCTION: Photoprotection is indicated to reduce the exposure to cutaneous actinic damage and it is important to prevent skin cancer. The face is the most irradiated area of the body and is also where skin cancers most commonly occur.
OBJECTIVE: To evaluate the amount of sunscreen applied and its facial coverage in patients previously diagnosed with skin cancer, treated at a Brazilian public institution.
METHODS: Quasi-experimental study involving 40 patients undergoing skin cancer follow-up. Participants were asked to apply sunscreen on their face, as usual, and the mass used was measured. After, participants were photographed under Wood's light to evaluate the homogeneity of the sunscreen´s coverage, and facial sunscreen coverage failure.
RESULTS: Fourteen (35%) participants applied an estimated amount lower than recommended (2mg/ cm2). The regions with smallest coverage were the ears and the "H" area of the face.
CONCLUSIONS: The insufficient or heterogeneous sunscreen application on face, neck and ears may promote a false perception of protection, leading to irresponsible exposure. As the population ages and the incidence of skin cancers increases, it is essential to stimulate photoprotection, with appropriate information, especially among high-risk individuals.

Keywords: Sunscreening Agents; Skin Neoplasms; Sunburn; Sunlight

INTRODUCTION: Acrochordons are very prevalent in dermatological offices and can reach almost 60% of the population over 70. One possible therapeutic approach is contact cryotherapy.
OBJECTIVES: Compare pain tolerance, aesthetic results, and the preference of participants for electrocoagulation or contact cryotherapy techniques in the treatment of acrochordons.
METHODS: Ten participants, with at least four acrochordons each, had their lesions divided into two groups. One group was submitted to electrocoagulation and the other to contact cryotherapy. We measured pain tolerance using the analog pain scale (EAD). The aesthetic result was assessed by visual comparison between the treatment groups in each participant, and the patient’s preference was evaluated by asking the participant objectively.
RESULTS: All points analyzed had statistical significance. The participants gave lower scores in EAD for lesions submitted to contact cryotherapy. The esthetic result evaluated after 30 days was superior in the lesions of the electrocoagulation group. All participants preferred the contact cryotherapy technique.
CONCLUSIONS: Contact cryotherapy is the preferred method with better pain tolerance in treating acrochordons, but the aesthetic result was better with electrocoagulation.

Keywords: Cryosurgery; Cryotherapy; Electrocoagulation; Electrosurgery; Fibroma

Filler-induced arterial obstruction can mimic other dermatological conditions. In this case series, the authors describe four patients with filler-induced arterial obstruction presenting with pustular rash that was misdiagnosed as a herpetic infection. Since correct and timely diagnosis is crucial for scar prevention, pustular rash has to be recognized by injectors as a clinical expression of vascular obstruction induced by dermal filler injection.

Keywords: Hyaluronic acid; Herpes simplex; Ischemia; Injections, intra-arterial

INTRODUCTION: Melasma is a recurrent and challenging dermatosis despite several clinical and interventional therapeutic approaches.
OBJECTIVE: This study aims to assess the safety and efficacy of using a bleaching cream in the period immediately after serial surface peels.
METHODS: Five women with melasma used a cream containing bleaches, moisturizers, and tranquilizers during the treatment period with serial surface peels. We assessed them in D0, D7, D30, D37, D60, D67, and D90 through photographs, record of the physician’s and patient’s opinion, description of adverse events, need to interrupt using the product, and the MELASQol questionnaire.
RESULTS: We observed improved hydration, skin quality, and bleaching, with little discomfort and a significant reduction in MELASQol scores, with statistical evidence.
CONCLUSIONS: The use of a topic cream with bleaching and tranquilizing properties is an effective and safe alternative to avoid interruption of melasma treatment during the period of serial surface peels.

Keywords: Chemexfoliation; Hyperpigmentation; Pigmentation disorders

Cryosurgery is a technique widely known and used among dermatologists. Intralesional application is already used to treat keloids and has the advantage of restricting the zone of action of low temperatures of liquid nitrogen. The use of contact cryosurgery in vascular lesions is well reported in the literature, but there are no intralesional technique publications on these types of lesions. Here, we report two cases, one of port-wine stain hamartomas in a 61-year-old patient and another of a cherry angioma in a 70-year-old patient, safely and satisfactorily treated with intralesional cryosurgery.

Keywords: Cryosurgery; Cryotherapy; Hamartoma; Hemangioma; Vascular malformations

INTRODUCTION: The use of botulinum toxin has become one the essential cosmetic procedures performed in the world.
OBJECTIVE: To identify patterns of muscle contraction of the forehead, glabellar complex, and orbicularis oculi muscle in patients from southern Brazil, establishing their epidemiology and possible associations between them.
METHODS: One hundred and one patients who sought treatment with botulinum toxin for the forehead, glabella, and periocular lines between 2012 and 2016 were included. Analyzes were made using digital photographs taken during a medical consultation before applying the products., The subjects received with different brands of botulinum toxin, according to the patients’ or the doctors’ preference
RESULTS: The most common contraction patterns were complete frontal, glabellar in converging arrows, and complete periocular. Women represented 94.1% of patients. Most patients were between 31 and 50 years old, with an average of 44.57 years. More frequent patterns in each area were more frequently associated.
CONCLUSIONS: The study shows the main muscle contraction patterns of the upper third of the face in 101 patients, as well as their clinical characteristics, comparing them with previously published articles. Studies on muscle contraction patterns can assist in the safer and more rational use of the products available, avoiding waste and complications.

Keywords: Muscle contraction; Skin aging; Face; Facial muscles; Botulinum toxins type A

Dermoscopy is a practical, non-invasive tool that can be used to distinguish tinea nigra from other lesions that appear macroscopically similar, including acral nevus. Under dermoscopy, tinea nigra presents with a pattern of spiculated gray-brown pigment deposition, whereas acral nevus most often presents as brown pigment deposition in a parallel furrow pattern.

Keywords: Dermoscopy; Nevus; Tinea

INTRODUCTION: The advent of squamous cell carcinomas (SCC) from chronic dermatoses is known but little explored. Although rare, tumors originating there have a worse prognosis, in part due to late diagnosis.
OBJECTIVES: This study aims to survey cases of squamous cell carcinoma developed on previous dermatoses diagnosed between 2000 and 2020 in a tertiary health service.
METHODS: This is a quantitative and retrospective study through biopsy reports survey and medical records review.
RESULTS: From an initial list of 11,249 histological reports compatible with squamous cell carcinoma, we obtained a final list of 10 patients. The study findings corroborate the literature regarding some known risk factors: abundant and chronic sun exposure, older than 50 years, lower skin phototypes, and immunosuppression. We also found a high frequency of smoking and lichenoid dermatoses (5/10 patients) in the studied population, including chronic cutaneous lupus erythematosus and hypertrophic lichen planus.
CONCLUSIONS: It is not possible to predict the primary risk factors for the development of squamous cell carcinomas regarding previous dermatoses, although there is a tendency for their appearance in lichenoid dermatoses and those with longer evolution.

Keywords: Skin diseases; Squamous cell carcinoma; Lupus erythematosus, Cutaneous; Lichen planus