Introduction: Progressive macular hypomelanosis (PMH) is characterized by hypopigmented maculae on the thorax, abdomen, and lumbar region. It is often misdiagnosed, and its etiology is unknown. Recently, suggestive lesions of porphyria, produced by Propionibacterium acnes, were discovered by red fluorescence of the lesions.
Objective: Evaluating the efficacy of Minocycline, 100 mg/day, in the treatment of progressive macular hypomelanosis.
Material and methods: Patients older than 16 with at least a 3-month history, without allergies to tetracycline derivatives, and without a history of treatment with antibiotics for 90 days before the study, were included. Pictures were taken before beginning treatment and after 30, 60, 90, and 120 days and after this whenever possible.
Results: Out of 19 patients, 11 completed the study. All of them showed recovery of the color in the affected areas. Treatment success could be demonstrated for a minimum of 7 months and a maximum of 11 months after treatment.
Conclusion: The isolated use of minocycline, 100 mg/day for 3 months, was effective in the treatment of PMH, confirming the probable role of P. acnes as the etiological agent.

Introduction: Muscle activity at the glabella causes wrinkles that are perpendicular to muscle contraction. Such wrinkles are currently treated with botulinum toxin. However, interpersonal local contraction variations are revealed during facial animation. Although a great number of articles on this topic have been published, the patterns of glabellar contraction have not yet been adequately studied and classified. Objective: To identify and classify the glabellar contraction patterns found in the population undergoing cosmetic treatment with botulinum toxin. Methods: Retrospective photographic analysis of 30 patients receiving botulinum toxin for the treatment of glabellar wrinkles.The contraction patterns were identified and classified based on the prevalence of lowering, approximation, or lifting movements at the glabella. Results: Five patterns were identified: 1) "U," 2) "V," 3) "Omega," 4) "Converging Arrows,” and 5) "Inverted Omega." The classification method allowed indentifying the most important muscles in each contraction pattern. Conclusion: There are interpersonal variations in facial animation. The classification of glabellar wrinkles enables a more accurate, individualized treatment with botulinum toxin. The most heavily used muscles receive higher doses or are injected into a larger number of sites. Those less solicited muscles are left untreated or receive lower doses, allowing for more effective and natural results.

Keywords: CLASSIFICATION, BOTULINUM TOXINS, REJUVENATION

Introduction: Progressive macular hypomelanosis is a common skin hypopigmentation found in all ethnicities, yet it is seldom diagnosed. It affects young adults, especially women, and is often mistaken with pityriasis alba and pityriasis versicolor. It is character- ized by symmetric, well-defined, non-desquamative nummular hypopigmented macules in body areas with a greater concentration of sebaceous glands (trunk, thorax, abdomen and lumbar regions). Its etiology is poorly understood, and there is no effective treatment. A red fluorescence has recently been discovered in the lesion, suggesting the presence of porphyrin, produced by Propionibacterium acnes.
Objective: To compare the efficacy of 100 mg/day minocycline vs. placebo in the treat- ment of progressive macular hypomelanosis.
Methods: Patients over 18 (n = 20), who had suffered from the condition for more than 3 months (without treatment in the previous 3 months), who did not have an allergy to tetracycline, were randomized to receive minocycline or placebo. Wood''''''''s Lamp examina- tions and clinical evaluations (with descriptions and classifications using a color scale), and standardized picture records were conducted at baseline and 30 and 90 days after treatment.
Results: Eighteen patients completed the study. The group treated with minocycline pre- sented a statistically significant improvement (p < 0.05) compared to the control group.,br> Conclusion: 100 mg/day minocycline for 30 days was effective in treating progressive macular hypomelanosis, meaning that Propionibacterium acnes probably has a role in the condition''''''''s pathogeny.

Keywords: MINOCYCLINE, HYPOPIGMENTATION, PLACEBO EFFECT, TREATMENT

Introduction: Hyperhidrosis is characterized by excessive, generalized, or focal sweating. The idiopathic or primary forms are usually focal. The inframammary location is atypical, being underrepor-ted. The severity of hyperhidrosis is evaluated through objective methods (gravimetry) or measures of impact on the quality of life (Hyperhidrosis Disease Severity Scale). Objectives: To characterize inframammary hyperhidrosis regarding its prevalence associated factors, impact on quality of life, and gravimetry. Methods: An observational, descriptive, and transversal study was carried out, in which all patients seen during a certain week were asked about the presence of excessive inframammary sweating. Those who answered positively were administered a questionnaire, were assessed according to the severity scale, and underwent gravimetry. The data were analyzed using descriptive statistics and chi-square test (x2). Results: A total of 678 patients were seen, of whom 39 (5. 7%) confirmed the complaint of inframammary hyperhydrosis. Statistical association between the gravimetry's result and body mass index was detected. Conclusions: The prevalence of inframammary hyperhydrosis was demonstrated as an important location for primary focal inframammary hyperhydrosis. The characterization of inframammary hyperhydrosis-up until now a condition that has been little studied-can serve as a basis for future studies on therapeutic options that could improve patients' quality of life.

Keywords: HYPERHIDROSIS, GRAVIMETRY, SWEATING

Introduction: With several treatment options available - including laser - atrophic acne scars are nonetheless difficult to treat. The use of fractional technology results in dermal-epidermal ablation columns, interspersed with intact skin islands, allowing selective thermal damage, effective treatment and faster recovery. The objective of the present study is to demonstrate the efficacy and safety of fractional laser use in the treatment of atrophic acne scars among the Brazilian population. Methods: An open, prospective, interventional study was carried out with patients with acne scars, without restriction regarding the gender and skin phototype. Exclusion criteria were: pregnancy, breast-feeding, presence of infections or blood dyscrasias and the use of anticoagulants. The evaluation was performed by comparing texture, appearance, and relief as observed in digital photographs. Results: Of the 30 selected patients, 24 were included in the study. An improvement was noted in the parameters evaluated in the cases that underwent fractional laser (CO2, Erbium-Glass or both). Individuals who underwent multiple treatments showed better results. All those treated with 4 sessions had improvements greater than 50%. Post-inflammatory hyperpigmentation was detected in 7 of the 24 treated patients. Conclusion: The present study showed that, when using appropriate parameters and adequate care, fractional laser-assisted resurfacing is an effective and safe method for treating atrophic acne scars in the Brazilian population.

Keywords: ACNE VULGARIS; CICATRIX; LASERS; CHEMEXFOLIATION

Hyaluronic acid (HA) based cutaneous filling substances have become the treatment of choice for facial volumization. Hyaluronidase is a soluble protein that promotes the enzymatic degradation of HA. Commercially available preparations differ according to the substance's origin (bovine, ovine or human recombinant). Although cosmetic use has not yet been approved by the FDA, off-label use in dermatology is increasingly common. The purpose of the present article is to review the medical literature and prescribing information (package inserts) over existing commercially available products in order to provide an up-to-date view of the indications, dosage, injection techniques, and adverse effects.

Keywords: HYALURONIC ACID; HYALURONOGLUCOSAMINIDASE; ESTHETICS; OFF-LABEL USE

In recent years there has been a breakthrough in non-invasive techniques of facial rejuvenation. The greater understanding of the anatomical changes involved in the aging process was accompanied by rapid evolution in how to address these changes and the expansion of substances and technologies used in this approach. Of the arsenal of substances used for rejuvenation, the upper third of the face was before an almost exclusive territory of neuromodulators. Currently, fillers have stood out, especially those based onhyaluronic acid (HA), because they are safe and produce immediate and lasting – but reversible – results. The objective of this first article is to provide a brief literature review and update on the use of HA fillers in the rejuvenation of the upper third of the face, focusing on the forehead and glabella areas.

Keywords: DERMAL FILLERS; FOREHEAD; HYALURONIC ACID

Noninvasive techniques for facial rejuvenation have grown exponentially in recent years. The greater understanding of the anatomical changes involved in the aging process was followed by a rapid evolution in the approach of these alterations and a great development of substances and technologies used for this purpose.
Volume replacement, particularly with hyaluronic acid, has been standing out due to its widespread availability and ease of use, immediate and long-lasting results, reversibility, and safety when properly used.
The objective of this sequel article is to offer a review of the literature and an update on the use of hyaluronic acid cutaneous fillers in the rejuvenation of the temporal and supraorbital regions.

Keywords: DERMAL FILLERS; HYALURONIC ACID; REJUVENATION

INTRODUCTION: Stretch marks are an everyday challenge to the dermatologist. In the search for alternative therapies, we find 5-fluorouracil (5-FU) and microneedling for associating the following properties: inhibition of fibrosis, stimulation of collagen renovation and induction of skin pigmentation. Objective: To evaluate the efficacy and safety of 5-FU, in isolation or associated to microneedling, for the treatment of white stretch marks (striae alba).
METHODS: Comparative, double-blind study over 180 days, between 3 groups: Group A: microneedling and 5-FU; Group B intralesional 5-FU and Group C microneedling without medication. We measured improvement through a numerical scale of skin coloration, considering positive results those with reduction of the discrepancy between the adjacent skin and the stretch mark. We also evaluated patient satisfaction and irritation with each technique.
RESULTS: Group A achieved 10% of excellent clinical improvement, 10% very good and 60% mild. In group B, none of the patients had excellent of very good improvement. In group C, there was 20% of very good clinical improvement and 70% of mild.
CONCLUSIONS: All techniques showed some degree of improvement of the lesions. Therefore, we propose new studies comparing all three techniques, with a larger sample, to evaluate if more treatments would result in better results.

Keywords: Cosmetic Techniques; Fluorouracil; Striae Distensae; Therapeutics

INTRODUCTION: Hidrocystomas are skin-colored or translucent cysts, single or multiple, appearing on the face. They originate in the eccrine or apocrine sweat gland and are sometimes disfiguring. They can be excised by surgery, electrodissection, or by caustics, but are usually recurrent and the treatments can leave scars or dyschromia. Botulinum toxin A (BoNT-A) has been suggested as therapy in few cases in the literature.
OBJECTIVE: To analyze the effects of BoNT-A in cases of facial hidrocystomas.
METHODS: Retrospective observational study of case series. Patients with facial hidrocystomas treated with BoNT-A at the Cosmiatry Outpatient Dermatology Clinic of the Hospital do Servidor Público Municipal de São Paulo, were evaluated.
RESULTS: Of the 13 patients evaluated, 5 were included, the largest case series described so far. Of these, all lesions treated showed clinical improvement during the period evaluated. Four patients showed partial regression and one, total regression of the lesions.
CONCLUSION: In this series of cases, BoNT-A showed positive and long-lasting results in the treatment of facial hidrocytsomas, with no adverse effects.

Keywords: Botulinum toxins; Hidrocystoma; Therapeutics

INTRODUCTION: Raynaud's phenomenon (RP) is an exaggerated physiological response of the extremity vessels, mainly to cold and stress. Patients refractory to clinical treatment or intolerant to its adverse events may be treated with local injection of botulinum toxin (BTX).
OBJECTIVE: To describe the experience of botulinum toxin use in severe cases of RP.
METHODS: Observational, descriptive, retrospective, and unicenter study of case series of severe RP treated with BTX-A, from 2011 to 2015. Parameters of pain, numbness, color, and stiffness were scored by visual analogical scale (VAS) and tabulated and compared before and after the treatment.
RESULTS: Total pain improvement in 71.4% of cases and partial improvement in 28.6%. Numbness disappeared in 57.1% of cases and improvement in 42.9%. There was a total regression of stiffness in 57.1% of cases and partial improvement in 28.6%. The color was completely reversed in 57.1% of the patients. There was ulceration healing in the only case in with they were present. Ischemic attacks were reduced in 85,7% of cases. No complications occurred.
CONCLUSIONS: This study suggests that the use of BTX-A in patients with severe RP is a promising therapeutic option.

Keywords: Raynaud disease; Botulinum toxins; Botulinum toxins, type A

Hematomas are common following cosmetic surgery. When minor, they are treated with observation only as they are most often reabsorbed. However, even with small collections of blood, if no early intervention is adopted, poor aesthetic outcomes may occur. Early drainage has been especially described in otorhinolaryngology and radiology journals. The authors present an approach to early treating hematomas. Special emphasis is given to the use of hyaluronidase, which is well known by dermatologists and plastic surgeons for its ability to dissolve hyaluronic acid, but its utility in the treatment of hematomas is not so commonly known by these experts.

Keywords: Hyaluronoglucosaminidase; Hyaluronic Acid; Hematoma; Fibrosis