Hidradenitis suppurativa is a chronic inflammatory disease resulting from follicular obstruction. This recurrent condition leads to the formation of fistulas and scars, which affect a patient's quality of life. The literature offers multiple therapeutic modalities, such as topical and oral antibiotics, isotretinoin, dapsone, TNF-α inhibitors, finasteride, conventional surgical therapies, and lasers (CO₂, Nd:Yag). The present article provides a review of these treatments and their indications, according to the stages of Hurley, which provides the dermatologist with a greater command of different techniques, thus leading to a more adequate treatment of patients.

Keywords: HIDRADENITIS SUPPURATIVA; THERAPEUTIC; LASER THERAPY.

Introduction: Although cellulite has been related to being overweight and having unhealthy eating habits, normal weight patients can also present with cellulite. Objective: To assess the effects of three different diets in the reduction of cellulite grading in normal weight women. Methods: Forty-three women were randomized into 3 groups: Group 1 followed a low-carbohydrate diet; Group 2, a high protein content diet; and Group 3, a control diet with standard amounts of macronutrients. Body weight for each patient was recorded and cellulite grading was assessed with the Cellulite Severity Scale. Results: Patients in Group 2 had, on average, lower cellulite grading for the right and left gluteus compared to patients in Groups 1 and 3. Patients in Group 2 also saw a reduction in body weight and a reduction in cellulite grading on the thighs during the course of the study. Conclusion: Patients in Group 2 had improvement in cellulite grading, possibly related to the reduction in body weight and the consequent reduction of adipose tissue. Larger studies are needed to support these data and establish the relationship between the composition of different diets and cellulite improvement.

Keywords: CELLULITIS; LIPODYSTROPHY, DIET THERAPY.

Introduction: Facial paralysis triggers asymmetries and other functional and aesthetic facial changes, which lead to significant physical and psychological disorders. Botulinum toxin type A is a safe, effective, and well-tolerated therapy, making it a good option for treating those conditions. Objective: To demonstrate the clinical improvement and the degree of satisfaction among patients bearing facial asymmetries and dyskinesias, who have been treated with botulinum toxin type A injections performed by dermatologists. Methods: Patients with facial asymmetries and dyskinesias were selected between January 2011 and December 2013, to receive botulinum toxin injections aimed at reducing muscle activity on the normal side of the face (in cases of facial hemiparesis) or directly into the affected muscles in cases of dyskinesias. The clinical evaluations and photographic records in static and dynamic positions were carried out on the days of the first application (D0) and fifteen days after (D15). Each patient was rescheduled for a future session within120 days. Results: There was clinical improvement with reduction of asymmetries and dyskinesias verified at the beginning of treatment following application of the toxin. A significant improvement in the patients' quality of life, with a positive impact in different areas of their personal lives, could be noticed. Conclusions: Treatment with botulinum toxin type A, performed by dermatologists with previous experience in the management of this procedure in other conditions, proved to be an important alternative in the treatment of asymmetries and facial dyskinesias.

Keywords: FACIAL ASYMMETRY; FACIAL PARALYSIS; QUALITY OF LIFE; BOTULINUM TOXINS, TYPE A.

Introduction: Chronic exposure to ultraviolet radiation is the primary cause of skin carcinomas. Actinic keratosis is considered a precursor lesion. Topical application of photolyase showed effectiveness with the removal of 40-45% of the dimers formed by ultraviolet radiation, contrasting with conventional photoprotection for its ability to repair already damaged cellular DNA. Confocal microscopy is used for the in vivo visualization of skin alterations. Objective: To evaluate the effects of the cream containing photolyase and SPF 100 sunscreen on facial actinic damage and keratoses, using dermoscopy and confocal microscopy as evaluation parameters. Methods: Observational longitudinal clinical trial in 17 actinic keratosis lesions. Dermatoscopy and confocal microscopy were carried out before applying the cream and 120 days after, with comparison of the images. Results: Of the 14 Grade I actinic keratoses, nine showed clinical and dermoscopic improvement, three remained unchanged and one progressed to Grade II actinic keratosis. Confocal microscopy showed a reduction of scales and improvement in the epidermal architecture in the five Grade I actinic keratoses. The three Grade II actinic keratoses analyzed did not show improvement. Conclusions: The application of photolyase in cream with sunscreen promotes photoprotection and DNA repair. Confocal microscopy is a useful tool for monitoring the treatment of actinic keratoses.

Keywords: KERATOSIS, ACTINIC; MICROSCOPY, CONFOCAL; DERMOSCOPY.

Introduction: Several therapeutic modalities have been used to treat keloids and hypertrophic scars. Objective: Treatment of keloids and hypertrophic scars with excision and intralesional injection of methotrexate. Methods: Therapeutic intervention open study with 11 patients. Laboratory tests and photographs were carried out before, during, and after the treatment. From the seventh day after the excision of the lesions, the suture was injected weekly with methotrexate for six months. The weekly dose was 2.5 mg / 10cm suture, with a maximum dose of 5mg per patient. The evaluation was carried out by the physician and the patient. Results: Six months after the end of the treatment, there was no recurrence of the lesion in five cases, partial recurrence in six cases and an absence of cases with total recurrence. No alterations were observed in the laboratory tests. Conclusions: The maximum weekly dose of 5mg methotrexate for six months used in this pilot study to treat keloids and hypertrophic scars is safe and hinders recurrence. Further studies are needed to complement the present paper.

Keywords: KELOID; CICATRIX, HYPERTROPHIC; THERAPEUTICS; SKIN.

Introduction: Organic acids are widely used in cosmeceutic-based skincare due to their exfoliation and cell renewal related effects. A star anise derivative known as shikimic acid is an example. Objectives: To evaluate the antioxidant activity of shikimic acid and the clinical efficacy of dermocosmetic preparations containing 3% of this active principle. Methods: The antioxidant activity was assessed through an in vitro method. Formulations of gel, gel cream, and a 3% solution of the acid were sequentially dispensed and preliminarily subjected to stability and sensory analysis. The clinical study was performed through non-invasive biophysical and skin imaging techniques. Results: The shikimic acid showed antioxidant potential. All formulations were found to be stable and the addition of shikimic acid improved the sensory analysis of the gel and gel cream. In the clinical assessment, the gel and the solution showed significant alterations in microrelief and in the parameters linked to skin exfoliation. However, the gel cream formulation did not show such an effect, suggesting the importance of the vehicle for the effectiveness of the cosmeceutics. Conclusions: Shikimic acid can be considered an active principle with good potential for application in dermocosmetic formulations aimed at exfoliation and improvement of the skin's microrelief.

Keywords: CHEMEXFOLIATION; ANTIOXIDANTS; COSMETICS; EFFICACY; SHIKIMIC ACID.

Introduction: In dermatology, several medications are injected intralesionally to treat diseases locally and the microinjection of non-cross linked hyaluronic acid in the dermis is used for restoring skin hydration. Objective: To determine whether there was improvement in skin hydration due to injection of pure non cross-linked hyaluronic acid in patients' periorbital wrinkles and surrounding skin. Methods: Ten patients (between 40-63 years of age) with periorbital wrinkles rated between 1 and 4 according to the Wrinkle Severity Rating Scale were treated in the yeear of 2007 with microinjections of non cross-linked hyaluronic acid on the 1st, 15th and 30th days of the study. The medical researcher, the non-medical observer, and the patients assessed the skin at the treatment site on the 45th day of the study according to a descriptive scale of clinical outcomes (absent, poor, good, and very good). A followup evaluation was carried out during five years aimed at identifying potential complications. Results: According to the descriptive scale, the analysis of the clinical outcomes data presented the following results, expressed in number of patients: patients' opinion (poor = 2, good = 6, very good = 2); non-medical observer's opinion (poor = 3, good = 4, very good = 3); medical researcher's opinion (poor = 3, good = 6, very good = 1). Echymoses and bleeding occurred immediately after the injections. Conclusion: Injection of hyaluronic acid can be a therapeutic option for re-hydrating dry and damaged skin.

Keywords: HYALURONIC ACID; AGING; SKIN PHISIOLOGICAL PROCESSES; MESOTHERAPY

Introduction: Melasma appears as a hyperpigmentation, which mainly affects body areas exposed to the sun, and is considered a common condition. Objective:To evaluate the efficacy of 82% lactic acid peeling in the treatment of facial melasma through a prospective and comparative study. Methods: Three fortnightly application sessions with 82% lactic acid peeling were carried out in 16 patients with facial melasma - eight of them were using the standard triple combination drugs for the treatment of hyperpigmentation while the others were untreated for 60 days. The Wilcoxon signed-rank test was applied in order to compare the two groups' values for the Melasma Area Severity Index. Results: The lactic acid peeling improved the hyperpigmentation in all patients studied, with no permanent side effects, proving to be an effective treatment. The Wilcoxon signed-rank test showed a significant reduction (p = 0.0003) in the Melasma Area Severity Index, in all patients. Conclusion: The 82% lactic acid peeling treatment can be an important tool in the improvement of resistant melasma.

Keywords: CHEMEXFOLIATION; THERAPEUTICS; SKIN; LACTIC ACID; HYPERPIGMENTATION.

Introduction: Cutaneous melanoma has significant relevance among malignant skin tumors, for despite its low incidence (3-4%) it is associated with the highest mortality. In Brazil, estimates for the year 2014 correspond to 10% of all cancers, establishing this as an important public health issue. Objectives: To present epidemiological data related to melanoma skin cancer in the midlands of the Brazilian State of São Paulo. Methods: Descriptive retrospective cross-sectional analysis of data from a tertiary hospital's medical records. The analysis was subject to measurement and information bias. A descriptive analysis with frequency and percentage was carried out. Results: There was a prevalence of cutaneous melanoma in women (71%), patients between 50 and 70 years of age (56%), Caucasians (78%), and individuals who identified their lesions through self-examination (42%), with predominant involvement of the trunk (35%). The most prevalent histological subtype was the superficial spreading (58%). Conclusions: Understanding the epidemiology of cutaneous melanoma in a given geographic region enables and facilitates medical actions, allowing for the better establishment of strategies for primary and secondary prevention.

Keywords: MELANOMA, EPIDEMIOLOGY, SKIN NEOPLASMS.

In dermatology, botulinum toxin stands out in the treatment of wrinkles and expression lines, mainly being used for aesthetic purposes. However, in recent years the use of botulinum toxin in the treatment of dermatological diseases has grown and shown good results. The present review is aimed at reporting the use of botulinum toxin in clinical conditions that may be treated by dermatologists, exploring its mechanism of action and long-term results, thus gathering practical information for specialist physicians.

Keywords: BOTULINUM TOXINS; DISEASE; DERMATOLOGY; SKIN.

The subungual glomus tumor is a benign neoplasia of glomus cells and is clinically characterized by paroxysmal pain and hypersensitivity to cold, which causes functional impairment to patients. Diagnosis is based on history and physical examination, and can be better guided based on radiologic study - with ultrasound and Doppler. The authors demonstrate clinical and ultrasonographic aspects of a case, describing the surgical procedure.

Keywords: GLOMUS TUMOR; ULTRASONOGRAPHY, DOPPLER, COLOR; AMBULATORY SURGICAL PROCEDURES.

One of the signs of perioral aging is the lengthening of the upper lip followed by perioral sagging that leads to the depressed angle of the mouth. Various perioral rejuvenation techniques - such as the use of fillers and ablative techniques - are described, however the inversion of the lip does not usually fully improve with those treatment modalities. The authors describe three patients with depressed angles of the mouth that were surgically corrected through a simple, however little used technique, which produces satisfactory aesthetic results.

Keywords: MOUTH; AGING; SURGERY, PLASTIC.

The solitary dermatofibroma or benign superficial fibrous histiocytoma is a common tumor that arises in the lower limbs of young women. Multiple eruptive dermatofibromas constitute a rare presentation of dermatofibromas (0.3%), often associated with underlying diseases. They are defined by the presence of 15 or more lesions or the appearance of five to eight tumors within less than four months. On PubMed/MEDLINE, to date, there are about 40 published cases of multiple eruptive dermatofibromas related to systemic diseases such as systemic lupus erythematosus, Sjögren's syndrome, hepatitis C, AIDS and the use of imunossupressants. The authors report a case where the emergence of multiple eruptive dermatofibromas preceded the onset of systemic lupus erythematosus by 20 years.

Keywords: HISTIOCYTOMA, BENIGN FIBROUS; LUPUS ERYTHEMATOSUS, SYSTEMIC; IMMUNOSUPPRESSIVE AGENTS.

The basal cell nevus syndrome - also known as Gorlin-Goltz syndrome - is an autosomal dominant disorder that occurs with the development of basal cell carcinomas in young patients and other clinical and radiological findings. As this syndrome tends to be a systemic disease, a better understanding of it by the various medical specialties is important for early diagnosis, allowing appropriate treatment and secondary prevention. In the present case, the authors describe an adult patient with multiple exuberant basal cell carcinomas having spread through the body over 10 years.

Keywords: BASAL CELL NEVUS SYNDROME; CARCINOMA, BASAL CELL; EPIDERMAL CYST

Confluent and reticulated papillomatosis of Gougerot and Carteaud is a disease of uncertain etiology, the main differential diagnosis being pityriasis versicolor. The authors describe two cases of the disease - one in a man and one in a woman - both with good therapeutic response without recurrence after use of minocycline.

Keywords: HYPERPIGMENTATION; CERATOSIS; MINOCYCLINE.

The authors describe the case of a 75-year-old female patient, bearing a single asymptomatic, nodular lesion of fibroelastic consistency for three years, located on the left hallux. Following surgical excision of the lesion, the pathological examination and immunohistochemistry revealed a superficial acral fibromyxoma. This type of lesion was first described in 2001 and today there are approximately 100 cases in the literature. It is a benign mesenchymal tumor of slow growth, with a predilection for ungual and peri-ungual regions. There are no reports of malignant transformation and recurrence has been associated with incomplete resection.

Keywords: FIBROMA; NEOPLASM; NAIL DISEASES.