Introduction: Skin photoaging can be treated with ablative therapies that cause immunological changes to the skin. Objectives: To evaluate the results of chemabrasion in the treatment of perioral wrinkles and the change in number of Langerhans cells. Material and Methods: Application of 35% trichloroacetic acid followed by manual dermabrasion using waterproof sandpaper, in 12 female patients with perioral wrinkles and results were then examined 30 days and 1 year later. Immunohistochemistry was used to measure Langerhans’ cells which were counted before treatment and 1 month post-treatment. Results: Improved perioral photoaging and reduced number of Langerhans’ cells (p = 0.002) were seen in all patients. Conclusions: Chemabrasion provides effective results in the treatment of perioral wrinkles but Langerhans cells remain low for 30 days after therapy.

Keywords: SKIN AGING, CHEMABRASION, METHODS, DERMABRASION, TRICHLOROACETIC ACID, THERAPEUTIC USE, IMMUNOHISTOCHEMISTRY, LANGERHANS CELLS

Introduction: Striae are frequent complaints in dermatology, however most studies are based on the use of laser, and the effects of other treatment modalities are observed by few doctors. ,Objective: To compare three therapeutic modalities: Subcision alone, trichloroacetic acid (TCA) 20% alone, and subcision combined with application of TCA 20% in treatment of striae. Materials and Methods: Eleven female patients, skin phototype II-IV with striae gravidarum, had their lower abdomen divided into 4 quadrants. One stria of each quadrant was selected to be subjected to one of 3 procedures and 1 quadrant was the control. Objective evaluation was performed by the physician and subjective evaluation was performed by the patient. Results: Reduction in width with subcision and in length with TCA 20% were observed by measurement. In the subjective evaluation, improvement was observed mainly with the subcision-TCA 20% treatment. Photografic evaluation was disregarded. At statistical analysis, there was no significant difference between treatments. There were no adverse effects related to treatments. Conclusion: Despite the reported improvement, especially with the subcision-TCA 20% treatment, there was no statistically signifi cant difference between treatments.

Keywords: STIRAE, TRICHLOROACETIC ACID, PREGNANCY, DERMATOLOGY

Rosacea is a prevalent chronic cutaneous disorder that often presents relapsing course and is challenging to treat. It is frequently necessary to use off-label treatments to achieve satisfactory results.We report the use of a single session of medium depth peel with Jessner''''''''s solution and 35% trichloroacetic acid in fifteen patients, which achieved good clinical outcomes and histopathological improvement.The use of medium-depth peels must, therefore, be considered a therapeutic option for the treatment of rosacea.

Keywords: ROSACEA, CHEMEXFOLIATION, TRICHLOROACETIC ACID, RESORCINOLS, SALICYLIC ACID

The authors introduce a method for the treatment of different intensities and scales of rhinophyma, with trichloroacetic acid. This is a safe process, created and performed by the authors for five decades, with an absence of descriptions of adverse effects.

Keywords: TRICHLOROACETIC ACID; RHINOPHYMA; THERAPEUTICS.

Introdução: actinic melanosis is a pigmentation disorder caused by the cumulative action of sunlight on the skin and its incidence increases with advancing age. Objective: Considering the lack of studies comparing agents with the same concentration, however in different vehicles, the authors compared the clinical effects of chemical peelings performed with 20% trichloroacetic acid (ATA) paste or solution in the treatment of actinic melanoses in the back of the hands. Methods: A prospective, controlled, randomized study was carried out with 15 patients bearers of bilateral actinic melanoses on the back of the hands. Three monthly sessions with 20% ATA peelings were performed with paste in one hand and solution in the other. The degree of whitening was evaluated by 13 blinded dermatologists, and patients were asked about the satisfaction and preferred method. Results: There was no preference for any of the methods used (p = 0.41), however, according to the medical evaluation, there was greater whitening with the paste (p = 0.01). Only the paste caused significant adverse effects, affecting 4/15 patients. Conclusions: Compared to the solution, when applied for two minutes in the treatment of actinic melanosis, the 20% ATA paste had greater whitening capacity, however demonstrated a tendency to cause more local adverse effects.

Keywords: TRICHLOROACETIC ACID; MELANOSIS; HAND; CHEMEXFOLIATION; SKIN PIGMENTATION

Introduction: Rhinophyma is the final stage of rosacea. It leads to the stigmatization of the patient.
Objective: To establish the safety and efficacy of dermachemabrasion in the treatment of rhinophyma.
Methods: The method, which consists of tangential excision and dermabrasion with sandpaper followed by 30% trichloroacetic acid on the previously sanded area, was prospectively applied in 7 patients. The excised material was histologically studied aiming at detecting hidden neoplasias. Safety and efficacy were evaluated clinically and through standardized photographic records.
Results: The patients' ages ranged from 57 to 68 years (6 men, 1 woman). The complete reepithelialization occurred within 7 to 14 days. The 7 patients progressed without infection, with satisfactory reepithelialization and results from the aesthetic point of view, with absence of dyschromias or scarring. The histological analysis revealed the presence of a hidden neoplasia (superficial basal cell carcinoma) in one case.
Conclusion: Dermachemabrasion is a low cost, simple to execute and effective treatment that leads to excellent cosmetic results in addition to having the advantage of the possibility of histological analysis, which is extremely important, since there are reports of hidden malignancy in rhinophyma.

Keywords: RHINOPHYMA; TREATMENT OUTCOME; DERMABRASION; TRICHLOROACETIC ACID

Scalp folliculitis is a common condition in dermatological practice and a diagnostic and therapeutic challenge. The authors describe a case of chronic suppurative folliculitis in a 53-year-old man who had bore the condition for 18 years. The control of chronic staphylococcal infection with sulfamethoxazole-trimethoprim for 7 months, with progressive shaving of keloid lesions (5 sessions) and application of 90% trichloroacetic acid on wounds up until re-epithelialization (7 months), were successful in treating the disease.

Keywords: Folliculitis; Staphylococcus aureus; Trichloroacetic acid

INTRODUCTION: Acne vulgaris is an inflammatory disorder of the pilosebaceous gland. Palmitic acid is one of the major types of free fatty acid and may play a role in acne pathogenesis. In addition, recent studies suggested that Staphylococcus epidermidis might be involved in acne.
OBJECTIVE: To explore the association between Staphylococcus epidermidis and palmitic acid in acne vulgaris.
METHODS: Forty-three high school students at an urban area in South Sulawesi, Indonesia, were included. The palmitic acid level was measured using gas chromatography and comedone was cultured to detect the microbiota profile. Mann-Whitney test was used to analyze the median palmitic level diference between groups with different acne vulgaris severity.
RESULTS: Fourteen patients (32.6%) had mild acne vulgaris, while 14 and 15 patients had moderate and severe acne vulgaris, respectively The severe and moderate group showed significantly higher palmitic acid level compared with the mild group. Subgroup analysis of patients with moderate and severe acne vulgaris positive for S. epidermidis showed a significantly higher palmitic acid level compared with the mild group.
CONCLUSIONS: This result suggests that S. epidermidis may be associated with the palmitic acid level and may contribute to acne pathogenesis.

Keywords: Acne vulgaris; Staphylococcus epidermidis; Palmitic acid

BACKGROUND: Anogenital warts are the most prevalent sexually transmitted infection (0.5%) among dermatological consultations. Cryotherapy with liquid nitrogen (LN) and therapy with trichloroacetic acid (TCA) are remarkable among the treatment strategies.
OBJECTIVE: To evaluate the effectiveness of LN versus TCA in to treat penile warts in patients from a Brazilian public institution.
METHODS: Open, parallel, randomized clinical trial. Following randomization, the warts were counted and submitted to cryotherapy (10s) or case therapy (TCA 80%) in each visit. The primary dependent variable was the lesion count before and after four weeks of treatment. We assessed the following variables: complete clearance, age, immunosuppression, smoking, topography, and education.
RESULTS: 142 treatments were evaluated in 52 participants. There was a predominance of young adults, and the main topography affected was the penis shaft. The mean reduction rate per session was 48% for LN and 26% for TCA (p=0.11). 42 (81%) participants achieved complete clearance, with 39 (75%; 95% CI: 64-85%) reaching clearance in up to three sessions. Age was associated with a worse therapeutic response rate (ß =-0.09; p<0.01).
CONCLUSIONS: LN and TCA proved to be effective to treat penile warts, without difference between treatments. Age was associated with a worse therapeutic response.

Keywords: Trichloroacetic acid; Cryosurgery; Sexually transmitted diseases; Papillomavirus infections; Warts

Since antiquity, chemical peelings are still widely used to treat skin aging. There are a variety of substances, techniques, and considerations for each type of peeling. However, this case series aims to present a non-described form of application of trichloroacetic acid (TCA) and retinoic acid to treat fine static wrinkles on the face. The technique consists of applying the TCA peeling directly to the facial rhytids and, subsequently, retinoic acid peeling all over the face for 6 hours.

Keywords: Chemexfoliation; Trichloroacetic acid; Skin aging; Chemical abrasion

A patient with dissecting folliculitis of the scalp who did not respond to antibiotic therapy received four monthly sessions of intradermal administration of 100 IU of botulinum toxin A. Four months after treatment, a complete recovery of the affected area of the patient's scalp was observed. A biopsy taken from the affected area showed the presence of Staphylococcus lugdunensis and Staphylococcus aureus resistant to erythromycin. Botulinum toxin A had no effect on the viability or biofilm production of the Staphylococcus strains, indicating that the healing effect of the toxin was associated with the host response alone.

Keywords: Botulinum Toxins Type A; Folliculitis; Alopecia; Staphylococcus aureus; Staphylococcus lugdunensis.