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: 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

Six patients underwent two sessions of microneedling associated to drug delivery on the face, hands or stretch marks, at three-week interval between sessions. Patients were evaluated using clinical analysis and objective measures. Compared to baseline, objective face analysis showed decrease in acne lesions and improvement in the skin texture. The evaluation of stretch marks showed great improvement, and face and hands presented excellent results compared to baseline. The association of microneedling to drug delivery for rejuvenation of the face and hands, and for the treatment of stretch marks presented promising results in our study.

Keywords: ADMINISTRATION, CUTANEOUS; HYALURONIC ACID; REJUVENATION; STRIAE DISTENSAE; TRANEXAMIC ACID; HYDROXYPROLINE

INTRODUCTION: Despite all the existing therapeutic tools, melasma continues to be a dermatological challenge. Therefore, the search for new treatment modalities aims to optimize results and reduce systemic side effects.
OBJECTIVE: Evaluate the clinical improvement of patients with melasma treated with robotic micro-needling associated to drug delivery of tranexamic acid.
MATERIAL AND METHODS: Seventeen women with melasma were selected to be treated during eight weeks with four fortnightly sessions of robotic microneedling associated to drug delivery of 1.0ml of 4mg/ml tranexamic acid. The group was evaluated before and after the treatment with the following parameters: photographic evolution evaluated by three examiners, self-evaluation with Melasma QoL and MASI improvement.
RESULTS: Fifteen Fitzpatrick phototype II to VI patients completed the study. Of those, 31.11% showed little or no improvement; 24.45% moderate to intermediate improvement; 33.33% significant improvement and 11.11% improved almost to resolution. In regards to MASI, there was a significant improvement, with a reduction from 21.33% to 11.19%.
CONCLUSIONS: The proposed association showed satisfactory results, constituting an innovative, replicable and safe therapeutic modality for the treatment of melasma.

Keywords: Combined modality therapy; Hyperpigmentation; Tranexamic acid

Atrophic acne scars result from an abnormal wound-healing response that can be treated with microneedling (MN). Insulin may play a role in wound healing. The effectiveness and safety of combining MN with topical insulin as an alternative therapy for atrophic acne scar revision have not yet been widely reported. We report the case of a 33-year-old woman with an atrophic acne scar on the middle third of her face. The patient was treated with MN and topical insulin for four sessions at two-week intervals. MN plus insulin can be considered an alternative for acne scar revision.

Keywords: Acne Vulgar; Insulina; Cicatriz; Hiperpigmentação

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