Introduction: The importance of early diagnosis and treatment of actinic keratoses is well established. There are several effective therapeutic options for the treatment of this condition. Objectives: To compare the efficacy and patient preference between 5% imiquimod cream and photodynamic therapy in the treatment of actinic keratoses. Methods: Twelve patients with a total of 245 lesions were treated with MAL-PDT and 5% imiquimod cream. Randomization was performed in order to determine the hemiface (left or right) for each treatment. First, the patients underwent MAL-PDT.After one month, they started using imiquimod in the other hemiface twice a week for 16 weeks.After six months, the two treatments were analyzed for efficacy, tolerability, patient preference, and aesthetic results using the observations of a blinded investigator. Results: Both treatments showed good therapeutic responses, with 72% of lesions treated with MAL-PDT and 76% of lesions treated with imiquimod having complete improvement. The average size of residual lesions was similar in the two treatments. Ten patients (83%) preferred the treatment with photodynamic therapy (p = 0.03). Conclusions: Photodynamic therapy and imiquimod are effective in the treatment of actinic keratoses. The results of this study showed similar efficacy and good aesthetic results with the two treatments. Nevertheless, most patients preferred the photodynamic therapy.

Keywords: KERATOSIS, ACTINIC; TREATMENT OUTCOME; THERAPEUTIC.

Introduction: Standard dilution of botulinum toxin is performed with 0.9% saline solution. Some studies show that when diluted in lidocaine and epinephrine, the toxin preserves its function without compromising effectiveness or safety.
Objective: To establish whether the paralyzing effect of ona-toxin type A reconstituted in anesthetic (2% lidocaine) and vasoconstrictor agent (1: 50,000 epinephrine) is as effective as that of the same toxin reconstituted in saline solution, at 48 hours, 1 week, 2, 4, 12 and 24 weeks, for the treatment of periocular lines. To compare the tolerance to pain between the two reconstitution alternatives.
Methods: Fifteen patients with periocular wrinkles were randomized to receive onabotulinum toxin diluted in lidocaine with epinephrine or in saline. Re-evaluations were carried out in 48 hours, 1 week, 2, 4, 12 and 24 weeks.
Results: The data indicate that there was no difference in the symmetry and durability of the botulinum toxin, nor in the pain during the application.
Conclusions: There was no statistically significant difference in the frequency of lateral periocular muscle paralysis and symmetry resulting from the applications of onabotulinum toxin reconstituted in lidocaine with epinephrine or in saline solution. This outcome is consistent with those of previous studies.

Keywords: BOTULINUM TOXINS, TYPE A; DILUTION; LIDOCAINE

INTRODUCTION: The standard application of botulinum toxin for frontal wrinkles is at the intramuscular level. Some authors have suggested that the combination with intradermal application can bring about a more natural result, avoiding the paralyzing effect of the intramuscular application only. Objective: Establish if the paralyzing effect of type A onabotulinum toxin in the forehead, applied intradermally, is as effective as of the same toxin applied intramuscularly after: 48 hours, one, two, four, eight and 12 weeks for the treatment of frontal wrinkles.
MATERIAL AND METHODS: Sixteen patients with frontal wrinkles were randomized to receive intramuscular or intradermal onabotulinum toxin and were reevaluated after 48 hours, one and two weeks, one, two and three months.
RESULTS: Data were collected from 16 patients. Mean age was 33 years (standard deviation 5.96). Paralysis occurred in 93.3% in the intramuscular side and in 53.5% in the intradermal side in two weeks (p= 0.07). Median pain grade was 2.69 in the intramuscular side and 4 in the intradermal side (p=0.072).
CONCLUSIONS: Despite the highest frequency of the presence of paralysis in the intramuscular side in all evaluations, there was no statistically significant difference between the sides.

Keywords: Botulinum toxins type A; Injections, intradermal; Injections, intramuscular

The 1064-nm Nd:YAG laser in Q-switched and micropulsed modes has been used in rejuvenation, pore reduction, skin texture improvement, and wrinkle reduction. The aim of this study is to evaluate the combination of 1064-nm Nd:YAG laser in micropulsed and Q-switched modes in the same session for global facial treatment. Thirty female patients underwent six treatment sessions every two weeks. Three blinded dermatologists evaluated the results through clinical photographs and Visia^® or Focco^® images obtained before and 30 days after the last treatment session. The parameters of interest were solar melanosis, telangiectasias, wrinkles, dilated pores, melasma and skin texture. Three patients had face biopsies before and 30 days after the end of treatment. Most patients showed improvement in all evaluated parameters, except for two patients who had worsening of melasma. An increase in collagen was observed in two of the three histological examinations performed after treatment. The combination of laser modes studied herein offers a safe treatment that can improve wrinkles, skin texture, and laxity with minimal downtime.

Keywords: Lasers; Skin Aging; Rejuvenation