Sociedade Brasileira de Dermatolodia Surgical & Cosmetic Dermatology


ISSN-e 1984-8773


Volume 1
Number 4

Continuing medical education

Hair care: a medical overview (part 2)

Tratamentos estéticos e cuidados dos cabelos: uma visão médica (parte 2)

Leonardo Spagnol Abraham, Andreia Mateus Moreira, Larissa Hanauer de Moura, Maria Fernanda Reis Gavazzoni, Flávia Alvim Sant’Anna Addor

Questions and answers of previous number

Abstract: The authors complement the fi rst article on the approach of dermatological aesthetic hair treatments. This article addresses the ultimate hair straightening with major straightening legalized – sodium, lithium and guanidine hydroxides and ammonium thioglycolate –, their differences, mechanisms of action, indications and safety to human health. Besides these straighteners, we discuss the illegal and indiscriminate use of hairdressers salons in Brazil in the group of aldehydes (formaldehyde and glutaraldehyde) for smoothing hair. This study focuses its legal implications and public health, carcinogenic potencial and the identification of such filings with ANVISA. Also studied the shampoos and conditioning agents indicated for treatment of the hair shaft. Finally, we discuss the implications of hair care in general health of the hair shaft and the scalp.

Original Article

A comparison of the immunological response to botulinum toxin type A in skin before and after axillary hyperhidrosis treatment

Comparação da resposta imunológica à toxina botulínica tipo A na pele antes e após o tratamento da hiperidrose axilar

Bhertha Miyuki Tamura, Luiz Carlos Cucé

Abstract: Introduction:There are both unpublished and published anecdotal case reports of skin rash, acneiform eruptions and onset of Herpes simplex in patients injected with botulinum toxin for treatment of facial wrinkles and hyperhidrosis. We carried out a research to determine if there are immunological changes in the skin in ab initio treatment of patients with botulinum toxin. Methods: The immunological response to botulinum toxin type A was assessed in skin before and after its application in 15 patients with axillary hyperhidrosis. The following immunohistochemical markers were used to determine the local immunological profi le before and after application of botulinum toxin: CD4+, CD8+, CD1a, CD25, anti-TNF-á, HLA-Dr, ICAM-1, anti- IFN-ã and anti-IL-4. Results and discussion: A descriptive statistical analysis of each marker was carried out and the data were analyzed by Wilcoxon sign test. It was concluded that there was no alteration in skin after hyperhidrosis treatment with botulinum toxin a when markers were compared.


Clinical evaluation of the efficacy of trichloroacetic acid and subcision, combined or isolated, for abdominal striae

Avaliação clínica da eficácia do ácido tricloroacético e da subcisão, isolados ou combinados, no tratamento de estrias abdominais

Maurício Shigueru Sato, Aline Fukuda, Larissa Luvison Gomes da Silva, Fabiane Mulinari-Brenner, Rebecca Tung

Abstract: Introduction: Striae are frequent complaints in dermatology, however most studies are based on the use of laser, and the effects of other treatment modalities are observed by few doctors. ,Objective: To compare three therapeutic modalities: Subcision alone, trichloroacetic acid (TCA) 20% alone, and subcision combined with application of TCA 20% in treatment of striae. Materials and Methods: Eleven female patients, skin phototype II-IV with striae gravidarum, had their lower abdomen divided into 4 quadrants. One stria of each quadrant was selected to be subjected to one of 3 procedures and 1 quadrant was the control. Objective evaluation was performed by the physician and subjective evaluation was performed by the patient. Results: Reduction in width with subcision and in length with TCA 20% were observed by measurement. In the subjective evaluation, improvement was observed mainly with the subcision-TCA 20% treatment. Photografic evaluation was disregarded. At statistical analysis, there was no significant difference between treatments. There were no adverse effects related to treatments. Conclusion: Despite the reported improvement, especially with the subcision-TCA 20% treatment, there was no statistically signifi cant difference between treatments.


2940-nm Erbium Laser, fractionated with dual pulse, for photorejuvenation: clinical and pathologic trial of eff ects on skin tissue

Laser de Erbium 2940 nm fracionado com pulso duplo, para o fotorrejuvenescimento: estudo clínico e histopatológico dos efeitos no tecido cutâneo

Roberto A. Mattos, Neusa Y.S. Valente, Mônica Senise, Valéria B. Campos

Abstract: Introduction: The 2940-nm Erbium Laser has been used for years in photoaging treatment, with pulse duration of 0.25 ms. Currently, it has been widely used in fractionated mode.New pulse duration of 5 ms was introduced in an attempt to promote tissue coagulation,in addition to ablation, improving its treatment performance. Objective: To investigate the mechanism by which this laser rays act on cutaneous tissue, in its fractionated and dual pulse mode, clinically and histopathologically. Material and methods: Six female patients with marked photoaging (Fitzpatrick Classifi cation Scale, degrees III and IV) were designated to this technique. Biopsies were performed 1 week before and 2 months after treatment. Clinical and histological assessments were conducted using the following stains: hematoxylin-eosin, Verhoeff, and Masson’s trichrome. Results: There was signifi cant clinical improvement in all patients, and histology showed foci sizes compatible with the laser microbeam shot in areas where decreased solar elastosis occurred. In two cases with more signifi cant results, these areas were measured. Conclusions: Clinically, there was marked improvement in six patients treated. Focal changes were found and they were similar in size to the rays shot, while previous studies with fractionated 2940- nm Erbium showed areas of non-circumscribed neocollagenesis.


Comparison between two moisturizing lotions with diff erent pHs in skin moisture improvement and pruritus reduction

Comparação entre duas loções hidratantes de diferentes pHs na melhora da hidratação da pele e na redução do prurido

Vanessa Lucília Silveira de Medeiros, Mariana Colombini Zaniboni, Lúcia Helena Fávaro Arruda, Sérgio Luiz de Oliveira, Nilo Lemo Cobreiros

Abstract: Introduction: Atopic dermatitis (AD) affects approximately 15% of the population and is one of chronic infl ammatory diseases more common in childhood. Intense pruritus and skin xerosis are the most important symptoms of the disease. Restoration of epidermal barrier protection elements through the use of emollients is essential for disease treatment. Objective: To evaluate the improvement in pruritus, skin hydration, and xerosis in two groups of patients using the same moisturizer (colloidal oatmeal, glycerol and petrolatum), but with different pH values in patients with AD. Materials and Methods: Twenty-one patients aged 7 to 54 years with AD moderate to severe and pruritus were randomly divided in two groups. The groups were switched after 30 days. Results: The results were assessed after 60 days. Improvement in pruritus, xerosis, and hydration were evaluated by the physician, the patient, and by corneometry. There was no statistical difference in the two groups; therefore, data were evaluated as belonging to a single group at the end. Decrease in pruritus was observed by 59% of patients and 52% of physicians; xerosis reduction was observed by 52% of patients and 43% of physicians. The level of skin hydration in areas with eczema has increased by 79% compared with baseline period. Conclusion: Moisturizers containing colloidal oatmeal, glycerin, and petrolatum with pH close to the one in normal skin showed to be appropriate to improve pruritus in patients with AD.


Study evaluating the efficacy of topical and injected tranexamic acid in treatment of melasma

Estudo de avaliação da eficácia do ácido tranexâmico tópico e injetável no tratamento do melasma

Denise Steiner, Camila Feola, Nediana Bialeski, Fernanda Ayres de Morais e Silva, André César Pessanha Antiori, Flávia Alvim Sant’Anna Addor, Bruno Brandão Folino

Abstract: Introduction: Melasma is an acquired hypermelanosis of multifactorial etiology and diffi cult to treat. Tranexamic acid (TA) has been studied as an alternative therapy. Objective: To evaluate the effi cacy and safety of TA in treatment of melasma, comparing the use of localized microinjection versus topical therapy. Material and Method: Eighteen women with melasma were selected and treated for 12 weeks. Group A: at-home topical application of TA 3% twice a day. Group B: intradermal injections of TA (4 mg/ml) weekly. Before and after treatment, the groups were compared according to the following parameters: photographic evolution, MASI evolution, self-assessment and colorimetry. Results: Seventeen patients completed the study. In group A, photographic evaluation showed improvement in 12,5%, worsening in 50%, and 37.5% had no change. In group B, there was improvement in 66.7% and 22.2% had no change. For the MASI, there was signifi cant improvement (p = 0.0026), with no difference between treatments (p = 0.6512). In group A selfassessment, 37.5% of the patients rated as good and 50% as imperceptible. In group B, 66.7% rated as good and 33.3% as imperceptible. Colorimetric evaluation showed significant improvement on both treatments (p = 0.0008). Conclusion: Although the subjective clinical evaluation has demonstrated the superiority of injected treatment, in objective evaluation, both treatments were significantly effective, presenting TA as a promising new therapeutic option for melasma.


Review articles



Gabriel Teixeira Gontijo, Maria Cecília Carvalho Pugliesi, Fernanda Mendes Araújo

Abstract: Introduction: Incidence of skin cancer has increased signifi cantly in recent decades, corresponding to a public health problem in many countries. Skin is the organ most affected by the deleterious effects of ultraviolet radiation and the association between sun exposure and skin cancer is well-documented. Objective: To conduct a comprehensive review of the main photoprotection measures. Method: We conducted searches on MEDLINE from June 22 through August 18. Descriptive studies, review, and comparisons were analyzed together. Results: We selected 11 articles in with a review of photoprotection, effects of ultraviolet radiation on the skin, prevalence of the use of sunscreens, and behavioral measures between adults and adolescents were reported. Conclusions: The use of broad-spectrum sunscreens, besides simple behavioral measures, appears to have a major impact on prevention of skin cancer.


Case reports

Treatment of lichen planus pigmentosum with intense pulsed light

Tratamento do líquen plano pigmentoso com luz intensa pulsada

Meire Brasil Parada, Samira Yarak, Nilceo S. Michalany

Abstract: This is case report of lichen planus pigmentosus associated with classical lichen planus treated with intense pulsed light. Intense pulsed light technology has been used successfully for removal of various benign pigmented skin lesions and, in this rare case, it has proved its effectiveness.


Surgical pearls

A new method for obtaining autologous dermal graft for tissue filler techniques

Novo método para obtenção de derme autóloga para material de preenchimento

Sergio Schrader Serpa

Abstract: Several types of synthetic filler materials has been made available in recent years. However, autologous substances can still be considered more advantageous and secure. The author developed a collector that makes it easy to quickly obtain an autologous dermis already de-epithelized and he also describes the surgical instrument and details of its use.

How do i do?

Healing by secondary intention of the nasal ala: reviewing old concepts

Cicatrização por segunda intenção de asa nasal: revisando antigos conceitos

Ivander Bastazini Júnior, Letícia Arsie Contin, Cinthia Janine Meira Alves, Consuelo Maria Santos Albuquerque Nascimento

Abstract: Surgical repair of large defects in nasal ala is often needed. There are several reconstruction techniques, which in general are complex, require greater technical knowledge, and not always reach the desired esthetic result. The authors discuss the indications and practicality, in addition to good cosmetic results of healing by secondary intention of large defects in nasal ala.


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