Sociedade Brasileira de Dermatolodia Surgical & Cosmetic Dermatology


ISSN-e 1984-8773


Volume 3
Number 1


Changes in S&CD

Modificações na Surgical

Dra. Bogdana Victoria Kadunc


Continuing medical education

Complications in laser dermatologic surgery Part I: Non-fractional non-ablative lasers

Complicações com o uso de lasers.Parte I: lasers não ablativos não fracionados

Ana Beatriz Palazzo Carpena El Ammar, Francine Batista Costa, Célia Luiza Petersen Vitello Kalil, Valeria B. Campos

Questions and answers of previous number

Abstract: Laser procedures are currently widely used in dermatology due to their low aggressiveness, excellent results, and fast recovery time with few complications.They are indicated in the treatment of photoaging, for removing or attenuating vascular alterations and pigmented lesions, and treating scars and excessive hairs.These lasers offer high levels of safety, however they can cause serious complications if used improperly.The objective of this study is to describe the side effects caused by different lasers and how to manage them, since there are few studies on this topic.This knowledge is crucial for improving patient care and preventing morbidity and sequelae. Side effects caused by non-fractional non-ablative lasers will be discussed in Part I of this paper. Fractional and non-fractional ablative lasers, as well as fractional non-ablative lasers, will be discussed in Part II.


Original Article

Nutritional approach to skin aging: correlation between the effects on fibroblasts and clinical results

Abordagem nutricional do envelhecimento cutâneo: correlação entre os efeitos em fibroblastos e os resultados clínicos

Flávia Alvim Sant’Anna Addor

Abstract: Introduction: Some foods can have therapeutic value in the treatment of photoaging. Objective: To clinically evaluate the efficacy of a nutritional supplement in the improvement of photoaging signs and correlate with an in vitro study. Methods: A nutritional supplement was evaluated clinically and in vitro, with a culture of fibroblasts. Patients with clinical signs of photoaging (n = 48) were studied while using a nutritional supplement, with clinical and instrumental (cutometry) evaluations at 56, 84 and 112 days. Results: There was progressive and significant improvement (p < 0.05) in the elasticity, firmness, fine lines and general appearance of the skin.The fibroblast cultures indicated a significant rate of collagen synthesis when compared to the control culture after 48 hours of incubation. Discussion: The oral use of some vitamins and natural compounds has a therapeutic effect on the signs of photoaging.This study has demonstrated that a combination of linseed oil, lycopene, carotenoids, vitamin E, zinc and selenium possibly improve the signs of aging not only through antioxidant and anti-inflammatory mechanisms, but also by increasing collagen production. Conclusions: Nutritional supplements are useful in the care of photoaged skin.


Double-blind randomized study of 5% and 10% retinoic acid peels in the treatment of melasma: clinical evaluation and impact on the quality of life

Estudo duplo-cego e randomizado do peeling de ácido retinoico a 5% e 10% no tratamento do melasma: avaliação clínica e impacto na qualidade de vida

Geraldo Magela Magalhães, Maria de Fátima Melo Borges, Aline Raissa de Carvalho Queiroz, Ana Andrade Capp, Sabrina Veloso Pedrosa, Michelle dos Santos Diniz

Abstract: Introduction: Melasma is a highly prevalent dermatosis that greatly affects patients' quality of life and is challenging to treat.The Melasma Area and Severity Index and the Melasma Quality of Life Scale are useful tools in the clinical and impact on quality of life evaluations, respectively. Objective: To compare the effects of 5% and 10% retinoic acid peels in patients with melasma, using the Melasma Area and Severity Index and the Melasma Quality of Life Scale to evaluate the clinical and quality of life impacts, respectively . Methods: Patients (n = 30) were randomized to receive either 5% or 10% retinoic acid peels in weeks 0, 2, 4 and 6 of the treatment. Clinical and quality of life evaluations took place in weeks 0 and 8. Results: In a global evaluation of the two groups, there was a statistically significant improvement in scores from baseline to week 8, yet there were no statistically significant differences between treatment groups. Conclusions: Retinoic acid peels are effective and safe, as an isolated therapy, in the treatment of melasma.There is no difference in treatment results between 5% and 10% concentrations.


Botulinum toxin in plantar hyperhidrosis assessed by a digital imaging system

Toxina botulínica em hiperidrose plantar avaliada através de sistema de imagens digitais

Bhertha M.Tamura, Tatiana Basso Biasi, Raquel Leão Souza, Luiz Carlos Cucé

Abstract: Introduction: Hyperhidrosis is a condition characterized by an excessive and uncontrolled production of sweat; the most current treatment is botulinum toxin. Objective: Botulinum toxin type A acts through a transient block of acetylcholine release in the cholinergic autonomic fibers to reduce sweating. Its use is increasing as patients learn about its efficacy. Methods: Patients (n = 7) were treated with botulinum toxin with a total dose of 100 U.We analyzed patient and physician assessments and digital photography images using Image-Pro, a digital imaging system®. Results: Patients presented an average clinical improvement of hyperhidrosis of 73%, which was photographically documented. Conclusions: There is no need to use higher doses of botulinum toxin to obtain good results.


Comparing the pain ratings of two topical lidocaine preparations

Estudo comparativo entre escores de dor após uso de duas preparações de lidocaína tópica

Ivander Bastazini Júnior, Ana Luiza Grizzo Peres Martins, Fernanda Simões Alves, Dejair Caitano do Nascimento

Abstract: Introdução: The increase in the demand for cosmetic procedures has in turn stimulated the search for effective and safe analgesia.Topical anesthetics are an alternative to infiltrative anesthesia, and promote an appropriate analgesia without inducing adverse effects. Objective: To compare the pain ratings of two topical lidocaine formulations in patients undergoing fractional CO2 laser therapy. Methods: Eight patients underwent a single fractional CO2 laser session after applying a commercial formulation of 4% lidocaine on the right side of the face and a dispensed 30% lidocaine formulation combined with 7% tetracaine on the left side of the face.The intensity of the pain was assessed using the visual analogue pain intensity scale at the end of the procedure. Results: No significant statistical differences were detected between the formulations. Conclusions: Formulations with high concentrations of anesthetics are not more effective than commercial products in producing analgesia.


Cutaneous triangular excision with primary closure

Excisão triangular cutânea com fechamento primário

Ézio Augusto Amaral Filho, Adma Silva de Lima Wojcik, Fabiane Andrade Mulinari Brenner, Jesus Rodriguez Santamaria, Betina Werner

Abstract: Introdução: Skin tumors are common and may present irregular growth, requiring resections with diverse geometric shapes. Many descriptions have been reported. Objective: To describe a triangle-shaped excision technique followed by primary closure in the treatment of skin cancer. Methods: Patients (n = 11) with tumors of between 1.8 and 5.7 cm located in areas that favored the use of equilateral triangle-shaped incision and primary closure were studied. Results: All patients had their surgical closure in the shape of a “Y.”Two cases of partial dehiscence of the suture were observed in the post-operative period. Conclusions: The surgical technique of primary closure of triangular excisions of skin allows effective control of the surgical margins and leads to good cosmetic results, preserving the surrounding tissue.


Melasma and non-ablative (1540 nm) laser: a prospective study

Melasma e laser fracionado não ablativo (1540nm): um estudo prospectivo

Denise Steiner, Carla Arantes Bertolucci Buzzoni, Fernanda Ayres de Morais e Silva, André César Antiori Freire Pessanha, Elisangela dos Santos Boeno, Thiago Vinicius Ribeiro Cunha

Abstract: Introduction: In 2006 the US Food and Drug Administration approved the use of fractional photothermolysis for the treatment of melasma. Objectives:To evaluate the treatment of melasma patients with fractional photothermolysis. Methods: Patients with a clinical diagnosis of melasma (n = 20) received three non-ablative laser sessions at 4-week intervals.The parameters used were: pulse = 15 ms, and progressively increasing energies in each session (8, 10 and 12 J). Results were evaluated using the Melasma Area and Severity Index and colorimetry analysis (with indices ITA, L, a, b) at baseline and 4 weeks after the last session. Results: Female patients (n = 18), with ages between 23 and 48 and Fitzpatrick phototypes from II to IV, completed the study. One patient did not complete both Melasma Area and Severity Index evaluations.There was a statistically significant decrease in the Severity Index (p <0.0001, CI = 95%) and an average increase in the colorimetry indices L (p = 0.0003, CI = 95%) and ITA (p = 0.0017, CI = 95%), meaning a decrease in the pigmentation. Conclusions: Fractional photothermolysis is a safe and effective option in the treatment of melasma, and should be considered an alternative to conventional methods.


Use of silicone spray in cutaneous repair in dermal ablation procedures: study of 20 cases

Efeito do uso de silicone em spray na reparação cutânea em procedimentos envolvendo ablação epidérmica: estudo de 20 casos

Flávia Alvim Sant'Anna Addor

Abstract: Introdução:There is no standardized approach to immediate post-procedure care for epidermal ablation; the conscientious choice of products can provide greater comfort to the patient, reduced risks and complications, and shorter recovery times. Objective: To analyze the safety and effectiveness of silicone spray in tissular restoration after two epidermal ablation procedures – fractional ablative 2,790 nm YSGG laser and dermabrasion. Methods: Patients with photoaging or acne scars (n = 20) applied silicone spray on one side of the face and liquid Vaseline (control) on the other side of the face after the procedures.Transepidermal loss of water was measured in all patients. Results: Erythema and burning sensation were the most common findings, and were significantly more frequent in the areas where Vaseline was applied. Conclusions: Silicone spray is safe and effective for use after epidermal ablative procedures, and is significantly superior to Vaseline in controlling burning sensations and erythema


Review articles

Adipose tissue derived stem cells: isolation, in vitro culture and potential uses in dermatology

Células-tronco derivadas de tecido adiposo: isolamento, cultivo in vitro e perspectivas de utilização em dermatologia

Vania M. F.Yokomizo, Tania M. H. Benemond, Fabiana F. Bressan, Juliano R. Sangalli, Naira C. G. Pieiri, Juliana B. Casals, Daniele S.Martins, Flávio V.Meirelles

Abstract: There are extensive reports on the characteristics and therapeutic potential of adult mesenchymal stem cells. The possibility of isolating them from excess adipose tissue obtained from other procedures is promising and extremely desirable. However, the protocols for such applications are still described in a summarized, rather than standardized, manner.Thus, the objective of this paper is to present a simple, practical and effective protocol for the collection of adipose tissue in the hospital environment, and for the isolation and in vitro cultivation of adult mesenchymal stem cells obtained from adipose tissue in a laboratory, with the purpose of discussing the potential uses of this technique in the field of dermatology.


Diagnostic Imaging

Preoperative analysis of cutaneous tumors

Análise Pré-operatória de tumores cutâneos

Carlos Barcaui

Abstract: Dermatoscopy can be used in the pre-operative analysis of melanocytic and non-melanocytic tumors.The effectiveness of this technique can be demonstrated in the selection of the best site for carrying out excisional biopsies, in the delimitation of tumoral margins, in the pre-operative estimation of tumoral thickness of melanomas, and in the screening of recurrences.


New Techniques

Technical variations in Mohs Micrographic Surgery

Variações técnicas em Cirurgia Micrográfica

Guilherme Augusto Gadens, Paulo Rodrigo Pacola, Leonard H.Goldberg

Abstract: Introduction: Mohs Micrographic Surgery is a well-known and established method in the United States, and is currently considered the gold standard treatment in many cases involving cutaneous neoplasias. Since it was first described by Dr. Frederic E. Mohs, the micrographic surgery technique has been continuously changed and adapted to better suit the daily life needs of dermatologic surgeons. This article examines different and innovative Mohs Micrographic Surgery techniques.


Ring technique for the correction of unaesthetic periauricular scars

Técnica do anel para correção de cicatrizes inestéticas periauriculares

Marina Emiko Yagima Odo, Lilian Mayumi Odo, Luiz Carlos Cucé

Abstract: Unattractive periauricular widened or hypertrophic scars can result from the tension on rhytidoplasty incision sutures. During a 5-year retrospective study, 10 female patients with such scars were treated with the periauricular ring technique. Polytetrafluoroethylene and double 2-0 mono nylon threads were used in 6 and 4 cases, respectively, introduced with a fascia lata non-bevelled needle . Following the scar exeresis, the borders were approximated and the ring tied and attached to the temporal muscle fascia.The outcomes were satisfactory. In 2 cases the threads were removed without altering the scars’ final aesthetic result.


The use of microcannulas in facial volume restoration treatment with Poly-L-Lactic acid

Uso de microcânulas em tratamentos de restauração do volume facial com ácido poli-L-lático

Rachel Calcagnotto Garcia, Adriano Calcagnotto Garcia

Abstract: The use of Poly-L-Lactic acid has enabled improvements in filling and volume restoration procedures. Since large areas of the body may be treated with injectable products, patients worry about pain and bruising after such procedures. In addition, the traditional technique that uses short needles makes it difficult to reach deeper areas.An innovative application technique is described, using a 40 X 0.8 mm microcannula (long tube, blunt tip), with retrograde injection in some areas of the face. The new approach has presented satisfactory results, with a reduction in adverse effects and good patient satisfaction.


Case reports

Keloid treatment: comparative intralesional injections of 5-fluorouracil, corticosteroid and 5-fluorouracil combined with corticosteroid

Tratamento de queloide: comparação entre infiltrações intralesionais com 5-fluorouracil, corticosteroide e 5-fluorouracil associado a corticosteroide

Carolina Okada Zerbini Guimarães, Meire Brasil Parada, Ediléia Bagatin

Abstract: Keloids are an excessive proliferation of dermal fibroblasts following a skin injury, which are difficult to treat. Isolated measures present a low rate of efficacy, while combined techniques lead to better results.A case of keloidal scar in the pubic region after a myomectomy surgical incision is described. The scar was divided into three parts, each of which was treated with intralesional injections of 5- fluorouracil, corticosteroid and 5-fluorouracil combined with corticosteroid.


Primary angiosarcoma of the scalp and lepromatous leprosy: an uncommon combination in an elderly patient

Angiossarcoma primário em couro cabeludo e hanseníase virchowiana: associação incomum em paciente idosa

Natália Braga Hortêncio Juca, Weline Lucena Landin Miranda, Igor Santos Costa, Luciana Maria Pereira de Oliveira, Heitor de Sá Gonçalves

Abstract: Introduction: Primary cutaneous sarcomas are rare mesenchymal cancers with histopathological heterogeneity. Angiosarcomas are an uncommon cutaneous malignant sarcoma sub-type that effect mainly elderly male patients.Their location is primarily cephalic, and they present as multifocal lesions which lead to local edema, bleeding and ulceration. Aggressiveness, fast growth and undefined surgical margins explain the high rates of recurrence.We describe a case of primary angiosarcoma of the scalp in an elderly female patient, who was being treated with a multidrug therapy for lepromatous leprosy.The combination of angiosarcoma and leprosy is uncommon, and the absence of similar reports in the literature motivated the description of this case.



High incidence of Xeroderma Pigmentosum in a countryside community in the state of Goiás, Brazil

Alta incidência de Xeroderma Pigmentosum em comunidade no interior de Goiás

Sulamita Costa Wirth Chaibub

Abstract: We describe a settlement in the Araras District in central Brazil that presents a high incidence of Xeroderma Pigmentosum.Twenty patients have had clinical diagnoses compatible with this condition so far. Reports from surviving relatives suggest an additional 20 deaths linked to typical Xeroderma Pigmentosum symptoms.This is possibly the first report of its kind in the literature, due to the extension of the family factor prevalence, the patients’ age range and different characteristics of the clinical manifestations.


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