Introduction: The aging process in the infraorbital region involves a loss of volume, gravitational and skin changes.
Objective: To describe the etiopathogenic classification and treatment of dark circles caused by lower eyelid contour changes.
Methods: A new technique of hyaluronic acid filling, using a blunt cannula through a unique orifice is presented.
Results: Reformulating the dark circles classification is useful for making the best therapeutic options. The technique's advantages are its safety and good aesthetic results.
Conclusion: Filling with hyaluronic acid using this new technique has proven safer than other pre-existing techniques.

Keywords: EYELIDS; REJUVENATION; HYALURONIC ACID/ADMINISTRATION & DOSAGE.

Introduction: Photodamaged skin of the anterior thorax region is characterized by flacidity, wrinkles, hyperpigmentation, erythema, telangiectasia, and atrophy. Microneedling has been used for the transdermal drug delivery of active agents to the skin through microchannels. Objective: To clinically evaluate the rejuvenation of the skin of the anterior thorax region resulting from the use of microneedling associated with drug delivery. Methods: Double-blind randomized, placebo-controlled study conducted with 22 women who underwent three microneedling sessions followed by the topical application of a test product containing hyaluronic acid and other active principles or placebo. The evaluation was performed through photographic comparison carried out by a dermatologist oblivious to the study and the application of self-assessment questionnaires to patients. Results: Clinical evaluation showed improvement in the overall skin rejuvenation of the anterior thorax region in 100% of the patients. The statistical analysis showed a 28% improvement (p <0.05) with use of the test product as compared to the placebo. The responses to the questionnaires demonstrated an improvement of 30% in the patients treated with microneedling and the test product. Conclusions: The microneedling technique associated with the transdermal administration of drugs used for rejuvenation provides improved overall appearance of the skin of the anterior thorax region, with a high degree of tolerability and satisfaction.

Keywords: REJUVENATION; COLLAGEN; ADMINISTRATION; CUTANEOUS

Introduction: Laser toning technique is performed with the Q-switched Nd:YAG laser 1064 nm, aiming at stimulating neocollagenesis. The technique can also be associated with the application of suitable medicines for drug delivery, increasing its potential for skin permeation.
Objective: To evaluate the results of laser toning Q-switched Nd:YAG laser 1064 nm associated with drug delivery through a pilot study.
Methods: Four patients underwent four laser sessions with application of a formula for drug delivery or placebo, fortnightly.
Results: According to the photographic assessment, laser toning promoted improvement of acne, pores, wrinkles and sensitivity. When associated with the drug delivery, there was superiority in results. In clinical evaluation differences were observed only in the pores analysis (+11%). 75% of patients had acneiform eruption.
Conclusion: Results of this pilot study show that laser toning can be enhanced when combined with drug delivery.

Keywords: LASERS; ADMINISTRATION, CUTANEOUS; COLLAGEN; HYDROXYPROLINE; HYALURONIC ACID; ASCORBIC ACID

The topical route for the delivery of drugs is essential in dermatology: it optimizes the penetration of medicaments, and when performed with the assistance of lasers, it takes place in a uniform and controlled manner. The degree of evidence of drug delivery is being investigated for many drugs. Moreover, the technique combines outstandingly with lasers for rejuvenation and treatment of skin diseases. It is therefore possible to conclude that the use of lasers for drug delivery is promising. While there are clinical studies on some substances that allow their indication and use, others require further controlled analyses, with longer follow-up periods, aimed at allowing thorough evaluations.

Keywords: LASERS; ADMINISTRATION, CUTANEOUS; SKIN ABSORPTION; DRUG DELIVERY SYSTEMS; DRUG ADMINISTRATION ROUTES

Six patients underwent two sessions of microneedling associated to drug delivery on the face, hands or stretch marks, at three-week interval between sessions. Patients were evaluated using clinical analysis and objective measures. Compared to baseline, objective face analysis showed decrease in acne lesions and improvement in the skin texture. The evaluation of stretch marks showed great improvement, and face and hands presented excellent results compared to baseline. The association of microneedling to drug delivery for rejuvenation of the face and hands, and for the treatment of stretch marks presented promising results in our study.

Keywords: ADMINISTRATION, CUTANEOUS; HYALURONIC ACID; REJUVENATION; STRIAE DISTENSAE; TRANEXAMIC ACID; HYDROXYPROLINE

Introduction: In the Brazilian public health system, the current demand for dermatological procedures is greater than the offer, resulting in a waiting list of patients bearing dermatoses to be treated surgically. Aimed at reducing that waiting list, a collective effort of surgical procedures was carried out in the tertiary public health service. The corresponding data on the patients and lesions is disclosed in the present study. Objective: To assess the profile of the patients – and respective skin lesions – who are awaiting to undergo dermatological procedures. Methods: A simple descriptive profile analysis of the patients, treated dermatoses and procedures performed was carried out. Results: Thirty-one patients (aged between 21 and 95 years, mean = 63.7 years). Seventeen (54.83%) were women and 14 (45.17%) were men. Thirty-eight lesions were treated: 21 neoplastic (carcinomas and melanomas), 8 pre-neoplastic (actinic keratoses) and 9 non-neoplastic (nevi, keloid and neurofibroma). Conclusions: The present article is relevant due to the fact it identifies cases and patients awaiting dermatological surgical procedures in the public health system. Based on it, a better planning of public health strategies in the dermatological field should be possible. Also, it highlights the importance of the dermatologist physician’s action in the public health, diagnosing and treating pre-neoplastic and neoplastic lesions.

Keywords: DERMATOLOGY; AMBULATORY HEALTH SERVICES; HEALTH CENTERS; POPULATION STUDIES IN PUBLIC HEALTH; PUBLIC HEALTH; PUBLIC HEALTH ADMINISTRATION; NEOPLASMS; MELANOMA; CARCINOMA; CARCINOMA, BASAL CELL

INTRODUCTION: Photoaging results from the action of external agents, the main being ultraviolet radiation. It is clinically characterized by yellowish skin with irregular pigmentation, presence of wrinkles, atrophy, telangiectasias, decreased elasticity, and premalignant and malignant lesions. It corresponds to one of the most common dermatological complaints, requiring that dermatologist physicians keep up-to-date regarding treatments.
OBJECTIVE: To evaluate the effect of imiquimod in the treatment of photoaging.
METHODS: A prospective intervention study was carried out involving 12 female patients. The response was clinically assessed by the patient and examiner physician, and in light of histological parameters.
RESULTS: Six of the 12 patients, experienced side effects – three of which dropped out of the study. Of the 9 patients who completed the treatment, 8 perceived an overall improvement in the appearance of the skin. The examiner physician could observe improvement in 8 patients – slight in 6, and significant in 2 of them. Regarding histological aspects, there were decreases in solar elastosis (4 patients), melanin amount (5 patients) and fibrosis (4 patients).
CONCLUSIONS: Imiquimod can be an option for the treatment of photoaging, and should be evaluated in subsequent, controlled studies with larger samples.

Keywords: Skin; Skin aging; Administration, Topical

INTRODUCTION: The proteins involved in the process of epidermal differentiation play a key role in retention of water and maintenance of the stratum corneum.
OBJECTIVE: To assess the compaction of the skin barrier and protein expression of filaggrin, involucrin, loricrin and sphingomyelin after the use of a moisturizing cream containing saccharide isomerate and hydroxyethyl urea.
MATERIALS AND METHODS: Ex vivo evaluations were performed in skin culture in addition to immunofluorescence in order to identify proteins, as well as in vitro analysis with tissue culture in culture medium and histological sections, all of which compared with a control group.
RESULTS: In the ex vivo evaluation, the protein markers increased in the group treated with the moisturizing cream as compared to the skin culture model with atopic dermatitis. In the in vitro evaluation, it was possible to observe an improvement in the skin barrier compaction with the application of the cream on a reconstituted three-dimensional epidermis model, as compared with the control.
CONCLUSIONS: The moisturizing cream promoted a significant increase in the production of filaggrin, involucrin and loricrin, as well as in the compaction of the skin barrier, thus suggesting a positive effect on skin hydration and protection of the cutaneous barrier, preserving and restoring the skin.

Keywords: Administration; Amino acids; Carbohydrates; Cutaneous; Fluid therapy; Keratins; Keratinocytes; Skin; Skin care; Skin cream; Peptides; Proteins; Urea; Wetting agents

INTRODUCTION: Idiopathic guttate hypomelanosis is an acquired leukoderma, whose available therapeutic options have inconsistent results.
OBJECTIVES: To evaluate the effect of isolated or combined ablative fractionated laser to drug delivery of piperine for treatment of idiopathic guttate hypomelanosis.
MATERIALS AND METHODS: In a prospective and comparative study, seven patients with idiopathic guttate hypomelanosis in the legs were elected, andfive lesions were selected on each leg of each. Both legs of each patient were submitted to two Er:YAG 2940nm laser sessions, followed by drug delivery of piperine 20% only in the right leg. Blind evaluators conducted the assessment through photographs and comparative measurements of the lesions.
RESULTS: The lesion size ranged from 0.2cm to 1.5 cm. Both treatments significantly reduced lesion size (p< 0.00008, right leg;p< 0.002, left leg). Thegeneralized estimating equation method showed that there was no statistical difference between the groups regarding the reduction of lesion size. The evaluation achieved better scores for the right leg (laser + piperine) (p=0.126).
CONCLUSION: Although statistically significant differences were not found between the side treated with laser and drug delivery versus the side treated only with laser, we believe that the technique may represent an option in the therapeutic arsenal.

Keywords: Administration, topical; Drug administration routes; Lasers

INTRODUCTION: Topical delivery of drugs is essential in Dermatology Due to the difficulty of permeation of the stratum corneum, drug delivery techniques have been highlighted. The use of non-specific formulations for this purpose makes raises the concern of possible adverse events and the microbiological safety of these formulations.
OBJECTIVE: To assess bacterial and fungal growth in anhydrous fluid serum through simple sterility test. Materials and METHODS: The simple sterility test was performed on an anhydrous serum containing lipophilic and hydrophilic active substances. This test was performed three months after the manufacture of the product.
RESULTS: The formulation studied was approved in the simple sterility test conducted three months after the manufacture of the product, even without the use of preservatives in the formulation.
DISCUSSION: The assessed formulation was approved in the sterility test possibly due to the fact that the serum vehicle has mineral and anhydrous origin, characteristics that do not favor the proliferation of microorganisms.
CONCLUSIONS: Although only the vehicle counting specific assets has been tested, the results of this study are promising and demonstrate the need for future studies broadly encompassing this subject.

Keywords: Drug Administration Routes; Brazilian Pharmacopeia; Skin Cream

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

Ferment filtrate (FF), a by-product of nutrient-rich yeast, is believed to be used cosmetically in East Asia since the 1970s. We systematically reviewed the topical effects of ferment filtrate on skin health and determined limitations in the available studies. Recent literature has shown evidence in reducing the baseline fluctuation of pore size, roughness, hyperpigmentation, and redness. However, these studies are limited in efficacy due to their small sample size, their confounding variables, and their limited generalizability. Because of the increase of cosmetic products containing this ingredient, critical analysis of the available and future literature is necessary to prevent consumer misinformation.

Keywords: Skin Diseases; Administration, Topical; Cosmetic Technology; Cosmetic Techniques