Sociedade Brasileira de Dermatolodia Surgical & Cosmetic Dermatology

IR PARA

ISSN-e 1984-8773

Summary

Volume 1
Number 1
2009





Editorial

Bogdana Victoria Kadunc

Bogdana Victoria Kadunc

Bogdana Victoria Kadunc

Abstract:


Omar Lupi

Omar Lupi

Omar Lupi

Abstract:


Hamilton Ometto Stolf

Hamilton Ometto Stolf

Hamilton Ometto Stolf

Abstract:


Continuing medical education

LASERS ON FACIAL REJUVENESCENCE

Laser no rejuvenescimento facial

Valéria Campos, Roberto A. de Mattos, Alexandre Fillippo, Luis Antonio Torezan

Abstract: The 10,600-nm CO 2 and 2940-nm Erbium lasers were the first ones used for rejuvenescence, with surprising results due to their ability stimulate collagen. Since they are ablative lasers, the postoperative period is difficult and prolonged, and with important complications. To minimize those undesirable effects, non-ablative lasers with different wavelengths were introduced (840 nm, 1320 nm, long pulse 1640 nm, among others), with a very mild postoperative period, but with a very limited capacity to promote neocollagenesis. New studies were responsible for non-ablative fractional lasers (1440 nm, 1540 nm, and 1550 nm) with a different action: they promote dermal-epidermal coagulation columns, have a moderate postoperative period, and a reasonable capacity to stimulate collagen fibers with a negligible risk of side effects. However, they are very limited in severe photoaging. To fill this gap, new fractional 10,600-nm CO2 and 2940-nm Erbium lasers were introduced. This reduced the incidence of side effects, but also reduced the final effect, which is not as good when compared with the same, non-fractional, lasers. They represent a good option for the treatment of severe photoaging.


Original Article

THE SKIN MOISTURIZING EFFECTS OF DIFFERENT CONCENTRATIONS OF UREA: A CLINICAL AND CORNEOMETRY STUDY*

Correlação entre o efeito hidratante da ureia em diferentes concentrações de aplicação: estudo clínico e corneométrico

Flávia Alvim Sant’Anna Addor, Sérgio Schalka, Vanessa Melo Cardoso Pereira, Bruno Brandão Folino

Abstract: Objectives: The objective of this study was to evaluate the effects of different concentrations of urea on skin moisture.
Institution: A double blind, randomized, placebo-controlled study was conducted at the Medcin Instituto da Pele – Clinical Research Center –, in Osasco, SP, Brazil.
Material and methods: Individuals with dry skin were submitted to one application of three different concentrations of a urea moisturizer, namely 3%, 5%, and 10%, and a control moisturizer. Clinical, subjective, and corneometry measurements were evaluated at 1, 4, and 6 hours.
Results: All moisturizers, including the control emulsion, improved significantly the skin moisture in the first evaluation (p < 0.05); 10% urea was superior to other concentrations, especially at the 4-hour evaluation, when it was compared with 3% urea, and at the 6-hour evaluation, when compared with the 5% and 3% presentations; at the 1-hour evaluation, patients referred itching and stinging with the use of 10% urea moisturizer.
Conclusion: The duration of the hygroscopic properties of urea is directly related with its concentration. Adverse symptoms, such as stinging, were observed only with higher concentrations.


Keywords: UREA

PILOT STUDY TO EVALUATE THE EFFICACY OF MINOCYCLINE IN THE TREATMENT OF PROGRESSIVE MACULAR HYPOMELANOSIS (PMH)

Estudo piloto para avaliar a eficácia da minociclina no tratamento da hipomelanose macular progressiva (HMp)

Ada Regina Trindade de Almeida, Thaíssa Penteado Bedani, Erica A. Fernandes Debs, Juliana Areas Deltrame Ferreira

Abstract: Introduction: Progressive macular hypomelanosis (PMH) is characterized by hypopigmented maculae on the thorax, abdomen, and lumbar region. It is often misdiagnosed, and its etiology is unknown. Recently, suggestive lesions of porphyria, produced by Propionibacterium acnes, were discovered by red fluorescence of the lesions.
Objective: Evaluating the efficacy of Minocycline, 100 mg/day, in the treatment of progressive macular hypomelanosis.
Material and methods: Patients older than 16 with at least a 3-month history, without allergies to tetracycline derivatives, and without a history of treatment with antibiotics for 90 days before the study, were included. Pictures were taken before beginning treatment and after 30, 60, 90, and 120 days and after this whenever possible.
Results: Out of 19 patients, 11 completed the study. All of them showed recovery of the color in the affected areas. Treatment success could be demonstrated for a minimum of 7 months and a maximum of 11 months after treatment.
Conclusion: The isolated use of minocycline, 100 mg/day for 3 months, was effective in the treatment of PMH, confirming the probable role of P. acnes as the etiological agent.


SURGICAL TREATMENT OF CHRONIC PARONYCHIA: A COMPARATIVE STUDY OF 138 SURGERIES USING TWO DIFFERENT TECHNIQUES

Tratamento cirúrgico da paroníquia crônica. Estudo comparativo de 138 cirurgias utilizando duas técnicas diferentes

Nilton Di Chiacchio, Érika A. Fernandes Debs, Glaysson Tassara

Abstract: Introduction: Chronic paronychia is an inflammatory disorder of the proximal nail fold (PNF) lasting more than six weeks that accounts for 18% of nail dystrophies. Clinically, it is characterized by inflammation of the PNF, absence of the cuticle, and dystrophy of the nail plate. Clinical treatment is usually unsatisfactory. Surgical treatment consists on the removal of the PNF, which can be done using the oblique or perpendicular incision techniques.
Objective: The objective of the present study was to compare the efficacy of oblique and perpendicular surgical techniques in the treatment of chronic paronychia.
Methods: Sixty-two patients with chronic paronychia, in one or more fingers (with a total of 138 surgeries), were randomly divided into two groups, according to the surgical technique used (perpendicular or oblique incision). Postoperative evaluation was done after six months using a three-point scale: absence of improvement, improved, cured.
Results: One hundred and thirty-four cases (97.1%) were considered cured, and 4 (2.9%), two in each group, were considered as having improved.


PERIORBITAL WRINKLE SEVERITY EVALUATION USING DIGITAL IMAGE PROCESSING: A VALIDATION STUDY

Avaliação da intensidade das rugas periorbitais por processamento digital de imagens: um estudo de validação

Vínicius C. Brand, Rosilene C. A. de Souza, Hélio Pedrini, Hermênio C. Lima

Abstract: Introduction: Dermatologists get an idea of how old a patient is by looking at his/her facial wrinkles. There are several methods to quantify skin microrelief and wrinkles.
Objective: To use imaging processing technology to assess the wrinkle area and its interrelation with dermatologists subjective impression.
Material and methods: One hundred seventy-one volunteers, randomly selected, aged 18-69 years, both gender, Fitzpatrick skin type II-IV, with Glogau scale index I-IV were selected. Digital photography was obtained in two different conditions: relaxed or contract wrinkle condition (CWC), and at least 6 repeated pictures for checking the repeatability of each method. Six participating dermatologists evaluated the pictures and ascertained patients’ wrinkle using a digital pen. Wrinkle intensity was done by 3 different image processing methods. Quantitative assessment of facial skin folds intensity, and inter- plus intramethod consistency were determined and compared to manual evaluation.
Results: Dermatologists variability was 61.49%. Intratests agreement varied from 4.4 to 31%. The gradient method had the best results and detected the wrinkle conditions (p < 0.001). Also, this method had a positive correlation with the manual assessment.
Conclusions: Periorbital wrinkles could be determined by digital image processing. Dermatologists had internal precision but low accuracy. Sobel operator digital processing is a valid and reliable instrument for quantitative wrinkle assessment.


EVALUATION OF THE SYSTEMIC TOXICITY OF PHENOL ON FACIAL PEELINGS

Avaliação da toxicidade sistêmica do fenol em peelings faciais

Bogdana Victoria Kadunc, Adriana Amorim Vanti

Abstract: Introduction: Phenol has been used in medicine for several decades, but many aspects of its systemic toxicity are not completely known.
Objective: Evaluating the renal and cardiac toxicities of phenol absorbed percutaneously in facial peelings.
Material and methods: A prospective, comparative, randomized study was undertaken with 4 groups of 15 patients each, with 4 different types of facial peelings: pure, at 50 and 88% in continuous applications, pure at 88%, and associated with Baker’s Formula with applications at specific time intervals. Urinary levels of this substance were determined by gas chromatography and cardiac changes by a continuous electrocardiogram for 24 hours (Holter).
Results: Gas chromatography showed fast phenol elimination in the urine, with a half-life of 6 to 8 hours. Cardiac changes seen on the Holter were observed in all groups, which stopped immediately without medical intervention.
Conclusions: Phenol, used in facial peelings, does not affect renal function, but it can cause arrhythmias in susceptible individuals, which are not related with the concentration or technique used.


Review articles

SYSTEMATIC REVIEW OF CHEMICAL PEELINGS

Revisão sistemática sobre peelings

Ediléia Bagatin, Karime Hassun, Sérgio Talarico

Abstract: Fundaments: chemical peelings represent damage to the skin or an accelerated form of exfoliation induced by caustic agents, having several indications; they are classified as superficial, medium-depth, and deep. The number of publications on the subject is elevated, but critical analysis are necessary to achieve objective conclusions.
Objectives: verifying the efficacy and safety of chemical peelings through a systematic review of the literature.
Methods: from January 5 to February 15, 2009, searches in three data bases were performed: Cochrane Library, MEDLINE (1966 – 2009), and LILACS. Criteria for study selection were established, with emphasis on methodological quality. The best comparative or controlled studies were described individually. The remaining review articles and descriptive and experimental studies were analyzed together.
Results: we found 414 publications and reviewed 165; 129, or 78%, corresponded to descriptive (82), review (37), or experimental (10) studies. The remaining 36 (22%) represented controlled or comparative studies, of which 19 (53%) were randomized and only four had the ideal delineation, i.e., placebo-controlled, randomized, and blind. Agents mentioned more often included: glycolic acid, salicylic acid, trichloroacetic acid (TCA), and phenol. Few studies evaluated the histologic effects and/or used quantitative parameters to determine their efficacy and safety.
Limitations: the heterogeneity of the studies; few studies with good methodological quality.
Conclusions: there are no doubts related to the the benefits of chemical peelings, which are demonstrated more by the clinical experience than by well-conducted and reproducible studies that are fundamental for the elaboration of new conduct guidelines.


Case reports

FLAP ROTATION FOR DEFECTS OF THE NASAL ALA*

Retalho de rotação para defeitos da asa

Luciana Takata Pontes, Arash Kimyai-Asadi, Ming H. Jih, Aparecida Machado Moraes, Hamilton Ometto Stolf

Abstract: Surgical defects of the nasal ala are difficult to repair because of the need to preserve local function and the aesthetic aspect. Skin grafts are thin, pale, and have a smooth surface, which contrast with the skin of the nose. Flaps from the malar and proximal regions usually extend over the alar crease, causing deformities and obstruction of the nasal vestibule. The authors describe a reconstruction technique for defects of the nasal ala, which preserves the cosmetic unit without causing changes in the nasal vestibule or air flow.


Surgical pearls

ADIPOSE TISSUE GRAFTING IN CICATRICIAL ALOPECIA

Enxerto de gordura em alopecias cicatriciais

Ival Peres Rosa, Sérgio Henrique Hirata, Camila C. de Paula, Eduardo Mauro Yoshiaki, Enokihara Samira Yarak

Abstract: Hair transplantation is one of the therapeutic options for the treatment of cicatricial alopecia; however, the adherence between the scalp and the periosteum hinders its execution and compromises the final result. The use of adipose tissue grafting, as fat fragments harvested from the infra-gluteal crease, at least 30 days before the transplantation to optimize the results, is proposed.



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