Sociedade Brasileira de Dermatolodia Surgical & Cosmetic Dermatology


ISSN-e 1984-8773


Volume 2
Number 2


Dear Dermatologists

Caros amigos dermatologistas

Bogdana Victoria Kadunc


Continuing medical education

Topical Anesthetics

Anestésicos tópicos

Giselle Carvalho Froes, Fernanda de Assis Ottoni, Gabriel Gontijo

Questions and answers of previous number

Abstract: Introduction: The use of topical anesthetics, has increased in recent years.While they are undoubtedly useful when recommended appropriately by a dermatologist, the improper use of topical anesthetics may result in complications, mainly due to inadequately applying them to wounded or inflamed skin; use on large areas of the body or mucus membranes; or use by high-risk patients. Adverse reactions can include transient local effects, allergic and/or irritative reactions, or more severe (though rare) effects, such as methemoglobinemia, arrhythmias, and cardiorespiratory failure. This paper discusses the commercial formulations of topical anesthetics currently available, their history, pharmacology, clinical use, and potential side effects.


Original Article

Safety and efficacy evaluation of a new hyaluronic acid based filler in the treatment of nasolabial folds and lips outline

Avaliação da segurança e eficácia de novo preenchedor à base de ácido hialurônico no tratamento dos sulcos nasolabiais e contorno dos lábios

Sergio Talarico, Karime Marques Hassun, Érica de Oliveira Monteiro, Meire Odete Brasil Parada, Laura Bariquelo Buratini, Lúcia Arruda, Ediléia Bagatin

Abstract: Introduction: The use of dermal filling techniques for soft tissue augmentation has greatly increased in recent years.Hyaluronic acid is one of the most used temporary dermal fillers in the treatment of facial wrinkles, furrows, and folds due to its effectiveness and safety. Objective: To evaluate the efficacy and safety of Perfectha®, a new hyaluronic acid filler, for nasolabial folds and lip correction. Methods: Open, multicenter study comprising 87 women. Efficacy was evaluated by the Global Aesthetic Improvement Scale and the Wrinkle Severity Rating Scale. Safety was evaluated through observation and the reporting of side effects. Results: One week after the injection of the filler, improvement in nasolabial folds and lips was observed in 86% and 89% of the women,respectively. Mild or moderate transient inflammatory reaction and ecchymoses occurred in 15% and 9% of patients, respectively, mainly in nasolabial folds. Two patients presented labial herpes simplex after treatment of the lips.The good results were maintained in 76% and 57% of women for nasolabial folds and in 72% and 45% of women for lips after 3 and 6 months, respectively. Conclusion: Perfectha® was effective and safe for these indications.


Comparative study between blepharopeeling and fractional CO2 laser in the treatment of periorbital rejuvenation

Estudo comparativo entre blefaropeeling e laser fracionado de CO2 no tratamento do rejuvenescimento periorbital

Fernanda Ayres de Morais e Silva, Denise Steiner, Tatiana Aline Steiner, André César Antiori Freire Pessanha, Thiago Vinícius Ribeiro Cunha, Elisangela dos Santos Boeno

Abstract: Introduction: Complaints about wrinkles and flaccidity in the periocular region are frequent. Blepharopeeling, associated with the Baker-Gordon formula, and the application of ablative fractional CO2 lasers are considered effective options in the treatment of the periocular region. Objective: To compare the techniques, recovery process and results of blepharopeeling and fractional CO2 lasers in the periorbital region. Methods: Comparative split-face study of patients with dermatochalasis and moderate rhytids. Blepharopeeling was applied on the right side of the face, and the fractional CO2 laser was used on the left side of the face. Results were assessed through photographic analysis, measurements of the superior palpebral fold and clinical improvement. Results: Patients (n=11) demonstrated clinical and photographic improvement using both methods. The recovery time was longer for the phenol peeling. No significant differences were observed in the measurements of the superior palpebral fold. Conclusion: While both therapeutic modalities were found to be effective in the treatment of periorbital aging, blepharopeeling produced greater clinical improvement of palpebral flaccidity.


Rejuvenation with photodynamic therapy: clinical improvement, collagen and elastic fiber analysis

Rejuvenescimento com terapia fotodinâmica: melhora clínica e análise do colágeno e das fibras elásticas

Ana Carolina Ferolla, Bertha M.Tamura, Luis Carlos Cucé

Abstract: Introduction: Photodynamic therapy is a promising treatment for moderate photoaging. Objective: To evaluate the clinical and histological changes in elastin and collagen fibers following photodynamic therapy with 5-aminolevulinic acid. Methods: Female patients received three sessions of photodynamic therapy with 5-aminolevulinic acid, irradiated by a red-light (630 nm) light-emitting diode every 2 weeks.We evaluated the clinical improvement of photoaging, and also the increase in collagen and elastic dermal tissue by histomorphometry, using Picrosirius and Weigert-oxone staining, before treatment, 24 h after the first session, and 21 days after the third session.The results were evaluated using a semiquantitative method according to the following scores: 0 = absence of reaction, 0.5 = very weak reaction, 1.0 = minor reaction, 2.0 = moderate reaction, 3.0 = intense reaction. Results: Thirteen patients participated in the study.When assessed 21 days after the last treatment, 12 patients showed improvement in photoaging, especially regarding skin color and texture, clearing of solar melanosis, regression of actinic keratosis, and improvement of flaccidity. In the histomorphometric evaluation, an increase in collagen and elastic fiber tissue was observed.These outcomes have been statistically proven. Conclusions: Photodynamic therapy with 5-aminolevulinic acid, associated with red light, was clinically and histopathologically proven to be an effective treatment for clinical photoaging.


Double-blind comparative study of hydroquinone and ursine grape extract in the treatment of melasma

Estudo duplo cego comparativo entre hidroquinona e extrato de uva-ursina no tratamento do melasma

Andréia Mateus Moreira, Bruna Souza Felix Bravo, Adriana Gutstein da Fonseca Amorim, Ronir Raggio Luiz, Maria Cláudia Almeida Issa

Abstract: Introduction: Melasma is an acquired and progressive hyperpigmentation of photoexposed areas. For being a recurrent and refractory dermatosis, its treatment continues to be a challenge.Objective: To evaluate the efficacy and security of the Skin Whitening Complex in the treatment of the facial melasma,and to compare it to the hydroquinone. Materials and methods: Double-blind Comparative study of 13 women bearers of melasma. All received two different formulations, labelled as “right side of the face" and left "side of the face". The formulations were applied twice a day for 90 consecutive days. Only the pharmacist responsible for the formulations had knowledge of their content. The tests of Wilcoxon and 2 of McNemar-Bowker were employed in the statistical analysis. Results: Ten of the 13 patients presented the global clinical improvement of the melasma. Four patients presented total improvement and six (p = 0004) presented partial improvement in the hemiface treated with hydroquinone 4%. In the hemiface treated with Skin Whitening Complex 5%, the improvement was total in two patients, and partial in six (p = 0007).There were no statistically significant differences between the two treatments (p = 0223). Conclusions: Although the treatment with hydroquinone 4% presents better clinical results, there were no statistically significant differences between the two treatments. Skin Whitening Complex 5% has shown efficient and safe in the treatment of the melasma.


Clinical-surgical dermatology: assessment of the changes in types of procedures performed in a dermatologic residency in the Brazilian State of Paraná

Dermatologia clínico-cirúrgica: avaliação da mudança no perfil dos procedimentos de um serviço de residência médica no Paraná-BR

Rosinete Lauren de Souza Lima Morais, Carolina Guislandi, Jesus Rodriguez Santamaria, Sergio Zuneda Serafini, Fabiane Mulinari-Brenner

Abstract: Introduction: During the last four decades, dermatology has evolved from a purely clinic into a clinical-surgical specialty. In addition to diagnosing conditions and conducting clinical therapies, dermatologists began performing surgical treatments of cutaneous affections and neoplasias, corrections of scars, and cosmetic cutaneous procedures. Objective: To describe the change in types of procedures performed at the Dermatology Service of the Clinical Hospital of the Federal University of Paraná during the period studied. Material and methods: A systematic review of the Dermatology Service’s proprietary registers, and of additional data supplied by the hospital's Statistics and Planning System, was carried out for the period ranging from 2002 to 2007. Results: A relative increase of 16% in the number of surgical procedures has been verified in the study period, with an increase in the complexity of the procedures – with the ratio of excisions of benign lesions/ malignant tumors falling to 1.04:1 in 2007, from 2.25:1 in 2002. Among cosmetic procedures there has been a 74% increase in the application of chemical peels during this time. The use of fillers and botulinum toxin evolved from sporadic procedures in 2002 to frequent practice in 2007, with 3.33 and 3 procedures being conducted per month, respectively. Conclusions: The data, which were obtained objectively, demonstrate the transformation of the activities of the Dermatology Service of the Clinical Hospital of the Federal University of Paraná from mainly clinical to clinical-surgical procedures, with an increase in the complexity of the procedures performed to help train dermatology residents, in accordance with the development of the specialty throughout Brazil and the rest of the world.


Review articles

The effect of light in the treatment of acne vulgaris

A ação da luz no tratamento da acne vulgar

Francisco M. Paschoal, Ana Paula Palu Baltieri Ismael

Abstract: For several years, the treatment of acne vulgaris has been based on the use of oral or topical medication, isolated or in association with other medications. Such options still represent excellent therapeutic alternatives; however, there are cases in which they cannot be used either because of their side effects or the lack of response to treatment due to the growing bacterial resistance to antibiotics. Based on the observation that light has been successfully used to treat many pathologies – including acne – a number of therapeutic devices have been developed that demonstrate good results.The objective of this article is to present a review of the pathology of acne and of the photobiological principles used in its treatment, considering some of the main current phototherapeutic modalities.


Using a 308 nm excimer laser in the treatment of vitiligo

Excimer” laser 308nm no tratamento do vitiligo

Tânia Nely Rocha, Rafael Henrique Rocha

Abstract: Introduction: Vitiligo is an acquired idiopathic disorder characterized by hypochromic and achromic well-delimited macules.The 308 nm excimer laser can be used to treat this condition. Objective:To analyze studies published in indexed medical journals on the use of the 308 nm excimer laser in the treatment of vitiligo. Method: Adopting a qualitative approach, a survey of related articles from 2001 to 2009 was carried out using the Medline, Lilacs and Scielo databases. Results: According to the literature review, the 308 nm excimer laser achieved positive results in the treatment of vitiligo. Recent lesions and those located on the face responded better than those located elsewhere.The extremities of the body were more difficult to treat using this method.The patient’s age did not affect the outcome. On average, 11 sessions were necessary before the re-pigmentation started. Ideally, the laser application should be carried out from one to three times a week, with at least 48-hour intervals. Conclusion: The 308 nm excimer laser is effective and safe in the treatment of vitiligo when compared to other treatment modalities.The results depend on the location and the timeline of the disorder.


Case reports

Treatment of basocellular carcinoma with the association of photodynamic therapy and Mohs micrographic surgery

Tratamento de carcinoma basocelular com associação de terapia fotodinâmica e cirurgia micrográfica de Mohs

Rodrigo Negri Pereira, Erica Ligório Fialho, Gabriel Gontijo

Abstract: The treatment of extensive, recurrent and poorly delimited basocellular carcinomas, located in highrisk areas of the body in patients with several comorbidities, is a challenge for the dermatologic surgeon. Mohs micrographic surgery is usually employed in such cases, presenting the risks inherent to large surgeries, in addition to the difficulties of closing the operative wound – which very frequently extends beyond the clinical limits of the lesion. In this paper, we report the use of photodynamic therapy prior to Mohs micrographic surgery in a 90-year-old diabetic and hypertensive female patient, with the objective of reducing and better delimiting the lesion for the subsequent exeresis.


Surgical pearls

A new tourniquet for nail unit surgery

Um novo torniquete para cirurgia do aparelho ungueal

Nilton Di Chiacchio, Walter Refkalefsky Loureiro, Nilton Gioia Di Chiacchio, Daniela Satico Yoshida Nei

Abstract: Nail unit surgery requires that the surgical field be free of bleeding to allow good visibility of the structures and lesions involved.There are several types of tourniquets aimed at meeting this requirement, each with its advantages and disadvantages.We present a new and simple buckle tourniquet that is adjustable, safe, and cost-effective.


Alternative connector for anesthetic and calcium hydroxyapatite dilution in the cutaneous filling technique

Conector alternativo para diluição de anestésico e hidroxiapatita de cálcio para preenchimento cutâneo

Mariana Hammerschmidt, Mauricio Sato

Abstract: A number of anesthetic options are available for use in cutaneous fillings.The combination of calcium hydroxyapatite with lidocaine in the same syringe using the female Luer Lok connector has been recently described.An additional connector option to combine these substances, the device itself, and the details of the association are described.


How do i do?

Tumescent anesthesia as an aid for wide local excision in dermatologic surgery

Anestesia tumescente: técnica auxiliar para excisões extensas em cirurgia dermatológica

Jerry D. Brewer, Randall K. Roenigk

Abstract: Introduction: Local anesthesia is the most common form of anesthesia used in cutaneous surgery. Some patients have comorbidities that put them at risk for general anesthesia.Tumescent anesthesia is the technique of injecting a large amount of dilute local anesthesia into the subcutaneous plane of the skin.Tumescent anesthesia can minimize discomfort, aid in hemostasis, and contribute to the ease of closing large surgical defects that would otherwise be challenging. Objective: To discuss the pros and cons of using tumescent anesthesia in dermatologic surgery. Conclusion: Tumescent anesthesia is a viable option that can aid in cutaneous reconstructive surgery, especially when removing tissue in the deeper subcutaneous fat or fascia.Tumescent anesthesia is also associated with good results and few adverse reactions.


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