The lips are important anatomical units for perfect facial aesthetic balance. A number of methods can be used to improve lip appearance, including chemical and physical peels, botulinum toxin, cosmetic surgery and the use of cutaneous fillers. In the face of the already widespread and yet still growing use of fillers worldwide, the need for precise anatomical knowledge arises as an important tool to prevent complications. The objective of the present study is to shed light on the anatomical peculiarities of this facial topography and review recommendations linked to best practices with cutaneous fillings.

Keywords: ANATOMY; ESTHETICS; HYALURONIC ACID; LIP; LIP PRODUCTS

Introduction: The treatment of keloids and hypertrophic scars are an everyday challenge for the dermatologist. Despite the existence of a large therapeutic armamentarium, a variable rate of effectiveness, side effects, and recurrences make it difficult to achieve satisfactory results. As an isolated or in-combination therapy, 5-fluorouracil has the potential to be a part of the treatment paradigm for hypertrophic and keloid scars. Objective: To evaluate, during 12 years, the outcomes of the use of 5-FU (50 mg/ml) in a ratio of 9:1 with triamcinolone acetonide (20 mg/ml) in patients bearing keloids and hypertrophic scars. Methods: Retrospective study of 32 patients with keloids, hypertrophic scars, and cicatricial fibrosis who underwent 1 to 17 intralesional injections of a combination of 5-FU and triamcinolone acetonide in fortnightly intervals. A visual analog scale (VAS) was employed to evaluate the pain/discomfort caused by the lesion, as well as to assess the patient's perception of the scar when seeing it in the mirror. Results: In the comparison of the visual analogue scales (VAS) after the treatment, there was a significant reduction in the level of pain/discomfort (VAS pain) (p = 0.001) and in the assessment of the scar's appearance in the mirror (VAS mirror) (p <0.001). Three patients (9.4%) had complications: hyperchromia (two patients = 6.3%) and atrophy (one patient = 3.1%). Conclusions: 5-FU injections in hypertrophic scars, keloids, and fibroses was found to be a minimally invasive, cost effective, and easily reproducible therapeutic approach with consistent results, which does not invalidate or preclude other techniques.

Keywords: CICATRIX, HYPERTROPHIC; FLUOROURACIL; KELOID

Introduction: A topical cosmetic formulation is currently commercially available for the treatment of Brittle Nail Syndrome, a formulation made up of Equisetum arvense, Methyl sulfonyl methane and Hydroxypropyl chitosan. However, the habit of applying nail polish hinders the adherence to treatments that preclude their use. Objective: To propose a scheme that alternates the use of the formulation five times a week, with nail polish. Methods: A clinical, single-blind, crossover controlled intraindividual trial was carried out with 38 female patients. The patients' hands were randomized into two groups (A and B). Results: From weeks 1 to 8, and from Sunday to Thursday, Group A applied the formulation A while Group B did not undergo treatment. In weeks 9 to 16, Group A suspended the application of the formulation, while Group B began treatment. From Thursday to Sunday Groups A and B had their nails painted. A common nail polish was standardized for both groups. A quantitative score was used to evaluate outcomes and observe the percentage of patients who had improvements greater than 50% and 75%. Conclusions: The formulation was more effective in controlling the signs of the syndrome when the nail polish was used in the intervals of the applications. The present study allowed the authors to propose a treatment regimen using the formulation 5 times a week, alternating with the practice of painting the nails.

Keywords: NAIL DISEASES; NAILS; PRODUCTS FOR NAILS AND CUTICLES

Introduction: With several treatment options available - including laser - atrophic acne scars are nonetheless difficult to treat. The use of fractional technology results in dermal-epidermal ablation columns, interspersed with intact skin islands, allowing selective thermal damage, effective treatment and faster recovery. The objective of the present study is to demonstrate the efficacy and safety of fractional laser use in the treatment of atrophic acne scars among the Brazilian population. Methods: An open, prospective, interventional study was carried out with patients with acne scars, without restriction regarding the gender and skin phototype. Exclusion criteria were: pregnancy, breast-feeding, presence of infections or blood dyscrasias and the use of anticoagulants. The evaluation was performed by comparing texture, appearance, and relief as observed in digital photographs. Results: Of the 30 selected patients, 24 were included in the study. An improvement was noted in the parameters evaluated in the cases that underwent fractional laser (CO2, Erbium-Glass or both). Individuals who underwent multiple treatments showed better results. All those treated with 4 sessions had improvements greater than 50%. Post-inflammatory hyperpigmentation was detected in 7 of the 24 treated patients. Conclusion: The present study showed that, when using appropriate parameters and adequate care, fractional laser-assisted resurfacing is an effective and safe method for treating atrophic acne scars in the Brazilian population.

Keywords: ACNE VULGARIS; CICATRIX; LASERS; CHEMEXFOLIATION

Introduction: Skin aging is a complex biological process that is characterized not only by clinical but also cellular alterations. The use of effective topical formulations for reducing and preventing oxidative stress is of utmost importance to delay cellular senescence. Objective: To evaluate the in vitro and in vivo efficacy of a formulation containing vitamin C, fragmented hyaluronic acid and mannose, in the prevention of skin aging. Methods: Clinical, subjective, and instrumental evaluations were carried out in 37 women (mean age: 46 years) and in vitro comparative evaluations of a dermal equivalent model contraction. Results: Statistical improvement was observed in the clinical parameters of hydration, sagginess, brightness, uniformity of skin color and amount of wrinkles after 3 months of treatment. A reduction by 12.6% in the volume of wrinkles 30 minutes after application and by 17.8% after three months of use was also evidenced by instrumental evaluation. There was greater contraction of the dermal equivalent model when compared to a commercial product for wrinkle reduction containing the same active principle. Conclusions: The product was proven effective in skin rejuvenation, by significantly reducing the amount of wrinkles. The in vitro study showed an increase in collagen synthesis, suggested by the greater activation of fibroblasts in the dermal equivalent model.

Keywords: SKIN AGING; ASCORBIC ACID; HYALURONIC ACID; MANNOSE

Introduction: Discoloration and grooves are common in the lower eyelid and tend to give the bearer's appearance - even at a young age - an effect of tiredness, advanced age, and deepening of the eyeballs. Aimed at correcting these visual effects, cutaneous filling for local volume restoration has been currently indicated as a treatment, with the proposition of a number of products and techniques. Objective: To describe and evaluate the superficial application technique with the use of a fluid monophasic polydensified hyaluronic acid. Materials and methods: Sixty patients being treated between 2011 and 2014 underwent the technique. The evaluation was carried out by an applicator physician through the comparison of photographs and through questionnaires based on the Hirmand's classification answered by the patients. Results: The applicator physician rated the treatment as excellent (35% of cases), very good (50%) or good (15%), whereas for patients the results were excellent (30%), very good (50%) or good (20%). There were no reports of significant or long-term adverse effects. Conclusion: This superficial subdermal technique is easy to perform, has few adverse effects, and yields good results, leading to a high degree of patient satisfaction.

Keywords: SKIN AGING; HYALURONIC ACID; HYPERPIGMETATION

Introduction: Progressive macular hypomelanosis is characterized by the emergence of hypopigmentation, predominantly in the trunk region of young women of mixed racial origin. Although recent studies suggest that Propionibacterium acnes may have an important role in the pathogenesis, its etiology remains unclear. Objective: To evaluate the prevalence of the condition with regards to gender, age, skin phototype, affected areas and disease onset, and the relationship with ordinary acne and oily skin in the city of Niterói, Rio de Janeiro State, in the coastal region of Southeast Brazil. Methods: Retrospective epidemiological study that uses the analysis of medical records of 103 patients with diagnosis of progressive macular hypomelanosis, from 2001 to 2012. Results: Eighty-two percent of studied patients were women and 18% men, with a predominance of phototypes III (42.7%) and IV (42.7%). The average age of onset of the disease at diagnosis was 26 years. In 46.0% of patients the disease duration ranged from 1 to 4 years. When two areas were affected (50%), the dorsum was the most frequent (79.0%), followed by the abdomen (20.0%). In 98% of cases, patients had oily skin, and 71.8% had active acne. Conclusion: Progressive macular hypomelanosis is a chronic condition that primarily affects the skin of the dorsum and abdomen of young women with skin phototypes III and IV, who are also bearers of oily skin and acne. There are still many doubts regarding the true etiology and treatment of progressive macular hypomelanosis. The high percentage of association with skin oiliness and acne vulgaris suggests that these clinical conditions are possibly related.

Keywords: HYOPIGMENTATION; EPIDEMIOLOGY; ACNE VULGARIS

Platelet-rich plasma has been proven to be promising in regards to its applicability in dermatology, especially in the healing of chronic ulcers and for soothing signs of aging. The autologous platelet-rich plasma is obtained through blood centrifugation, in a way that its components are separated by density gradient. The final product is a gel rich in growth factors that act in tissue repair, activating fibroblasts and inducing the extracellular matrix remodeling.

Keywords: PLATELET-DERIVED GROWTH FACTOR; PLATELET-RICH PLASMA; TRANSFORMING GROWTH FACTORS; VASCULAR ENDOTHELIAL GROWTH FACTORS; WOUND HEALING

A Wood's lamp is a cost effective, safe, easy to use diagnostic tool that is readily available at medical practices. However, its dermatological application has been restricted to the detection of cutaneous infections, the evaluation and classification of pigmentation disorders (such as melasma and vitiligo), and the analysis of disturbances in the metabolism of porphyrins. In the present report the authors demonstrate the use of a Wood's lamp as an alternative to confocal optical microscopy, in the delimitation of the surgical margins of a hypomelanotic lentigo maligna melanoma, whose lack of melanin pigmentation and tumor location in a photodamaged area had hampered a patient's surgical planning.

Keywords: LIGHT; MELANOMA; MELANOMA, AMELANOTIC; MICROSCOPY, CONFOCAL;

The upper lip is commonly affected by cutaneous carcinomas. The excision of the neoplasia with safe oncologic margins calls for a large incision, and sometimes flaps are necessary. In addition to its aesthetic value, a successful lip reconstruction includes the maintenance of perfect oral functionality. The authors describe a nasolabial rotation cutaneous flap associated with an advancement flap of the oral mucosa in a single surgical event, performed on a patient bearing basal cell carcinoma involving the left side portion of the upper lip.

Keywords: SURGICAL FLAPS; CARCINOMA, BASAL CELL; MOUTH MUCOSA

Case report of a male patient bearing a rare granular cell tumor in the left arm, confirmed by histology and immunohistochemistry (positive S100 and CD68 proteins).

Keywords: ARM; GRANULAR CELL TUMOR; SKIN NEOPLASMS

Erythroplasia of Queyrat is an in situ squamous cell carcinoma of the glans penis. Due to its unusual location, surgical treatment can cause mutilation. CO₂ laser-assisted vaporization is a treatment option with excellent aesthetic and functional results, but it requires strict follow up owing to its high recurrence rates. The authors describe a case of erythroplasia of Queyrat treated with fractional CO₂ laser, with an absence of recurrence during a one-year follow up

Keywords: CARCINOMA, SQUAMOUS CELL; CARCINOMA IN SITU; FORESKIN; LASER COAGULATION; LASERS; LASERS; GAS; PENIS; PENILE NEOPLASMS

Since ancient times, humans have had an interest in improving their body contour. Liquid silicone has been used for this purpose, in order to improve deformities. The authors present a case of a female patient with paralysis in the right lower limb, who underwent improper injections of a large volume of injectable silicone in the affected limb aimed at correcting its contour. Ten years later, the patient developed local complications linked to the silicone injections - localized scleroderma lesions and superficial lipomatous nevus with progressive growth in the affected limb - and clinical and laboratory pictures of rheumatoid arthritis. Injectable liquid silicone should be contraindicated as a substance for implants.

Keywords: POSTOPERATIVE COMPLICATIONS; SILICONES; SKIN NEOPLASMS

Cutaneous leiomyosarcoma is a rare neoplasm with a tendency to recur, and with possible metastases. The authors report a case of a female patient who was being treated with triamcinolone injections in a dermal leiomyosarcoma lesion that was misdiagnosed as keloid.

Keywords: KELOID; LEIOMYOSARCOMA; SKIN NEOPLASMS

Introduction: Hidradenitis is a chronic inflammatory disease that has a negative impact on the patient's quality of life but which has few effective therapeutic options. Currently, the use of laser technology has been standing out as a treatment. Objective: To evaluate the use of 1,340nm ND:YAP laser (Neodimiun:Ytrium Aluminum Perovskite) to treat hidradenitis. Methods: Performing 4 1,340nm ND:YAP laser sessions in 3 patients bearing hidradenitis. Results: All patients had a clinically and histologically evidenced reduction of inflammatory lesions. Conclusions: In the present study, the 1,340nm ND:YAP laser was effective in the treatment of hidradenitis, and can potentially become a new therapeutic option.

Keywords: HIDRADENITIS; LASERS; LASER THERAPY