Keloids and hypertrophic scars result from abnormal wound healing with excessive growth of fibrous tissue. Despite the high incidence in the population, the high rates of relapse and the significant psychosocial impairment, treatment remains a challenge for dermatologists. The objective of this study was to review literature on clinical, etiological and therapeutical aspects of keloids and hypertrophic scars, emphasizing its therapy with bleomycin, demonstrating its effective and safe use. The search was conducted in Scopus and MEDLINE databases, for the period from 1995 to 2016, using the key words: queloide/keloid; cicatriz hipertrófica/cicatrix, hypertrophic; and bleomicina/bleomycin.

Keywords: KELOID; CICATRIX, HYPERTROPHIC; BLEOMYCIN

Introduction: Stromal vascular fraction derived from adipose tissue is a rich source of different cells, containing large amounts of stem cells, which ability for diferentiation into various strains. In dermatology, there are several studies on the effectiveness of stem cells, which present antioxidant and rejuvenating effects. However, there are few reports about the anti-aging effects of stromal vascular fraction.
Objective: To evaluate the effectiveness of stromal vascular fraction in facial rejuvenation.
Methods: A prospective, comparative, controlled study was carried out, wit, with 10 patients divided into two groups and subjected to treatment of nasolabial folds with: Group 1: stromal vascular fraction and Group 2: conventional filler (calcium hydroxyapatite). Clinical, photographic and histological evaluations were conducted, with statistical analysis of data.
Results: Both techniques produced satisfactory results and were similar.
Conclusion: Application of stromal vascular fraction is a relatively new technique that presents good clinical results and is a promising option for rejuvenation.

Keywords: ADULT STEM CELLS; SKIN AGING; REJUVENATION

Introduction: Glomus tumor is a benign and rare neoplasm that appears as solitary and painful nodule, mainly subungual. It presents characteristic clinical manifestations such as paroxysmal pain and sensitivity to local pressure and to cold.
Objective: To conduct a clinical epidemiological survey of glomus tumors diagnosed in a reference unit in 16 years.
Methods: Retrospective study assessing clinical and epidemiological data of 15 patients with glomus tumor confirmed by histopathological report from 2000 to 2016. Data on age, gender, tumor location, associated symptoms, duration of symptoms until diagnosis, clinical presentation, histological type and recurrence after surgery were analysed.
Results: Fifteen cases were diagnosed, 11 in women (73.3%) and four in men (26.7%). Mean age was 63 years. The most frequent location was the subungual region. Mean duration of symptoms until diagnosis was 8 years.
Conclusions: In this study, the number of cases of glomus tumor fluctuated throughout these 16 years, with a mean of 0.9 cases/year. A higher prevalence in women over 60 years, subungual region location and solid glomus histologic subtype was observed.

Keywords: GLOMUS TUMOR; NAIL DISEASES; NEOPLASMS

Introduction: Infrared radiation (IR-A) causes structural changes in the skin, similar to those caused by prolonged exposure to ultraviolet radiation. Evaluation of efficacy and safety of cosmetic products concentrates in in vitro tests and clinical trials. A promising alternative is the use of fragments of human skin from elective cosmetic surgery, to evaluate the actual clinical benefits of a product applied topically.
Objective: The objective of this study was to correlate IR-A radiation effects in biopsies and in ex vivo skin fragments and in human fibroblasts culture by quantifying MMP-1, TIMP-1 and GADD45a mediators.
Methods: Collection of biopsies from 15 volunteers after IR-A applications for 5 consecutive days. Exposure to IR-A radiation of human skin fragments from elective cosmetic surgery, and human fibroblasts culture. Measurement of MMP-1, TIMP-1 and GADD45a mediators for further comparison of results.
Results: In the three models used, the IR-A radiation induced an increase in MMP-1, inhibited the synthesis of GADD45a, and did not changed TIMP-1 values.
Conclusion: Due to the positive correlation of the models studied, it may be suggested the use of ex vivo skin as plausible and sustainable tool to overcome differences between knowledge generated from in vitro and clinical experiments.

Keywords: SKIN AGING; MATRIX METALLOPROTEINASE 1; SOLAR RADIATION; IN VITRO TECHNIQUES

Introduction: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles. Treatment should be early and effective to prevent scarring and psychosocial effects, and isotretinoin is the drug of choice for moderate or severe cases.
Objective: To assess efficacy, safety and tolerability of an isotretinoin similar to the reference product.
Methods: A bicentric study, with therapeutic intervention was conducted, including 50 participants aged 13 to 35 years, with moderate to severe acne, using isotretinoin 0.5 mg/kg/day up to 120 mg/kg. Efficacy was assessed through lesions counting, the investigator's global assessment (IGA) scale, patient satisfaction and application of the quality of life questionnaire specific for Acne (Acne Qol). Safety and tolerability were assessed by analysis of adverse events and laboratory tests. Results: Mean age was 20 years, 70% of participants were men, with a reduction of 99% of lesions after treatment and complete remission of lesions in 91.5% of participants. IGA scale reduced 98% in the score after treatment. Also, 100% of participants declared to be satisfied, with significant improvement in quality of life. Adverse events were similar to those described in the literature.
Conclusion: The assessed isotretinoin was equally effective, safe and well-tolerated when compared with published data of the standard product.

Keywords: ACNE VULGARIS; TREATMENT OUTCOME; ISOTRETINOIN

Introduction: Rosacea is a chronic disease that usually manifests as flushing, persistent facial erythema, telangiectasia, papules and pustules. Intense Pulsed Light (IPL) is reported for treatment of vascular lesions of facial telangiectasia rosacea.
Objective: To assess clinical and dermoscopy improvement of facial erythema and flushing, and the clearing of vessels to dermoscopic after using IPL.
Methods: Nine patients were selected, with facial telangiectasic rosacea, aged between 36 and 59 years, with skin types I to III, without any treatment in the past six months. The treatment consisted in applications of the Intense Pulsed Light(IPL) with dual-band, 535-680 nm and 860-1200 nm, in one single shot. To favor the target hemoglobin, there is a greater protection for the skin. Three sessions were conducted within the interval of 1 month.
Results: After treatment, 87.5% of patients noticed reduction in flushing and telangiectasia. Adverse events were minimal and transient. To date no treatment was complete for telangiectasia rosacea.
Conclusions: This study demonstrated that treatment with IPL technology using "dual-band" is effective in obtaining a large (>75%) clinical improvement in 50% of patients and moderate improvement (51% to 75%) in 28.6% of patients.

Keywords: ROSACEAE; INTENSE PULSED LIGHT THERAPY; TELANGIECTASIA, ERYTHEMA

Introduction: Cosmetics stands outs in commerce, not only in Brazil but also worldwide. There is great need for knowledge on buying motivations of consumers for the development of better-targeted products and improved adhesion to dermatological treatments.
Objective: To know the cosmetic consumption habits and provide a link from the pharmaceutical with the medical area.
Methods: An analytical observational study, cross-sectional, was conducted by questionnaire.
Results: Main change in male skin is oiliness; in women, besides oiliness, there is concern with blemishes. The consumption of hygiene products is unanimous in both sexes. Women are more concerned with the treatment and prevention of sun damage. The vast majority of women use anti-acne products and makeup. Hair products have the same sales trend for both men and women, but this is not observed among products for skin.
Conclusions: Men and women have different motivations when buying cosmetics. The way consumers relate with products has changed dramatically and they are seeking to express their individuality in society. This reflects a need for medical knowledge of such motivations in order to improve patients' adherence to treatment.

Keywords: COSMETICS; HABITS; QUESTIONNAIRES; DATA COLLECTION; BEHAVIOR

Introduction: Laser toning technique is performed with the Q-switched Nd:YAG laser 1064 nm, aiming at stimulating neocollagenesis. The technique can also be associated with the application of suitable medicines for drug delivery, increasing its potential for skin permeation.
Objective: To evaluate the results of laser toning Q-switched Nd:YAG laser 1064 nm associated with drug delivery through a pilot study.
Methods: Four patients underwent four laser sessions with application of a formula for drug delivery or placebo, fortnightly.
Results: According to the photographic assessment, laser toning promoted improvement of acne, pores, wrinkles and sensitivity. When associated with the drug delivery, there was superiority in results. In clinical evaluation differences were observed only in the pores analysis (+11%). 75% of patients had acneiform eruption.
Conclusion: Results of this pilot study show that laser toning can be enhanced when combined with drug delivery.

Keywords: LASERS; ADMINISTRATION, CUTANEOUS; COLLAGEN; HYDROXYPROLINE; HYALURONIC ACID; ASCORBIC ACID

In recent years there has been a breakthrough in non-invasive techniques of facial rejuvenation. The greater understanding of the anatomical changes involved in the aging process was accompanied by rapid evolution in how to address these changes and the expansion of substances and technologies used in this approach. Of the arsenal of substances used for rejuvenation, the upper third of the face was before an almost exclusive territory of neuromodulators. Currently, fillers have stood out, especially those based onhyaluronic acid (HA), because they are safe and produce immediate and lasting – but reversible – results. The objective of this first article is to provide a brief literature review and update on the use of HA fillers in the rejuvenation of the upper third of the face, focusing on the forehead and glabella areas.

Keywords: DERMAL FILLERS; FOREHEAD; HYALURONIC ACID

Transverse hypercurvature is a deformity of the nail plate, unaesthetic and painful, causing discomfort to the patient. Treatment can be conservative or surgical. Related to the conservative treatments, placing the flexible plastic blade on the nail plate using cyanoacrylate glue, promotes rapid improvement of pain and its widening from three to six months. The use of cyanoacrylate accelerator facilitates the procedure, making it faster.

Keywords: NAILS, MALFORMED; NAILS, INGROWN; NAIL DISEASES; AMBULATORY SURGICAL PROCEDURES

Androgenetic alopecia is a condition with an important psychological impact. Clinical treatments present variable responses and require care for long periods, a factor that decreases the chances of adhesion. Microneedling with or without minoxidil injection is a new treatment modality. This study reports cases of two male patients, aged 30 and 44 years, with satisfactory partial response to four sessions of microneedling with minoxidil and three sessions of microneedling alone, using a tattoo machine and microinfusion of drugs into the skin technique.

Keywords: ALOPECIA; MINOXIDIL; NEEDLES

Use of botulinum toxin type A in first intention healing wounds has been widely adopted in order to inhibit the formation of hypertrophic scars. In this report we demonstrate the use of the toxin in a surgical wound left to heal by secondary intention, after the removal of a squamous cell carcinoma in situ by Mohs micrographic surgery in supralabial region, with good cosmetic result. Botulinum toxin acts by inhibiting the proliferation of fibroblasts, by differentiating fibroblasts and by producing type I collagen, which are the main factors responsible for the good quality of the healing process.

Keywords: BOTULINUM TOXINS, TYPE A; CICATRIX; WOUND HEALING; CARCINOMA, SQUAMOUS CELL

Rhinophyma tends to determine important nasal changes, with aesthetic and functional impairment, especially in more advanced cases. Despite the various techniques already described, the search for the ideal treatment persists. Two patients with rhinophyma underwent tangential excision associated with electrocoagulation, with subsequent intensive cosmetic treatment. The described technique is effective, safe, with excellent aesthetic results and no recurrences during the study period. This proposed combined treatment appears as a great alternative for the treatment of rhinophyma due to its technical simplicity and its good long-term results.

Keywords: RHINOPHYMA; ELECTROCOAGULATION; NOSE DISEASES

Vitiligo is an acquired depigmentation characterized by partial or total loss of epidermal melanocytes. Many therapeutic modalities have been proposed for its treatment. In cases of stable vitiligo surgical treatments are preferred. Grafting by epidermal scraping is a variant of micrografts by punch technique. It is a new, simple and low cost technique, with high rates of repigmentation. The objective of this report is to demonstrate the authors' experience with this technique and discuss the results in an initial series of two cases (three lesions).

Keywords: PHOTOTHERAPY; VITILIGO; PIGMENTATION DISORDERS; DERMABRASION; MELANOCYTES

Hyaluronic acid is the currently most used filler in dermatology due to its low risk of adverse events. The objective of this study is to report a case of granulomatous reaction after filling with two types of hyaluronic acid, in the perioral region and in the nasolabial folds. A female patient with rheumatoid arthritis treated with leflunomide presented onset of symptoms 30 months after filling. Autoimmune diseases may facilitate the occurrence of complications and should be followed carefully before filling with hyaluronic acid. As already reported with the use of interferon and omalizumab, granulomatous reaction to fillers may occur after use of leflunomide.

Keywords: HYALURONIC ACID; GRANULOMA; RHEUMATOID ARTHRITIS; FOREIGN-BODY REACTION

The dermal filling of soft tissue is a common practice. However there are potential serious complications associated. The authors are of the opinion that professionals who perform dermal filling procedures must have solid knowledge of anatomy and complete mastery of fillers injection technique. The behavior in potential cases of complications must be started early and conducted efficiently.

Keywords: BLINDNESS; HYALURONIC ACID; INJECTIONS