Sociedade Brasileira de Dermatolodia Surgical & Cosmetic Dermatology


ISSN-e 1984-8773


Volume 4
Number 3



Continuing medical education

Adverse events in injectable hyaluronic acid

Eventos adversos do ácido hialurônico injetável

Elisete Isabel Crocco, Renata Oliveira Alves, Cristina Alessi

Questions and answers of previous number

Abstract: The use of fillers for treatment of rhytids and facial volume enlargement has grown considerably in recent years. The various filler types used currently can be classified into temporary, semi-permanent (permanence of at least 18 months in the tissue) and permanent. Fillers can also be classified according to their composition (collagen, hyaluronic acid, polylactic acid, polymethylmethacrylate, hydroxyapatite). Moreover, the hyaluronic acid may be of synthetic or animal origin. Hyaluronic acid (temporary resorbable filler) has been one of the most frequently used substances. There is no ideal, pure and commercially available substance that is free of side effects. This study evaluates the side effects of using hyaluronic acid-based fillers in order to enable early diagnosis and treatment, and reduce morbidity and sequelae among patients.


Original Article

Long-term follow-up of patients who underwent surgery for chronic paronychia

Acompanhamento a longo prazo de pacientes submetidos a cirurgia de paroníquia crônica

Natassia Pinheiro de Lavor Queiroz, Emerson Henrique Padoveze, Ana Flávia Nogueira Saliba, Gabriel Ângelo de Araújo Sampaio, Erica Araújo Fernandes Debs, Nilton Di Chiacchio

Abstract: Introduction: Chronic paronychia is an inflammatory disease of the proximal nail fold that usually lasts for more than six weeks. Surgical of removal the proximal nail fold is recommended in cases that are resistant to clinical treatment. Objective: To analyze the long-term response to the surgical treatment of chronic paronychia. Methods: Prospective cohort study of 62 patients who had undergone surgical treatment to correct chronic paronychia from November 2004 to April 2008. The patients were asked to return for reassessment and clinical observation of the presence or absence of signs of chronic paronychia and were classified into two groups: cured and uncured. Results: Of the 62 patients, 12 attended the clinical reassessment, for a total of 31 procedures for analysis. The average length of patient follow-up was 5 years and 2 months. The results were maintained in 27 (87%) of the procedures performed. Conclusions: Surgical removal of the proximal nail fold is a good option for the treatment of chronic paronychia due to its simplicity, effectiveness, and long-lasting results.


In vitro evaluation of the safety profile of cosmeceuticals containing growth factors and their analogues

Avaliação in vitro do perfil de segurança de cosmecêuticos contendo fatores de crescimento e seus análogos

Gustavo Dieamant, Adilson Costa, Liliana Bechelli, Juliana Tibério, Carolina Pereira

Abstract: Introduction: Aging skin is a condition that affects (or will affect) all people, and its treatment is considered a clinical challenge. Growth factors and their analogues are emerging as a promising therapeutic option. Objectives: To evaluate the safety profile of some dermocosmetic products with formulations based on growth factors – or their analogs intended for that purpose – using in vitro human skin cell culture models. Methods: Two types of cell cultures were studied, and the effects of the study products on the proliferation of melanoma cells and normal human fibroblasts were evaluated. Results: No significant morphological alterations were found in the cultured human melanoma, and no significant decrease in the number of healthy cells was verified in the normal fibroblasts culture. In some cases there was even a proliferation of those cells. Conclusions: These preliminary data demonstrate that cosmeceutical products containing growth factors as an active principle can be considered safe for topical application.


Efficacy and safety of treating body aging with a dermocosmetic containing retinaldehyde, glycolic acid, and nicotinamide

Avaliação da eficácia e segurança de um dermocosmético contendo retinaldeído, ácido glicólico e nicotinamida no tratamento do envelhecimento corporal

Sergio Schalka, Bianca Lenci Inácio Viscomi, Patricia Bombarda, Um Sun Park, Vanessa de Melo Cardoso Pereira

Abstract: Introduction: The aging process of areas of the body that are frequently exposed to the sun has a clinical pattern different from that of facial photoaging. According to a number of published studies, the combination of retinaldehyde, glycolic acid, and nicotinamide presents promising results. Objective: To evaluate the efficacy and safety of a new dermocosmetic formulation in the treatment of body photoaging. Methods: Clinical, prospective, open, and monocentric study that evaluated 60 volunteers (phototypes I to III) with signs of photoaging in the neck region. Clinical and instrumental measurements (cutometry, corneometry, evaporimetry, and profilometry) were taken in the initial visits and 30 and 60 days after using the study product, which was applied at night, combined with the daytime application of sunscreen. Results: After using the test product, the categories of clinical parameters (wrinkles, smoothness, hydration, and sagging) and biophysical hydration (measured using corneometry) presented statistically significant improvement (p < 0.05) in the intermediate and final visits. Despite showing improvement, the biophysical measurements of skin viscoelasticity and roughness were not statistically significant. Conclusion: This combination was effective in the clinical improvement of body photoaging, and is an effective and safe alternative for treating this condition.


Evaluation of a simplified technique for the treatment of rhytids in the perioral and periorbicular regions with CO2 laser

Avaliação de uma técnica simplificada para tratamento de rítides da região perioral e periorbicular com laser de CO2

Bhertha M. Tamura

Abstract: Introduction: The use of fractional ablative lasers has optimized the results of photorejuvenation treatments by decreasing the number of complications and reducing the post-procedure recovery time.Methods: The authors evaluated a modification in the classic ablative resurfacing technique with CO2 laser, in which the operator has visual control of the fractioning, allowing healthy skin to be left alone between treated areas. Nine volunteers (aged 38-73), with moderate to severe photodamage, received visual fractioning in the perioral (three sessions) and periocular regions (two sessions). Photographic evaluations were conducted by two non-medical professionals, the operator physician, and the patients.Results: In the periorbicular region, four patients (44%) presented considerable improvement, and five (56%) moderate improvement. Of the four patients who underwent treatment of the perioral region, three (75%) reported considerable improvement and one (25%) reported moderate improvement. The photographic evaluation of the non-medical professionals was identical to patient-reported outcomes. In the physician's assessment for the perioral region, three (33%) presented considerable improvement and six (67%) had moderate improvement. For the perioral region, two presented moderate improvement and two had slight improvement. The skin fully recovered within 15-30 days, with erythema the most persistent symptom.Conclusion: The technique is a good option for the improvement of perioral and periorbicular wrinkles.


Treatment of localized fat and gynoid lipodystrophy with combination therapy: multipolar radiofrequency, red LED, pneumatic endermologie, and cavitational ultrasound

Tratamento de gordura localizada e lipodistrofia ginóide com terapia combinada: radiofrequência multipolar, LED vermelho, endermologia pneumática e ultrassom cavitacional

Alexandre de Almeida Filippo, Abdo Salomão Júnior

Abstract: Introduction: A new combination therapy combines four different technologies for the treatment of localized fat and gynoid lipodystrophy. Objectives: To evaluate the efficacy and safety of this new treatment modality. Methods: Female patients (n = 21, aged 24-39) were treated with four different technologies from April to December 2011: cavitational ultrasound, multipolar radiofrequency, endermologie with pneumatic system, and LED. Eight 40-minute sessions were carried out on a weekly basis. The patients were evaluated before and after the eight treatment sessions with laboratory measurements of total cholesterol, triglycerides, creatinine, glucose, AST and ALT; and weight, waist circumference, and degree of patient satisfaction measurements. Results: The laboratory controls of the 21 patients remained within normal limits. On average, the treated patients lost 1.62 kg, presented a 2.85 cm reduction in their waist circumference, and rated their satisfaction with the treatment as 6.83 out of 10 grade in the evaluation scale. None of the patients presented systemic signs or symptoms as a result of the treatment. Conclusion: The method proved to be safe and effective in the treatment of localized fat and gynoid lipodystrophy.


Clinical evaluation of the effectiveness of andiroba oil in burns caused by hair removal with intense pulsed light: a prospective, comparative and double-blind study

Avaliação clínica da eficácia do óleo de andiroba na queimadura pós-depilação com luz intensa pulsada: estudo prospectivo, comparativo e duplo-cego

Elen Violeta Souza Santos Cela, Márcia de Britto da Rocha, Tatiana Maciel Gomes, Chang Yung Chia, Camille Furtado Alves

Abstract: Introduction: Intense pulsed light is commonly used for hair removal. Corticosteroids of low or medium potency are generally employed for pain and inflammatory reaction relief following such procedures. Botanical compounds, such as andiroba oil emulsion, have been proven to have moisturizing and anti-inflammatory effects. Objective: To compare the effectiveness of andiroba oil emulsion to desonide as an option to topical corticosteroids. Methods: A prospective, comparative, double-blind study evaluated nine female patients who underwent air removal with intense pulsed light in the inguinal region. The patients were treated immediately after the procedure with desonide on one side and andiroba oil emulsion on the other. The patients rated the pain sensation using a visual analog pain scale, and an observer dermatologist physician evaluated the inflammatory reaction caused by the procedure, comparing the two sides blindly. Results: There were no significant differences in pain relief or inflammation between the two products. The analgesic and anti-inflammatory potential of andiroba oil emulsion practically equaled that of desonide. Conclusions: This pilot study's results indicate that andiroba oil emulsion can be a treatment option following photoepilation.


Diagnostic Imaging

Digital dermoscopy in early diagnosis of melanoma and histopathology for high-risk patients

A importância da dermatoscopia digital no diagnóstico precoce do melanoma e no auxílio à histopatologia em paciente de alto risco

Flávia Vieira Brandão, Bianca Costa Soares de Sá, Clóvis Antônio Lopes Pinto, João Pedreira Duprat Neto

Abstract: The early detection of melanoma is crucial for improving survival rates. Dermoscopy improves the accuracy of clinical examination, enabling a diagnosis in the early stages. However it has limitations in the diagnosis of incipient melanomas. Full body mapping and digital dermoscopy help diagnose nonspecific lesions and allow the detection of new suspicious lesions. Patients at high risk of developing melanomas benefit the most from this approach. The authors report the case of a high-risk patient whose melanoma diagnosis was only possible with the help of dermoscopy-guided histopathological analysis.


Systematic review

A historical review of mineral water

Revisão histórica das águas termais

Samanta Nunes, Bhertha Miyuki Tamura

Abstract: The French cosmetics industry has been marketing thermal mineral waters that have certain biological effects. Previous studies have demonstrated that oligomineral elements have hydrating, antioxidant, and anti-inflammatory properties. This literature review discusses in vitro and in vivo clinical studies of commercially available thermal mineral waters to determine their effects on the skin and their main indications. A historical review was also carried out on the use of thermal mineral waters in dermatology, with an emphasis on identifying their physical and chemical properties and comparing the qualitative composition of the oligominerals present in those waters.


New Techniques

Innovation in aesthetic correction of nasal skin flaps

Inovação na correção estética dos retalhos cutâneos nasais

Vitor Pavan Pasin, Patricia Naomi Ando, Leandro Almeida Bueno de Moraes, Marcio Rodrigures Soares, Sergio Henrique Hirata, Mauro Yoshiaki Enokihara, Ival Peres Rosa

Abstract: Flaps are widely used in the surgical reconstruction of the nasal region. During the post-operative period, an unattractive depressed scar in relation to the nearby skin can be observed. Even after abrasion – which the literature recommends 30-60 days after the procedure – this complaint often persists. This study proposes tangential excisions with a razor blade (shaving) of the flap's entire area until it is level with the surrounding region, followed by dermabrasion to refine any remaining irregularities. The results are deemed excellent since the scars become less noticeable – a very satisfactory outcome due to the aesthetic and social importance of the treated area.


Case reports

Merkel''''''''s tumor: a case report

Tumor de Merkel: relato de caso

Ed Wilson Tsuneo Rossoe, Késsia Katarine Maciel Lopes Fernandes, Ivana Dias Ferreira do Prado, Iracema Lerianna Mayer de Souza Bazzo, Antônio José Tebcherani, Tereza Cristina dos Santos

Abstract: Merkel cell carcinomas are highly aggressive neuroendocrine skin tumors that have a poor prognosis. The authors present a case report and emphasize the importance of early diagnosis and treatment.


Dermal filling complication after hepatitis C treatment with interferon and ribavirin

Complicação de preenchimento cutâneo após tratamento de hepatite C com interferon e ribavirina

Daniela Martins Bringel, Lislaine Bomm, Amanda da Costa Azevedo, Roberto Souto, João Carlos Fonseca

Abstract: This article describes the case of a female hepatitis C patient who presented with a foreign body granuloma in the nasolabial folds and glabella five years after receiving an application of permanent dermal filler. The patient used interferon and ribavirin for treating hepatitis C for six months, and the granulomas appeared 30 days after the end of the treatment. Treatment with oral steroids was carried out, with a gradual improvement in the appearance of the skin.


Hydrofiber dressing with silver: a treatment option for Pemphigus vulgaris

Curativo de hidrofibra com prata: opção de tratamento para pênfigo vulgar

Sonia Maria Fonseca de Andrade, Michelle Cavalcante Pontes, Daniela Tiemi Sano, Ana Claudia Grizzo Peres Martins, José Luiz Gonzaga Júnior

Abstract: Pemphigus vulgaris is a serious condition characterized by blisters and mucocutaneous erosions, which is treated systemically and topically. Some affected patients present lesions in the integument that are resistant to available therapies. Hydrofiber with silver is a retainer and humidifier dressing with broad bacterial spectrum, which is effective in treating wounds and bullous diseases. The authors describe a case of Pemphigus vulgaris with lesions on the face and neck that was treated with hydrofiber with silver dressing. There was an improvement in the lesions within 10 days.


Giant pigmented hairy nevus: clinical and histopathological 3-year follow-up after removal with 1,064 nm Q-Switched Nd:YAG Laser

Nevus Pigmentado Piloso Gigante: Acompanhamento clínico e histopatológico de três anos após remoção com Laser Q-Switched Nd.YAG 1064nm

Carlos Roberto Antonio, João Roberto Antonio, Eurides de Oliveira Pozetti, Solange Corrêa Garcia Pires D’Avila, Izabela Lidia Soares Cardeal, Fabiana Caetano Gerbi, Rafael Leszczynski, Gabriela Blatt Pereira

Abstract: Giant congenital melanocytic nevi are extremely rare, however there is a 5-10% chance they will develop into melanomas. Laser-based treatment of this type of lesion is still very controversial. Some studies report great success without malignant development and others have achieved good aesthetic results but with malignancy. This article describes the clinical and histological development of a case of a female patient with a giant congenital melanocytic bathing trunk nevus, after 14 sessions of 1,064 nm Q-Switched Nd:YAG laser and three years of follow-up without histological signs of malignancy. The authors highlight the need for histological monitoring of this type of lesions.



Treatment of developing vitiligo with oral mini-pulse of dexamethasone

Tratamento do vitiligo em progressão com minipulso oral de dexametasona

Helena Zenedin Marchioro, Mariana Martins Bardou Zunino, Juliana Maria Zucco Viesi, Felipe Bocnhia Cerci, Caio César Silva de Castro

Abstract: Introduction: The authors have carried out a retrospective analysis of data from 26 patients with developing vitiligo who were treated with oral mini-pulse of dexamethasone. Clinical response and side effects were evaluated at monthly intervals. Of the 26 patients included in the study, 12 (46.2%) presented a repigmentation of lesions, 11 (42.3%) stabilized, and 3 (11.5%) experienced a worsening of the condition. Ten patients (38.5%) had side effects, the most common of which was weight gain. There was a correlation between the duration of the treatment and the frequency of side effects.


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