A range of treatment options is available to restore and increase dermal collagen. The purpose of the present review, based on articles selected on PubMed database, is to study the histological effect of four methods for skin rejuvenation: Intense Pulsed Light, non-ablative fractional laser, ablative fractional laser and percutaneous collagen induction. The therapeutic implications of each type of treatment will depend on the induced collagen type and its ability to elicit a regenerative healing response versus a fibrotic scarring response. Intense Pulsed Light and the percutaneous collagen induction produced regenerative healing response with increased collagen type I.

Keywords: INTENSE PULSED LIGHT; LASER THERAPY; COLLAGEN; REJUVENATION; SKIN AGING

Introdução: actinic melanosis is a pigmentation disorder caused by the cumulative action of sunlight on the skin and its incidence increases with advancing age. Objective: Considering the lack of studies comparing agents with the same concentration, however in different vehicles, the authors compared the clinical effects of chemical peelings performed with 20% trichloroacetic acid (ATA) paste or solution in the treatment of actinic melanoses in the back of the hands. Methods: A prospective, controlled, randomized study was carried out with 15 patients bearers of bilateral actinic melanoses on the back of the hands. Three monthly sessions with 20% ATA peelings were performed with paste in one hand and solution in the other. The degree of whitening was evaluated by 13 blinded dermatologists, and patients were asked about the satisfaction and preferred method. Results: There was no preference for any of the methods used (p = 0.41), however, according to the medical evaluation, there was greater whitening with the paste (p = 0.01). Only the paste caused significant adverse effects, affecting 4/15 patients. Conclusions: Compared to the solution, when applied for two minutes in the treatment of actinic melanosis, the 20% ATA paste had greater whitening capacity, however demonstrated a tendency to cause more local adverse effects.

Keywords: TRICHLOROACETIC ACID; MELANOSIS; HAND; CHEMEXFOLIATION; SKIN PIGMENTATION

Introdução: Vitiligo is an acquired autoimmune form of hypopigmentation or depigmentation in which half of the cases begins in childhood. Objectives: To describe the clinical and epidemiological profile of childhood vitiligo in a referral center for dermatology. Methods: A cross-sectional, descriptive study was carried out based on the analysis of medical records of patients younger than 13 years diagnosed with vitiligo from 2004 to 2014. Results: Of the 113 cases identified, 54% were female and 46% male, the age ranged from 0 to 12 years, with most patients in the 4-8 years-old subgroup (54.8%). In 59% of the medical records there was no record of triggering factors of vitiligo; 31% of patients associated the onset of the illness to emotional stress, 3% to physical trauma and 7% did not associate it to any triggering factor. Conclusions: The discreet prevalence in women has also been reported in other studies. Vitiligo behavior in children is different from that observed in adults. The influence of psychological factors as triggers and potential lasting effects on self-esteem should be considered in the approach of the patient. Although studies on vitiligo in this age group are scarce in the literature, the results of the present study were similar to the reports already available in the literature.

Keywords: CHILD; EPIDEMIOLOGY; VITILIGO

Introdução: Hyperpigmentation is a common dermatological condition, usually associated with exposure to the sun and relative difficulty of treatment. Pycnogenol^® is an extract obtained from the French pine tree Pinus pinaster, with known antioxidant and anti-inflammatory activity, having been proven to inhibit melanin synthesis in previous studies. Objective: To evaluate the whitening activity of Pycnogenol^® in an ex vivo experimental model after exposure to ultraviolet A and B, infrared-A radiations and visible light. Method: Human skin fragments obtained from elective plastic surgery were treated with Pycnogenol ^® and then irradiated with ultraviolet A and B, and infrared-A radiations, and visible light, having been sent for histological evaluation of melanin pigmentation by the Fontana-Masson staining technique. Results: The histological evaluation demonstrated an increase in melanin deposition in all irradiated groups. However, fragments pre-incubated with Pycnogenol^® showed a reduction in the deposition of this pigment after irradiation. Conclusions: This study demonstrates the reduced melanin deposition in skin culture treated with Pycnogenol^® after irradiation with ultraviolet A and B, and infrared-A radiations, and visible light, concluding that this substance may have lightening properties.

Keywords: HYPERPIGMENTATION; SKIN LIGHTENING PREPARATIONS; SOLAR RADIATION

Introduction: Introduction: Extended cervicoplasty is used to treat the aging stigmas of the lower third of the face, especially in cases of severe tissue sagging. However, the maintenance of its long-term results has been little studied in the literature. Objective: To assess the maintenance of the results of extended cervicoplasty in the long-term. Methods: Twenty-three patients with severe tissue sagging underwent extended cervicoplasty, having been followed up for five years. The postoperative results in the first and fifth year were evaluated by 8 plastic surgeons. The analysis of the results was performed using the McNemar and paired t-student tests. Results: In the first year, 12 (52.2%) patients had the outcome rated as very good, 9 (39.1%) as moderate and 2 (8.7%) as poor. In the fifth year, 9 (39.1%) had the outcome classified as very good, 11 (47.8%) as moderate and 3 (13.1%) as poor. None of the patients had the outcome rated as excellent or bad in any of the analyzed periods. There was no significant difference regarding the classification (p = 0.450); and the total score (p = 0.373) during the study period. Conclusion: Even in difficult cases, extended cervicoplasty provided good results that were maintained in the long-term.

Keywords: RHYTIDOPLASTY; CERVICOPLASTY; NECK

Introdução: A non-invasive alternative for the treatment of localized fat is cryolipolysis that, by freezing adipocytes, reduces fat volume in the region where the procedure was performed. Objective: To statistically describe the experience of a referral center for this procedure. Methods: A cross-sectional study with 251 patients undergoing cryolipolysis was carried out with the epidemiological analysis of patient data. Results: Thirty-eight males and 213 females underwent the procedure, with a total number of 740 treated areas. The anterior abdomen (lower third) was the most popular region, with 45.30% of cases. Eighty-eight percent were satisfied or very satisfied with the result. Nearly all cases required 2 or more sessions to achieve this degree of satisfaction. Conclusions: Cryolipolysis is a noninvasive method for the selective reduction of fat that has shown efficacy in reducing the subcutaneous tissue, with minimal and reversible side effects in this study.

Keywords: LASERS; ABDOMINAL FAT; LIPOLYSIS

Introdução: Nasal filling can be used as an alternative to traditional rhinoplasty aiming at correcting small nasal defects and for complementation or correction after surgical procedures. Objective: To describe the profile of patients who underwent nasal filling and demonstrate the efficacy and safety of a new hyaluronic acid based filling substance. Methods: Retrospective analysis with statistical study of nasal filling procedures conducted in 280 patients. Results: The sample was composed mostly of Caucasian women with a mean age of 43 years. The nasal regions more commonly treated with the filler were the nasal root, tip and septum. Patients showed significant improvement and expressed satisfaction with the results. 17.1% of the patients were re-treated, and 7.2% had easy to resolve complications. Conclusion: The results were long lasting and natural, especially those related to thinning of the nasal tip.

Keywords: NOSE; HYALURONIC ACID; ESTHETICS

Introdução: The beneficial role of medium peelings and microneedling in photoaging and scars yield satisfactory results. Objective: A retrospective, descriptive, single-center study evaluating the results of the association of 88% phenol and microneedling for treating sagging, wrinkles and acne scars on the face. Methods: Medical records and standardized photographs, taken before and 3 months after the procedure, of 28 patients diagnosed with wrinkles, sagging or acne scars and treated with 88% phenol peeling followed by microneedling with 2.5 mm needles, were analyzed. Events and complications were recorded 15 days after the procedure. The investigator physician performed clinical and photographic assessments 3 months after the procedure, when patient satisfaction questionnaires were also applied. Results: Twelve patients had only wrinkles and sagging, 5 had only acne scars and 10 had both pictures, with skin phototypes I to III. Erythema persisted for 30 days and post-inflammatory hyperpigmentation was observed in 7 of 28 patients. Based on the clinic and photographic evaluations, the author considered the results as good and very good. 100% of patients reported satisfaction with the outcomes. Conclusions: Good results were observed with the association of 88% phenol and microneedling. Few patients experienced adverse effects, allowing the author to suggest that the procedure showed a good safety profile.

Keywords: THERAPETICS; REJUVENATION; CICATRIX S

Radiofrequency is considered a safe and non-invasive method for treating cutaneous sagging and for improvement of the body and facial contours. It has proven effectiveness, which is however limited in the more serious cases of ptosis. The effects of radiofrequency are based on the volumetric heating of the deep dermis, heating the collagen and elastic fibers. The heat generated by the radiofrequency leads to the contraction of collagen, improving the skin's firmness and elasticity. Furthermore, the heating induces the activation of fibroblasts, leading to neocollagenization (altered in diameter, thickness and frequency), with subsequent tissue remodeling.

Keywords: PULSED RADIOFREQUENCY TREATMENT; COLLAGEN; SKIN AGING

The term melanonychia refers to a brownish pigmentation produced by melanocytes in matrix, which extends from the proximal region up until the distal margin of the nail plate. This condition occurs due to the activation or hyperplasia of melanocytes, which presents benign lesions, such as nevi and lentigo or malignant lesions, such as melanoma of the nail unit. The intraoperative dermoscopic analysis of the nail matrix improves the diagnostic accuracy and guides on the best biopsy method for melanonychia. A proper biopsy technique is aimed at obtaining a good quality sample for the histological diagnosis - the gold standard - associated with a lower risk of permanent dystrophy.

Keywords: NAILS; LENTIGO; DERMOSCOPY

In search of a perfect aesthetic, facial filling procedures have been widely used. The presence of animal proteins or synthetic substances in some cutaneous fillers can cause serious allergic reactions, especially when performed by untrained professionals. There are not ideal, pure and free of side effects substances available in the marketplace. The present article is aimed at reporting a case where a facial filling was performed by a non-medical professional, resulting in foreign body reaction and severe skin infection, leading to deformities caused by the procedure carried out. The complications entailed invasive procedures for removal of the material used, and treatment with corticosteroids.

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

The basal cell and squamous cell carcinomas are known as non-melanoma skin cancers, having amounted to 98,420 new cases in men and 83,710 in women in Brazil in 2014. The reconstruction of surgical defects in the nose is a challenge for dermatologic surgeons regarding good functional and aesthetic results, since its structure is rigid and of little mobility. The authors introduce an interesting reconstruction method of a large nasal defect after excision of a basal cell carcinoma, using auricular cartilage graft and unipedicled advancement flap from the lower cheek.

Keywords: CARCINOMA, BASAL CELL; NOSE NEOPLASMS; NASAL SURGICAL PROCEDURES; EAR CARTILAGE; SURGICAL FLAPS

Post-inflammatory hyperchromia is an important sequel of inflammatory dermatoses. In addition to depigmenting topical treatments, chemical peels can be effective in treating it. The present report describes a case of post-inflammatory hyperchromia after treatment of Lichen Planus handled with thioglycolic acid peels. Thirty percent thioglycolic acid applied in the form of a peel is described as a therapeutic option with discrete results and can be considered an ally in managing this dermatologic condition.

Keywords: CHEMEXFOLIATION; HYPERPIGMENTATION; THIOGLYCOLATES

The present paper describes the case of a 47 year-old patient with facial Lupus Panniculitis, with absence of disease activity in excess of one year. The large malar and temporomandibular atrophy caused by the pathology has become a great problem for the patient, with impacts on her quality of life. A cutaneous filling procedure was carried out with hyaluronic acid using microcannulas, compensating the defect and with aesthetically appropriate results.

Keywords: CHYALURONIC ACID; PANNICULITIS, LUPUS ERYTHEMATOSUS; QUALITY OF LIFE

Melanonychia corresponds to color patterns in the nail plate, ranging from brown to black. It is a diagnostic challenge due to the fact it has several differential diagnoses, including benign and malignant entities. There are no reports of pigmented fibroma of the nail matrix causing striata (or longitudinal) melanonychia. In light of this fact, the authors report a case of melanonychia striata secondary to pigmented fibroma of the nail, with clinical examination and dermoscopic findings suggestive of nodular melanoma.

Keywords: NAILS; MALFORMED NAILS; NEOPLASMS; FIBROMA