Sociedade Brasileira de Dermatolodia Surgical & Cosmetic Dermatology


ISSN-e 1984-8773


Volume 5
Number 1


Portuguese | English


Dra. Bogdana Victoria Kadunc

Dra. Bogdana Victoria Kadunc


Continuing medical education



Nilton Di Chiacchio, Glaysson Tassara Tavares, Emerson Henrique Padoveze, Diego Leonardo Bet, Nilton Gioia Di Chiacchio

Questions and answers of previous number

Abstract: Onychomatricoma is a benign neoplasia that occurs pecifically in the nail apparatus. It was described in 1992, and is the only tumor in which the change of the nail plate is actively caused by the lesion. It lies in the nail matrix,and has fingerlike projections that are embedded in the nail plate, resulting in thickening, longitudinal grooves, yellow discoloration and splinter hemorrhages. Although described as a rare tumor, it is believed to be underdiagnosed. The present study is aimed at reviewing onychomatricoma’s clinical features as well as the complementary examinations that are used to recognize and diagnose this tumor.


Original Article

Keloid treatment using postoperative radiotherapy with electron beams: a comparative randomized study of two methods

Tratamento de queloides usando radioterapia pósoperatória com elétrons: estudo comparativo e randomizado com dois esquemas

Batista de Oliveira Junior, Silvana Artioli Schellini, Joel Carlos Lastória, Lídia Raquel de Carvalho, Hamilton Ometto Stolf, Ana Laura Paludetto de Oliveira

Abstract: Introduction: While several keloid treatment modalities exist, they all offer disappointing results when performed in isolation. The combination of surgical excision and post-operative irradiation with electron beams is effective in improving the quality of scars and reducing the recurrence rate of the condition. Objective: To assess, on a comparative basis, the prospects for cure, and also side effects in the irradiated areas of two treatment methods using electron beams. Methods: A prospective, comparative and randomized clinical study was carried out at the Faculdade de Medicina de Botucatu-UNESP, in Botucatu (SP), Brazil, between 2008 and 2010. The study included patients who were post-operative after their treatment for the resection of keloids. The study population was divided into groups G1 and G2, having received radiotherapy treatment with electrons from a linear accelerator at 30 Gy/10 fractions and 32 Gy/16 fractions, respectively. The patients were followed up with for 18 months. Results were assessed through the observation of two independent evaluators and the distribution of a questionnaire to study participants. Results: Forty-three patients were investigated (21 in G1 and 22 in G2). 52.4% showed good results in G1, with a recurrence rate of 47.6%. In G2, 91% showed good results, with a 9% recurrence rate. Conclusion: The 32 Gy/16 fractions method was proved to be superior to the 30 Gy/10 fractions method, resulting in a better therapeutic response and fewer side effects.


Comparative study of the treatment of large actinic keratoses with glycolic acid peeling and 5fluorouracil vs. cryopeeling

Estudo comparativo do tratamento de ceratoses actínicas extensas com peeling de ácido glicólico + 5fluoracil x criopeeling

Laura Yoshizaki Dini, Camila Trindade Stangarlin, André Cesar A. Pessanha, Denise Steiner

Abstract: Introduction: Chronic and intense photodamage usually produces numerous actinic keratoses, with early and global treatment of the affected skin being of paramount importance. Objective: To evaluate the effectiveness of two different treatments for multiple actinic keratoses. Methods: Five patients were selected Were selected five patients with diffuse, with diffuse actinic keratoses on the dorsum of the hands and forearms. The patients underwent the following protocol: Side A (right): biweekly superficial chemical peeling with 70% glycolic acid in gel, followed by the subsequent application of 5% 5-fluorouracil solution; Side B (left): monthly sessions of cryopeeling. The number of sessions ranged from four to six in Side A and two to three in Side B, according to the degree of photodamage. Results: All patients had a satisfactory clinical response, with improvement of actinic keratoses throughout the whole area of actinic damage, and good tolerance of the treatment among patients. The only exception was that a more intense and persistent erythema arises after the cryopeeling. Conclusions: Both treatments are valid and effective alternatives for the treatment of the field cancerization.


Comparative study of the use of exogenous pigmentation as an adjuvant therapy to Intense Pulsed Light in the treatment of melanoses on the dorsum of the hands

Estudo comparativo do uso de pigmentação exógena como adjuvante à luz intensa pulsada no tratamento de melanoses solares do dorso das mãos

Fernanda Regina Lemos Bebber Douat, Vanessa Cristina Soares, Fernanda H. Mello de Souza Klein, Juliano Vilaverde Schmitt, Deborah Skusa de Torre Ataíde

Abstract: Introduction: The use of exogenous pigmentation as an adjuvant therapy to Intense Pulsed Light in the treatment of melanoses is routine, nevertheless there is an absence of published comparative studies. Objective: To compare Intense Pulsed Light therapy in isolation, or combined with exogenous pigmentation in the treatment of solar lentigines on the dorsum of the hands. Methods: Twenty women (mean age = 56.5 years) with skin types from I to III, underwent three sessions of Intense Pulsed Light, with a brown makeup pencil pigment reinforcement being applied to the lesions on the right hand. The patients were queried about the degree of discomfort, swelling, crusting, and improvement experienced, their treatment of preference and which they felt provided greater effectiveness, and the incidence of side effects. Results: When assessing all three of the treatment sessions together, the median discomfort score, as well as the degree of inflammation and crusting (p < 0.01), were higher on the right hand. Regarding the subjective impression of the final result, 15 in 20 patients preferred the technique applied on the right hand, considering it more effective (p < 0.01). Eleven in 20 patients reported fewer side effects in the un-pigmented side (p = 0.12). The degree of discomfort did not correlate significantly with the preferred technique (p = 0.67). Conclusions: In this sample, there was a preference for the method with the adjuvant use of exogenous pigmentation, however the incidence of pain and side effects was higher in this group.


Comparison of 2.5% thioglycolic acid, 2% hydroquinone, 2% Haloxyl, and 10% thioglycolic acid peeling in the treatment of periorbital hyperpigmentation

Comparação entre ácido tioglicólico 2.5%, hidroquinona 2%, haloxyl 2% e peeling de ácido glicólico 10% no tratamento da hiperpigmentação periorbital

Daniela Carvalho de Moraes Souza, Cristiane Ludtke, Emanuelle Rios de Moraes Souza, Natana Werle Rocha, Magda Blessmann Weber, Ana Paula Dornelles Manzoni, Fabiane Kamagai Lorenzini

Abstract: Introduction: Periorbital hyperpigmentation is a multifactorial dyschromia that involves the eyelid's vascularization and melanin hyperpigmentation. Objective:To compare the efficacy of 2.5% thioglycolic acid, 2% hydroquinone, 2% Haloxyl, and 10% thioglycolic acid peel in the reduction of dark circles. Methods: Eighty patients were divided into four groups. Groups 1, 2, and 3 underwent treatments with 2.5% thioglycolic acid, 2% hydroquinone, and 2% Haloxyl, respectively. Group 4 underwent five biweekly sessions of chemical exfoliation with 10% thioglycolic acid. All patients were evaluated by two physicians after the treatment: the one who performed the treatment, and another who was blinded to the outcome. The assessment was carried out using photographs and a clinical satisfaction questionnaire distributed to the patients. Results: The best results occurred in Groups 1 and 2. Group 3 had slightly inferior results, possibly due to the low concentration used. Group 4 had the least significant results, however this outcome may have been influenced by the higher age of the group members and the lack of daily use of medications. Conclusions: There is still not an ideal treatment for dark circles, with the currently available therapeutic resources only alleviating the difference in color between the lower eyelids and the rest of the face.


A splitface comparative study between two phenolbased peelings (BakerGordon and Hetter formulas) in the treatment of facial rhytids

Estudo comparativo de hemifaces entre 2 peelings de fenol (fórmulas de BakerGordon e de Hetter), para a correção de rítides faciais

Bárbara Nader Vasconcelos, Guilherme Mafra Figueira, João Carlos Macedo Fonseca, Livia Moreira de Mendonça, Carla da Rocha Fonseca

Abstract: Introduction: Aging is considered to be a set of inevitable and irreversible physiological changes. Several techniques have been used with the aim of slowing down and even reversing this process. Objective: To compare the efficacy and local side effects of two phenol-based formulas: the Baker-Gordon formula and the Hetter formula. Methods: Seven pacients were included in a split-face comparative study. The Baker-Gondon and the Hetter formulas were applied on the right and left facial sides respectively. The pain felt during the procedure and intensity of clinical changes in the period following the peeling were measured through a 3 degrees subjetive scale, for each side of the face. The clinic results after 6 months were evaluated by patients and the doctor Who performed the procedures. Results: The pain intensity during the procedure was equivalent for both formulas. With the Hetter's formula the skin's integrity was restored more quickly and the undesirable effects were of lower intensity. Regarding the final clinical results two patients preferred the Baker-Gordon formula, one gave preference to the Hetter's formula and for 4 patients the results were unconcerned. In the medical evaluation, 5 patients had similar results on both facial sides , while 2 presented better clinical results with each formula, respectively. Conclusion: The Gordon-Baker and the Hetter formulas are equivalent for the treatment of facial rhytids.


Changes in patients’ habits regarding exposure to the sun and photoprotection after basal cell carcinoma diagnosis

Alterações nos hábitos de fotoexposição e fotoproteção de pacientes após diagnóstico de carcinoma basocelular

Ana Paula Dornelles Manzoni, Isadora Hoefel, Magda Blessmann Weber

Abstract: Introduction: Skin cancer is the most common type of neoplasia in humans, with ultraviolet radiation being considered the main cause. Basal cell carcinoma is the most frequent cutaneous neoplasia, and photoprotection is seen as the most effective measure in its prevention. Nonetheless, there is still some resistance to the use of sunscreens among the general population. There is also a lack of reports in the literature on whether such resistance differs in patients with basal cell carcinoma. Objectives: To evaluate whether there is change in habits regarding exposure to the sun and use of sunscreen after diagnosis of basal cell carcinoma in patients treated at the Dermatology Outpatient Clinic of Universidade Federal de Ciências da Saúde de Porto Alegre (RS), Brazil. Methods: A cross-sectional study was carried out with 120 patients diagnosed and treated for basal cell carcinoma, who responded to a questionnaire regarding their sun exposure habits and use of photoprotection methods before and after diagnosis. Results: Of the 120 patients interviewed, 73.3% reported changes in their habits regarding exposure to the sun and use of sunscreen after receiving a diagnosis of basal cell carcinoma. The main reasons alleged by those who denied having changed their behavior towards sun exposure (26.7%), were the lack of fear of new tumors, as well as the high cost of sunscreens. Conclusions: A diagnosis of basal cell carcinoma motivates most patients to improve their use of preventive measures regarding protection from the sun. Nonetheless, about a third of the studied population still resisted such measures, the main reason cited being the high cost of sunscreens. Therefore, awareness campaigns about the importance of using photoprotection methods to prevent skin cancer must be implemented, and the development of programs aimed at making sunscreens available to the general population – especially to high-risk patients – must be sought.


A study of the prognosis of vitiligo during pregnancy

Estudo de prognóstico do vitiligo na gestação

Gerson Delatorre, Carlos Alberto Bruno Mendes de Oliveira, Talitha Possagno Chaves, Renata Falkenbach Von Linsingen, Caio Cesar Silva de Castro

Abstract: Introduction: Vitiligo is a pigmentation disorder with great potential for cosmetic disfigurement and emotional impact on patients – especially during pregnancy. The prognosis of autoimmune diseases during pregnancy is variable, and no studies evaluating the prognosis of vitiligo during pregnancy was found in the literature review carried out by the authors. Objective: To evaluate the behavior of vitiligo during pregnancy and the postpartum period. Methods: A descriptive transversal investigation was carried out with a population of 86 women diagnosed with vitiligo, who answered a standardized questionnaire. Results: Among the women studied, only 28 patients (43.07%) had a diagnosis of vitiligo coinciding with pregnancy, totaling 57 pregnancies (33.92%) with vitiligo. Regarding the behavior of vitiligo during pregnancy, there was a worsening of vitiligo in 10 pregnancies (17.54%), stability in 38 (66.66%), and improvement in seven (12.28%). As for the evolution of vitiligo within 6 months postpartum, 16 patients (28.07%) had a worsening of the disease, 36 (63.15%) remained stable, and three (5.26%) improved. In two pregnancies (3.50%) the patient did not provide information about the behavior of the disease. Conclusion: In most patients, vitiligo remained stable during pregnancy, as well as in the 6 months postpartum.


Review articles

Chemical peels: review and practical applications

Peelings químicos: revisão e aplicação prática

Vania Marta Figueiredo Yokomizo, Tania Maria Henneberg Benemond, Chinobu Chisaki, Paula Henneberg Benemond

Abstract: Cosmetic-driven research currently yields an avalanche of products and treatments for all dermatological sub-segments. Many treatments aimed at rejuvenating skin have been developed. Although chemical peels have now been used for more than a century–and despite the availability of new technologies–the treatment is still widely known and employed due to its practicality, low cost, and excellent results. The present study offers a review of all types of peelings recognized by the scientific literature – from the most superficial to the deepest – compiling the practical experience of the authors and detailed descriptions of the application technique, results, and complications.


Diagnostic Imaging

Confocal microscopy in the diagnosis of pink facial lesions

Microscopia confocal no diagnóstico das lesões róseas da face

Gisele Gargantini Rezze, Luiz Roberto Terzian, Francisco Macedo Paschoal

Abstract: Solitary pink lesions of the face may have nonspecific dermoscopic patterns, and are thus deemed difficult to diagnose. Differential diagnoses to consider are: actinic keratosis, squamous cell carcinoma, basal cell carcinoma, and amelanotic melanoma. Confocal microscopy can be used as an auxiliary clinical examination in their diagnosis and in determining the most significant sites for carrying out a biopsy. The authors describe a case that illustrates the usefulness of a confocal microscopy examination in pink lesions.


New Techniques

Usefulness of rotation and advancement flap for the closure of skin defects in the malar region

Utilidade do retalho de avanço e rotação para fechamento de defeitos cutâneos na região malar

Gaston Galimberti, Damian Ferrario, Gabriela Ribeiro Casabona, Leiza Molinari

Abstract: The present study introduces an advancement and rotation flap that can be used for the reconstruction of surgical defects located in the malar region. The design is essentially a triangle containing the defect, where one line runs parallel to the lateral part of the nose along the nasolabial fold, while another starts at the same point and follows the dynamic lines of the malar region. In order to complete the geometrical shape of the flap, a Burow’s triangle is performed at the end of the fold. The final tension force occurs on the nasal wall, preventing ectropion. The repositioning of the malar fat restores the contour of the region.


Microinfusion of drugs into the skin with tattoo equipment

Microinfusão de medicamentos na pele através de máquina de tatuagem

Samir Arbache, Carlos Eduardo de Godoy

Abstract: A tattoo results from the introduction of pigments into the skin or mucous membranes. Pigments are chemical substances that behave like optical markers. Their visibility (through epithelial transparency) is undeniable proof that cutaneous perfusion with micro-perforations is an effective procedure. This method was used to infuse Bleomycin sulfate in two patients bearing keloid lesions, employing the same equipment and components used by professional tattoo artists, with adaptations for dermatological use, and strictly observing aseptical and rational requirements.


Case reports

Treatment of Fordyce granules with a CO2 laser: report of two cases

Tratamento dos grânulos de Fordyce com laser de CO2 - Relato de dois casos

Márcia Almeida Galvão Teixeira, Silvana Maria de Morais Cavalcanti, Angela Rapela de Medeiros, Emmanuel Rodrigues de França

Abstract: Fordyce granules are referred to as benign ectopic sebaceous glands characterized by multiple yellow papules, occurring mainly in the lower lip. It is mainly observed in adult men. The present study describes two cases of patients with Fordyce granules who were treated using a CO2 laser and obtained good cosmetic results.


Reconstruction of the lower lip with Camille Bernard’s technique after excision of infiltrative basal cell carcinoma

Reconstrução do lábio inferior com técnica de Camille Bernard após excisão de carcinoma basocelular infiltrativo

Priscilla Maria Rodrigues Pereira, Carlos Alberto Chirano Rodrigues, Lívia Lima de Lima, Sandra Adolfina Reyes Romero, Adriana Valkira de Oliveira Mariano

Abstract: Lip tumors account for 15% of head and neck neoplasias. When the defect is greater than one third of the lip, the Camille Bernard’s flap is suitable for the reconstruction of the lower lip. The present study describes a case with a satisfactory outcome, where functional, aesthetic, and sensory preservation of the lower lip was obtained by using this technique in its surgical reconstruction, following excision of a locally advanced tumor.



Rheological characteristics of hyaluronic acidbased dermal fillers before and after flowing through needles

Características reológicas de preenchedores dérmicos à base de ácido hialurônico antes a após passagem através de agulhas

Adilson Costa, Lívia Carolina Della Coletta, Aline Siqueira Talarico, Maria Carolina Fidelis, Ellem Tatiani de Souza Weimann

Abstract: Hyaluronic acid-based dermal fillers are currently among the most commonly used substances in cosmetic procedures. The present study aims at identifying alterations in the rheological properties of different types of fillers containing hyaluronic acid, before and after flowing through needles. The same analysis is carried out with fillers with and without hyaluronidase.


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