Nerve sheath myxoma (NSM) is a rare benign tumor of peripheral nerve sheath origin that typically presents as a small nodule on the extremities of young adults. We report an unusual case of dermal NSM of the toe in a 40-year-old man, present since birth. Due to its nonspecific clinical features, NSM may be difficult to diagnose before biopsy and can resemble other benign soft-tissue lesions. Histopathologic and immunohistochemical evaluation is therefore essential for establishing accurate diagnosis. Awareness of this uncommon entity and its inclusion in the differential diagnosis of small, firm subcutaneous lesions may facilitate appropriate management and help prevent misdiagnosis.

Keywords: Myxoma; Neurothekeoma; Toes

Rosacea is an inflammatory disease characterized by 4 clinical stages, with phymatous rosacea representing the final stage of progression. Its insidious and chronic course may result in exuberant rhinophyma associated with functional impairment, including nasal obstruction. This study reports a series of 5 cases of exuberant rhinophyma treated with electrosurgery, with satisfactory outcomes achieved after up to four treatment sessions.

Keywords: Rhinophyma; Electrosurgery; Rosacea

The earlobe is often pierced, and complications such as significant defects may occur, particularly after the use of ear gauges. Surgical correction of these defects is challenging due to tissue loss and the risk of aesthetic deformities. We report the case of a 26-year-old man with a residual left earlobe defect following ear gauge use, successfully treated with a novel waterdrop-shaped excision technique. This approach allowed simple primary closure while preserving the natural contour and volume of the earlobe, resulting in an excellent aesthetic outcome. This technique represents a feasible alternative for intermediate earlobe defects.

Keywords: Ear Deformities, Acquired; Body Piercing; Surgery, Plastic

INTRODUCTION: HIV-associated facial lipoatrophy can impair social relationships, treatment adherence, and mental health, frequently leading to depression. Correction of facial lipoatrophy is associated with significant improvement in quality of life.
OBJECTIVES: To evaluate the efficacy of poly-L-lactic acid (PLLA) in correcting HIV-related facial lipoatrophy.
METHODS: Sixty-one patients with HIV-associated facial lipoatrophy received PLLA injections once a month until clinical improvement. The primary endpoint was the need for retreatment. Two independent dermatologists and the researcher classified lipoatrophy according to photographs. Malar skinfold thickness was measured with an adipometer.
RESULTS: All patients showed improvement in facial lipoatrophy after receiving a mean of 7.9 vials of PLLA. Skinfold thickness improved by 105%. Maximum follow-up was 58 months, and the mean duration of the effect was 33.4 months. Patients who discontinued HAART or had higher CD4+ cell counts at baseline presented better responses. Lower responses were observed in patients with very severe lipoatrophy and thinner skin.
CONCLUSION: PLLA treatment is an effective and durable alternative for patients with moderate HIV-associated facial lipoatrophy, but of limited effectiveness for patients with thin skin and very severe lipoatrophy.

Keywords: HIV-Associated Lipodystrophy Syndrome; Polylactic Acid-Polyglycolic Acid Copolymer; Antiretroviral Therapy, Highly Active; Skinfold Thickness

BACKGROUND: Melasma is a common hyperpigmentary disorder. Hydroquinone is widely used to treat melasma, but its use may be limited by adverse effects. Topical tranexamic acid (TXA), alone or combined with other agents, is a potential alternative.
OBJECTIVES: To evaluate the noninferiority of a new quadruple combination (QC) containing 3% TXA, niacinamide, 4-butylresorcinol and a hydroxyacid complex compared with 4% hydroquinone (HQ4) in the treatment of melasma.
METHODS: Eighty participants with melasma were included and randomly assigned to 2 groups: QC and HQ4. The study duration was 120 days. Efficacy criteria include mMASI, colorimetry (ITA and L*) and MELASQOL.
RESULTS: There was a significant improvement in mMASI, ITA, L* and MELASQOL in both groups (p<0.05) with no statistical difference (p>0.05) between them, indicating the noninferiority of QC serum compared with HQ4. Notably, the new serum showed greater improvements in mMASI, ITA and L* at D30 compared with HQ4, suggesting a greater initial response to treatment.
CONCLUSION: The new QC serum demonstrated non-inferiority to HQ4 after 12 weeks of treatment. In addition, its benefits were maintained for 4 weeks after treatment discontinuation. QC serum may represent a safe and effective alternative to HQ4 in the treatment of facial melasma.

Keywords: Hyperpigmentation; Melanosis; Tranexamic Acid; Niacinamide

Keloids are a benign fibroproliferative response of scar tissue that extends beyond the boundaries of the original wound, characterized by a high recurrence rate despite the various available treatments, including combination therapy. We report the case of a female patient with multiple spontaneous keloids, refractory to surgical excision and intralesional corticosteroid injections, with a significant impact on quality of life. A combined approach consisting of surgical excision and intralesional cryosurgery was performed. After one year, sustained regression, volumetric reduction, and no recurrence were observed. This case highlights intralesional cryosurgery as an effective strategy in the combined management of refractory keloids.

Keywords: Keloid; Cicatrix, Hypertrophic; Cryotherapy; Cryosurgery

INTRODUCTION: Oral collagen supplementation has been investigated as a strategy to support skin appearance, although clinical effects are generally modest. In aesthetic dermatology, both the magnitude and temporal pattern of changes are relevant.
OBJECTIVE: To assess the effects of oral supplementation with collagen oligopeptides on facial wrinkle appearance in women aged 45-60 years.
METHODS: A randomized, double-blind, placebo-controlled clinical trial was conducted in 102 women. Participants received collagen oligopeptides (2.5 g/day) or a placebo for 12 weeks. Wrinkle intensity was the primary endpoint, assessed using standardized digital imaging. Dermal density and collagen-related optical signals were analyzed as exploratory outcomes.
RESULTS: A significant reduction in wrinkle intensity was observed in the active group at week 8. A reduction was already apparent at week 4, although not statistically significant, and values remained numerically lower at week 12. The placebo group showed minor variations. Exploratory parameters showed numerical increases but were not statistically significant.
CONCLUSION: Collagen oligopeptide supplementation was associated with a reduction in wrinkle intensity, with an early effect that was partially maintained over time, indicating a measurable aesthetic benefit.

Keywords: Skin Aging; Collagen; Dietary Supplements; Peptides; Dermis

BACKGROUND: Combination therapies targeting multiple pathways of skin aging and hyperpigmentation are increasingly explored. However, the combined efficacy of gamma-aminobutyric acid (GABA), dimethylaminoethanol (DMAE), cysteamine, and bakuchiol remains limited.
OBJECTIVES: To assess the efficacy of a double-layer serum and cream containing GABA 3%, DMAE 2%, cysteamine 2.5%, and bakuchiol 1% on skin brightness, pore count, and wrinkles.
METHODS: In this 8-week, double-blind, randomized, placebo-controlled trial, 50 participants were randomized, and 44 completed the study. Subjects received either the active formulation or a placebo. Outcomes included wrinkle scores, pore counts, skin brightness (L-value), and melanin index assessed at baseline and weeks 2, 4, 6, and 8. Data were analyzed using repeated-measures MANOVA.
RESULTS: A significant time-by-group interaction was observed for L-value (p < 0.001), with the treatment group showing a modest increase (+1.63) compared to minimal change in controls (-0.49). Wrinkle scores changed over time in both groups without clinically meaningful between-group differences. No significant treatment effects were observed for pore counts or melanin index.
CONCLUSION: The formulation improved measured skin brightness but did not demonstrate significant depigmenting or structural anti-aging effects over 8 weeks, suggesting primarily cosmetic benefits.

Keywords: GABA Agents; Cysteamine; Aging

Enlarged or ptotic submandibular glands (SmG) can negatively impact the mandibular angle and facial contour. Although botulinum toxin type A (BoNT-A) is well established as a treatment for parotid hypertrophy, its use for the treatment of SmG enlargement remains underexplored. A literature search was conducted in the PubMed, Cochrane, and LILACS databases, covering studies from November 1977 to November 2024. Seven studies met inclusion criteria, encompassing animal models, cadaveric studies, clinical trials, and case reports. Studies reporting SmG size found volumetric reduction following BoNT-A administration. Current evidence suggests BoNT-A injections into the SmG effectively reduce gland volume and may enhance facial contour.

Keywords: Submandibular Gland; Botulinum Toxins, Type A; Neck; Aging; Esthetics

Reconstruction of paramedian nasal tip defects is challenging because of the thick, adherent skin and limited tissue mobility in this region. The East-West advancement flap is a well-established reconstructive technique but has traditionally been limited to defects smaller than 1.5 cm. We describe a modification incorporating a superiorly oriented crescent-shaped extension at the base of the inferior Burow's triangle to redistribute closure tension and preserve adjacent healthy tissue. This modification extends the applicability of the flap to larger defects while maintaining simplicity. In the cases presented, the technique achieved satisfactory aesthetic outcomes without clinically apparent nasal tip distortion or other complications, representing a practical reconstructive option for selected larger paramedian nasal tip defects.

Keywords: Mohs Surgery; Surgical Flaps; Nose

Onychocytic matricoma (OCM) is a rare benign neoplasm of the nail matrix that presents as longitudinal pachymelanonychia with striking onychogenic capacity. Few cases have been reported in the literature, mostly involving the fingernails. Treatment consists of complete surgical excision of the lesion, which is curative in most cases. We report a case of OCM on the great toenail, contributing to the clinical and histopathologic recognition of this entity.

Keywords: Nails; Rare Diseases; Neoplasms

We report 5 cases of melanoma with initial clinical presentations suggestive of common dermatoses, including seborrheic keratosis, basal cell carcinoma, Bowen disease, actinic keratosis, and solar lentigo. In 4 cases, documented dermoscopy revealed findings discordant with the initial clinical impression and prompted biopsy; in 1 case, lesion evolution and recurrent bleeding prompted excision, confirming a thick nodular melanoma. This series highlights how familiar clinical patterns may promote diagnostic anchoring and delay suspicion. Lesion evolution, patient concern, total-body skin examination, systematic dermoscopy, and a low threshold for biopsy are practical strategies for reducing biases and improving early diagnosis.

Keywords: Melanoma; Dermoscopy; Diagnostic Errors

Melasma is a chronic facial dermatosis that strongly affects mental health and self-esteem, especially among women, causing anxiety, depression, and frustration due to its visibility and recurrence. This narrative review analyzed publications from the last five years (PubMed, SciELO, LILACS, VHL) regarding the condition's psychosocial impact. The results indicate a prevalence of depressive symptoms of up to 43.4%. Therapeutic success is found to depend on an integrated and humanized approach, combining effective treatments (such as oral tranexamic acid and the triple topical formula) with psychological support, aiming not only for lesion clearance but also for the restoration of patients' quality of life.

Keywords: Melanosis; Mental Health; Psychosocial Impact; Dermatology