Introduction: Constitutional infraorbital hyperchromia (commonly called under-eye circles) is a common dermatosis that is difficult to treat. Objective:To evaluate the clinical improvement of constitutional infraorbital pigmentation resulting from the application of a series of five 10% thioglycolic acid gel peeling sessions. Methods: Patients were administered five successive 10% thioglycolic acid gel peel sessions, in 15-day intervals. In the first session, the product was left on for two minutes, with three minutes added in each subsequent session, culminating with 15 minutes of contact in the last session. Fifteen days after the last session, a satisfaction scale ranging from 0 (lack of improvement) to 10 (total improvement) was administered to the patients, to the dermatologist investigating the peelings, and to a blindevaluator medical doctor (a dermatologist that had not had taken part in the treatment sessions). Results: Study subjects (n=10) were females aged 24-50.The average clinical satisfaction presented by the patients, the investigator, and the blind-evaluator were 7.8, 7.6 and 6.8, respectively, with no statistically significant differences among them (p=0.065). Conclusion: The serial application of 10% thioglycolic acid gel peels is a safe, efficient, and costeffective treatment for constitutional infraorbital pigmentation.

Keywords: CHEMEXFOLIATION, EYE, HYPERPIGMENTATION, EYELID DISEASES

Acne is a multifactorial disease encountered on a daily basis by general medical practitioners and, especially, dermatologists. It has been a constant focus of studies that increasingly unveil details of its physiopathology and help refine treatments in order to address the majority - if not all - pathogenic factors.This article''''''''s objective is to draw attention to the therapeutic associations and combinations in acne management, highlighting its chronic disease character, typified by recurrence, and the requirement for continued treatment that is not only effective but also safe.

Keywords: ACNE VULGARIS, ACNE VULGARIS/PHYSIOPATHOLOGY, BACTERIAL DRUG RESISTENCE

Introduction: Melasma is a common hypermelanosis that mainly affects women and has a negative impact on the quality of life. It is a chronic and recurrent condition, and a number of treatments have already been proposed.
Objective: Assessment of quality of life for women with melasma before and after treatment with botanical extracts and hydroquinone.
Methods: A clinical, phase IV, randomized, blinded study was conducted at a clinical research institute. Women (n = 56) aged 18-60, with phototypes I-IV, were randomized into two groups (epidermal or mixed melasma). The Melasma Quality of Life Scale was used to compare the patients'''''''' quality of life before and after the use of Bellis perennis, Glycyrrhiza glabra and Phyllanthus emblica botanical extracts twice a day (Group A), or 2% hydro- quinone used at night (Group B). The Melasma Area and Severity Index was used to assess the treatments'''''''' efficacy.
Results: Appearance, frustration, embarrassment and feeling less attractive were the Melasma Quality of Life Scale variables that had the greatest negative impact on quality of life at the beginning of the study. After 60 days of treatment, there was improvement in all MELASQoL aspects, with no statistical differences between the two groups.
Conclusion: The improvement in melasma patients'''''''' self esteem provided by the use of the botanical extracts matched that of 2% hydroquinone.

Keywords: MELASMA, QUALITY OF LIFE, PHYLLANTHUS EMBLICA

Introduction: Cutaneous aging affects (or will affect) all people at some point in their life, and its treatment represents a clinical challenge.
Objective: To evaluate the cutaneous effects of an oral supplement based on marine protein, concentrated acerola and extracts of grape seed and tomato in women with cutaneous aging.
Methods: Forty-five volunteers used 2 daily tablets of the supplement for 360 consecutive days. Clinical evaluations (carried out by both the investigator physicians and by the volunteers), ultrasonographic and photographic examinations were carried out every 30 days.
Results: Thirty-three volunteers (73.3%) completed the study. Clinically significant improvement was verified by the investigator physicians and the volunteers after 30 days of using the oral supplement (p < 0.05). The results were maintained after 330 days (p ¿ 0.05). The ultrasonographic analysis demonstrated increases in the dermal density of the photoexposed (132.3%; p < 0.001) and photoprotected areas (51.9%; p ¿ 0.001). Through medical analysis, statistically significant improvements were found in the following criteria: wrinkles, fine lines, solar melanoses, other hyperchromias, erythema, hydration, radiance , sebum, smoothness and overall appearance of the skin. Through the volunteers'''''''' self-evaluation, improvements in the wrinkles'''''''' pattern, fine lines, solar melanoses, other hyperchromias, erythema, hydration, radiance, sebum, smoothness and overall appearance of the skin were reported.
Conclusion: The long-term use (360 days) of an oral supplement based on marine protein, concentrated acerola and extracts of grape seed and tomato was proven to be a good adjuvant systemic approach for treating cutaneous aging.

Keywords: SKIN AGING, DIETARY SUPPLEMENTS, VITAMIN C, GRAPE SEED EXTRACT

Introduction: Melasma is a common, acquired, long-lasting skin disorder that is often resistant to treatment and causes negative psychological effects on patients.
Objectives: To evaluate the efficacy, safety, and tolerability of the topical combination of kojic acid, arbutin, sepiwhite® and achromaxyl ® compared to 2% and 4% hydroquinone in the treatment of facial melasma.
Methods: A single-blind, comparative, monocentric clinical study with 120 volunteers (aged 18-50, I to IV Fitzpatrick skin types) was conducted. The study population was divided into 3 groups: Group A (n = 40; Blancy®, 2 times a day), Group B (n = 40, 2% hydroquinone at night), and Group C (n = 40, 4% hydroquinone at night), and instructed to use the study product for 90 consecutive days. Clinical (classification and quantification of melasma) and photographic evaluations were carried out, and a questionnaire assessed the impact on the patients'''''''' quality of life and the products'''''''' general efficacy.
Results: Most volunteers (n = 102, 85%) completed the study (Group A = 34, Group B = 33, Group C = 35). The Melasma Area Severity Index metrics presented a statistically significant decrease (i.e., improvement) throughout the study in all three groups (p-value < 0.001).
Conclusion: The topical use of the kojic acid, arbutin, sepiwhite® and achromaxyl® combination proved to be an effective and safe alternative for treating melasma.

Keywords: MELANOSIS, HYDROQUINONES, ARBUTIN, QUALITY OF LIFE

Introduction: The skin is subject to intrinsic and extrinsic aging processes, which makes treating cutaneous photoaging clinically challenging.
Objective: To use objective and subjective parameters to evaluate the safety, tolerability, and clinical efficacy of a cosmetic product containing 0.05% retinaldehyde, 4% nicotinamide, and 1% Vitis vinifera extract in the treatment of skin aging.
Methods: A monocentric, prospective, open study evaluated 40 female volunteers (25-40 years old) with Fitzpatrick skin types I to IV, who used the dermocosmetic product for 60 consecutive days. Subjective assessments were carried out by the physician and the volunteer patients. In addition, ultrasound examination and objective assessment of photographic records using the Visia® imaging system, skin biopsies, corneometry, pH metry, and sebumetry were conducted.
Results: Thirty-six volunteers completed the study. Subjective evaluations revealed improvements in wrinkles, fine lines, sagging, vitality, and overall appearance. Ultrasound and skin biopsies showed increased collagen (94.4% and 30.6%, respectively). Pictures from the Visia® device demonstrated a reduction in stains, wrinkles, and pores, and improvements in the skin''''''''s texture. Sebumetry revealed a decrease in the oiliness and the pH. Measurements taken with the corneometer remained constant.
Conclusions: This dermocosmetic product is effective and safe in the treatment of photoaging.

Keywords: RETINOIDS, RETINALDEHYDE, NIACINAMIDE, SKIN AGING

Gynoid lipodystrophy (cellulite) is a common, unattractive dermatosis that affects many women around the world. Depending on the severity of the appearance, the condition may cause important psychosocial disorders. Many therapies have been clinically tested, and many have been proscribed, not only for their therapeutic inefficiency, but also for their risk to patients’ health. Other treatments, notwithstanding their weak scientific basis, are still in vogue. Medical devices, few of which are backed by actual scientific evidence, also currently claim to help treat this condition. This paper provides an extensive scientific literature review and analysis, and aims to help dermatologists decide what specific therapies to recommend and provide assurances regarding the clinical rationale of results when treating patients with this condition.

Keywords: CELLULITIS, LIPODYSTROPHY, ADIPOSE TISSUE

Introduction: Aging skin is a condition that affects (or will affect) all people, and its treatment is considered a clinical challenge. Growth factors and their analogues are emerging as a promising therapeutic option. Objectives: To evaluate the safety profile of some dermocosmetic products with formulations based on growth factors – or their analogs intended for that purpose – using in vitro human skin cell culture models. Methods: Two types of cell cultures were studied, and the effects of the study products on the proliferation of melanoma cells and normal human fibroblasts were evaluated. Results: No significant morphological alterations were found in the cultured human melanoma, and no significant decrease in the number of healthy cells was verified in the normal fibroblasts culture. In some cases there was even a proliferation of those cells. Conclusions: These preliminary data demonstrate that cosmeceutical products containing growth factors as an active principle can be considered safe for topical application.

Keywords: INTRACELLULAR SIGNALING PEPTIDES AND PROTEINS, SKIN, SKIN AGING

Hyaluronic acid-based dermal fillers are currently among the most commonly used substances in cosmetic procedures. The present study aims at identifying alterations in the rheological properties of different types of fillers containing hyaluronic acid, before and after flowing through needles. The same analysis is carried out with fillers with and without hyaluronidase.

Keywords: HYALURONIC ACID, ESTHETICS

Introduction: The skin is the largest organ of the human body and constitutes a covering layer that has many essential functions such as defense, sensorial, thermoregulatory, and aesthetic. Therefore, maintaining its integrity is extremely important for the homeostasis of the organism. Objective: To evaluate the efficacy and safety of a cutaneous moisturizer that, in addition to traditional substances, contains in its composition other ingredients capable of stimulating the function of the aquaporins. Methods: One hundred volunteers were clinically evaluated through medical examination and subjective self-evaluation, regarding the efficacy and safety of the product. Of these, 30 also underwent instrumental analysis through corneometry (assessment of the skin's hydration), pH metry (measurement of the skin's pH) and TEWLmetry (assessment of TransEpidermal Water Loss). Results: During a 90-day study, all efficacy variables subjectively analyzed showed clinical improvement (dryness, hydration, softness, desquamation, and itching). In the analysis of objective variables, it was observed that the corneometry measurements showed a significant increase in skin hydration. Conclusion: With the present study's clinical outcomes, the test product was proven effective for having significantly increased skin hydration (according to corneometry) and extremely efficient for its action on the signs and symptoms of skin xerosis (according to theassessment of the physiciansand volunteers).

Keywords: HYDRATION, DESICCATION, AQUAPORINS.

Introduction: Cutaneous melanoma has significant relevance among malignant skin tumors, for despite its low incidence (3-4%) it is associated with the highest mortality. In Brazil, estimates for the year 2014 correspond to 10% of all cancers, establishing this as an important public health issue. Objectives: To present epidemiological data related to melanoma skin cancer in the midlands of the Brazilian State of São Paulo. Methods: Descriptive retrospective cross-sectional analysis of data from a tertiary hospital's medical records. The analysis was subject to measurement and information bias. A descriptive analysis with frequency and percentage was carried out. Results: There was a prevalence of cutaneous melanoma in women (71%), patients between 50 and 70 years of age (56%), Caucasians (78%), and individuals who identified their lesions through self-examination (42%), with predominant involvement of the trunk (35%). The most prevalent histological subtype was the superficial spreading (58%). Conclusions: Understanding the epidemiology of cutaneous melanoma in a given geographic region enables and facilitates medical actions, allowing for the better establishment of strategies for primary and secondary prevention.

Keywords: MELANOMA, EPIDEMIOLOGY, SKIN NEOPLASMS.

Introduction: Obesity is a major health problem worldwide due to its high morbidity and mortality. Objective: To evaluate the reduction of abdominal fat in volunteers who underwent low-frequency diode laser therapy. Methods: A total of 60 volunteers (18 to 50 years of age, with a BMI of between 18.5 kg/m2 and 30 kg/m2, and who had abdominal fat), underwent a treatment performed twice a week for 31 days and were then evaluated. The abdominal circumference was evaluated in three locations, with photographic and ultrasound images taken of the studied area. Results: There was a reduction in the abdominal circumference measurements in the evaluated sites, with dermal compression and a significant reduction of hypodermis verified through ultrasound. Conclusion: The low-frequency diode laser therapy showed significant results in the reduction of localized fat and abdominal circumference measurements.

Keywords: LASER; ABDOMINAL FAT; LYPOLISIS.

Introduction: Progressive macular hypomelanosis is characterized by the emergence of hypopigmentation, predominantly in the trunk region of young women of mixed racial origin. Although recent studies suggest that Propionibacterium acnes may have an important role in the pathogenesis, its etiology remains unclear. Objective: To evaluate the prevalence of the condition with regards to gender, age, skin phototype, affected areas and disease onset, and the relationship with ordinary acne and oily skin in the city of Niterói, Rio de Janeiro State, in the coastal region of Southeast Brazil. Methods: Retrospective epidemiological study that uses the analysis of medical records of 103 patients with diagnosis of progressive macular hypomelanosis, from 2001 to 2012. Results: Eighty-two percent of studied patients were women and 18% men, with a predominance of phototypes III (42.7%) and IV (42.7%). The average age of onset of the disease at diagnosis was 26 years. In 46.0% of patients the disease duration ranged from 1 to 4 years. When two areas were affected (50%), the dorsum was the most frequent (79.0%), followed by the abdomen (20.0%). In 98% of cases, patients had oily skin, and 71.8% had active acne. Conclusion: Progressive macular hypomelanosis is a chronic condition that primarily affects the skin of the dorsum and abdomen of young women with skin phototypes III and IV, who are also bearers of oily skin and acne. There are still many doubts regarding the true etiology and treatment of progressive macular hypomelanosis. The high percentage of association with skin oiliness and acne vulgaris suggests that these clinical conditions are possibly related.

Keywords: HYOPIGMENTATION; EPIDEMIOLOGY; ACNE VULGARIS

Introduction: The skin may present dysfunctions that result in histological alterations and elementary lesions, many of them caused by immunologic mechanisms and/or alterations in the epidermal barrier. Objective: The present study was aimed at verifying in vitro whether some cosmetic products marketed in Brazil in the form of liquid soaps, have anti-inflammatory and protective efficacy in the skin barrier. Methods: An in vitro study was carried out with four commercial soaps, which were evaluated in a cell culture of human keratinocytes for the determination of their anti-inflammatory and epidermal barrier restorative effects, as well as their capacity to reduce cutaneous hypersensitivity. Concentrations of keratin 10 and 14, loricrin, IL-12, IFN-γ and TRP V-1 were measured in the cell culture supernatants of human keratinocyte through the sandwich ELISA assay. Results: The four test substances led to significant reductions in the synthesis of IFN-γ and IL-12. Only the test substance C triggered a significant increase in the synthesis of keratin 10. All test substances showed significant reductions in the synthesis of keratin 14 and TRPV-1, and a significant increase in the synthesis of loricrin. Conclusions: Some cosmetic products in the form of soap can have in vitro results regarding their anti-inflammatory, epidermal barrier restoration and skin hypersensitivity reduction effects.

Keywords: ANTI-INFLAMMATORY AGENTS/ADVERSE EFFECTS; DERMATITIS, ATOPIC; SOAPS

Acne in adult women is defined as an acneic picture present in women from 25 years of age. It can onset in adolescence and continue into adulthood or appear in the latter phase. It has an impact on personal relationships and can lead to introspection and depression. It is predominantly characterized by inflammatory lesions located preferentially on the chin and neck. Its causes have not yet been fully elucidated. Its pathogenesis involves circulating androgens in combination with other factors such as heredity, stress, ultraviolet exposure, obesity, diet, smoking habits and the presence of associated endocrine disorders. Treatment includes the arsenal for treating acne vulgaris combined with other therapies.

Keywords: ACNE; HYPERANDROGENISM; PROPIONIBACTERIUM ACNES; HYPERINSULINISM

Acne vulgaris is a very common dermatosis affecting the general population. Due to its prevalence, it is a much studied pathology. A number of studies on the subject are published on a yearly basis, including those on its pathogenesis. The present review aims at compiling the classically known etiopathogenic factors of acne vulgaris and introducing new concepts, such as the inflammatory nature of this condition. This new knowledge is crucial in the search for the best treatment option.

Keywords: ACNE VULGARIS; PROPIONIBACTERIUM ACNES; LINOLEIC ACID

Propionibacterium acnes (P. acnes) is one of the main microorganisms found on the skin. It is predominantly found in hair follicles, prefers anaerobic conditions, preferably colonizes the areas with high sebum production, and is the main bacterium involved in the pathogenesis of acne. The indiscriminate use of antibiotics for the treatment of acne vulgaris can result in the development of bacterial resistance. The present article is aimed at updating dermatologists with the most current data - from the classification to the physiopathogenic mechanisms involved in bacterial resistance to P. acnes and its possible clinical implications.

Keywords: PROPIONIBACTERIUM ACNES; DRUG RESISTANCE, BACTERIAL; ACNE VULGARIS

Introdução: Hyperpigmentation is a common dermatological condition, usually associated with exposure to the sun and relative difficulty of treatment. Pycnogenol^® is an extract obtained from the French pine tree Pinus pinaster, with known antioxidant and anti-inflammatory activity, having been proven to inhibit melanin synthesis in previous studies. Objective: To evaluate the whitening activity of Pycnogenol^® in an ex vivo experimental model after exposure to ultraviolet A and B, infrared-A radiations and visible light. Method: Human skin fragments obtained from elective plastic surgery were treated with Pycnogenol ^® and then irradiated with ultraviolet A and B, and infrared-A radiations, and visible light, having been sent for histological evaluation of melanin pigmentation by the Fontana-Masson staining technique. Results: The histological evaluation demonstrated an increase in melanin deposition in all irradiated groups. However, fragments pre-incubated with Pycnogenol^® showed a reduction in the deposition of this pigment after irradiation. Conclusions: This study demonstrates the reduced melanin deposition in skin culture treated with Pycnogenol^® after irradiation with ultraviolet A and B, and infrared-A radiations, and visible light, concluding that this substance may have lightening properties.

Keywords: HYPERPIGMENTATION; SKIN LIGHTENING PREPARATIONS; SOLAR RADIATION

Introduction: Melasma is a common pigmentary condition that affects exposed body areas, especially in the frontal and malar regions. Hydroquinone is an effective active principle in the treatment of hyperpigmentation, however, due to issues linked to its tolerability, many studies are being conducted aimed at developing alternative therapies with equivalent effectiveness.
Objective: To evaluate the efficacy and tolerability of a cosmeceutical formulation containing ellagic acid, hydroxyphenoxy propionic acid, yeast extract and salicylic acid in Brazilian patients with mild to moderate melasma.
Methods: Forty patients with mild to moderate melasma on the face used the cosmeceutical twice daily, combined with sunscreen for 90 days. Subjective assessments of efficacy and tolerability were carried out. Measurements of the MASI grade and the application of the MELASQoL-BP questionnaire were also performed. The evaluation of the skin's brightness and the colorimetric characteristics were obtained by colorimetry.
Results: After 90 days of treatment, a significant improvement could be observed in the clinical and colorimetric parameters evaluated, and in the quality of life questionnaire. In addition, the MASI score improved by 43%. The treatment was effective without causing adverse events.
Conclusions: The evaluated cosmeceutical formulation was proven as an effective alternative to hydroquinone for the treatment of melasma, with excellent cutaneous tolerability profile.

Keywords: HYPERPIGMENTATION; MELANOSIS; BLEACHING AGENTS