Introduction: For some patients, pain during the injection of botulinum toxin can represent a limitation for performing the procedure. There are doubts about whether the use of topical anesthetic decreases pain or interferes with the treatment's efficacy and duration of effect. Objectives: To study the effect of 4% lidocaine cream in controlling pain during BoNT-A - Speywood Unit botulinum toxin application, comparing it to the vehicle. In addition, the study was aimed at verifying whether the cream influences the treatment's outcome and duration. Methods: An experimental, prospective, double-blind, randomized study was carried out. The pain was assessed through a compartmentalized numerical rating scale (CNRS). The effect was assessed through a four-point contraction qualitative scale. Results: After evaluating the pain scale, higher values were observed in the placebo group when compared to the group that used anesthetic, with statistical significance. Furthermore, there was no statistical difference in the efficacy and duration of effect over weeks 4, 8, 12, and 16. Conclusions: BoNT-A - Speywood Unit toxin was effective and safe for the treatment of glabellar and frontal wrinkles. The use of topical anesthetics (4% lidocaine cream) reduced the pain during the procedure. In addition, there was no interference in the toxin's efficacy and effect duration.

Keywords: BOTULINUM TOXIN TYPE A, LIDOCAINE, PAIN, THERAPY.

Introduction: Transcutaneous ultrasound procedures are viewed as the most effective non-surgical treatment for facial skin rejuvenation, although their mechanisms of action are poorly understood. Objective: This study aims to evaluate the morphological changes induced by ultrasound treatments on skin tissue: epidermis, papillary and reticular dermis, and subcutaneous fat. To evaluate the clinical efficacy of ultrasound treatment for facial skin tightening. Methods: Ex vivo human skin samples were sham-treated or treated with high-frequency ultrasound using MedVisage^TM (General Project Ltd.). Different parameters of power output (1.5 and 3.0 W) and frequency modulation (100, 500, 3,000, 3,500 Hz) were compared. Clinical efficacy was evaluated based on a single 5-minute ultrasound treatment (3.0 W, 3,000 Hz) on 4 volunteers. Results: Ultrasound treatment caused significant compaction of collagen and elastic fibers in the reticular dermis, whereas less prominent changes occurred in the papillary dermis. The overall effects varied depending on energy output and modulation frequency. No changes to subcutaneous adipocytes, blood capillaries, epidermal keratinocytes, dermal fibroblasts and mast cells were observed. Clinically, ultrasound treatment consistently resulted in a well-tolerated, objective reduction of facial skin wrinkles. Conclusion: High-frequency ultrasound treatment is an effective and safe noninvasive technique for skin-tightening purposes.

Keywords: HIGH-INTENSITY FOCUSED ULTRASOUND ABLATION; SKIN AGING; HISTOLOGY; DERMIS.

Confluent and reticulated papillomatosis of Gougerot and Carteaud is a disease of uncertain etiology, the main differential diagnosis being pityriasis versicolor. The authors describe two cases of the disease - one in a man and one in a woman - both with good therapeutic response without recurrence after use of minocycline.

Keywords: HYPERPIGMENTATION; CERATOSIS; MINOCYCLINE.

The dermal filling of soft tissue is a common practice. However there are potential serious complications associated. The authors are of the opinion that professionals who perform dermal filling procedures must have solid knowledge of anatomy and complete mastery of fillers injection technique. The behavior in potential cases of complications must be started early and conducted efficiently.

Keywords: BLINDNESS; HYALURONIC ACID; INJECTIONS

Introduction: Low level laser therapy has been considered a non-invasive treatment alternative to body remodeling and fat tissue reduction.
Objective: To evaluate the efficacy of low level laser therapy in reducing body circumference measures and subcutaneous adipose tissue of the abdomen and hips areas.
Methods: An open, prospective, monocentric study was performed including 25 women with localized fat on the hips and abdomen. Nine sessions of low level laser therapy were performed over 3 weeks. The participants were assessed at baseline and at 1, 4 and 12 weeks after treatment. Assessment of weight and body circumferences, lipid profile tests and MRI were performed.
Results: The abdominal circumference measurements showed a significant reduction up to 12 weeks after the treatment. Participants showed a more marked reduction in the hips region one week after the last session. Also one week after the completion of the treatment, 80% of the participants considered that the treatment improved their body contour. There was absence of reports of adverse events related to the treatment.
Conclusion: Low level laser therapy is safe and effective in reducing the circumference measurements, particularly in the abdominal region.

Keywords: LOW-LEVEL LIGHT THERAPY; SUBCUTANEOUS FAT; MAGNETIC RESONANCE IMAGING; LASER THERAPY; ABDOMINAL SUBCUTANEOUS FAT

Introduction: Actinic keratoses are the most common premalignant skin lesions, with a chronic and recurrent nature. Daylight photodynamic therapy has been used in the treatment of actinic keratoses of the face and scalp.
Objective: To demonstrate the possibility of implementing daylight photodynamic therapy at a public service, for the treatment of facial actinic keratosis, using one tube of methyl aminolevulinate cream for up to four patients.
Methods: Ten patients were selected to undergo daylight photodynamic therapy at the Centro de Dermatologia Dona Libânia, located in the city of Fortaleza (CE), Brazil. Curettage was performed on the actinic keratosis and a methyl aminolevulinate cream based chemical filter was applied across the face.
Results: One tube of methyl aminolevulinate cream was enough for treating up to four patients with multiple facial actinic keratoses, whereas studies suggest the use of at least one gram to treat one face completely.
Conclusion: It was possible to conclude when administering daylight photodynamic therapy, an amount of less than one gram of methyl aminolevulinate cream in the treatment of facial actinic keratoses is a dosage sufficient to obtain an effective clinical response.

Keywords: KERATOSIS, ACTINIC; PHOTOCHEMOTHERAPY; ECONOMICS, PHARMACEUTICAL

Introduction: Acoustic wave therapy stimulates tissue regeneration and healing processes. Therefore, it is expected that this treatment modality might have effects on scars.
Objective: To evaluate the efficacy and safety of acoustic wave therapy in the improvement of keloids.
Methods: An open, prospective, monocentric study was carried out with 20 participants with clinical diagnosis of keloid. Weekly sessions of acoustic wave therapy were performed, for eight weeks. Participants were assessed at baseline and at 1 and 12 weeks after the end of the treatment. The investigators took measurements of elasticity and performed clinical evaluations based on the Vancouver Scars Scale. At the end of the treatment the participants’ satisfaction with the treatment was evaluated.
Results: After the treatment, the percentage of participants with keloid thickness between 2mm and 5mm decreased to 47% (from 71%), increasing the percentage of participants with reduced keloid thickness in the total sample (<2mm, to 41% from 24%). Some participants also had improvement in the keloids’ vascularization and pliability. No treatment-related adverse events have been reported.
Conclusions: Acoustic wave treatment is safe and can be effective in the improvement of the keloid’s functionality and some clinical aspects.

Keywords: KELOID; CICATRIX; SCALES

The use of skin flaps for covering lesions is a better option than skin grafts, due to the diversity of the receptor area after the tumor’s resection and the greater degree of safety. For better results, the lesion’s location and extent, as well as the safety of the vascularization, should also be taken into account. Three resections were performed, with different coverage techniques. The patients had excellent development, without necrosis or dehiscence.

Keywords: RECONSTRUCTIVE SURGICAL PROCEDURES; SURGICAL FLAPS; FREE TISSUE FLAPS; PLASTIC SURGERY; SKIN DISEASES

Introduction: Signs of aging usually arise more intensely on the face, neck, and hands, in the form of considerable loss of volume, which is a common indicator of aging.
Objective: To compare the duration, and adverse effects of two types of subcutaneous fillers in the treatment of the volumetric aging of hands.
Methods: Group A: four patients who used the same amount of the products in both hands; Group B: four patients who used greater amounts of calcium hydroxyapatite in one of the hands and Group C: four patients who used greater amounts of hyaluronic acid also in one of the hands. The patients were evaluated through changes in a validated scale for hand aging, recorded by digital photographs before and 1,3,6,9,12,15 and 18 months after the procedure.
Results: In Group A the patients had the same duration for both fillers; in Group B patients treated with hydroxyapatite calcium had longer duration; in Group C, the patients treated with hyaluronic acid presented longer duration. Adverse effects were more frequent with the use of calcium hydroxyapatite.
Conclusions: It can be concluded that the filler duration is proportional to the volume injected for both fillers, and that hyaluronic acid is safer for the treatment of this cosmetic irregularity.

Keywords: hyaluronic acid; hand dermatoses; rejuvenation

Introduction: Molluscum contagiosum is a dermatovirosis caused by a poxvirus. In the literature there are descriptions of different therapeutic approaches of this infection.
Objective: To evaluate the efficacy of imiquimod – isolated and associated with curettage – in the treatment of molluscum contagiosum.
Methods: Group A: 20 patients used 5% imiquimod cream 3 times a week for 6 weeks. Group B: 10 patients used a creamy base 3 times a week, for 6 weeks. After the initial 6 weeks, all patients underwent curettage.
Results: Group A: 31% decrease in the number of lesions in the 6th week, with a curettage effectiveness of 97.6%; Group B: 4.8% increase in the number of lesions in the 6th week, with a curettage effectiveness of 81.1%. The mean value for the pain level during curettage was 1.8 for Group A and 3.0 for Group B.
Conclusions: Due to the facts that the rate of cure of contagious molluscum lesions increased and the pain decreased when the curettage procedure was conducted after the use of the immunomodulator, it was possible to conclude that the association of 5% imiquimod cream to the curettage may be a therapeutic possibility.

Keywords: Molluscum Contagiosum; Dermatology; Dermatologic Surgical Procedures

Eyelid defects resulting from skin cancer excision are common in the daily practice of dermatologic surgeons. The aim of this review is to summarize the most relevant methods for eyelid repair, proposing reconstructive algorithms for both lower and upper eyelids. Both algorithms were designed according with dichotomic decisions based on the thickness (partial- versus full-thickness) and the size of the eyelid defect (less than 1/3, less than 2/3 or larger than 2/3 of the eyelid length).

Keywords: Eyelids; Reconstruction; Eyelid Neoplasms; Eyelid Neoplasms/surgery; Cornea

INTRODUCTION: Sclerotherapy is the most widely used method for the treatment of varicose veins of the lower limbs. The most common complication is the appearance of hyperchromic spots in the treated region. Pycnogenol^® has long been known as a phlebotonic, anti-inflammatory and skin depigmenting drug. Studies have already proven the efficacy of this drug in the prevention and treatment of post inflammatory hyperpigmentation.
OBJECTIVE: To evaluate the effectiveness of Pinus pinaster extract (Pycnogenol^®; PPE) in the prevention of hemosiderin deposits in human skin culture submitted to inflammatory stress.
METHODS: Fragments of human skin were stimulated with interleukin 1 alpha (IL-1 α) to induce an inflammatory response and, concurrently treated with PPE for further histological evaluation and hemosiderin semi-quantification.
RESULTS: The histological evaluation of skin fragments exposed to IL-1 alpha revealed a 26.6% higher hemosiderin density compared with the control group. Moreover, skin fragments incubated concomitantly with PPE showed significant reductions in hemosiderin deposits when compared with the group only exposed to the inflammatory microenvironment.
CONCLUSIONS: The results presented in this study showed an important effect of PPE (Pycnogenol^®) in the prevention of hemosiderin accumulation caused by inflammatory stress similar to the post-sclerotherapy process.

Keywords: Hemosiderin; Hyperpigmentation; Sclerotherapy

Diagnosing basal cell carcinomas, both clinically and dermoscopically, is part of most dermatologists' daily routine. However, tumors of this lineage, when densely pigmented, can be a challenge for the physician and surgeon. Dermoscopic features typical of melanocytic lesions may be present in these carcinomas, and the similarity with melanoma results in a real dilemma. More in-depth knowledge on this topic can make a difference in the management of these cases.

Keywords: Carcinoma, Basal cell; Dermoscopia; Diagnosis; Melanoma

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

Osteoma cutis is a rare tumor characterized by the presence of bone tissue in the dermis and/or hypodermis. We describe the case of a patient diagnosed with osteoma cutis on the scalp for approximately ten years with progressive growth and local alopecia area. The patient underwent surgical excision of the lesion using the rotation flap "S" italic technique to reconstruct the area aiming at the best possible aesthetic result.

Keywords: Nasal Surgical Procedures; Neoplasms, Basal Cell; Nose Neoplasms

Tattooing is an ancient practice and very popular nowadays. The pigments used have changed over time but still present varied and poorly regulated compositions. There are many described cases of adverse effects after tattooing, mainly infectious and hypersensitivity reactions. We report the case of a 64-year-old woman, healthy, with papules on her eyebrows one month after performing micropigmentation. The excisional biopsy diagnosed molluscum contagiosum, and the lesions were curetted. There are few reports in the literature of the spread of molluscum contagiosum caused by tattooing.

Keywords: Molluscum contagiosum. Tattooing. Poxviridae infections.

Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease where there is a mutation in the tumor suppressor gene, with a greater predisposition to neoplasms, especially of the gastrointestinal tract. The first manifestations begin during childhood with the presence of mucocutaneous melanosis and, later, gastrointestinal hamartomatous polyps. We describe a case of a young woman whose initial PJS manifestation started during her childhood with cutaneous melanosis. Three sessions with the Q-switched 1064nm Nd:YAG and 532nm KTP lasers were performed to treat the melanosis with excellent results and without recurrence.

Keywords: Lasers; Lentigo; Peutz-Jeghers syndrome

Ferment filtrate (FF), a by-product of nutrient-rich yeast, is believed to be used cosmetically in East Asia since the 1970s. We systematically reviewed the topical effects of ferment filtrate on skin health and determined limitations in the available studies. Recent literature has shown evidence in reducing the baseline fluctuation of pore size, roughness, hyperpigmentation, and redness. However, these studies are limited in efficacy due to their small sample size, their confounding variables, and their limited generalizability. Because of the increase of cosmetic products containing this ingredient, critical analysis of the available and future literature is necessary to prevent consumer misinformation.

Keywords: Skin Diseases; Administration, Topical; Cosmetic Technology; Cosmetic Techniques

INTRODUCTION: Acne is a chronic inflammatory disease of the pilosebaceous unit of multifactorial origin, which causes a significant impact on quality of life.
OBJECTIVE: Clinical trial assessing the superiority of efficacy of a treatment regimen with an oral probiotic associated with a fixed combination of adapalene 0.1% and benzoyl peroxide 2.5% compared to an oral placebo with the same topical treatment in patients with acne.
METHODS: This was a randomized, double-blind, placebo-controlled study conducted with 212 patients aged from 12 to 35 years. The study was divided into two phases of 90 days each. In the first phase, patients received treatment with adapalene 0.1% and benzoyl peroxide 2.5% associated with a probiotic (IT), or adapalene 0.1% and benzoyl peroxide 2.5% associated with placebo (CT). In the second phase (90 days), patients received only oral treatment with a probiotic or placebo. Efficacy criteria were: reduced Investigator Global Assessment (IGA) scale to 0 or 1 and reduced lesion count.
RESULTS: There was a significant difference in the proportion of participants with IGA 0 or 1 - the arm receiving the test treatment was superior to the control (p<0.05). Both treatments were safe and well tolerated.
CONCLUSION: In light of the evidence on efficacy and safety, treatment with probiotics should be considered as an adjuvant therapy for acne control.

Keywords: Acne vulgaris; Probiotics; Gastrointestinal microbiome

In recent years, the use of probiotics in dermatology and cosmetology has been demonstrating a notable rise, offering both preventive and therapeutic benefits for the skin. The intestinal microbiota plays crucial roles, including enzymatic degradation of dietary fiber, starch, proteins, and fats, as well as the synthesis of vitamins B, K, nicotinic acid, amino acids, and various metabolites. The use of multicomponent probiotics composed of strains of the genus Bacillus is a promising way to optimize the positive effects of these microorganisms in dermatological and cosmetic practice and avoid their undesirable effects.

Keywords: Bacillus; Probiotics; Dermatology; Cosmetic Microbiology.