Sociedade Brasileira de Dermatolodia Surgical & Cosmetic Dermatology


ISSN-e 1984-8773


Volume 3
Number 2


Portuguese | English


A reason to celebrate!

Comemorando !!!

Dr. Bogdana Victoria Kadunc


Continuing medical education

Complications in laser dermatologic surgery. Part II: fractional and non-fractional ablative laser and fractional non-ablative laser

Complicações com o uso de lasers. Parte II: laser ablativo fracionado e não fracionado e laser não ablativo fracionado

Francine Batista Costa, Ana Beatriz Palazzo Carpena El Ammar, Valeria B. Campos, Célia Luiza Petersen Vitello Kalil

Questions and answers of previous number

Abstract: Conventional ablative lasers remove the epidermis and part of the dermis completely, and achieve excellent results in the treatment of photoaging. Non-ablative lasers have become more popular, since they inflict less thermal damage on the dermis and do not remove the epidermis, thus reducing the recovery time and the risk of side effects. Fractioning has recently been introduced in non-ablative lasers, with the goal of developing a system with the efficiency of the ablative and the safety of the non-ablative lasers. Fractional ablative lasers form total dermal-epidermic ablation columns, whereas fractional non-ablative lasers generate microscopic zones of dermal-epidermic thermal lesions, yet they preserve the stratum corneum.


Original Article

A quality of life measurement for patients with cellulite

Celluqol® - instrumento de avaliação de qualidade de vida em pacientes com celulite

Doris Hexsel, Magda Blessmann Weber, Maria Laura Taborda, Taciana Dal'Forno, Débora Zechmeister-Prado

Abstract: Introduction: After puberty, most women develop some amount of cellulite. With the increasing number of dermatological consultations about treating cellulite, a broader understanding of the characteristics, wishes and expectations of these patients regarding their quality of life has become necessary.
Objective: To develop and validate an instrument to evaluate the quality of life of patients with cellulite.
Methods: The study consisted of two stages: in the first, instruments for assessing patients' quality of life were developed and validated; in the second, two questionnaires were administered to 100 females with cellulite, aged 18 to 45.
Results: The reliability of the results was assessed using factorial analysis and Cronbach's alpha test. With the use of exploratory factorial analysis, it was possible to test (1) the hypothesis that all questions in the shortened questionnaire measured a single factor (cellulite) and (2) the hypothesis that each block of questions in the full version of the questionnaire measured a single domain or factor among the parameters being assessed (dressing style, physical activity, partner, feelings and change in daily habits).
Conclusion: The validation analysis showed that both questionnaires effectively measure cellulite patients' quality of life.


Evaluation of the duration of injectable hyaluronic acid in nasolabial folds and perioral rhytids

Avaliação da permanência do ácido hialurônico injetável no sulco nasogeniano e rítides labiais

Celia Luiza Petersen Vitello Kalil, Ana Paula Avancini Caramori, Mercedes Dalpias Balkey

Abstract: Introdução: Hyaluronic acid has been increasingly used in aesthetic procedures. Objective: To evaluate the degree of improvement and duration of results in patients who received treatment for wrinkles with hyaluronic acid.
Methods: Prospective, open, non-randomized, non-controlled study of 20 female patients who presented superficial wrinkles in the superior lips contour and a prominent nasolabial fold. The efficacy of hyaluronic acid was assessed using the Wrinkle Severity Rating Scale. The duration of results was assessed through biopsies. Safety was evaluated through clinical observation and reports of adverse events.
Results: A significant clinical improvement was observed after 15 days, which was sustained for 4 months. A minor worsening was observed after that period, although patients still presented favorable aesthetic results up to 12 months after the procedure. A majority of patients (n = 17) had a biopsy in the left retro-auricular region 180 days after the procedure. From this group, the substance was observed in 13 slides (76.4%).
Conclusion: Hyaluronic acid is an effective and safe product. This study has proven that the product remains in the dermis for up to 6 months.


Dermatoscopy in the early detection, control and surgical planning of basal cell carcinomas

A dermatoscopia na detecção precoce, controle e planejamento cirúrgico dos carcinomas basocelulares

Luis Fernando Kopke

Abstract: Introduction: Dermatoscopy can help practitioners analyze details that are imperceptible to the naked eye, such as basal cell carcinoma arboriform vascularization patterns, which can b e linked to the tumoral limit. Clinical examinations might yet fail in the early detection and demarcation of the extension of such lesions.
Objective: To study the use of dermatoscopy in basal cell carcinomas, aiming at early detection and delimitation of their extension. Method: Basal cell carcinomas (n = 123) were studied prospectively and not randomly, using dermatoscopy, at the author's private practice. Suspect areas, mainly the nose, underwent dermatoscopic scanning. If the vascular pattern was identified, the tumor was delimited by dermatoscopy, and the incision was carried out using that marking. Surgical margins were checked using conventional cuts, cross sections or micrographic surgery.
Results:The vast majority of the tumors (92%) were located in the face, of which 59% were not well delimited, 21% were well delimited, and 20% were clinically undetectable. Although the vascular pattern was not observed in 18% of the tumors, in cases with a positive identification, it correctly delimited the tumors in 84% of cases (of which 44% were verified with conventional sampling, 48% with micrographic surgery and 8% with cross sections).
Conclusion: Dermatoscopy is an important tool in the early detection and delimitation of the superficial extension of basal cell carcinomas, and is helpful in the surgical planning and clinical control of such lesions.


Classification of periorbital wrinkles and treatment with Botulinum Toxin Type A

Classificação das rugas periorbitárias e tratamento com a toxina botulínica tipo A

Bhertha M.Tamura, Marina Y.Odo

Abstract: Introduction: Periorbital wrinkles are an important component of facial aging that can be minimized with botulinum toxin treatment.
Objective: To treat periorbital wrinkles through botulinum toxin injections in the orbicularis muscle, using classic lateral points and additional points in the lower eyelid, which were developed based on the classification of these wrinkles.
Methods: Clinical and photographic data from 530 patients who had periorbital wrin- kles classified and treated between 2002 and 2007 were analyzed.
Results: Thirty percent of patients over 45, and 80% of those under 45, demonstrated complete improvement of the wrinkles after treatment in the classic points. The remaining patients needed treatment in the additional points in the lower eyelids.
Conclusion: The classification of wrinkles helped improve treatment. Despite the considerable benefit offered by injecting in the classic points, the necessity of treating additional points in the lower eyelids with botulinum toxin was verified. The presence of subcutaneous cellular tissue and the patient's age should also be taken into consideration.


Keloids in the ears: follow-up of 41 patients who had surgery and intralesional corticosteroid injections

Queloides em orelhas: seguimento de 41 pacientes submetidos à cirurgia e infiltração com corticosteróides

Leticia Arsie Contin, Ivander Bastazini Jr, Cinthia Janine Meira Alves, Priscila Wolf Nassif, Dejair Caetano do Nascimento

Abstract: Introduction: Surgery combined with post-operative intralesional corticosteroid injections is considered a good treatment for keloids that occur in the ears, yet the recurrence rate for this procedure is not yet well established. There is no consensus about the minimum number of corticosteroid infiltrations needed to decrease the number of recurrences.
Objective: To correlate the rate of recurrence among patients who had surgery and postoperative intralesional corticosteroid injections to treat keloids in the ear lobe with the number of injections.
Methods: Retrospective study of 41 patients who underwent surgical excision of ear keloids combined with up to two (Group A) or 3 or more (Group B) triamcinolone ace- tonide intralesional injections sessions.
Results: The total recurrence rate was 37% (13% in patients from Group A and 24% in patients from Group B). Results were not more effective when the number of injections was equal to or higher than 3 (p = 0.74).
Conclusions: There was no statistical significance in the number of post-operative corticosteroid intralesional injections in the treatment of ear keloids. Further studies are necessary to corroborate these results.


Safety in liposuction using local tumescent anesthesia: a report of 1,107 procedures between 1998 and 2004

Segurança em lipoaspiração usando a anestesia local tumescente: relato de 1.107 casos no período de 1998 a 2004

Juliano Borges, Celia Maria M. P. Cotrim, Bruna Dacier

Abstract: Introduction: Liposuction is a cosmetic procedure that removes undesired body fat. More recently, it has been associated with complications and deaths, raising concerns about the risk involved in the procedure. Since the tumescent technique was described by Jeffrey Klein, surgeons from around the world have contributed to the development of the technique, making liposuction with microcannulas and local anesthesia a safe and effective procedure that achieves its objective. Nevertheless, severe complications and deaths are described in the literature when the procedure is performed under general anesthesia or with IV drugs, or when there is a breach of the protocols recommended for local tumes- cent anesthesia. Therefore, it is necessary to establish protocols for liposuction procedures that use local tumescent anesthesia, to promote safety.
Objective:To demonstrate that using local tumescent anesthesia in liposuction is safe.
Methods: Retrospective study of medical records of 568 patients who underwent 1,107 liposuction procedures assisted by local tumescent anesthesia between 1998 and 2004.
Results: There were no deaths or complications that required hospitalization.
Conclusions: When standardized protocols are observed, liposuction assisted exclusively by local tumescent anesthesia was shown to be a safe procedure.


Cellium® GC: evaluation of a new natural active ingredient in 210 mg/ml topical solution, through scalp biopsy

Avaliação por biópsias de couro cabeludo da atividade de novo ingrediente ativo natural, o “Cellium® GC”, formulado em solução tópica de 210mg/mL

Luís Carlos Cucé, Consuelo J. Rodrigues, Régia Celli R. Patriota

Abstract: Introduction: Androgenic alopecia is a progressive alteration of the scalp with few treatment options, which motivates the search for new local or systemic medications to control this pathology.
Objective: To evaluate patient tolerance for and identify the action mechanism of the Cellium® GC compound in the treatment of androgenic alopecia.
Methods: Male patients (n = 20) with androgenic alopecia participated in this open prospective study. The compound was used on the scalp twice a day, at home, for 12 con- secutive weeks. Biopsies were carried out before and after treatment to evaluate the alterations in the cutaneous immune response, cellular proliferation and anti-apoptosis activity. Questionnaires were administered to evaluate efficacy and patient satisfaction.
Results: Nineteen patients completed the study, with an average satisfaction of 8.3 out of 10. Immunohistochemical analyses of scalp biopsies showed a significant increase in the cutaneous immune response after treatment: 73.9% increase in CD1A+ Langerhans cells (p = 0.003, t paired test), 41.7% increase in the cellular proliferation marker Ki-67+ (p = 0.012), and an 89% increase in BCL-2+ anti apoptotic proteins (p = 001). The product was also found to be tolerable and safe.
Conclusions: Cellium® GC improved the skin's immune defense and the proliferation of keratinocytes, and produced high levels of patient satisfaction in the treatment of androgenic alopecia.


Review articles

Axillary hyperhidrosis treatment update

Atualização no tratamento de hiperidrose axilar

Gabriel Teixeiro Gontijo, Gustavo Vieira Gualberto, Natália Augusta Brito Madureira

Abstract: Introduction: Axillary hyperhidrosis is a common problem that can affect sufferers' personal and professional lives. Clinical histories and physical examinations are important tools to assess the severity of the condition and to indicate the most appropriate therapy for each case. There are a number of treatments for axillary hyperhidrosis, including topical and systemic therapy, iontophoresis, botulinum toxin, and surgical procedures. The authors have conducted a review of the most important treatments.


Diagnostic Imaging

Seborrheic keratosis that resemble melanoma

Queratose seborreica simuladora de melanoma

Alessandra Yoradjian, Natalia Cymrot Cymbalista, Francisco Macedo Paschoal

Abstract: Seborrheic keratosis are benign epithelial tumors that are usually easily diagnosed through clinical and dermatoscopic examination. They can sometimes resemble malignant lesions, especially melanoma. This article illustrates two such cases, highlighting the detailed dermatoscopic observations that help distinguish these lesions, to help increase the accuracy of diagnoses.


New Techniques

Correction of transverse overcurvature of the nail using autologous dermal graft

Correção de hipercurvatura transversa da unha utilizando enxerto de derme autóloga

Glaysson Tassara Tavares, Nilton Di Chiacchio, Walter Refkalefsky Loureiro, Nilton Gioia Di Chiacchio, Diego Leonardo Bet

Abstract: Introduction: Transverse over curvature is a commoninaes the tic and pain ful deformity of the nail plate. There are several conservative and surgical techniques for trea ting this condition. We describe a simple and cost effective techni que using auto logous dermal grafts.


Reconstruction of the ear using silicone fiber

Reconstrução de defeito condrocutâneo auricular usando fibra de silicone

Ivander Bastazini Júnior, Ana Luiza Grizzo Peres Martins

Abstract: Reconstructions of the auricular pavilion are complex, especially when there is a loss of cartilaginous support. A case of chondrocutaneous defect reconstruction, after the exeresis of a basal cell carcinoma in the upper third of the auricular pavilion, is reported. Silicone fiber was used to model and provide support for the ear. The technique of using cartilage or compound grafts in the auricular pavilion is described.


Correction of unaesthetic hair transplantation

Correção de transplante capilar inestético

Renata Indelicato Zac, José Rogério Régis, Patrícia Jannuzzi Vieira e Oliveira, Daniela Rezende Neves, Kleber de Sousa Silveira

Abstract: When outdated techniques and large skin grafts are used in hair transplants, the results are unattractive and disfiguring. More recently, natural looking results have been achieved by transplanting follicular units. The correct shape and implantation level in the hairline contribute to a natural appearance. Correction methods include: camouflage with follicular units, removal of transplanted hairs and suture, reduction of the scalp, correction of scars, and laser therapy. In this article, the combination of different surgical techniques and laser epilation are described with satisfactory results in the correction of hair transplants.


Case reports

Congenial melanocytic nevus – surgical treatment

Nevo melanocítico congênito - tratamento cirúrgico

Ed Wilson Tsuneo Rossoe, Lucia Mensato Rebello Couceiro, Gabriele Spercoski Gonçalves Salles, Antônio José Tebcheran, Tereza Cristina dos Santos

Abstract: Giant congenial melanocytic nevi are uncommon lesions that have a higher risk of developing into cutaneous melanomas. When located on the face, they can cause neurological problems, including leptomeningeal melanocytosis and epilepsy. They can also be unattractive. A case of a 17-year-old female patient with congenial melanocytic nevus affect- ing one-third of the right side of her face is reported. The patient underwent the lesion’s resection and reconstruction with a partial skin graft in a single surgery. The objective of this study was to demonstrate a therapeutic proposal for congenial melanocytic nevi located in the periorbicular region.


Vulvar granular cell tumor (Abrikossoff’s tumor) – Case report

Tumor de células granulosas (tumor de Abrikossoff) vulvar – Relato de caso

Jefferson Alfredo de Barros, Daniela Presente Taniguchi, Marcos Antônio Rodrigues Martinez, Carlos D' Apparecida Santos M. Filho, Mônica Chmeliauskas Moya, Antônio José Tebcherani, Julizia Foloni Silva

Abstract: Introduction: The granular cell tumor was first described by Abrikossoff in 1926. It is a benign, uncommon neoplasia, most frequently found on the tongue. It occurs in the vulva in 5 to 6% of cases. Its histogenesis is not known for sure, but is probably linked to Schawann cells. It is treated surgically, with a good prognosis. The tumors may recur, and some may become malignant according to the literature. The authors describe a case of a vulvar nodule with a histopathologic diagnosis of granular cell tumor, which was successfully treated with surgery.



Pigmented basal cell carcinoma mimicking a malignant lentigo melanoma in black female patient

Carcinoma basocelular pigmentado simulando lentigo maligno melanoma em paciente negra

Marcela Duarte Villela Benez, Ana Luiza Furtado da Silva, Gustavo Costa Veradino, Solange Cardoso Maciel Costa Silva

Abstract: A case of pigmented basocellular carcinoma clinically mimicking a malignant lentigo melanoma in the temporal region of a black female patient is reported. Basal cell carcinoma rarely occurs in black patients. When present, however, it is the second most common malignant skin neoplasia, and is usually pigmented. When the face is affected in such patients, it is difficult to differentiate between malignant lentigo melanoma and basal cell carcinoma. Dermatoscopy is a very helpful diagnostic tool in these cases.


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