Introduction: Melasma is an acquired hypermelanosis of multifactorial etiology and diffi cult to treat. Tranexamic acid (TA) has been studied as an alternative therapy. Objective: To evaluate the effi cacy and safety of TA in treatment of melasma, comparing the use of localized microinjection versus topical therapy. Material and Method: Eighteen women with melasma were selected and treated for 12 weeks. Group A: at-home topical application of TA 3% twice a day. Group B: intradermal injections of TA (4 mg/ml) weekly. Before and after treatment, the groups were compared according to the following parameters: photographic evolution, MASI evolution, self-assessment and colorimetry. Results: Seventeen patients completed the study. In group A, photographic evaluation showed improvement in 12,5%, worsening in 50%, and 37.5% had no change. In group B, there was improvement in 66.7% and 22.2% had no change. For the MASI, there was signifi cant improvement (p = 0.0026), with no difference between treatments (p = 0.6512). In group A selfassessment, 37.5% of the patients rated as good and 50% as imperceptible. In group B, 66.7% rated as good and 33.3% as imperceptible. Colorimetric evaluation showed significant improvement on both treatments (p = 0.0008). Conclusion: Although the subjective clinical evaluation has demonstrated the superiority of injected treatment, in objective evaluation, both treatments were significantly effective, presenting TA as a promising new therapeutic option for melasma.

Keywords: TRANEXÂMIC ACID, MELASMA, THERAPEUTICS, THERAPY

Introduction: Complaints about wrinkles and flaccidity in the periocular region are frequent. Blepharopeeling, associated with the Baker-Gordon formula, and the application of ablative fractional CO2 lasers are considered effective options in the treatment of the periocular region. Objective: To compare the techniques, recovery process and results of blepharopeeling and fractional CO2 lasers in the periorbital region. Methods: Comparative split-face study of patients with dermatochalasis and moderate rhytids. Blepharopeeling was applied on the right side of the face, and the fractional CO2 laser was used on the left side of the face. Results were assessed through photographic analysis, measurements of the superior palpebral fold and clinical improvement. Results: Patients (n=11) demonstrated clinical and photographic improvement using both methods. The recovery time was longer for the phenol peeling. No significant differences were observed in the measurements of the superior palpebral fold. Conclusion: While both therapeutic modalities were found to be effective in the treatment of periorbital aging, blepharopeeling produced greater clinical improvement of palpebral flaccidity.

Keywords: PHENOL, LASER THERAPY, EYELIDS, SKIN AGING

Introduction: In 2006 the US Food and Drug Administration approved the use of fractional photothermolysis for the treatment of melasma. Objectives:To evaluate the treatment of melasma patients with fractional photothermolysis. Methods: Patients with a clinical diagnosis of melasma (n = 20) received three non-ablative laser sessions at 4-week intervals.The parameters used were: pulse = 15 ms, and progressively increasing energies in each session (8, 10 and 12 J). Results were evaluated using the Melasma Area and Severity Index and colorimetry analysis (with indices ITA, L, a, b) at baseline and 4 weeks after the last session. Results: Female patients (n = 18), with ages between 23 and 48 and Fitzpatrick phototypes from II to IV, completed the study. One patient did not complete both Melasma Area and Severity Index evaluations.There was a statistically significant decrease in the Severity Index (p <0.0001, CI = 95%) and an average increase in the colorimetry indices L (p = 0.0003, CI = 95%) and ITA (p = 0.0017, CI = 95%), meaning a decrease in the pigmentation. Conclusions: Fractional photothermolysis is a safe and effective option in the treatment of melasma, and should be considered an alternative to conventional methods.

Keywords: MELANOSIS, LASERS, COLORIMETRY

Introduction: Chronic and intense photodamage usually produces numerous actinic keratoses, with early and global treatment of the affected skin being of paramount importance. Objective: To evaluate the effectiveness of two different treatments for multiple actinic keratoses. Methods: Five patients were selected Were selected five patients with diffuse, with diffuse actinic keratoses on the dorsum of the hands and forearms. The patients underwent the following protocol: Side A (right): biweekly superficial chemical peeling with 70% glycolic acid in gel, followed by the subsequent application of 5% 5-fluorouracil solution; Side B (left): monthly sessions of cryopeeling. The number of sessions ranged from four to six in Side A and two to three in Side B, according to the degree of photodamage. Results: All patients had a satisfactory clinical response, with improvement of actinic keratoses throughout the whole area of actinic damage, and good tolerance of the treatment among patients. The only exception was that a more intense and persistent erythema arises after the cryopeeling. Conclusions: Both treatments are valid and effective alternatives for the treatment of the field cancerization.

Keywords: KERATOSIS ACTINIC, THERAPEUTICS, FLUOROURACIL, CRYOTHERAPY

Introduction: Cutaneous fillings are a common procedure in today's dermatology, with the majority being carried out with hyaluronic acid isolated or combined with other substances. Objective: To study the effects of adding hyaluronic acid and polyethylene glycol to cultures of human dermal fibroblasts. Methods: The study evaluated: cell proliferation and production of type 1 collagen (COL1A1) in the presence or absence of anti-CD44 antibodies (membrane receptor for hyaluronic acid); the synthesis of metalloproteinase-1 (mmp-1), of tissue factor inhibitor of metalloproteinase-1 (TIMP - 1) and of transforming growth factor-α (TGF-α) through the analysis of gene expression via PCR (polymerase chain reaction); cell proliferation through the detection of the incorporation of a thymidine analogue in the cellular DNA. Results: Increased proliferation of fibroblasts and collagen synthesis were observed in the cultures exposed to hyaluronic acid, partially inhibited by the presence of anti-CD44 antibodies in the cultures. The exposure of cultures to hyaluronic acid enhances the production of TIMP-1 and TGF - α, and reduces the expression of MMP-1. These effects were not noticed in the cultures exposed to polyethyene glycol. Conclusion: In an in vitro setting, the addition of hyaluronic acid to cultures of human dermal fibroblasts increases proliferation and synthesis of COL1A1, TIMP-1 and TGF-α, decreasing that of MMP-1. The addition of anti-CD44 to the cultures reduces cell proliferation and collagen synthesis, which may indicate the role of that receptor in mediating those events.

Keywords: FIBROBLASTS, HYALURONIC ACID, EXTRACELULAR MATRIX.

Pyogenic granuloma or lobular capillary hemangioma is a benign skin and mucous membranes lesion whose etiology is not yet explained. The authors report an atypical and exuberant clinical case of this benign dermatologic condition, clinically simulating malignancy.

Keywords: GRANULOMA, PYOGENIC; SCALP DERMATOSES; HEMANGIOMA, CAPILLARY; MELANOMA

Introduction: Stromal vascular fraction derived from adipose tissue is a rich source of different cells, containing large amounts of stem cells, which ability for diferentiation into various strains. In dermatology, there are several studies on the effectiveness of stem cells, which present antioxidant and rejuvenating effects. However, there are few reports about the anti-aging effects of stromal vascular fraction.
Objective: To evaluate the effectiveness of stromal vascular fraction in facial rejuvenation.
Methods: A prospective, comparative, controlled study was carried out, wit, with 10 patients divided into two groups and subjected to treatment of nasolabial folds with: Group 1: stromal vascular fraction and Group 2: conventional filler (calcium hydroxyapatite). Clinical, photographic and histological evaluations were conducted, with statistical analysis of data.
Results: Both techniques produced satisfactory results and were similar.
Conclusion: Application of stromal vascular fraction is a relatively new technique that presents good clinical results and is a promising option for rejuvenation.

Keywords: ADULT STEM CELLS; SKIN AGING; REJUVENATION

Introduction: Mohs micrographic surgery is a technique that offers high cure rates for non-melanoma skin cancer.
Objective: To describe the clinical and epidemiological profile of patients who underwent Mohs micrographic surgery in a reference center in dermatologic surgery.
Methods: Medical records of patients who underwent Mohs micrographic surgery in the period 2014-2015 at a dermatology reference center, in the city of Mogi das Cruzes (SP, Brazil), were analyzed.
Results: The patients' ages ranged from 38 to 87 years; of these 54% were women. The most affected topography was the nose (54% of patients). Previous history of skin cancer was positive in 62% of cases. The indication driver for micrographic surgery was the lesion's location in 67% of the patients, followed by the size (23%) and tumor recurrence (10%). The most prevalent intraoperative diagnosis was basal cell carcinoma (90%).
Conclusions: Mohs micrographic surgery is an excellent therapeutic option in cases of tumors of aggressive nature, large diameter and high-risk location. This study is in line with the current literature regarding the epidemiological data linked to the occurrence of nonmelanoma skin cancer.

Keywords: MOHS SURGERY; SKIN NEOPLASMS; DERMATOLOGIC SURGICAL PROCEDURES

Juvenile xanthogranuloma is a form of non Langerhans cell histiocytosis that mainly affects children. It usually emerges as asymptomatic yellow-brownish papules. The diagnosis is clinical and confirmed by histology. Due to its trend to involute, treatment is usually not recommended. Dermoscopy arises as a noninvasive diagnostic tool that reveals a typical pattern for this condition.

Keywords: XANTHOGRANULOMA, JUVENILE; DERMOSCOPY; HISTIOCYTOSIS, NON-LANGERHANS-CELL

Introduction: Male androgenetic alopecia, has high prevalence and causes great discomfort in patients. The platelet-rich plasma generates an environment acts to create a suitable microenvironment for tissue repair and possibly prolongs the anagen phase of the hair follicles.
Objective: To evaluate the safety, efficacy and viability of the PRP use for the treatment of male androgenetic alopecia. Methods: We selected 08 male patients with androgenetic alopecia. Participants had the side of the scalp randomized scalp to receive PRP or placebo. 3 were performed monthly applications.
Results: Patients who received treatment realized some degree of improvement especially as regards the fall. The results were obtained through the analysis dermatoscopic was evaluated as "trichoscale". We observed an increase of anagen hairs, down telogen hairs and vellus wires and increase terminal wires. The results were statistically significant as the reduction of vellus wires and increase of terminals wires.
Conclusions: This study showed a clinical improvement observed for photos as well as positive results documented by analysis "trichoscale". There was statistical significance of data obtained especially after the first month of treatment.

Keywords: ALOPECIA; PLATELET-RICH PLASMA; MEN

Amyloidosis is characterized by the deposition of a modified protein. It can affect the skin by accumulating in the papillary dermis. In general, it develops with brownish maculae predominant in the interscapular region, and rarely coursing with generalized forms. This report describes a 59 year-old female patient who had had a spot in the lower back for 43 years, which in the last 8 years had progressively spread for the entire body. Dermoscopy has proven extremely effective in locating the various foci of pigmentary incontinence, which together with apoptotic keratinocytes constitute the pathophysiological basis for the formation of the amyloid protein.

Keywords: AMYLOIDOSIS; CONGO RED; DERMOSCOPY

Introduction: Skin cancer is the most common type of cancer in the world. It is classified into melanoma (corresponding to 4% of cases) and non-melanoma types: basal cell carcinomas (70 to 80% of cases) and squamous cell carcinoma (25% of cases). The Brazilian Society of Dermatology conducts the National Campaign Against Skin Cancer on a yearly basis, aiming at diagnosing and providing early treatment to the neoplasia.
Objective: To demonstrate the incidence of lesions suspicious of skin cancer in selected patients originated from the 2016 National Campaign Against Skin Cancer, at the dermatologic clinic of a university hospital located in the Brazilian State of São Paulo’s midlands.
Methods: Two hundred and thirty patients were examined, of which 24 were selected with 22 undergoing biopsy of the suspected lesions.
Results: Sixteen basal cell carcinoma cases, one squamous cell carcinoma and one melanoma were confirmed through anatomopathology.
Conclusions: Notwithstanding the small sample, it was possible to conclude that the results found are compatible with those of the literature reviewed. It is of paramount importance to carry out the campaign as a way to streamline the population’s access to a dermatologist, which results in the early diagnosis and treatment of skin cancers.

Keywords: Melanoma; carcinoma, basal cell; skin neoplasms; neoplasms, squamous cell; health promotion

Kaposi's sarcoma is a rare multicentric neoplasm originating from endothelial cells, with cutaneous and extracutaneous manifestation. The present paper describes a case of an uncommon clinic variant of a Kaposi’s sarcoma in a 32 year-old male patient bearer of acquired immunodeficiency syndrome (AIDS), with regression after undergoing combined treatment with antiretroviral therapy and radiotherapy.

Keywords: sarcoma, kaposi; herpesvirus 8, human; acquired immunodeficiency syndrome; keloid

Systemic oral medications – such as cyclosporine (CYA) or methotrexate (MTX) – for the treatment of psoriasis have limited bioavailability due to incomplete gastrointestinal absorption and first-pass hepatic metabolism. Moreover, they are associated with adverse effects. The application of CYA or MTX using the microinfusion of drugs into the skin method (MMP^®) for the treatment of psoriasis vulgaris yielded a therapeutic response with significant reduction of lesions, and absence of side effects. In the present report, the authors describe 4 cases of psoriasis vulgaris treated using the MMP^® method, with the application of CYA or MTX.

Keywords: Cyclosporine; Methotrexate; Psoriasis

Introduction: Rosacea is a chronic facial condition characterized by erythema, edema, telangiectasias, papules and possibly pustules and nodules. There are four subtypes: erythematous-telangiectatic rosacea (I), papulopustular rosacea (II), phymatous rosacea (III) and ocular rosacea (IV). Its pathogenesis is multifactorial, and the treatments, diverse.
Objective: To demonstrate the effect of botulinum toxin in the improvement of flushing and erythema in patients with erythematous-telangiectatic rosacea.
Methods: Six patients with Subtype I rosacea were selected in the Dermatology Department’s outpatient clinic of a university medical service. The patients received applications of botulinum toxin type A (dilution of 100 units to 5 ml of saline solution), with intradermal injections of 0.2 to 0.5 units per point in the affected region. Evaluations were carried out after one, two, three and six consecutive months.
Results: There was improvement of the facial erythema and flushing during the three months following the application, with symptoms returning around the sixth month after the treatment, in line with the estimated duration of toxin effectiveness.
Conclusions: There was improvement of the patients' symptoms and satisfaction, and it was deemed a treatment of easy application, associated with a low index of adverse effects and prolonged duration of outcomes.

Keywords: Botulinum Toxins, Type A; Erythema; Quality of Life; Rosacea

Systemic sclerosis (SE) is an autoimmune disease of the connective tissue. Of unknown etiology, it is characterized by sclerosis (fibrosis), which affects the skin, blood vessels and internal organs. The diagnosis is confirmed by a compatible clinical picture, autoantibody research and capillaroscopy of the nail bed. The present report highlights the importance of the dermatologist physician in the diagnosis of systemic diseases. Based on the observation of the skin – which is visible and palpable in all of its dimensions – and in the interpretation of all its signs, it is possible to conclude that it can reveal early internal disorders that could develop unnoticeably.

Keywords: Scleroderma, systemic; Fibrosis; Autoantibodies

INTRODUCTION: Vitiligo is a chronic acquired skin disease, which evolves with depigmentation. The control of disease activity is a therapeutic challenge. Systemic corticosteroids, in daily use or in pulse doses, are the most used treatment for the disease.
OBJECTIVE: To evaluate the effect of minocycline on the control over vitiligo activity compared with the corticosteroid therapy.
METHODS: Randomized clinical trial with 16 active vitiligo vulgaris patients, divided into two groups: MINO group: minocycline 100mg/day, orally, for three months; and CORT group: prednisolone 0.3mg/kg/day, orally, for two months, and 0.15 mg/kg/day in the third month. The patients were evaluated before and after the treatment by photographic records and evaluation of the scores obtained by the VIDA score (vitiligo disease activity score).
RESULTS: According to the photographic records, there was control of vitiligo activity in 100% of patients in the MINO group compared with 60% in the CORT group. In the comparison using the VIDA score, we noticed a statistically significant diference for both groups; however, we found that the reduction was greater in the MINO group, evidencing more effectiveness of minocycline in controlling the vitiligo activity.
CONCLUSION: This study demonstrated the efficacy of minocycline in the control of active vitiligo compared with a systemic corticosteroid regimen. Additional studies should be performed to confirm its efficacy.

Keywords: Vitiligo; Minocycline; Prednisolone

It is noteworthy the range of facial treatments, with aesthetic purpose, with which we can preserve the balance of the shape or beauty of our patients. Fillers, botulinum toxin, laser, and other technologies are widely used in dermatology. Eyelids can also be treated with these and other therapeutic resources. However, herniation of the fat pockets of the upper eyelids does not present significant results with these methods. The advancement of techniques known as minimally invasive and other technologies does not satisfy the treatment of this facial aesthetic unit. Thinking about the global rejuvenation of the face, it is unlikely that we will achieve a result of excellence without acting on the eyelids. Upper blepharoplasty remains irreplaceable, and it is the treatment of choice for skin redundancy and herniation of fat pockets. This surgery, with a long history in Dermatology, has a unique and fundamental role in facial rejuvenation. In this study, we tried to demonstrate the surgical technique of superior blepharoplasty educationally and to prove its efficacy and safety, with good aesthetic and functional results. With full knowledge of this anatomical region and technical precepts, we recognize that we can perform it safely.

Keywords: Blepharoplasty; Surgery, plastic; Eyelids; Esthetics; Dermatologic surgical procedures; Rejuvenation

Facial erythema after phenol peeling is one of the expected effects of the healing process and collagen formation. Intense Pulsed Light (IPL) therapy is one of the forms used as a treatment accelerating recovery, reducing redness, inflammation, and itching symptoms that may occur after peeling. IPLT can also be used to treat hypertrophic scars, which is also one of the adverse events that can happen with deep peeling. We report a successful case of IPLT treatment in a patient who presented facial erythema and hypertrophic scarring after undergoing phenol peeling.

Keywords: Phenol; IPL treatment; Hypertrophic Scar.