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

Introduction: Rosacea is a chronic facial condition characterized by erythema, edema, telangiectasias, papules and possibly pustules and nodules. There are four subtypes: erythematous-telangiectatic rosacea (I), papulopustular rosacea (II), phymatous rosacea (III) and ocular rosacea (IV). Its pathogenesis is multifactorial, and the treatments, diverse.
Objective: To demonstrate the effect of botulinum toxin in the improvement of flushing and erythema in patients with erythematous-telangiectatic rosacea.
Methods: Six patients with Subtype I rosacea were selected in the Dermatology Department’s outpatient clinic of a university medical service. The patients received applications of botulinum toxin type A (dilution of 100 units to 5 ml of saline solution), with intradermal injections of 0.2 to 0.5 units per point in the affected region. Evaluations were carried out after one, two, three and six consecutive months.
Results: There was improvement of the facial erythema and flushing during the three months following the application, with symptoms returning around the sixth month after the treatment, in line with the estimated duration of toxin effectiveness.
Conclusions: There was improvement of the patients' symptoms and satisfaction, and it was deemed a treatment of easy application, associated with a low index of adverse effects and prolonged duration of outcomes.

Keywords: Botulinum Toxins, Type A; Erythema; Quality of Life; Rosacea

Rosacea is a common chronic skin disease that has several clinical manifestations, with erythema and inflammation being predominant characteristics. Its presence is associated with psychosocial impact on patients' lives. Although there are several options for topical and systemic treatments, it is known that only the inflammation is treated and that the erythema persists in most cases. More recently, there have been some publications describing the treatment of rosacea with botulinum toxin associated with good results. In this manner, the authors sought to evaluate the action of botulinum toxin in the treatment of rosacea that is persistent and refractory to various clinical treatments.

Keywords: Rosacea; Botulinum Toxins; Therapeutics

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

Rhinophyma is a disfiguring and progressive disease of the nose with high prevalence. Despite being considered a benign condition, many patients have sought curative treatments due to aesthetic deformity and social stigmatization. There are several surgical techniques described in the treatment of this disease. This report aims to present a case that required an unusual therapeutic approach for the treatment of rhinophyma, given the patient's multiple comorbidities. The procedure was performed with no complications in the intra and postoperative period. The patient maintains an outpatient follow-up with a good long-term aesthetic result.

Keywords: Dermatologic Surgical Procedures; Rhinophyma; Rosacea

INTRODUCTION: Rosacea is a chronic inflammatory skin disease. The intradermal application of botulinum toxin (BT) has been studied as a therapeutic option for patients who struggle to manage flushing and/or persistent facial erythema. There is no standard protocol for TB application in rosacea.
OBJECTIVE: To evaluate the effectiveness of botulinum toxin application on erythematotelangiectatic rosacea.
METHODS: Pilot study with case series. We applied intradermal TB in 10 patients with a diagnosis of rosacea and symptoms of persistent erythema and/or facial flushing. Patients received 10 to 15 injections per hemiface (1 unit of onabotulinum TB per injection) and 0 to 5 injections in the nasal region, totaling 25 to 35 units per patient.
RESULTS: Seventy-five percent of the patients presented a reduction in flush and erythema intensity. The follow-up time was three months, and no serious adverse events were observed.
CONCLUSIONS: The therapeutic arsenal to control erythema and facial flushing of rosacea, especially refractory to the usual treatment, should consider the intradermal application of TB type A.

Keywords: Erythema; Rosacea; Flushing; Botulinum toxins

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