Sociedade Brasileira de Dermatolodia Surgical & Cosmetic Dermatology


ISSN-e 1984-8773


Volume 1
Number 3


Continuing medical education

Hair care: a medical overview (part 1)

Tratamentos estéticos e cuidados dos cabelos: uma visão médica (parte 1)

Leonardo Spagnol Abraham, Andreia Mateus Moreira, Larissa Hanauer de Moura, Gavazzoni Dias

Questions and answers of previous number

Abstract: Doubts concerning the action of hair cosmetics and the health of both body and hair are more frequent in the dermatological visits. Dermatologists need no only to enrich the knowledge of scalp diseases but also of molecular interactions of cosmetics used in hair fi ber, including the infl uence of such products when absorbed by the epithelium of the scalp. The amount of medical visits increases every day to fi nd out which techniques and chemical products are best indicated to enable the desired changes in hair from its natural appearance and, at the same time, to keep the hair healthy and beautiful. In this article, divided in two parts, we discuss the hair physiology, structure and chemical nature, as well as the agents used for its smoothing, coloring, hygiene and cosmetic treatment, and the consequences that such procedures can have on overall health, including their use safety during pregnancy and lactation.


Surgery technique report

Split ear lobe repair: literature review and new technique proposal

Reparo do lóbulo da orelha partido:revisão da literatura e proposta de nova técnica

Adriana Alves Ribeiro, Luciana de Matos Lourenço, Thais Helena Cardoso de Barros Matsuda, Nelson Marcos Ferrari

Abstract: Split earlobe usually results from sudden trauma or continuous use of heavy earrings. Among the various surgical techniques proposed for split earlobe correction, the choice will depend on the existing split, partial or total, and should offer a lower chance of recurrence. The total split corrections may be made with or without preservation of the earring orifi ce. Lobe fixation during intervention is essential, whatever the technique used, and can be done with tongue blade or sterile chalazion clamp. For the surgical procedure, we used Adson clamp, iris scissors, and scalpel blade 11 or 15. Skin suture was done with mononylon 5.0 or 6.0. In the new technique, besides the advantage of maintaining the orifi ce, there is greater security to upport the earring with less chance of recurrence.


Use of chalazion clamp for minor salivary gland biopsy in the diagnosis of Sjögren’s syndrome

Uso da pinça de calázio para biópsia de glândula salivar menor no diagnóstico da síndrome de Sjögren

Dalva Regina Neto Pimentel, Marilda Aparecida Milanez Morgado de Abreu, Cleonice Hirata, Maurício Mota de Avelar Alchorne, Luc Louis Maurice Weckx

Abstract: Minor salivary gland biopsy is essential for the diagnosis of Sjögren’s syndrome. The authors demonstrate the use of chalazion clamp to facilitate this procedure. Chalazion clamp retains the lip mucosal bleeding and exposes the salivary glands more easily for their dissection and excision individually, which facilitates the removal of various glands to histopathological examination.


Systematic review

Striae distensae: physiopathology

Striae distensae: fisiopatologia

Raquel Cristina Tancsik Cordeiro, Aparecida Machado de Moraes

Abstract: Introduction: Cutaneous atrophic striae or striae distensae (SD) is a very common disease. Although SD is considered an aesthetic complaint, it can have important psychosocial consequences. Moreover, its occurrence may reflect changes in tissue, and express local and systemic pathological conditions. Considering the multiplicity of factors involved, the literature is divergent and inconclusive. Objective: To investigate striae physiopathological aspects, which have been studied, through systematic review of the literature. Method: We conducted searches using three databases: MEDLINE (1966- 2009), Cochrane Library and LILACS, in Portuguese, English and Spanish, besides: search for keywords in PubMed, review of bibliographic references of the articles found, and manual search of the main Dermatology journals. Results: We identified 113 articles, 101 in MEDLINE, 12 in Cochrane Library and none in LILACS, for striae distensae. Of these, 25 publications were considered for descriptive purposes, were analyzed 10 studies that were individually controlled (compared with samples of healthy skin) or comparative (recent and old striae). Conclusions: There are few researches of good quality on the physiopathology of cutaneous striae. The priority of most studies is on therapy, with little interest in Understanding the physiopathology. The knowledge of SD physiopathology is not only important for the development of preventive methods and more effective treatment, but also for better understanding of local and systemic changes related To the connective tissue.


Case reports

External carotid artery aneurysm: a rare condition diagnosed in cosmetic consultation

Aneurisma da artéria carótida externa: uma condição rara diagnosticada durante uma consulta cosmética

Edileia Bagatin, Karin V. Ferreira, Marcos Docema, Cristhine Leão, Karime M. Hassun, Erica de Oliveira Monteiro, Sérgio Talarico

Abstract: The aim of this report is to highlight and warn cosmetic dermatologists about the need of a complete and careful examination of any patient that looks for our evaluation, even when they ask only for cosmetic treatments and/or procedures. This is nowadays a very important concern as people and some physicians are involved in an exaggerated search for eternal beauty. This represents a very profitable practice for dermatologists and plastic surgeons. But we should never forget that a dermatologic consultation can be an opportunity to discover an unnoticed dermatosis or signs related to systemic diseases.


Investigative studies

Periorbital wrinkles treatment using collagen induction therapy

Tratamento de rugas periorbitais por terapia de indução de colágeno

Gabriella Fabbrocini, Maria Pia de Padova, Valerio De Vita, Nunzio Fardella, Francesco Pastore, Antonella Tosti

Abstract: Introduction: Periorbital wrinkles are very common and permanent cutaneous folds that develop on the periocular area. The treatment for wrinkles varies with the degree of severity. A relatively new treatment, called collagen induction therapy (CIT), seems to be appropriate for the treatment of periorbital wrinkles. Objective: To confi rm the usefulness of CIT in periorbital wrinkles treatment. Patients and methods: In total, 20 patients (12 females, 8 males; between 50-65 years of age) with periorbital wrinkles were included. Each patient was treated with a specific tool in two sessions. Using digital cameras, photos of all patients were taken to evaluate wrinkles’ depth, and silicone rubber was used to make a microrelief impression of the wrinkles. The photographic data were analysed by using the sign test statistic (a < 0.05). Skin layer data were analysed by computerized image analysis. Results: Analysis of the patient photographs, supported by the sign test, and the degree of irregularity of the surface microrelief, supported by Fast Fourier Transform and by wrinkle’s image processing, showed that, after only two sessions, the wrinkles’ severity grade in most patients was greatly reduced. Conclusion: The present study suggests that CIT can be a suitable technique to improve periorbital wrinkles.


Randomized, double-blind, controlled topical anesthesia induced by iontophoresis of lidocaine

Ensaio randomizado, duplo-cego e controlado de anestesia tópica induzida por iontoforese de lidocaína

Juliano Vilaverde Schmitt, Hélio Amante Miot

Abstract: Introduction: Needle infi ltration of local anesthetic is a painful procedure, thus, a topical anesthetic is a comfortable alternative; however, it is difficult to deliver transcutaneous polar drugs. Iontophoresis is a noninvasive technique that uses electrical current for releasing electrically charged drugs through biological membranes. Objective: To evaluate the anesthesia induced by iontophoresis of lidocaine for a standardized painful stimulus. Material and methods: Randomized, controlled, double-blind study, involving 10 volunteers under the anesthetic effects of topical application of lidocaine gel 2% and noradrenaline 1:50,000, with or without iontophoresis of 1.85 milliamps for 13 minutes. Pain sensitivity was evaluated by the prick of a 21G needle in the arms posterior region, using a visual numerical scale. Results: Patients mean age was 50.8 ± 11.4 years. Nine of them were women. All had previously received infi ltrative anesthesia. Iontophoresis was well tolerated by volunteers. The median pain scores were 0 and 3 for the arm that received the iontophoresis and for the one that did not receive, respectively (p < 0.01). Conclusion: The anesthetic effect in the region subjected to iontophoresis suggests an effi cient and comfortable method for promoting local anesthesia in the surgical approach of pediatric, hyperalgic, or needlephobic patients.


Intense Pulsed Light alone versus Intense Pulsed Light and aminolevulinic acid in the treatment of photodamaged skin: importance of long term follow-up

Luz Intensa pulsada isolada versus Luz Intensa pulsada e ácido aminolevulínico no tratamento da pele fotodanifi cada: importância do acompanhamento a longo prazo

Maria Cláudia Almeida Issa, Carlos Barcauí, Alexandra Cariello Mesquita, Fernanda Ramos Franco de Sá, Mônica Manela Azulay

Abstract: Introduction: The photodynamic therapy (PDT), using 5-aminolevulinic acid (ALA) associated to IPL has become an issue of great interest to treat photodamaged skin with AKs. Objective: To determine the long term efficacy of 5-ALA+IPL in the treatment of the photodamaged skin with AKs, comparing to IPL alone. Material and methods: Nine patients with photodamaged facial skin were enrolled in this study. Two sessions of ALA-IPL were done on a split face and IPL alone on the other side, with a month interval. Results: AK lesions clearance was observed only on the area treated with ALAIPL (62.9%) after 3 months supervision. Recurrence of the improved lesions (70.6%) was observed in 12 month follow up. Improvement of melanoses, telangiectasia and wrinkles were observed on both sides, but more evident on the side treated with ALA-IPL. Conclusion: ALA-IPL brings improvement in photodamaged skin, including in AK lesions, what was not observed with IPL alone. Nevertheless, a long time of supervision is necessary to confirm the efficacy of the therapy.


Matricectomy of the hallux’s ingrowing nail: immunohistochemical study of the removed matrix

Matricectomia da unha encravada do hálux: estudo imuno-histoquímico da matriz retirada

Bherta M. Tamura, Benjamin Golcman, Luiz Carlos Cucé, Mirian N. Sotto, Neil F. Novo

Abstract: Introduction: The lateral extent of the germinal matrix area of the nail is not demonstrated in the literature. Objective: To identify the lateral limits of the ungueal matrix. Material and methods: We evaluated the proliferation area of the lateral extent of the nail matrix on surgical samples resulting from the matricectomy for the treatment of ingrowing nail of the hallux with the Ki-67 immunohistochemical marker. We obtained 21 samples and observed the epidermis, ventral and dorsal region of the matrix, as well as ventral and dorsal matrix of the lateral/medial angle. Results: The test of multiple comparisons demonstrated that the number of cells in the ventral matrix is higher than the number found in the skin, in the dorsal matrix, in the angle of the dorsal matrix and in the angle of the ventral matrix. The number of cells in the skin and in the angle of the ventral matrix is higher than the number found in the angle of the dorsal matrix. Conclusion: The lateral limit of the ungueal matrix has proliferation activities. The surgery performed without the complete removal of the lateral/medial proliferation region of the nail matrix may infl uence the recurrence rate of matricectomies.


Classification of melasma by dermoscopy: comparative study with Wood’s lamp

Classificação do melasma pela dermatoscopia: estudo comparativo com lâmpada de Wood

Carla Tamler, Rosa Maria Rabello Fonseca, Francisco Burnier Carlos Pereira, Carlos Baptista Barcauí

Abstract: Introduction: Melasma is the principal cause of facial hyperchromia and has a significant psychosocial impact. Wood´s lamp has been a useful device to estimate the depth of melanin determined by light-induced fluorescence. A dermatoscope enables a clear visualization of pigments distribution, and the color variation of melanin will depend on its location within the skin. Objective: Evaluate the classifi cation of melasma according to depth of melanin by dermatoscopy and to correlate the dermatoscopic findings with its classifi cation using Wood’s lamp. Material and methods: Analysis of concordance between dermatoscopy and Wood’s lamp in the classification of melasma. Forty patients were evaluated by expert examiners, using a Wood’s lamp (Burton® UVA 360nm LE T5 4W BLB) and dermoscopy (Bley Med-Skincam® 40x or 3Gen Dermlite II ProHR® 10x), in an independent manner. The epidermal type was considered as the presence of a regular pigment network, with a brownish homogeneous pigmentation; dermal type as an irregular and mixed network with bluish-gray pigmentation; and mixed type as areas presenting both features. Results: The degree of concordance between the methods was considered weak (k < 0.2) by statistical analysis. Conclusions: The authors consider the technique more suitable, since it has allowed the visualization of the pigmentary components in a more objective way.


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