Solar or actinic keratosis is a frequent pre-malignant lesion that often occurs in areas exposed to sunlight, and has a 6-10% relative risk of developing into squamous cell carcinoma. Patients with actinic keratosis have multiple and confluent subclinical lesions, leading to the characterization of the condition as being of the field cancerization type. They are multifocal areas with genetic mutations that may become the site of new primary tumors and local recurrence. In recent years, there has been increasing interest in the development of non-invasive diagnostic tests and treatment for these subclinical lesions, with an aim at preventing squamous cell carcinoma.

Keywords: KERATOSIS, ACTINIC; CARCINOMA, SQUAMOUS CELL; PHOTOTHERAPY.

Introduction: Obesity is a major health problem worldwide due to its high morbidity and mortality. Objective: To evaluate the reduction of abdominal fat in volunteers who underwent low-frequency diode laser therapy. Methods: A total of 60 volunteers (18 to 50 years of age, with a BMI of between 18.5 kg/m2 and 30 kg/m2, and who had abdominal fat), underwent a treatment performed twice a week for 31 days and were then evaluated. The abdominal circumference was evaluated in three locations, with photographic and ultrasound images taken of the studied area. Results: There was a reduction in the abdominal circumference measurements in the evaluated sites, with dermal compression and a significant reduction of hypodermis verified through ultrasound. Conclusion: The low-frequency diode laser therapy showed significant results in the reduction of localized fat and abdominal circumference measurements.

Keywords: LASER; ABDOMINAL FAT; LYPOLISIS.

Introduction: The importance of early diagnosis and treatment of actinic keratoses is well established. There are several effective therapeutic options for the treatment of this condition. Objectives: To compare the efficacy and patient preference between 5% imiquimod cream and photodynamic therapy in the treatment of actinic keratoses. Methods: Twelve patients with a total of 245 lesions were treated with MAL-PDT and 5% imiquimod cream. Randomization was performed in order to determine the hemiface (left or right) for each treatment. First, the patients underwent MAL-PDT.After one month, they started using imiquimod in the other hemiface twice a week for 16 weeks.After six months, the two treatments were analyzed for efficacy, tolerability, patient preference, and aesthetic results using the observations of a blinded investigator. Results: Both treatments showed good therapeutic responses, with 72% of lesions treated with MAL-PDT and 76% of lesions treated with imiquimod having complete improvement. The average size of residual lesions was similar in the two treatments. Ten patients (83%) preferred the treatment with photodynamic therapy (p = 0.03). Conclusions: Photodynamic therapy and imiquimod are effective in the treatment of actinic keratoses. The results of this study showed similar efficacy and good aesthetic results with the two treatments. Nevertheless, most patients preferred the photodynamic therapy.

Keywords: KERATOSIS, ACTINIC; TREATMENT OUTCOME; THERAPEUTIC.

Introduction: Due to the risk of invasion of the orbital cavity and involvement of noble structures, the periocular region requires specific knowledge related to the anatomy and biological behavior of tumors in this region. Objective: To present the particularities and complexity of the approach to periocular tumors, through the analysis of cases treated at a Mohs micrographic surgery specialist center. Methods: A retrospective, observational, cross-sectional study was carried out based on data collected through a review of medical records, operative records, and photographic archives. Thirty-four cases were analyzed between April 2010 and April 2014. Results: Thirty-one basal cell carcinomas, two squamous cell carcinomas, and one sebaceous carcinoma were operated. Of these, 22 (64.70%) were primary tumors, and 12 (35.29%) were recurrent or incompletely excised. The nodular was the most common type of basal cell carcinoma (38.70%), followed by the micronodular (25.80%), the infiltrating (22.58%), the sclerodermiform (6.45%), the superficial (3.22%) and the adenoid (3.22%). Most of the lesions affected the lower eyelid (44.11%), followed in number by the internal canthus (41.17%), the upper eyelid (11.76%), and the external canthus (2,94%). There was only one recurrence following Mohs micrographic surgery. Conclusions: Most tumors had an aggressive histological subtype, especially those located in the internal canthus. Despite the study's limitations, the strict histological control of Mohs micrographic surgery, combined with the multidisciplinary approach to patients, provided excellent oncological, functional, and cosmetic results.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; CARCINOMA, SQUAMOUS CELL; EYELID NEOPLASMS; ORBIT EVISCERATION.

Introduction: Injectable hyaluronic acid is regarded as the gold standard treatment in the aesthetic correction of wrinkles, loss of contour, and restoration of facial volume. However, it is expected that consequentially adverse - sometimes severe - reactions will arise concomitant with the growth in use of hyaluronic acid-based cutaneous fillers. Objective: To evaluate the application of hyaluronidase in the treatment of adverse effects of injectable hyaluronic acid, as well as possible reactions to the intradermal injection of that enzyme. Methods: A retrospective study was carried out with 50 patients who underwent the application of hyaluronidase aimed at correcting complications or unaesthetic effects following hyaluronic acid-based filling procedures in the face. Results: Twenty-three patients had some type of adverse effect (restricted to the injection site) ranging from erythema, burning sensations, and mild edema, during or after the application, with spontaneous improvement. There were no cases of moderate to severe edema. Most patients reported regression of excess hyaluronic acid a few hours after the injection. Conclusions: Hyaluronidase is an extremely effective tool both in acute adverse events and in the reversal of unsatisfactory results, and in the dilution of biofilm. All those who use hyaluronic acid when treating their patients should have technical mastery of hyaluronidase application.

Keywords: HYALURONIC ACID; ENZYMES; ACCIDENTS.

Introduction: Solar radiation can produce erythema and pigmentation in the skin, interfering with pigmentary dermatoses such as melasma. Photoprotection is essential in the treatment or prevention of hyperpigmentation. The use of Polypodium leucotomos extract was effective in reducing the damage resulting from solar radiation, through antioxidant and immunomodulatory mechanisms. Objective: To evaluate the efficacy of Polypodium leucotomos extract in reducing the erythema and pigmentation following exposure to solar radiation. Methods: Twenty volunteers were exposed to UVB and UVA radiation emitted by a solar simulator. The reading of the minimum pigmentary and erythema doses were performed after two and 24 hours of exposure, respectively. After seven, 14 and 28 days use of Polypodium leucotomos extract (1,000 mg daily), the minimum pigmentary erythema doses were re-assessed. Results: There was an increase in mean values for the minimum pigmentary and erythema doses in all visits, with a statistical significance of (p <0.05) after 28 days for the minimum pigmentary dose and after 14 and 28 days for the minimum erythema dose. Conclusions: The continued use of a compound containing Polypodium leucotomos extract was effective in increasing individual resistance to pigmentation and erythema resulting from UV radiation, meaning it can contribute to the treatment of skin pigmentation disorders such as melasma.

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

Introduction: The present article offers a brief review of the demographics and etiology of cellulite. It shows that cellulite is a true clinical entity, with multi-factorial causes, and that it may affect more than 90% of all post-pubertal women. Objective: A clinical trial aimed at assessing the effects of a special topical formulation (containing retinol, caffeine, vitamin C, and vitamin E, in an optimized delivery system) on the visible signs of cellulite. Methods: A topical formulation was used by 25 female patients every evening for 17 weeks. In order to assess its efficacy, the clinical trial employed before and after photographs, self-assessment, and a specific rating system to measure cellulite severity. Results: The photographs, the self-assessment, and the objective assessment carried out by the expert evaluator, all showed a reduction in the visible signs of cellulite severity. It was possible to observe improvement at the 4th week of treatment, with continued improvement for 17 weeks and beyond. Conclusion: The results showed that the product tested in the present study in fact led to the reduction of the visible signs of cellulite severity.

Keywords: CELLULITE, RETINOL, CAFFEINE, DELIVERY SYSTEM

In the literature there is significant confusion between the terms hypodermis and subcutaneous adipose tissue, which are often used interchangeably. They are however two distinct and independent structures, with independent metabolic responses. The distinction between these two layers and the knowledge of their behavior is of crucial importance for choosing the appropriate treatment. The objective of the present study was to review the existing literature on the topic, in order to demonstrate the anatomical and histological differences between the two tissues.

Keywords: SUBCUTANEOUS FAT; ADIPOSE TISSUE; SUBCUTANEOUS TISSUE.

The present article discusses the importance of differential diagnosis with lesions located in the umbilicus. A case of verrucous nevus is described in this location, emphasizing the role of dermoscopy in the diagnosis.

Keywords: MELANOMA, EPIDEMIOLOGY, SKIN NEOPLASMS.

With an aim at reducing surgical complications, the authors describe an innovative technique - the hemostatic enclosure - performed with simple interrupted surgical stitches. The technique is indicated for lesions of any size, due to its simple implementation and because it results in the increased safety of surgical procedures.

Keywords: HEMOSTASIS; HEMOSTASIS, SURGICAL; AMBULATORY SURGICAL PROCEDURES; SUTURES.

The authors introduce a method for the treatment of different intensities and scales of rhinophyma, with trichloroacetic acid. This is a safe process, created and performed by the authors for five decades, with an absence of descriptions of adverse effects.

Keywords: TRICHLOROACETIC ACID; RHINOPHYMA; THERAPEUTICS.

The Highly Active Antiretroviral Therapy promoted a better quality of life for seropositive patients. However, metabolic changes in patients, such as HIV lipodystrophy syndrome, may occur with antiretroviral therapy. Thus, it is necessary to adopt strategies to prevent and treat lipodystrophy and other possible side effects of. We report the case of a female patient with prior antiretroviral therapy and decreased thickness of the lower limbs bilaterally, especially in knees and distal third of the legs. The sites with evidence of lipoatrophy were filled with polymethylmethacrylate, with satisfactory results and adherence by the patient.

Keywords: HIV-ASSOCIATED LIPODYSTROPHY SYNDROME; POLYMETHYL METHACRYLATE; ACQUIRED IMMUNODEFICIENCY SYNDROME.

Keratoacanthoma is a malignant tumor that is rarely located in the subungual region, but which has a tendency to recur. Spontaneous regression of these lesions in the nail apparatus region almost never occurs, and a differential diagnosis with other neoplasias, particularly squamous cell carcinoma, is essential. The authors present the case of a man with a diagnosis of subungual keratoacanthoma, which responded well to surgical treatment and had a favorable development.

Keywords: NAILS; KERATOACANTHOMA; FINGER FALANGES.

Basal cell carcinoma is the most common skin cancer and can result in significant morbidity if not completely excised. The present article describes a case of nasal reconstruction using the Rieger flap, after the excision of a basal cell carcinoma, which yielded good aesthetic results. The authors have chosen this flap due to the fact that the donor area contains an abundant supply of tissue to cover surgical wounds, which is of a good color and texture for the upper region of the nose.

Keywords: CARCINOMA, BASAL CELL; RECONSTRUCTIVE SURGICAL PROCEDURES; NOSE NEOPLASMS; SURGICAL FLAPS.

Lichen planus pigmentosus is a rare variant of lichen planus and represents a therapeutic challenge. Dermabrasion was performed with a good clinical response in the treatment of this condition, on the face of a female patient who also bears frontal fibrosing alopecia.

Keywords: DERMABRASION; LICHENOID ERUPTIONS; ALOPECIA.