Dermatologists have recently been incorporating diagnostic imaging techniques in the investigation of cutaneous lesions. The development of ultrasound devices with a frequency greater than 15MHz has led to the creation of the high-frequency ultrasound (HFUS), which enables the identification of the skin's different layers and structures as well as appendages. This has expanded its use considerably in various dermatological conditions, particularly in cutaneous neoplasms. Its association with color Doppler allows the study of tumor microcirculation. In the present paper, the authors discuss the main clinical characteristics of malignant cutaneous neoplasms and how high-frequency ultrasound allows a better pre-operative evaluation of those lesions.

Keywords: ULTRASONOGRAPHY; SKIN NEOPLASMS; DIAGNOSIS.

Introduction: The nasolabial interpolation flap is an essential flap in nasal reconstruction. Its main indications are deep and extensive defects of the nasal ala. Objectives: To evaluate the usefulness of the nasolabial fold interpolation flap for alar reconstruction after Mohs micrographic surgery-especially in an outpatient setting and under local anesthesia-as well as to discuss refinements in its design and execution. Methods: Retrospective study of patients with nasal ala defects resulting from Mohs micrographic surgery repaired with nasolabial interpolation flap. Results: Eighteen patients were included in the study; 7 (39%) had localized defects in the ala only and were reconstructed with an isolated nasolabial interpolation flap; however 11 (61%) had defects involving both the ala and some adjacent anatomical subunit. These patients underwent a combined reconstruction. Resection of the remaining portion of a subunit was performed in 14 (78%) cases. There were no complications or recurrence after an average follow up of 29 months. Excellent functional and aesthetic results were achieved in all patients. Conclusions: The nasolabial interpolation flap is essential in the reconstruction of alar defects after Mohs micrographic surgery. If adjacent subunits are involved-such as the medial cheek or nasal sidewall-the nasolabial interpolation flap must be combined with another method of repair. The flap can be safely performed in an outpatient setting.

Keywords: MOHS SURGERY; SURGICAL FLAPS; NOSE NEOPLASMS.

Introduction: Pincer nails are characterized by an over-curvature of the nail in the transverse axis, causing the pinching of the nail bed at its distal portion. It most commonly affects the toes, occurring rarely in the fingers. Objective: To demonstrate the Fanti's technique for the treatment of pincer nails. Methods: Eleven patients from the Hair and Nails Ambulatory, bearing pincer nails, underwent surgery for the correction of the condition with the Fanti's technique. Results: All patients had complete clinical improvement during the 14-month follow-up period. Conclusions: The present study demonstrates the Fanti's surgical technique for the correction of pincer nails, where anatomical and functional improvement of the operated nails could be observed.

Keywords: NAIL DISEASES; NAILS; NAIL BITING.

Introduction: Studies have shown that oestradiol and progesterone influence wound healing, angiogenesis, and remodeling. Objectives: To evaluate the topical effects of oestradiol and progesterone-isolated and associated-on healing wounds of menopausal rats. Methods: Forty Wistar rats were randomly divided into 4 groups with the same number of animals: Group C) control group, using only the vehicle; Group E) oestradiol 0.5mg; Group P) 15mg progesterone; Group E+P) 0.5mg oestradiol and 15mg progesterone. Initially the rats underwent bilateral oophorectomy. On the 30th post-operative day, a circular wound 1cm in diameter was inflicted, and the topical applications carried out for 7 days. Biopsies were performed at days 3, 7, and 14, followed by excision of the wound. Biopsies were stained with Sirius-Red (collagen analysis) and Hematoxylin-Eosin (morphometric analysis). The P-values <0.05 were considered statistically significant. Results: Only in Group P there was an acceleration of re-epithelialization observed from the 7th to the 14th day (p = 0.016) and increased fibrosis from the 3rd to the 7th day (p = 0.008). Groups E and E+P, presented inhibited formation of type III collagen in the three study time points (p <0.001). Conclusions: Treatment with topical oestradiol, and topical oestradiol associated with progesterone inhibited the formation of type III collagen. The isolated progesterone only contributed to the process of re-epithelialization of wounds.

Keywords: ESTROGENS; PROGESTERONE; COLLAGEN; WOUND HEALING.

Introduction: Telogen effluvium is a chronic progressive alopecia of multifactorial etiology. Nutritional deficiency-sometimes subclinical-can trigger it. Objective: To evaluate the influence of a nutritional supplementation at physiological doses in patients with telogen effluvium. Methods: The supplementation of nutrients in food doses was carried out in 60 female patients for 180 days. Results: There was a significant improvement (p <0.05) in hair loss, which was confirmed by digital phototrichogram, where there was a significant increase in anagen hairs and reduction of telogen hairs. Conclusion: The present study demonstrated that in cases of telogen effluvium without an apparent cause, the replenishment of nutrients related to the hair cycle has a significant benefit in the regression of the picture as soon as after three months of treatment.

Keywords: ALOPECIA; NUTRIENTS; HAIR.

With the intention of contributing to the manuscript sent by Lüdtke et al. (2013) to this journal, the authors send this letter to the editors with comments relevant to the article, which examines the profile of the sample of patients with periorbital hyperpigmentation assisted at an ambulatory unit in southern Brazil. The authors of this letter present their considerations and suggestions to the authors of the referred article, and add relevant comments to the published study.

Keywords: HYPERPIGMENTATION; EYE; DERMATOLOGY.

Introduction: Transcutaneous ultrasound procedures are viewed as the most effective non-surgical treatment for facial skin rejuvenation, although their mechanisms of action are poorly understood. Objective: This study aims to evaluate the morphological changes induced by ultrasound treatments on skin tissue: epidermis, papillary and reticular dermis, and subcutaneous fat. To evaluate the clinical efficacy of ultrasound treatment for facial skin tightening. Methods: Ex vivo human skin samples were sham-treated or treated with high-frequency ultrasound using MedVisage^TM (General Project Ltd.). Different parameters of power output (1.5 and 3.0 W) and frequency modulation (100, 500, 3,000, 3,500 Hz) were compared. Clinical efficacy was evaluated based on a single 5-minute ultrasound treatment (3.0 W, 3,000 Hz) on 4 volunteers. Results: Ultrasound treatment caused significant compaction of collagen and elastic fibers in the reticular dermis, whereas less prominent changes occurred in the papillary dermis. The overall effects varied depending on energy output and modulation frequency. No changes to subcutaneous adipocytes, blood capillaries, epidermal keratinocytes, dermal fibroblasts and mast cells were observed. Clinically, ultrasound treatment consistently resulted in a well-tolerated, objective reduction of facial skin wrinkles. Conclusion: High-frequency ultrasound treatment is an effective and safe noninvasive technique for skin-tightening purposes.

Keywords: HIGH-INTENSITY FOCUSED ULTRASOUND ABLATION; SKIN AGING; HISTOLOGY; DERMIS.

Introduction: Childhood is considered a critical period for photoprotection, since approximately 80% of the exposure to the sun occurs during this phase of life. Objectives: To evaluate the characteristics of the knowledge and sun protection habits of children and their caregivers. Methods: A cross sectional study was conducted with questionnaires from October 2011 to July 2012. Results: 177 children (mean age = 7.66 years); 64.9% of children assessed exposure to the sun as dangerous, 88.7% knew what sunscreen is, and 94.3% considered its use important; however, 66.6% believed it was necessary only in summer. Regarding photoprotection habits, 37.3% reported exposure to the sun between 10a.m. and 4p.m. Among caregivers, 81.3% reported an absence of daily application of sunscreen on their children, and 33.9% reported that their children had already had some type of sunburn. Conclusions: Strong dissociation between knowledge and practice regarding exposure to the sun was observed in the present study. The discrepancy between knowledge and habits that was observed in the two groups can be explained by the quality of information on exposure to the sun. The present study’s data point to the need for a wider dissemination of adequate knowledge, both by the media and by physicians, to nurture healthy practices regarding exposure to the sun.

Keywords: SOLAR ACTIVITY; SUN PROTECTION FACTOR; SUNSCREENING AGENTS; CHILD RESTRAINT SYSTEMS; CAREGIRVES

The present paper describes the case of a 47-year-old female patient, with discoid lupus erythematosus-the most common clinical variant of chronic cutaneous lupus-presenting achromic cicatricial lesions on the face. The punch grafting technique was performed in the following regions: right supraorbital, right malar, and nasal. The donor sites were the left and right retroauricular regions. A repigmentation halo of about 1cm was observed around each graft. This technique has been used in the treatment of refractory vitiligo, however it can also be used in inactive achromic cicatricial lesions of discoid lupus with good results.

Keywords: LUPUS ERYTHEMATOSUS, DISCOID; SKIN TRANSPLANTATION; AMBULATORY SURGICAL PROCEDURES; SKIN.

Introduction: Onychomycosis is responsible for over 50% of the conditions affecting fingernails. Several factors contribute to poor topical or systemic therapeutic response. Objective: A retrospective, monocentric study was carried out with the aim of observing the effects of Nd:YAG laser in patients who had not responded to other previous treatments. Methods: Thirty patients were photographed and subsequently underwent collection of material for fungi culture, and then treated with sub-millisecond 1,064nm Nd:YAG laser sessions with real time temperature control. Results: Clinical improvement of the treated nails was observed, with minimal discomfort. Conclusions: 1,064nm Nd:YAG laser promotes the acceleration of growth and improves the clinical appearance of the treated nails.

Keywords: LASERS; LASERS, SOLID-STATE; ONYCHOMYCOSIS; PHOTOTHERAPY;SPECTRUM ANALYSIS; TRICHOPHYTON.

Pre-operative care in dermatologic surgery is aimed at preventing complications intra-and post-operatively. The clinical history will determine the need for additional tests for prophylaxis of bacterial endocarditis, infection at the surgical site, and valvular and orthopedic prostheses. Diabetes mellitus and systemic arterial hypertension should be under control. Warfarin (keeping the INR within the therapeutic range) and acetylsalicylic acid (for secondary prevention of cardiovascular events) should be maintained. Other drugs should be evaluated. Monopolar electrosurgery should be avoided in patients using implantable electronic devices.

Keywords: PREOPERATIVE CARE; ANTIBIOTIC PROPHYLAXIS; ANTICOAGULANTS; ELECTROSURGERY.

Periorbital hyperpigmentation is a common cause of dermatological consultations and can have a major impact on a patient’s quality of life. Diagnosis with the naked eye can sometimes leave doubt as to whether the pigmentation is vascular, due to deposition of pigment, or mixed. In the present article the authors describe the dermoscopic features of these three variants, which can help in choosing the most appropriate therapeutic approach for each case.

Keywords: DERMOSCOPY; EYE; HYPERPIGMENTATION; QUALITY OF LIFE

There are many treatments proposed for the aging skin. CO2 laser has a growing indication as such. The author reports a case involving a complication using treatment with this technology in the periorbital region.

Keywords: BLEPHAROPLASTY; LASER THERAPY; CARBON DIOXIDE; TREATMENT OUTCOME.

The reconstruction of surgical defects generated by the excision of nasal tumors is a challenge for dermatologic surgeons due to the rigid structure and low mobility in the region. Among the alternatives to repair these defects is the pedicled frontal interpolation flap, especially where there is involvement of two or more aesthetic units of the nose. The present study reports the case of a patient with basal cell carcinoma involving the alae, tip, and columella of the nose, in which surgical repair after resection was carried out with pedicled frontal interpolation flap or medial frontal flap with excellent cosmetic results.

Keywords: CARCINOMA, BASAL CELL; SURGICAL FLAPS; RECONSTRUCTIVE SURGICAL PROCEDURES

Over the last centuries, several surgeries for eyelid reconstruction have been developed, perhaps due to the complexity of this anatomical area. Tumors larger than two-thirds of the lower eyelid preclude their direct closure and require surgical reconstruction that preserves the anatomy of the eyelid. The purpose of the present study is to present a technique for reconstruction of the lower eyelid with jugal mucosa and Mustardé flap or advancement flap, without reconstruction of the tarsus. This technique was performed in a series of six cases, all presenting satisfactory post-operative results. These patients did not present distortion of the anatomy nor ectropion.

Keywords: CARCINOMA, BASAL CELL; CARCINOMA, SQUAMOUS CELL; MOUTH MUCOSA; EYELID NEOPLASMS; SURGICAL FLAPS.

Primary axillary hyperhidrosis is a common disease that affects the social and professional lives of individuals. There are various treatments described in the literature, such as topical, systemic, and surgical. The present study describes the technique applied in a female patient, bearer of axillary hyperhidrosis, who underwent surgical treatment of axillae, progressing with significant regression of local sweating. The objective of the present study is to demonstrate the effectiveness of this surgical technique, with low complication rates, as a therapeutic option for axillary hyperhidrosis.

Keywords: HYPERHIDROSIS; AXILLA; DERMATOLOGIC SURGICAL PROCEDURES; SWEAT GLANDS.