For several years, the treatment of acne vulgaris has been based on the use of oral or topical medication, isolated or in association with other medications. Such options still represent excellent therapeutic alternatives; however, there are cases in which they cannot be used either because of their side effects or the lack of response to treatment due to the growing bacterial resistance to antibiotics. Based on the observation that light has been successfully used to treat many pathologies – including acne – a number of therapeutic devices have been developed that demonstrate good results.The objective of this article is to present a review of the pathology of acne and of the photobiological principles used in its treatment, considering some of the main current phototherapeutic modalities.

Keywords: ACNE VULGARIS, PHOTOTHERAPY, LASER THERAPY

Acne is a multifactorial disease encountered on a daily basis by general medical practitioners and, especially, dermatologists. It has been a constant focus of studies that increasingly unveil details of its physiopathology and help refine treatments in order to address the majority - if not all - pathogenic factors.This article''''''''s objective is to draw attention to the therapeutic associations and combinations in acne management, highlighting its chronic disease character, typified by recurrence, and the requirement for continued treatment that is not only effective but also safe.

Keywords: ACNE VULGARIS, ACNE VULGARIS/PHYSIOPATHOLOGY, BACTERIAL DRUG RESISTENCE

Introduction: Isotretinoin was initially used to treat severe inflammatory acne and is now widely recognized as an effective therapy for acne vulgaris. Many factors are associated with the recurrence of this condition, which ranges from 5.6-65.4%. There is much con- troversy regarding the importance and contribution of each factor.
Objectives: To determine the recurrence rate in patients who underwent full treatment with oral isotretinoin (dose between 120 and 150 mg/kg) and risk factors.
Methods: Retrospective study of data from 276 patients treated with isotretinoin. The analysis was carried out after a minimum of 30 months after the end of the treatment. Recurrence was defined as the appearance of new active lesions that required retreatment.
Results: While the recurrence rate in patients who underwent the full dose was 25.53%, it reached 81.03% in those who received an incomplete dose. The other studied factors presented no statistical significance.
Conclusion: Oral isotretinoin therapy is effective in producing a significant and long- term reduction of acne. Nevertheless, it is important to note that recurrence can occur, especially when recommended doses are not reached.

Keywords: ACNE VULGARIS, ISOTRETINOIN, RECURRENCE

Extramammary Paget's disease is a rare cutaneous neoplasm typically occurring in the vulva of Caucasian women after menopause. Clinically, the most common symptom is pruritus, when an erythematous, desquamative and eczematous lesion can be observed. Due to the rarity and nonspecific appearance of the disease, it can be confused with other dermatological conditions, delaying diagnosis. The present case demonstrates a form of vulvar extramammary unilateral Paget's disease confirmed by anatomical pathologic and immunohistochemical study. The standard treatment used for the disease in this case was surgical and the patient underwent complete excision of the lesion, with continued monitoring every six months.

Keywords: GENITAL NEOPLASMS, FEMALE; VULGAR NEOPLASMS; VULVAR DISEASES; PAGET DISEASE, EXTRAMAMMARY.

Introduction: Progressive macular hypomelanosis is characterized by the emergence of hypopigmentation, predominantly in the trunk region of young women of mixed racial origin. Although recent studies suggest that Propionibacterium acnes may have an important role in the pathogenesis, its etiology remains unclear. Objective: To evaluate the prevalence of the condition with regards to gender, age, skin phototype, affected areas and disease onset, and the relationship with ordinary acne and oily skin in the city of Niterói, Rio de Janeiro State, in the coastal region of Southeast Brazil. Methods: Retrospective epidemiological study that uses the analysis of medical records of 103 patients with diagnosis of progressive macular hypomelanosis, from 2001 to 2012. Results: Eighty-two percent of studied patients were women and 18% men, with a predominance of phototypes III (42.7%) and IV (42.7%). The average age of onset of the disease at diagnosis was 26 years. In 46.0% of patients the disease duration ranged from 1 to 4 years. When two areas were affected (50%), the dorsum was the most frequent (79.0%), followed by the abdomen (20.0%). In 98% of cases, patients had oily skin, and 71.8% had active acne. Conclusion: Progressive macular hypomelanosis is a chronic condition that primarily affects the skin of the dorsum and abdomen of young women with skin phototypes III and IV, who are also bearers of oily skin and acne. There are still many doubts regarding the true etiology and treatment of progressive macular hypomelanosis. The high percentage of association with skin oiliness and acne vulgaris suggests that these clinical conditions are possibly related.

Keywords: HYOPIGMENTATION; EPIDEMIOLOGY; ACNE VULGARIS

Acne scars present at the end of the inflammatory phase of acne vulgaris have been treated with procedures that stimulate the production of collagen, such as microneedling. Six patients with acne scars were selected. Microneedling was performed with 2.5 mm needles. Subjective improvement was observed in all patients. In the technique of percutaneous collagen induction there is release of cytokines, growth factors and angiogenesis, with final production of type I collagen, making microneedling an excellent option for the treatment of acne scars, both for its cost/ benefit and for not drawing patients away from their daily activities.

Keywords: ACNE VULGARIS; CICATRIX; TREATMENT OUTCOME

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

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

Acne is a common condition that often results in scarring. We propose a novel treatment of acne scarring using: 1- chemical reconstruction of skin scars (CROSS), mainly with carbolic acid, 2- blunt bi-level cannula subcision, and 3- microneedling. A total of 139 patients were treated from 2017- 2018, of which 89 (64%) were Fitzpatrick Skin Types IV-VI. This triple approach to treating acne scars resulted in consistent high satisfaction from patients and photographic evidence of improvement. A combination of CROSS (to stimulate neocollagenesis), subcision (to release dermal connective tissue tethering), and microneedling (to stimulate neocollagenesis) is effective for acne scar treatment.

Keywords: Acne vulgaris; Acne keloid; Cicatrix; Cosmetic techniques

INTRODUCTION: Acne vulgaris, considered a chronic inflammatory and multifactorial disease, presents several therapeutic options. The use of probiotics is a good adjunctive treatment option due to its anti-inflammatory effect.
OBJECTIVE: Based on the promising character of these studies, which derive mostly from oral probiotic therapy, we decided to investigate what results could come from the topical use of a probiotic bacterium that has undergone the tyndallization process.
METHODS: In this study, we demonstrated the topical use of Lactobacillus plantarum GMNL06, alone, for three months.
RESULTS: We obtained a therapeutic response considered good or very good in 90% of mild or moderate acne cases.
CONCLUSIONS:Vulgar acne, considered a chronic inflammatory and multifactorial disease, presents several therapeutic options. The use of probiotics has become an adjunct treatment due to its anti-inflammatory effect. In this study, we demonstrated that the use of topical probiotics, in monotherapy, for three months obtained therapeutic response considered good or very good in 90% of mild or moderate acne cases.

Keywords: Probiotics; Bacteria; Acne; Treatment

BACKGROUND: The microneedling technique and the transdermal drug delivery are indicated to treat acne scars.
OBJECTIVE: Evaluation of the microneedling technique associated with the drug delivery of the epidermal growth factor (EGF).
METHODS: Randomized double-blind clinical trial of 30 patients divided into two groups: (1) - two microneedling sessions with a 30-day interval, (2) - two microneedling sessions with the same interval but associated with EGF drug delivery. The patients were evaluated clinically (global acne scarring grading system - Goodman and Baron) global acne scarring grading system via multispectral image and through self-perception questionnaires. The statistical analysis (Student T-test, SNK test, analysis of variance) was performed with the SisVar software (UFLA, 1996).
RESULTS: The groups were homogeneous regarding age, gender, and phototype. Clinical assessments showed a reduction in severity scores for both groups. The multispectral analysis revealed a decrease in porphyrins (p = 0.0296) and an improvement in skin texture in group 2 subjects.
CONCLUSION: Microneedling therapy was effective and safe for the acne scars treatment, and EGF demonstrated to be a promising strategy as well.

Keywords: Acne vulgaris; Cicatrix; Skin

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

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.

ABSTRACT

INTRODUCTION: Adult female acne (AFA) affects women over 25 years old. Although there are no solid data in the Brazilian literature, genetic, hormonal, and environmental factors are believed to contribute to its pathogenesis.
OBJECTIVE: To assess the prevalence of AFA and its possible risk factors in a sample of the Brazilian population.
METHODS: A cross-sectional clinical study was conducted with 258 women aged 25 to 55 stratified by race and age according to the Brazilian population (2010 census). The study analyzed their demographic, clinical, psychological, and exposure-related information.
RESULTS: Acne complaints were reported by 41.1% of participants, ranging from 15% in those aged 50–55 to 60% in those aged 25–29. Clinical examination confirmed lesions in 36.6% of women. In 70% of cases, acne had persisted since adolescence, and 13.2% of participants were undergoing treatment. Acne was significantly associated with age, race, age at menarche, hirsutism, smoking, oily skin, and makeup use (p<0.05).
CONCLUSIONS: Acne was a prevalent issue, especially before age 40, and was more common in Black and mixed-race individuals, those with clinical signs of hyperandrogenism, and makeup users. However, it was inversely associated with smoking.

Keywords: Acne Vulgaris; Adult; Hyperandrogenism.