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

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

O queratoacantoma (QA), apesar de frequente na prática diária, é um tumor que gera questionamentos. O aspecto mais intrigante associa-se à sua posição no limite entre malignidade e benignidade. A abordagem do tumor, bem como sua classificação, é controversa. Na definição da conduta, é importante levar em conta o potencial de transformação para carcinoma espinocelular. Desse modo, a excisão cirúrgica é a terapia de escolha, sempre que possível. Algumas situações merecem atenção adicional, como a imunossupressão associada. Neste artigo, relatamos um caso de QA gigante em um paciente com síndrome da imunodeficiência adquirida tratado com cirurgia micrográfica de Mohs.

Keywords: Ceratoacantoma; Retalhos Cirúrgicos; Neoplasias Nasais; Neoplasias Cutâneas; Cirurgia de Mohs; Síndrome de Imunodeficiência Adquirida; HIV; Imunossupressão

Sarcomas são neoplasias mesenquimais malignas, raras, que acometem, principalmente, crianças e adolescentes. O rabdomiossarcoma, subtipo oriundo da musculatura esquelética, é condição incomum em adultos, acometendo sítios de localização não habitual, crescimento rápido e de difícil tratamento. Apresenta-se caso de adulto jovem com nodulação em lóbulo auricular esquerdo, cuja análise histopatológica e imuno-histoquímica confirmou tratar-se de rabdomiossarcoma alveolar, o qual foi conduzido em conjunto com a Oncologia.

Keywords: Rabdomiossarcoma Alveolar; Miogenina; Desmina; Excisão de Linfonodo