Unattractive periauricular widened or hypertrophic scars can result from the tension on rhytidoplasty incision sutures. During a 5-year retrospective study, 10 female patients with such scars were treated with the periauricular ring technique. Polytetrafluoroethylene and double 2-0 mono nylon threads were used in 6 and 4 cases, respectively, introduced with a fascia lata non-bevelled needle . Following the scar exeresis, the borders were approximated and the ring tied and attached to the temporal muscle fascia.The outcomes were satisfactory. In 2 cases the threads were removed without altering the scars’ final aesthetic result.

Keywords: CICATRIX, CICATRIX HIPERTROPHIC, RHYTIDOPLASTY, EAR

Keloids were first described several centuries ago, however their handling and treatment are still often inadequate. A number of treatments are available, such as intralesional corticotherapy and compressive therapy. The case of a 24-year-old female patient with a 5 year history of keloids in the ear lobules, with recurrence after treatment, is reported. She experienced a full regression of the lesions (for 2 years) after surgical reduction followed by intralesional bleomycin injections. Bleomycin is emerging as a therapeutic option with few side effects and lasting results for keloids that are unresponsive to conventional treatments.

Keywords: BLEOMYCIN, CICATRIX, HYPERTROPHIC, KELOID

Fractional photothermolysis was developed as an alternative to ablative lasers (which are effective but pose a high risk of complications) and non-ablative lasers (which have limited effectiveness). Fractional photothermolysis has been successfully used in diverse dermatological conditions. This study describes the case of an Asian male patient with atrophic scarring secondary to trauma in the left paranasal region, who underwent treatment with 1,550 nm non-ablative fractional Erbium Glass laser, which led to a significant improvement in the lesion. This case corroborates the use of less-invasive procedures in difficult-to-treat dermatoses and in treating Asian skin types safely and effectively.

Keywords: LASERS; THERAPEUTICS; CICATRIX; ATROPHY.

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: The treatment of keloids and hypertrophic scars are an everyday challenge for the dermatologist. Despite the existence of a large therapeutic armamentarium, a variable rate of effectiveness, side effects, and recurrences make it difficult to achieve satisfactory results. As an isolated or in-combination therapy, 5-fluorouracil has the potential to be a part of the treatment paradigm for hypertrophic and keloid scars. Objective: To evaluate, during 12 years, the outcomes of the use of 5-FU (50 mg/ml) in a ratio of 9:1 with triamcinolone acetonide (20 mg/ml) in patients bearing keloids and hypertrophic scars. Methods: Retrospective study of 32 patients with keloids, hypertrophic scars, and cicatricial fibrosis who underwent 1 to 17 intralesional injections of a combination of 5-FU and triamcinolone acetonide in fortnightly intervals. A visual analog scale (VAS) was employed to evaluate the pain/discomfort caused by the lesion, as well as to assess the patient's perception of the scar when seeing it in the mirror. Results: In the comparison of the visual analogue scales (VAS) after the treatment, there was a significant reduction in the level of pain/discomfort (VAS pain) (p = 0.001) and in the assessment of the scar's appearance in the mirror (VAS mirror) (p <0.001). Three patients (9.4%) had complications: hyperchromia (two patients = 6.3%) and atrophy (one patient = 3.1%). Conclusions: 5-FU injections in hypertrophic scars, keloids, and fibroses was found to be a minimally invasive, cost effective, and easily reproducible therapeutic approach with consistent results, which does not invalidate or preclude other techniques.

Keywords: CICATRIX, HYPERTROPHIC; FLUOROURACIL; KELOID

Introdução: The beneficial role of medium peelings and microneedling in photoaging and scars yield satisfactory results. Objective: A retrospective, descriptive, single-center study evaluating the results of the association of 88% phenol and microneedling for treating sagging, wrinkles and acne scars on the face. Methods: Medical records and standardized photographs, taken before and 3 months after the procedure, of 28 patients diagnosed with wrinkles, sagging or acne scars and treated with 88% phenol peeling followed by microneedling with 2.5 mm needles, were analyzed. Events and complications were recorded 15 days after the procedure. The investigator physician performed clinical and photographic assessments 3 months after the procedure, when patient satisfaction questionnaires were also applied. Results: Twelve patients had only wrinkles and sagging, 5 had only acne scars and 10 had both pictures, with skin phototypes I to III. Erythema persisted for 30 days and post-inflammatory hyperpigmentation was observed in 7 of 28 patients. Based on the clinic and photographic evaluations, the author considered the results as good and very good. 100% of patients reported satisfaction with the outcomes. Conclusions: Good results were observed with the association of 88% phenol and microneedling. Few patients experienced adverse effects, allowing the author to suggest that the procedure showed a good safety profile.

Keywords: THERAPETICS; REJUVENATION; CICATRIX S

Patients with scars often seek dermatologists for improving the symptoms (pruritus, pain), aesthetics and functionality (for example, to improve the range of motion in the joints). After anamnesis and description of the scar, the patient should be informed about the best repair techniques, based on scientific evidence and the physician's personal experience. The authors describe the main surgical techniques to treat scars, such as Z-plasty, W-plasty, dermabrasion, among others

Keywords: CICATRIX; SURGERY; DERMABRASION

Keloids and hypertrophic scars result from abnormal wound healing with excessive growth of fibrous tissue. Despite the high incidence in the population, the high rates of relapse and the significant psychosocial impairment, treatment remains a challenge for dermatologists. The objective of this study was to review literature on clinical, etiological and therapeutical aspects of keloids and hypertrophic scars, emphasizing its therapy with bleomycin, demonstrating its effective and safe use. The search was conducted in Scopus and MEDLINE databases, for the period from 1995 to 2016, using the key words: queloide/keloid; cicatriz hipertrófica/cicatrix, hypertrophic; and bleomicina/bleomycin.

Keywords: KELOID; CICATRIX, HYPERTROPHIC; BLEOMYCIN

Introduction: Acne scars result from inflammation of acne vulgaris and are a frequent cause of complaints in dermatology practices. Atrophic scars are the most common, and may be classified into superficial, medium, and deep. There are several treatment options for deep atrophic scars, however they have limited efficacy in general, undesirable side effects and are expensive.
Objective: To evaluate the treatment of deep atrophic scars with high frequency electrosurgery.
Methods: Ten patients with deep atrophic acne scars received 3 high frequency electrosurgery treatment sessions with intervals of 1 month. The following were used to evaluate the outcome 1 month after the last session: histological aspects of selected scars as compared to the baseline; ratings attributed to the results by the patients (worsened, unchanged or improved); and standardized photographs at baseline and 1 month after the last session performed by a physician not related to the study, who also rated the results (worsened, unchanged or improved).
Results: Histological analysis evidenced a reduction in local fibrosis. All patients noticed improvement in the lesions. The evaluator dermatologist physician verified the presence of clinical improvement in all patients.
Conclusion: High frequency electrosurgery is a straightforward, inexpensive and effective method for the treatment of atrophic deep acne scars.

Keywords: CICATRIX; ACNE VULGARIS; ELECTROSURGERY

Introduction: The use of microneedling techniques has become increasingly important in the correction of scars.
Objective: To evaluate the results of percutaneous induction of collagen with needles in scars developed after automobile accidents.
Methods: A retrospective, descriptive and monocentric study analyzed medical records containing standardized photographs taken at baseline and 3 months after a single microneedling session, in 9 patients diagnosed with post-traumatic scars who were treated using the same protocol. Clinical and photographic evaluations of the treatment were performed by the investigator 3 months after the procedure according to a category scale (very good, good, reasonable, poor). Patient satisfaction questionnaires were also applied at this experimental timepoint.
Results: The clinical and photographic evaluation classified 5 patients as very good and 4 as good regarding the results achieved. All patients reported satisfaction with the outcomes.
Conclusions: The use of needle-induced percutaneous collagen yielded good esthetical and functional results in scars developed following accidental trauma. Adverse effects were not observed, which suggests that the described procedure has a good safety profile.

Keywords: THERAPEUTICS; ACCIDENTS; CICATRIX

Introduction: Acoustic wave therapy stimulates tissue regeneration and healing processes. Therefore, it is expected that this treatment modality might have effects on scars.
Objective: To evaluate the efficacy and safety of acoustic wave therapy in the improvement of keloids.
Methods: An open, prospective, monocentric study was carried out with 20 participants with clinical diagnosis of keloid. Weekly sessions of acoustic wave therapy were performed, for eight weeks. Participants were assessed at baseline and at 1 and 12 weeks after the end of the treatment. The investigators took measurements of elasticity and performed clinical evaluations based on the Vancouver Scars Scale. At the end of the treatment the participants’ satisfaction with the treatment was evaluated.
Results: After the treatment, the percentage of participants with keloid thickness between 2mm and 5mm decreased to 47% (from 71%), increasing the percentage of participants with reduced keloid thickness in the total sample (<2mm, to 41% from 24%). Some participants also had improvement in the keloids’ vascularization and pliability. No treatment-related adverse events have been reported.
Conclusions: Acoustic wave treatment is safe and can be effective in the improvement of the keloid’s functionality and some clinical aspects.

Keywords: KELOID; CICATRIX; SCALES

Both microneedling and ablative fractional laser can be used for the treatment of scars. The present article reports the case of a female patient who had the first half of a perioral scar treated with ablative fractional CO2 laser, and the second half treated with microneedling, using a 2mm roller. Outcomes were superior in the half treated with laser.

Keywords: Cicatrix; Collagen; Lasers

INTRODUCTION: Stretch marks are an everyday challenge to the dermatologist. In the search for alternative therapies, we find 5-fluorouracil (5-FU) and microneedling for associating the following properties: inhibition of fibrosis, stimulation of collagen renovation and induction of skin pigmentation. Objective: To evaluate the efficacy and safety of 5-FU, in isolation or associated to microneedling, for the treatment of white stretch marks (striae alba).
METHODS: Comparative, double-blind study over 180 days, between 3 groups: Group A: microneedling and 5-FU; Group B intralesional 5-FU and Group C microneedling without medication. We measured improvement through a numerical scale of skin coloration, considering positive results those with reduction of the discrepancy between the adjacent skin and the stretch mark. We also evaluated patient satisfaction and irritation with each technique.
RESULTS: Group A achieved 10% of excellent clinical improvement, 10% very good and 60% mild. In group B, none of the patients had excellent of very good improvement. In group C, there was 20% of very good clinical improvement and 70% of mild.
CONCLUSIONS: All techniques showed some degree of improvement of the lesions. Therefore, we propose new studies comparing all three techniques, with a larger sample, to evaluate if more treatments would result in better results.

Keywords: Cosmetic Techniques; Fluorouracil; Striae Distensae; Therapeutics

INTRODUCTION: Idiopathic guttate hypomelanosis (IGH) is a common photoaging manifestation, with no standard treatment and presenting mixed results to interventions. In Brazil, the use of micro-needling associated with 5-fluorouracil (5-FU) has been proposed to treat IGH.
OBJECTIVE: To compare the use of MMP^® (micro-infusion of drugs on the skin) with 5-FU, with MMP^® only as micro-needling (with no drugs), and intralesional 5-FU injected with an insulin syringe in the treatment of IGH.
METHODS: In a single blind randomized clinical trial, we compared the three treatments: MMP^® versus MMP with 5-FU and intralesional 5-FU injection for 180 IGH lesions in the forearm of nine patients.
RESULTS: After two treatment sessions, 5-FU alone was the most effective treatment, with statistical significance, compared with micro-needling alone. MMP+5-FU efficacy was lower than intralesional 5-FU injection and higher than micro-needling alone, although without statistical significance.
CONCLUSIONS: The intralesional application of 5-FU was more effective in the treatment of solar leukoderma. The use of a smaller quantity of medication is the great advantage of the MMP + 5-FU technique. Further studies are needed to standardize these techniques.

Keywords: Drug delivery systems; Fluorouracil; Hypopigmentation; Skin aging

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