Hyaluronic acid (HA) based cutaneous filling substances have become the treatment of choice for facial volumization. Hyaluronidase is a soluble protein that promotes the enzymatic degradation of HA. Commercially available preparations differ according to the substance's origin (bovine, ovine or human recombinant). Although cosmetic use has not yet been approved by the FDA, off-label use in dermatology is increasingly common. The purpose of the present article is to review the medical literature and prescribing information (package inserts) over existing commercially available products in order to provide an up-to-date view of the indications, dosage, injection techniques, and adverse effects.

Keywords: HYALURONIC ACID; HYALURONOGLUCOSAMINIDASE; ESTHETICS; OFF-LABEL USE

Introduction: The dermis is mainly composed of the extracellular matrix and fibroblasts that produce collagen types I and III, and elastic fibers. Objective: To verify through a prospective, comparative controlled clinical study whether there is an increase in the production of collagen fibers in healthy human skin after the injection of autologous fibroblasts in the dermis. Methods: Two skin fragments were collected from the right retro-auricular region of four women aged between 25 and 60 years. In one of the fragments, histology was carried out with Hematoxylin-Eosin and Picrosirius to qualify and quantify the collagen fibers (Control Group). A second fragment underwent enzymatic digestion in the laboratory aimed at extracting and culturing fibroblasts. After satisfactory growth (1 x 107 cells / ml) the cultured fibroblasts were injected in the left retro-auricular region of the patients (Study Group). Three months after biopsies were harvested from this region, they were subsequently stained with Hematoxylin-Eosin and Picrosirius for comparative study between the two groups. Results: Statistical analysis of the number of collagen fibers in the three layers of the dermis - upper, middle and deep - comparing the study and control groups, showed that the mean and median observed after the injection of the cells were greater than those observed before the injection. Conclusion: The injection of fibroblasts results in an increase in the amount of collagen fibers in all regions of the dermis, with the increase being greater in the deeper regions.

Keywords: FIBROBLASTS; CELL-AND TISSUE-BASED THERAPY; COLLAGEN

Introduction: Photodamaged skin of the anterior thorax region is characterized by flacidity, wrinkles, hyperpigmentation, erythema, telangiectasia, and atrophy. Microneedling has been used for the transdermal drug delivery of active agents to the skin through microchannels. Objective: To clinically evaluate the rejuvenation of the skin of the anterior thorax region resulting from the use of microneedling associated with drug delivery. Methods: Double-blind randomized, placebo-controlled study conducted with 22 women who underwent three microneedling sessions followed by the topical application of a test product containing hyaluronic acid and other active principles or placebo. The evaluation was performed through photographic comparison carried out by a dermatologist oblivious to the study and the application of self-assessment questionnaires to patients. Results: Clinical evaluation showed improvement in the overall skin rejuvenation of the anterior thorax region in 100% of the patients. The statistical analysis showed a 28% improvement (p <0.05) with use of the test product as compared to the placebo. The responses to the questionnaires demonstrated an improvement of 30% in the patients treated with microneedling and the test product. Conclusions: The microneedling technique associated with the transdermal administration of drugs used for rejuvenation provides improved overall appearance of the skin of the anterior thorax region, with a high degree of tolerability and satisfaction.

Keywords: REJUVENATION; COLLAGEN; ADMINISTRATION; CUTANEOUS

Introduction: Melasma is a common acquired hypermelanosis of difficult treatment due to the fact that it is a refractory and recurrent condition. Pycnogenol is a powerful antioxidant that can be effective in the treatment of melasma owing to its protective action against ultraviolet radiation. Objectives: To evaluate the effectiveness of 100 mg/day pycnogenol in the treatment of melasma. Methods: Prospective, randomized, interventional study carried out with 31 patients. The selected participants made use of 100 mg / day pycnogenol and sunscreen for 90 days. They were evaluated regarding the extent of melasma (MASI) and quality of life (MELASQol). Results: Efficacy results showed a significant reduction (p <0.05) in the scores for both scales (MASI and MELASQol). According to the participants' self-evaluation, 94.4% of them showed clinical improvement. Conclusion: 50 mg pycnogenol was shown to be effective in the treatment of melasma after use of 2 tablets / day for 90 days. The results for the MASI and MELASQoL (Melasma Quality of Life Scale) scores were statistically significant. Furthermore, the product was proven to be safe due to the low incidence of side effects.

Keywords: MELANOSIS; CHEMOPREVENTION; ADJUVANTS, PHARMACEUTIC

Introduction: The periorbital subunit is one of the first regions to present signs of aging, resulting in sagging, wrinkles, and pigmentation. Surgical and non-surgical ambulatorial procedures, including chemical peels, lasers, neurotoxins, and cutaneous filling, form an important basis for the rejuvenation of this region. Objective: The objective of this retrospective clinical study was to evaluate the effectiveness of micro-needling assisted radiofrequency for rejuvenating the periorbital region. Methods: Retrospective study of the technique's safety and effectiveness through the evaluation of the results with the application of a satisfaction questionnaire to patients and of the analysis of clinical outcomes by independent dermatologists. Results: Nineteen patients aged between 42 and 67 years who underwent the technique were evaluated. One hundred percent of the patients reported satisfaction with the results, whereas in the comparative evaluation of the photographs carried out by two independent dermatologists the rate of improvement was 50% in 4 patients, 75% in 8 patients, and 100% in 7 patients. Post-inflammatory hyperpigmentation was observed 10 to 15 days after the treatment in 11 patients, though it was reversed after clinical treatment. Conclusion: This new procedure emerges as an alternative treatment for periorbital aging.

Keywords: PIGMENTATION; EYELIDS; PULSED RADIOFREQUENCY TREATMENT; REJUVENATION

Introduction: Hyperhidrosis is the cause of intense suffering and embarrassment. Currently there are many treatments available for this disorder, however none of them offers guaranteed and lasting effectiveness. Objective: To evaluate the effectiveness of bipolar radiofrequency in axillary hyperhidrosis. Methods: Five patients were selected using the Minor positive test with clinical, photographic, and histological evaluations before and after the procedure. Six weekly sessions were carried out. Results: The patients rated the improvement as satisfactory, with some considering it almost complete. The photographic assessment showed negative for the Minor test and the biopsy did not evidence dermal fibrosis. Conclusion: Bipolar radiofrequency can be considered a safe method, with low complication rates and an excellent additional option in the treatment of hyperhidrosis.

Keywords: HYPERHIDROSIS; SWEATING; LASER THERAPY; AMBULATORY SURGICAL PROCEDURES

Introduction: Basal cell carcinoma is the most common skin cancer and corresponds to 70-80% of all malignant neoplasms of the skin. It is emerging as a global public health problem, with incidences of the condition increasing in all countries. Objective: To evaluate the epidemiological profile and characteristics of patients diagnosed with basal cell carcinoma in the previous four years in a reference hospital. Methods: A cross-sectional descriptive study was carried out at a dermatology reference center in the city of Bauru, São Paulo State, Brazil. Patients diagnosed with basal cell carcinoma, confirmed by histological examination from January 2010 to December 2013 were included in the study. The variables analyzed descriptively were: age at diagnosis, gender, city of origin, site of lesion, and race. Results: A higher incidence of basal cell carcinoma was observed in Caucasian women older than 60 years, with the malar and nasal regions arising as the usual locations. Conclusions: There is an increased incidence of basal cell carcinoma in young people, however the most affected population is still the elderly Caucasian population. The most common area for the cancer is the face, particularly the upper two thirds. The incidence of this cancer in younger populations is worrying, with the dermatologist having an important role in the prevention and early treatment.

Keywords: CARCINOMA, BASAL CELL; EPIDEMIOLOGY; SKIN NEOPLASMS; PATHOLOGY; DERMATOLOGY

Introduction: Confocal laser reflectance microscopy has been regarded as a tool with extensive application in dermatology, emerging as a revolutionary factor in the diagnosis of skin disorders and the evaluation of cutaneous characteristics. This is due to the fact that it allows cellular level visualization with almost histological resolution of cellular and tissular features through a non-invasive method, in real time. Objective: To evaluate the morphological and structural characteristics of skin aging in the epidermis and papillary dermis using confocal laser reflectance microscopy. Methods: Forty female volunteers with II, III, and IV skin phototypes were selected and divided into two age groups: young skin (18-35 years old) and aged skin (40-65 years old). The evaluation of the cellular characteristics of the different cutaneous layers was performed using a confocal laser reflectance microscope Vivascope 1500. Results: Using the confocal microscopy analysis, it was possible to observe an irregular pigmentation pattern, irregularly distributed keratinocytes, flattening of the dermal-epidermal junction, presence of damaged collagen fibers, and solar elastosis in the aged skin. Conclusions: Confocal laser reflectance microscopy is a technique that is highly useful for assessing morphological and structural characteristics of cutaneous aging at the epidermis and papillary dermis levels.

Keywords: MICROSCOPY, CONFOCAL; SKIN AGING; EPIDERMIS; DERMATOLOGY

In dermatology, facial fillers are of great importance in the treatment of wrinkles and expression lines, their use being for aesthetic purposes. Their application is usually carried out with needles, which can lead to complications during the procedure. Among them hematomas, ischemia, necrosis, and even blindness. In recent years however, the application of fillers with microcannulas has revolutionized the techniques of application, in this way avoiding the occurrence of complications during and after the procedure. The present paper is aimed at clarifying the nomenclature, characteristics, and dimensions of the cannulas.

Keywords: NEEDLES; HYALURONIC ACID; TECHNICAL SPECIFICATIONS

Recurring nevus or pseudomelanoma is a benign melanocytic lesion that appears in the same location after an incomplete surgical removal of nevi. These pigmented melanocytic lesions can in some cases be a diagnostic challenge when examined through dermoscopy, especially if there is a clinical history of growth or recurrence of the lesion, as happens with the recurrent nevus phenomenon. Confocal reflectance microscopy is an in vivo non-invasive imaging technique with high histomorphological resolution of the skin that can be used to differentiate between benign and malignant lesions, increasing the in vivo diagnostic accuracy. Nonetheless, in some cases only the histological and immunohistochemical examinations of the complete lesion can clarify the diagnosis.

Keywords: CARCINOMA, BASAL CELL; EPIDEMIOLOGY; SKIN NEOPLASMS; PATHOLOGY; DERMATOLOGY

The reconstruction of nasal surgical defects, especially when there is total thickness bilateral simultaneous involvement of the nasal ala, tip, and dorsum, is complex. Several surgical options are described, and most authors recommend ear cartilage graft or chondro-mucous flap of the nasal septum, associated with the frontal median flap in order to lend structural rigidity to the nasal ala, preventing it from collapsing during inspiration. The authors describe an alternative reconstruction technique without the use of cartilage through the combination of hinge flaps from the nasogenian fold, associated with a frontal paramedian flap.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; NOSE NEOPLASMS; SURGICAL FLAPS; NASAL CARTILAGES

Keloids are dermal fibroproliferative benign disorders that develop at the site of cutaneous injury, due to an imbalance of the mechanisms that control tissular repair and regeneration. The pathogenesis is not well understood, however it is postulated that an imbalance between anabolic and catabolic factors occurs in the healing process, resulting in overproduction of collagen. There are several treatment modalities, nevertheless recurrence rates are high. The objective of the present paper is to describe five cases of keloid in the ear lobe that showed a good response to a combination therapy: excisional surgery, corticosteroid injection, and pressure device.

Keywords: KELOID; AMBULATORY SURGICAL PROCEDURES; ADRENAL CORTEX HORMONES; PRESSURE

Hansenomas originate from the intense cutaneous infiltration by Mycobacterium leprae bacilli in Virchowian hansenic patients who tend to improve with treatment,however can develop keloid reactions. Alternative approaches are described for the treatment of disseminated receding hansenomas in the ears, face, upper limbs, and trunk in already treated virchowian patients. The exeresis of the lesion in the left ear was carried out and followed by injections of triamcinolone in the surgical scar, combined with simple injections in other lesions in exposed areas and an expectant approach in other areas. A good cosmetic result was observed in the excised lesion, in addition to a reduction in the lesions injected with corticosteroids. These procedures are easy to perform and cost effective, yielding good aesthetic outcomes.

Keywords: LEPROSY; LEPROSY, LEPROMATOUS; MYCOBACTERIUM LEPRAE; THERAPEUTIC USES

Basal cell carcinoma is the most common type of cancer and its non-surgical treatment has been the subject of many studies. Large lesions of this tumor are therapeutic challenges and the effective topical treatment has good applicability. The authors present a female patient diagnosed with multicentric superficial basal cell carcinoma in the lumbar region for more than 20 years, who refused to be treated surgically. The tumor reached dimensions of 12 cm x 10 cm. A decision was made for a non-surgical therapy, with the application of Imiquimod in a treatment of 5 weekly applications for 2 months. The treatment led to a clinical and histological cure, without recurrence to date (36 months), with excellent aesthetic results and few side effects.

Keywords: CARCINOMA, BASAL CELL; THERAPEUTICS; NEOPLASMS

Ascher syndrome (AS) is a rare disorder of unknown etiology characterized by the presence of double upper lip, blepharochalasis and nontoxic goiter (complete AS). The nontoxic goiter is present in 10-50% of cases (incomplete AS). Trauma, hormonal dysfunction, autosomal dominant inheritance, defects in elastic fibers and allergy are possible causes. Surgery is indicated due to the compromise of facial aesthetics, trauma, or visual difficulty, and to restore the patient's quality of life. The present article reports the case of a patient with a double and blepharochalasis lip, diagnosed as a bearer of the incomplete Ascher syndrome, and describes the adopted conduct.

Keywords: BLEPHAROPLASTY ; BLEPHAROPTOSIS; LIP

The malar region is the site of skin tumors and sometimes a primary closure is not possible after the excision of the lesion. The A-T flap is a good method for reconstructing an broad and deep defect in which the local surrounding tissue does not allow direct closure. The present study describes the implementation of an A-T flap as an option for the reconstruction of an operative wound secondary to the excision of a basal cell carcinoma.

Keywords: SURGICAL FLAPS; ZYGOMA; CARCINOMA, BASAL CELL