Introduction: The surgery of keloids as an individual therapy with high rates of recurrence needs adjuvant therapies as complement. Recent keloids are rich in fibroblasts, which are highly radiosensitive and what explains the good results of percutaneous radiotherapy after surgery. Objective: To compare the beta-therapy results with electron-beam technique in newly operated keloids. Material and Methods: a prospective, comparative and randomized study was outlined including patients in the immediate postoperative period of surgical excision of keloids. Divided in G1 and G2 groups respectively, they received treatment with Sr90 (beta-therapy)plates or with electrons from the linear accelerator. The monitoring lasted 10 years. The results were performed using the information from patients, photograph parameters, observation and measurement of injuries, according to the criteria: Unchanged, Regular, Good and Excellent. Results: There were 26 patients, 13 in each group. In G1, 54% presented regular and unchanged improvement criteria and 46% had good or excellent criteria. In G2, the results were respectively 23% and 77%. Conclusion: The irradiation with electron-beam is better than beta-teraphy for the treatment of keloids surgery, due to the distribution in the tissue. No radio-induced tumors were observed.

Keywords: KELOID, ELECTRONS, STRONTIUM

Introduction: The botulinum toxin is a valuable option for the treatment of dynamic facial wrinkles. The Lanzhou botulinum toxin type A (LBTX-A) was introduced in China in the early 90’s and approved in Brazil in 2003. Objective: Evaluate the efficacy and tolerability of LBTX-A for the cosmetic treatment of dynamic wrinkles of the upper face. Material and Methods: In a prospective, open-label, multicenter study, 110 subjects of both sexes (aged from 25 to 65 years) were treated with a total of 53 U of LBTX-A each, distributed in fi fteen sites in the frontal, corrugator, procerus, orbicular ocular lateral muscles. The patients were reviewed 7 times within 180 days. Efficacy was assessed by electromyography, photographic analysis and the investigator’s and patient’s opinions. Tolerability was assessed by the incidence of adverse events.Results: Two weeks post-injection, 94% of the treated patients considered the result as good or excellent. Results lasted 90 days in most cases. After injection, most patients reported mild or no pain, and minimal and reversible side effects as facial edema (6 patients), stuffiness feeling (3 patients) and eyelid ptosis (2 patients). Conclusions: We conclude that LBTX-A is effi cient and well tolerated for the treatment of dynamic facial lines.

Keywords: BOTULINUM TOXIN TYPE A, INJECTABLES, WRINKLES, FACIAL DYNAMIC LINES

Introdução: Gynoid lipodystrophy, popularly known as cellulite, is regarded as an issue of cosmetic concern to millions of women. Recent studies have shown that garlic extract can be useful to enhance lipolysis and decrease lipogenesis. Objective: The primary objective was to determine if topical application of a lotion containing garlic (15 ppm) would improve cellulite parameters. Material and Methods: 50 women were treated topically with a lotion containing 15 ppm of garlic. All patients treated one leg, did not treat the other one and were valuated (measurement of thigh diameter) before and in biweekly intervals up to 8 weeks after the onset of treatment. On eight of these subjects, microcirculatory parameters [red blood cell velocity in arterioles and venules (mm/s), functional capillary density (FCD), diameter of the dermal papilla (µm) and capillary diameter (µm)] were measured using the Cytoscan®. The exact thigh local for these measurements was marked in a transparent sheet, to assure that all of them were performed on the same place. Six women that performed the Cytoscan® exam group were also evaluated by ultrasound to determine the thickness of subcutaneous tissue. Results: after garlic treatment, there was a reduction of 1.62 cm on the diameter of the treated thigh (p < 0.001) without significant changes on papilla and capillary diameters, but FCD improved significantly (p < 0.03) and epidermis and dermis thickness decreased after topical garlic treatment. b>Conclusions: Garlic extract at a concentration of 0.0015% showed significant clinical, microcirculatory and ultrasonographic improvement of cellulite.

Keywords: GARLIC EXTRACT, CELLULITIS, MICROCIRCULATORY PARAMETERS

Introduction: The subungual glomus tumor is characterized by painful nodules triggered by thermal and tactile change. A complete lesion excision is the treatment of choice but relapses are frequent. Objective: To compare the rates of recurrence of conventional surgeries described in the literature with the ones we found after the Mohs micrographic surgery (MMS). Material and ethods: We included 10 patients diagnosed with subungual glomus tumor of which 9 were female and 1 male and who also underwent withdrawal of these lesions by the technique of Mohs micrographic surgery. Results: Of the 10 patients, eight were considered cured after following 14 to 93 months (around 47.8 months). There were two recurrences which occurred after 47 and 51 months, respectively. One case was reoperated by MMS without evidence of disease after 24 months. Conclusion: The results obtained with the use of MMS in subungual glomus tumors were similar to those reported in the literature with conventional techniques, usually with more limited follow-up.

Keywords: MICROGRAPHIC SURGERY, MOHS MICROGRAPHIC SURGERY, GLOMUS TUMOR

Introduction: Skin photoaging can be treated with ablative therapies that cause immunological changes to the skin. Objectives: To evaluate the results of chemabrasion in the treatment of perioral wrinkles and the change in number of Langerhans cells. Material and Methods: Application of 35% trichloroacetic acid followed by manual dermabrasion using waterproof sandpaper, in 12 female patients with perioral wrinkles and results were then examined 30 days and 1 year later. Immunohistochemistry was used to measure Langerhans’ cells which were counted before treatment and 1 month post-treatment. Results: Improved perioral photoaging and reduced number of Langerhans’ cells (p = 0.002) were seen in all patients. Conclusions: Chemabrasion provides effective results in the treatment of perioral wrinkles but Langerhans cells remain low for 30 days after therapy.

Keywords: SKIN AGING, CHEMABRASION, METHODS, DERMABRASION, TRICHLOROACETIC ACID, THERAPEUTIC USE, IMMUNOHISTOCHEMISTRY, LANGERHANS CELLS

Pulsed light devices have been simultaneously introduced to lasers in dermatology. Based on the emission of photons which have melanin, hemoglobin and water in the collagen as targets, their technology differs completely from lasers. The current devices contain many items of security, making the treatment effective and safe. New technologies were developed to combat the fl accidity: the radiofrequency based on the electrons emission and infrared light devices. The photodynamic therapy has also been more recently applied for rejuvenation with the aim of stimulating the collagen.

Keywords: PULSED LIGHT, INTENSE PULSED LIGHT, RADIO FREQUENCY, INFRARED, REJUVENATION

Introduction: Melasma is an acquired hypermelanosis of sun-exposed areas. The pathophysiology of melasma is uncertain. The most important factor in the development of melasma is exposure to sunlight, but it has also seems to be related to hormonal and vascular factors, genetic predisposition, and proteins related to tyrosinase. Due to its refractory and recurrent nature, the treatment of melasma is often diffi cult. The goals of treatment often include prevention or reduction of the affected area with the fewest possible adverse effects. The principles of therapy include protection against UV radiation, the inhibition of activity of the melanocytes and melanin synthesis. Objective: To perform a systematic review to identify the most effective and safe treatment, including topical treatments, oral treatments and surgical procedures for the melasma. Method: The study was conducted in the period from February 5th to March 15th 2009, using three databases: MEDLINE (1966-2009), Cochrane Library and LILACS. After establishing criteria for the selection of studies,the best controlled and comparative studies were described individually. Results: 703 articles in MEDLINE, 89 in LILACS and 100 in Cochrane Library have been detected, and from 143 articles 10 were descriptive studies (6,99%), 30 were reviews (20,97%), and 103 were randomized controlled trials (72,03%). Descriptive studies and reviews were analyzed together. Forty two articles with the best design were chosen for individual description. Twelve of 42 included controlled studies (28,57%) and 30/42 were comparative (71,43%), like split face 18 from 42 (42,86%) or parallel groups, 24 from 42 (57,14%), and 34 from 42 randomized (80,95%). Eight (19,05%) studies had the ideal design, i.e., blind placebo-controlled. Limitations: Heterogeneity of the studies, few with good methodological quality. Conclusions: The use of broad-spectrum sunscreen is important, as is topical hydroquinone, the most common treatment for melasma. Other skin-lightening agents include retinoic acid, azelaic acid, kojic acid and others. Combination therapies increase efficacy as compared with monotherapy. Chemical and physical peels, laser treatments, and intense pulsed light therapy are additional modalities that have been used to treat melasma.

Keywords: MELASMA, HYPERPIGMENTATION, CHLOASMA, TREATMENT

Introduction: Port wine stains (PWS) are vascular malformations present at birth, and, depending on their location, they can cause emotional changes in the patient. Studies on the treatment of PWS with intense pulsed light (IPL) and other types of lasers presented different responses. Objectives: The objective of this study was to review the literature on the treatment options of PWS with light sources, demonstrating the success of IPL associated with Nd:YAG laser. Method: A 14 years old female patient with PWS in the supralabial region was treated with the association of 1064- nm Nd:YAG laser and 560-nm IPL. She underwent eight treatment sessions with a mean interval of 30 days between each session. The study was conducted at the Célia Kalil Dermatology Clinic. Result: The port wine stains disappeared completely with a very low incidence of adverse events. Conclusion: The association of 560-nm IPL and 1064-nm Nd:YAG laser seemed an adequate treatment alternative for PWS.

Keywords: PORT WINE STAINS, LASERS, IPL, TREATMENT

The authors describe an easy to make and apply rule for local tumescent anesthetic solution in dermatologic surgical procedures. They attest the safety and simplicity of the rule, based on ambulatory surgery practice for over 20 years and 8 years usage of the solution in more than a thousand procedures.

Keywords: TUMESCENT LOCAL ANESTHESIA

We report the case of a patient presenting a 3 cm diameter ulcerated nodular basal cell carcinoma in the frontal left region, reaching the medial half of the eyebrow. The lesion was excised and the reconstruction was carried out with advancement fl aps in H and the left included the rest of the eyebrow, being larger than the contralateral. Thus, the harmony and symmetry of the superciliary and glabellar regions were remained. The scars were visible just by being positioned in wrinkles rows. The patient remains without injuries after two years of monitoring.

Keywords: CARCINOMA, BASAL CELL, CUTANEOUS ONCOLOGY, DERMATOLOGY SURGERY