Deep phenol chemical peeling with the Baker-Gordon formula is indicated for the treatment of severe facial aging. A review of pertinent literature on its main limiting factor-pain-was carried out with searches on two databases (PubMed and Cochrane Library) using the following keywords: chemexfoliation, peel, peeling, and phenol, also cross-referencing with the terms anesthesia and analgesia. The search resulted in 151 articles that contributed little to clarifying what would be the ideal approach for managing pain when using a deep chemical peel with the Baker-Gordon formula. As a result, for this procedure, the authors basically relied on the expert experience-in this case, that of the anesthesiologist-which has been described. Therefore, further studies should be carried out in order to achieve a higher level of scientific evidence.

Keywords: CHEMEXFOLIATION; PHENOL; ANESTHESIA; ANALGESIA.

Introduction: The paramedian forehead flap has been used for centuries in nasal reconstruction. It is a unique flap in terms of restoring complex nasal defects. It can adequately restore contour, texture, projection of the nasal tip and convexity of the ala, especially when combined with cartilage grafting. Objectives: To evaluate the versatility of the paramedian forehead flap in nasal reconstruction following Mohs micrographic surgery, especially in an outpatient setting and under local anesthesia. Furthermore, to discuss traditional approaches versus more recent refinements on its design and execution. Methods: Retrospective study of patients with surgical defects resulting from Mohs micrographic surgery that have been repaired using the paramedian forehead flap. Results: Nineteen patients were included in the study. Restoration or the nasal mucosa was required for full thickness defects in 4 (22%) patients. Structural support provided by auricular cartilage graft was required in 12 (67%) patients. The flap pedicle was designed ipsilaterally to the defect in 14 (74%) patients. Complications were minimal and unusual. Conclusions: The paramedian forehead flap is a valuable technique in the repair of extensive and deep nasal defects following Mohs micrographic surgery. With proper surgical planning, adequate measures for patient comfort, and meticulous technique, the paramedian forehead flap can be safely performed in an outpatient setting, achieving unique results in nasal reconstruction.

Keywords: MOHS SURGERY; SURGICAL FLAPS; NOSE NEOPLASMS.

Introduction: Scars caused by burns have the potential to cause clinical, social, and functional disruptions. Dermatologists should be able to intervene in this process by combining technological advances with traditional techniques. Objective: To evaluate the effect of Intense Pulsed Light applications on scars after burns, based on clinical parameters described in the international Vancouver Scar Scale. Methods: A prospective study was carried out with six patients who underwent five monthly Intense Pulsed Light sessions over the entire area of a wound. The analysis of the results was conducted by three evaluation groups: 3 physician researchers, the patients included in the study, and 3 physician observers. The evaluation was implemented using the Vancouver Scale, a questionnaire based on this scale, and additionally a general rating used by all evaluators based on a numerical scale. The data obtained by examining the differences before and after the treatment, was analyzed through the Wilcoxon signed-rank test. Results: A statistically significant decrease was observed in the analyses of all clinical parameters of the scars, when evaluated before and after the completion of the treatment. Conclusions: The present pilot study demonstrates the advantages of Intense Pulsed Light as an approach to this specific type of scar, with an aim of stimulating further studies in order to improve this low-cost technology, as compared to lasers.

Keywords: LASERS; INTENSE PULSED LIGHT THERAPY; CICATRIX; BURNS.

Introduction: The skin is the largest organ of the human body and constitutes a covering layer that has many essential functions such as defense, sensorial, thermoregulatory, and aesthetic. Therefore, maintaining its integrity is extremely important for the homeostasis of the organism. Objective: To evaluate the efficacy and safety of a cutaneous moisturizer that, in addition to traditional substances, contains in its composition other ingredients capable of stimulating the function of the aquaporins. Methods: One hundred volunteers were clinically evaluated through medical examination and subjective self-evaluation, regarding the efficacy and safety of the product. Of these, 30 also underwent instrumental analysis through corneometry (assessment of the skin's hydration), pH metry (measurement of the skin's pH) and TEWLmetry (assessment of TransEpidermal Water Loss). Results: During a 90-day study, all efficacy variables subjectively analyzed showed clinical improvement (dryness, hydration, softness, desquamation, and itching). In the analysis of objective variables, it was observed that the corneometry measurements showed a significant increase in skin hydration. Conclusion: With the present study's clinical outcomes, the test product was proven effective for having significantly increased skin hydration (according to corneometry) and extremely efficient for its action on the signs and symptoms of skin xerosis (according to theassessment of the physiciansand volunteers).

Keywords: HYDRATION, DESICCATION, AQUAPORINS.

Introduction: Several therapeutic modalities, such as surgeries, cutaneous filling, and ablative techniques are used for perioral rejuvenation. Objective: The present study was aimed at evaluating the efficacy and side effects of an ablative method, using fractional carbon dioxide (CO₂) laser in the treatment of perioral wrinkles. Methods: A retrospective study was carried out with 20 female patients who underwent a single session of fractional CO₂ laser, with high energy and density, for the treatment of perioral wrinkles. Photographs taken before and 90-days after the procedure were evaluated by two examiners unrelated to the study, who looked at the effect of the laser on the deep static wrinkles, fine lines, skin texture, and color. The patients were also classified, pre-and post-treatment, according to the classification of Baker for perioral wrinkles. Results: Three months after the treatment, it was possible to observe clinical improvement in 100% of the patients, in all the variables evaluated. In the classification of Baker, five patients classified as Grade II, and three who classified as grade III became Grade I and Grade II, respectively. Patients initially classified as Grade I did not have alterations in their classification for presenting few superficial wrinkles. Observed side effects were: transient erythema and edema in the early post-procedure period. Conclusion: Fractional CO₂ laser has proven to be a safe and effective option for the treatment of perioral wrinkles.

Keywords: SKIN AGING; LASER THERAPY; CARBON DIOXIDE.

Eccrine poroma is a benign tumor that occurs in eccrine or apocrine sweat glands. It is a solitary lesion, usually the same color as the skin and located on the palms and soles. The authors report a clinical case of pigmented eccrine poroma, in light of its rare and atypical clinical presentation of the tumor, which in this case simulates a malignant melanoma.

Keywords: POROMA; SWEAT GLAND NEOPLASMS; MELANOMA.

Introduction: First-degree burns can cause intense pain and, in the medium- and long-term, sequelae. In a previous study, the authors found that an emulsion of andiroba oil and desonide-a low potency corticosteroid-were equivalent for relieving pain and improving erythema caused by intense pulsed light-based epilation. The andiroba oil emulsion is used for treating radiation dermatitis in patients with breast cancer,through local application, before and after radiotherapy. Objective: To confirm the previous study's results and evaluate whether a pre-procedure program of preparation and prevention provides any benefit. Methods: A prospective, comparative, double-blind study was carried out with 33 patients, who blindly used andiroba oil emulsion and a humectant in the axillae (each product was applied on one side) before the epilation procedure. Epilation was performed using intense pulsed light, with parameters according to the skin phototype of the patients. After the procedure, the andiroba oil emulsion was applied on the side that had been prepared with the emulsion itself, while the desonide was applied on the contralateral axilla. Patients assessed pain intensity according to a visual analogue scale, and a dermatologist assessed the erythema using a modified scale, at several experimental time points. Results: Pain and erythema were less intense in the side prepared with the andiroba oil emulsion. The efficacy of both treatments proved to be equivalent. Conclusions: Thee fficacy and safety of the andiroba oil-based emulsion, as well as its protective effect on the skin in the pre-treatment preparation program, were confirmed in clinical use.

Keywords: BURNS; HAIR REMOVAL; GLUCOCORTICOIDS; WETTING AGENTS.

Onychomatricomas are rare benign tumors originating from the nail matrix and underlying stroma. They are usually asymptomatic and slow growing, affecting both middle-aged men and women, and more frequently involve the digits of the hands. Key clinical features for diagnosis are: yellowish longitudinal band of variable width, splinter hemorrhages, longitudinal grooves associated with the transverse overcurvature and fingerlike projections emerging from the nail matrix. The authors report three cases of this tumor affecting toes, emphasizing main clinical aspects, dermoscopic findings, and surgical treatment.

Keywords: NAILS; NAILS, MALFORMED; NEOPLASMS.

Introduction: The skin is a marker of chronological age and appearance, being important for self-esteem and quality of life. Fractional ablative radiofrequency is one of the treatments aimed at delaying the effects of aging. Objective: To describe the operating principles, methodology, and results of rejuvenation of the lower eyelids when treated with fractional ablative radiofrequency, and the resulting thermal damage observed on histology. Methods: Twenty female patients with aging skin on the lower eyelids were selected for treatment with this method. In one of the patients, who concurrently underwent upper blepharoplasty, ablative fractional radiofrequency was carried out on the skin fragment to be removed from the upper eyelid for anatomical-pathological examination and measurement of thermal damage. The evaluation of clinical results was performed using photographic comparison and analysis of satisfaction questionnaires answered by patients. Results: Photographic comparison showed significant skin retraction effects on the skin of the lower eyelids, while the analysis of questionnaires revealed a significant degree of patient satisfaction. Ten percent of patients experienced reversible local hyperpigmentation as a complication. Ablative and non-ablative damage was observed up to the superficial reticular dermis, with negligible thermal effects on the sides. Conclusion: Fractional ablative radiofrequency was proven safe, effective, and cost-effective in skin rejuvenation, nevertheless further studies should be conducted with the aim of determining the optimal parameters, as well as the ideal number of sessions needed to achieve the best result with the lowest percentage of side effects.

Keywords: PULSED RADIOFREQUENCY TREATMENT; REJUVENATION; SKIN AGING; ABLATION TECHNIQUES; LASER COAGULATION; LASERS.

Lipoid proteinosis is a rare, recessive autosomal multisystem genodermatosis characterized by progressive deposition and accumulation of an amorphous hyaline material in the skin and mucous membranes. The present study reports a 25-year follow-up of a patient with the disease and the combination of medical and surgical treatments used-such as protection against sun rays, oral vitamin E, 0.01% retinoic acid, 20% azelaic acid, excision of verrucous lesions, manual dermabrasion with sandpaper, and chemical peels with Jessner's solution and 35% trichloroacetic acid.

Keywords: LIPOID PROTEINOSIS OF URBACH AND WIETHE; AMBULATORY SURGICAL PROCEDURES; SURGICAL PROCEDURES, MINOR; CLINICAL EVOLUTION.

Introduction: Onychomycosis is a fungal nail infection, corresponding to about 50% of onychopathies. The most frequently used tests for diagnosis are direct microscopy and fungal culture. The collection of samples is the most critical stage in the diagnosis of onychomycosis. Due to lack of knowledge or technical difficulty, samples are collected from the most distal part of the nail, where the fungal viability is low. Objective: To evaluate the use of nail abrasion as an auxiliary method to collect material for the diagnosis of onychomycosis, comparing it with results obtained using the traditional collection method. Methods: Thirty patients with clinical suspicion of onychomycosis in the feet had samples of their finger nails collected for examination using two different methods. The collection was initially made with the traditional method (distal part of the nail). Subsequently, nail abrasion was performed in the most proximal portion of the lesion, with the collection of scales from the abraded area. Both samples underwent mycological examination and culture. Results: The samples collected following nail abrasion showed a higher percentage of positive results than those collected from the distal portion, with positivity rates of 76.7% and 36.7%, respectively (p = 0.0018). Conclusions: Nail abrasion is an effective auxiliary method in the diagnosis of onychomycosis, having been proved superior to the traditional collection technique.

Keywords: NAILS; ONYCHOMYCOSIS; ONYCHOMYCOSIS/DIAGNOSIS; DIAGNOSIS.

A great number of agents have been implicated as the cause of skin reactions to tattoos-especially red pigment. Dermatologic reactions are very diverse. The present study is aimed at reviewing the literature and illustrating the treatment performed at the authors' medical facility. Despite treatment with topical or intralesional steroids, most dermatologic reactions persist for a long time. Resistant reactions can be treated through excision, sometimes causing significant scarring. Despite the popularity of tattoos, adverse inflammatory reactions are common and can present a sizeable clinical challenge.

Keywords: PRIMARY TREATMENT; SURGERY, PLASTIC; TATTOOING.

Structural alterations resulting from the aging process of the face are related to muscular action, skin sagging, loss of bone support, and decrease in the volume of facial fat compartments-all inducing alterations in facial contour over the years. The authors have carried out a review of the main causes linked to the so-called facial contour alteration in aging and defined a new denomination for this process: "facial squaring", the process through which the shape of the face-which is that of an inverted trapezoid in youth-becomes that of a square over time.

Keywords: REJUVENATION; SKIN; FACIAL MUSCLES.

The observation of mucous membranes should be part of a dermatological examination. It is known that early diagnosis is critical for the prognosis of patients with malignant melanocytic lesions. Nevertheless, integrating this step into the examination routine and performing a differential diagnosis between benign and malignant mucosal lesions with only clinical signs, are great challenges. Dermoscopy is still seldom-used for pigmented lesions of mucous membranes, however recent studies have shown its potential. In light of a case of melanoma of the lip, the authors provide tips and data from the literature that highlight the usefulness of the technique, and support the use of dermoscopic examination in the dermatologist's routine.

Keywords: DERMOSCOPY; HUTCHINSON'S MELANOTIC FRECKLE; KERATOSIS, ACTINIC; FACE.

Oriented biopsies are fragments of tissue (usually fusiform) that are positioned relative to the tumor in a way to favor the observation of its histology in a panoramic and topographical manner. Commonly performed on the edge of a tumor, an oriented biopsy allows for better surgical planning, eventually helping to decrease the number of stages of micrographic surgery. The present article details the procedure's technical execution not only from a surgical, but also from a laboratorial perspective.

Keywords: BIOPSY; AMBULATORY SURGICAL PROCEDURES; MOHS SURGERY; PATHOLOGY, SURGICAL; SKIN NEOPLASMS.