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

Introduction: Acne scars are common, and their treatment is challenging. Several techniques have been used to remove, reposition, and flatten acne scars to improve the appearance of the skin’s surface. More recently, fractional CO₂ laser has been used to correct such scars due its good results and shorter recovery time.
Objective: To evaluate and compare fractional CO₂ laser vs. dermabrasion-based treatment of acne scars.
Methods: Nine patients were assessed – six received fractional CO₂ laser and three were treated with dermabrasion. Subjective and objective parameters were evaluated for both treatment modalities.
Results: Both patient groups showed objective and subjective improvement.
Conclusions: This study has demonstrated that fractional CO₂ laser and dermabrasion-based treatments have similar efficacy in moderate to severe acne scars.

Keywords: CICATRIX; ACNE VULGARIS; LASER THERAPY.

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: Scars caused by burns have the potential to cause clinical, social, and functional disruptions. Dermatologists should be able to intervene in this process by combining technological advances with traditional techniques. Objective: To evaluate the effect of Intense Pulsed Light applications on scars after burns, based on clinical parameters described in the international Vancouver Scar Scale. Methods: A prospective study was carried out with six patients who underwent five monthly Intense Pulsed Light sessions over the entire area of a wound. The analysis of the results was conducted by three evaluation groups: 3 physician researchers, the patients included in the study, and 3 physician observers. The evaluation was implemented using the Vancouver Scale, a questionnaire based on this scale, and additionally a general rating used by all evaluators based on a numerical scale. The data obtained by examining the differences before and after the treatment, was analyzed through the Wilcoxon signed-rank test. Results: A statistically significant decrease was observed in the analyses of all clinical parameters of the scars, when evaluated before and after the completion of the treatment. Conclusions: The present pilot study demonstrates the advantages of Intense Pulsed Light as an approach to this specific type of scar, with an aim of stimulating further studies in order to improve this low-cost technology, as compared to lasers.

Keywords: LASERS; INTENSE PULSED LIGHT THERAPY; CICATRIX; BURNS.

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: With several treatment options available - including laser - atrophic acne scars are nonetheless difficult to treat. The use of fractional technology results in dermal-epidermal ablation columns, interspersed with intact skin islands, allowing selective thermal damage, effective treatment and faster recovery. The objective of the present study is to demonstrate the efficacy and safety of fractional laser use in the treatment of atrophic acne scars among the Brazilian population. Methods: An open, prospective, interventional study was carried out with patients with acne scars, without restriction regarding the gender and skin phototype. Exclusion criteria were: pregnancy, breast-feeding, presence of infections or blood dyscrasias and the use of anticoagulants. The evaluation was performed by comparing texture, appearance, and relief as observed in digital photographs. Results: Of the 30 selected patients, 24 were included in the study. An improvement was noted in the parameters evaluated in the cases that underwent fractional laser (CO2, Erbium-Glass or both). Individuals who underwent multiple treatments showed better results. All those treated with 4 sessions had improvements greater than 50%. Post-inflammatory hyperpigmentation was detected in 7 of the 24 treated patients. Conclusion: The present study showed that, when using appropriate parameters and adequate care, fractional laser-assisted resurfacing is an effective and safe method for treating atrophic acne scars in the Brazilian population.

Keywords: ACNE VULGARIS; CICATRIX; LASERS; CHEMEXFOLIATION

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

Use of botulinum toxin type A in first intention healing wounds has been widely adopted in order to inhibit the formation of hypertrophic scars. In this report we demonstrate the use of the toxin in a surgical wound left to heal by secondary intention, after the removal of a squamous cell carcinoma in situ by Mohs micrographic surgery in supralabial region, with good cosmetic result. Botulinum toxin acts by inhibiting the proliferation of fibroblasts, by differentiating fibroblasts and by producing type I collagen, which are the main factors responsible for the good quality of the healing process.

Keywords: BOTULINUM TOXINS, TYPE A; CICATRIX; WOUND HEALING; CARCINOMA, SQUAMOUS CELL

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: Acne scars treatment is challenging since, in the most of the cases, there are different types of scars in the same patient.
OBJECTIVE: Associate three distinct acne scar treatment techniques in the same session in order to optimize results.
METHODS: Retrospective observational study evaluating 25 patients with acne scars treated with the following sequence of associated techniques: high frequency electrosurgery, CO₂ laser and Nd:YAP laser.
RESULTS: High patient satisfaction index and evident improvement in photographs in most of cases.
CONCLUSIONS: The combination of techniques in one session was safe and effective in the treatment of acne scars, a condition of great psychological impact to affected individuals.

Keywords: Acne vulgaris; Cicatrix; Laser therapy

INTRODUCTION: Scars are very prevalent in the world’s population and can have a significant psychological impact in the patient’s life. There are already conventional clinical and surgical methods for their treatment. However, recurrence and existing side effects drive the search for new therapeutic modalities.
OBJECTIVE: To evaluate the clinical improvement of patients with hypertrophic scarring treated with fractional ablative laser associated to triamcinolone drug delivery.
MATERIAL AND METHODS: Eighteen patients with scars to be treated were selected during eight weeks, with four fortnightly sessions of fractional ablative laser associated to 20mg/ml triamcinolone drug delivery. Before and after the treatment, the group was evaluated by three examiners, through the photographic evolution , considering the parameters appearance, dyschromia and degree of hypertrophy. Results: Fifteen patients completed the study. Of these, 35.53% had no or little improvement; 37.80%, moderate to intermediate improvement; 8.89%, expressive improvement and 17.80%, improvement near resolution.
CONCLUSIONS: The proposed association is a promising therapeutic option for the treatment of hypertrophic scars because it is quick to perform and to heal, with less side effects and better tolerated by the patient when compared to the therapies used alone, besides being easily replicable in the office.

Keywords: Cicatrix, hypertrophic; Lasers; Triamcinolone acetonide

INTRODUCTION: The treatment of unsightly hypertrophic scars secondary to surgeries in the thoracic region area challenging, particularly if associated to striae distensae. Surely, more than one therapy should be used, which will demand a long treatment time.
OBJECTIVES: To evaluate the effect of the association of fractional ablative and non-ablative lasers, microneedling and drug delivery in the management of hypertrophic scarring and striae distensae.
METHODS: Patient showing hypertrophic scars and striae on the anterior thoracic region was submitted to four monthly sessions of fractional ablative and non-ablative lasers, associated to microneedling and drug delivery.
RESULTS: At the end of the treatment protocol, the patient had improved mobility of the treated areas, quality of the skin and striae distensae in the treated region.
CONCLUSIONS: The associated treatment showed good results in the concurrent management of atrophic and hypertrophic scars.

Keywords: Cicatrix; Lasers; Needles

Botulinum toxin has transient flaccid neuromuscular paralysis as its mechanism of action. Recent studies are identifying new ways to use botulinum toxin for a variety of purposes, both in the aesthetic and in the therapeutic field. This work aimed to conduct a literature review on these applications. In the aesthetic field, botulinum toxin has shown benefit in the treatment of hypertrophic scars, rejuvenation of the scrotal region, definition of the gastrocnemius muscle, and microdoses use. In the treatment of pathologies, the review has shown that botulinum toxin may be useful for the treatment of post-herpetic neuralgia and other pain syndromes, craniofacial hyperhidrosis, rosacea, and Hailey-Hailey disease.

Keywords: Botulinum toxins; Botulinum toxins, Type A; Esthetics; Pruritus; Rejuvenation; Cicatrix; Cicatrix, Hypertrophic

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