Surg Cosmet Dermatol. 2016;8(3):193-203.Abstract PDF Portuguese PDF English Text Portuguese Text English
The topical route for the delivery of drugs is essential in dermatology: it optimizes the penetration of medicaments, and when performed with the assistance of lasers, it takes place in a uniform and controlled manner. The degree of evidence of drug delivery is being investigated for many drugs. Moreover, the technique combines outstandingly with lasers for rejuvenation and treatment of skin diseases. It is therefore possible to conclude that the use of lasers for drug delivery is promising. While there are clinical studies on some substances that allow their indication and use, others require further controlled analyses, with longer follow-up periods, aimed at allowing thorough evaluations.
Keywords: LASERS; ADMINISTRATION, CUTANEOUS; SKIN ABSORPTION; DRUG DELIVERY SYSTEMS; DRUG ADMINISTRATION ROUTES
Surg Cosmet Dermatol. 2016;8(3):206-209.Abstract PDF Portuguese PDF English Text Portuguese Text English
Introduction: The use of botulinum toxin in the periorbital muscles is aimed at reducing expression lines in that site, correcting the eyebrows' height and treating blepharospasm. However, the application of botulinum toxin in this area can lead to undesirable side effects, such as ptosis, edema in the lower eyelids, artificial appearance of the demarcation area between the orbicularis muscle's treated area and the malar region, ectropion and hematomas.
Objective: To treat the dynamic wrinkles in the lower portion of the orbicularis oculi muscle through injections of microdoses of botulinum toxin.
Methods: A prospective monocentric study with the analytical longitudinal observation of 300 patients undergoing treatment with botulinum toxin microdoses in the lower eyelids' rhytids was carried out. Sociodemographic data, patient satisfaction, dose quantification and complications were analyzed.
Results: Sixty-six percent of the patients showed a total improvement of the wrinkles after the first session. The other required an additional session. Eighty-six percent preferred the treatment with this therapeutic modality.
Conclusions: Despite the great benefit offered by the classic injection points for the treatment of periorbital rhytids types I to III, the authors observed the need to treat rhytids type B (presence of wrinkles on the lower eyelid). Due to the high rate of complications in this region, microdoses of botulinum toxin were proven to be effective and safe.
Keywords: BOTULINUM TOXINS, TYPE A; ESTHETICS; DERMATOLOGY
Surg Cosmet Dermatol. 2016;8(3):210-216.Abstract PDF Portuguese PDF English Text Portuguese Text English
Introduction: Low level laser therapy has been considered a non-invasive treatment alternative to body remodeling and fat tissue reduction.
Objective: To evaluate the efficacy of low level laser therapy in reducing body circumference measures and subcutaneous adipose tissue of the abdomen and hips areas.
Methods: An open, prospective, monocentric study was performed including 25 women with localized fat on the hips and abdomen. Nine sessions of low level laser therapy were performed over 3 weeks. The participants were assessed at baseline and at 1, 4 and 12 weeks after treatment. Assessment of weight and body circumferences, lipid profile tests and MRI were performed.
Results: The abdominal circumference measurements showed a significant reduction up to 12 weeks after the treatment. Participants showed a more marked reduction in the hips region one week after the last session. Also one week after the completion of the treatment, 80% of the participants considered that the treatment improved their body contour. There was absence of reports of adverse events related to the treatment.
Conclusion: Low level laser therapy is safe and effective in reducing the circumference measurements, particularly in the abdominal region.
Keywords: LOW-LEVEL LIGHT THERAPY; SUBCUTANEOUS FAT; MAGNETIC RESONANCE IMAGING; LASER THERAPY; ABDOMINAL SUBCUTANEOUS FAT
Surg Cosmet Dermatol. 2016;8(3):217-222.Abstract PDF Portuguese PDF English Text Portuguese Text English
Introduction: Mohs micrographic surgery is a technique that offers high cure rates for non-melanoma skin cancer.
Objective: To describe the clinical and epidemiological profile of patients who underwent Mohs micrographic surgery in a reference center in dermatologic surgery.
Methods: Medical records of patients who underwent Mohs micrographic surgery in the period 2014-2015 at a dermatology reference center, in the city of Mogi das Cruzes (SP, Brazil), were analyzed.
Results: The patients' ages ranged from 38 to 87 years; of these 54% were women. The most affected topography was the nose (54% of patients). Previous history of skin cancer was positive in 62% of cases. The indication driver for micrographic surgery was the lesion's location in 67% of the patients, followed by the size (23%) and tumor recurrence (10%). The most prevalent intraoperative diagnosis was basal cell carcinoma (90%).
Conclusions: Mohs micrographic surgery is an excellent therapeutic option in cases of tumors of aggressive nature, large diameter and high-risk location. This study is in line with the current literature regarding the epidemiological data linked to the occurrence of nonmelanoma skin cancer.
Keywords: MOHS SURGERY; SKIN NEOPLASMS; DERMATOLOGIC SURGICAL PROCEDURES
Surg Cosmet Dermatol. 2016;8(3):223-230.Abstract PDF Portuguese PDF English Text Portuguese Text English
Introduction: The evaluation of the clinical efficacy of cosmetic formulations in real conditions of use is indispensable and the correlation of these results with texture and sensory profile analyses is necessary because impacts directly in the continuity of cosmetic treatment.
Objective: The evaluation and correlation of the texture and sensorial profile, and clinical efficacy of cosmetic formulations containing alfafa oligosaccharides, cassava polysaccharides and sunscreens.
Methods: It was evaluated the texture and sensorial profile, and clinical efficacy of formulations through biophysical and imaging analysis techniques.
Results: The methods presented a good correlation, because formulation added with suncreens and active ingredients provided better spreadability and sensorial properties. The assessment of clinical efficacy was coherent with the sensory analysis once the "skin smoothness" parameter could be proven with the increase of hydration and improvement of skin microrelief.
Conclusions: The application and correlation of the used techniques enabled the definition and obtainment of a formulation with sensory acceptance and proven clinical efficacy in the improvement of texture and skin hydration. Thus, this study provides contribution in dermatological area, once an appropriate sensory favors the adhesion to the use of the product and the consequent treatment success.
Keywords: EFFICACY; COSMETICS; BIOPHYSICS; POLYSACCHARIDES; OLIGOSACCHARIDES
Surg Cosmet Dermatol. 2016;8(3):232-240.Abstract PDF Portuguese PDF English Text Portuguese Text English
Introduction: Melasma is a common pigmentary condition that affects exposed body areas, especially in the frontal and malar regions. Hydroquinone is an effective active principle in the treatment of hyperpigmentation, however, due to issues linked to its tolerability, many studies are being conducted aimed at developing alternative therapies with equivalent effectiveness.
Objective: To evaluate the efficacy and tolerability of a cosmeceutical formulation containing ellagic acid, hydroxyphenoxy propionic acid, yeast extract and salicylic acid in Brazilian patients with mild to moderate melasma.
Methods: Forty patients with mild to moderate melasma on the face used the cosmeceutical twice daily, combined with sunscreen for 90 days. Subjective assessments of efficacy and tolerability were carried out. Measurements of the MASI grade and the application of the MELASQoL-BP questionnaire were also performed. The evaluation of the skin's brightness and the colorimetric characteristics were obtained by colorimetry.
Results: After 90 days of treatment, a significant improvement could be observed in the clinical and colorimetric parameters evaluated, and in the quality of life questionnaire. In addition, the MASI score improved by 43%. The treatment was effective without causing adverse events.
Conclusions: The evaluated cosmeceutical formulation was proven as an effective alternative to hydroquinone for the treatment of melasma, with excellent cutaneous tolerability profile.
Keywords: HYPERPIGMENTATION; MELANOSIS; BLEACHING AGENTS
Surg Cosmet Dermatol. 2016;8(3):242-245.Abstract PDF Portuguese PDF English Text Portuguese Text English
Introduction: Atrophic stretch marks constitute skin disorders characterized by the loss of collagen and elastin in the dermis, and resemble scars. Fractional lasers, microneedling and chemical peels have led to good outcomes in some cases, however there is no ideal treatment.
Objective: The objective of the present retrospective clinical study was to evaluate the effectiveness of Pulsed Radiofrequency with Multineedles (RFPM®) in late atrophic stretch marks.
Methods: A retrospective study of the safety and effectiveness of the technique was carried out by evaluating outcomes with the application of a patient satisfaction questionnaire and the assessment of clinical results by independent dermatologist physicians.
Results: A total of 8 patients (aged between 22 and 38 years) who underwent the technique were evaluated, of whom 100% reported satisfaction with the outcomes. Additionally, in the comparative evaluation of photographs carried out by two independent dermatologist physicians, the improvement rate was 50% in 2 patients and 75% in 8 patients . Post-inflammatory hyperpigmentation was observed in 10 to 20 days after the treatment in 6 patients, having been reversed after clinical treatment.
Conclusions: The new procedure is an option in the treatment of atrophic stretch marks.
Keywords: STRIAE DISTENSAE; PULSED RADIOFREQUENCY TREATMENT; COLLAGEN
Surg Cosmet Dermatol. 2016;8(3):246-249.Abstract PDF Portuguese PDF English Text Portuguese Text English
Introduction: Actinic keratoses are the most common premalignant skin lesions, with a chronic and recurrent nature. Daylight photodynamic therapy has been used in the treatment of actinic keratoses of the face and scalp.
Objective: To demonstrate the possibility of implementing daylight photodynamic therapy at a public service, for the treatment of facial actinic keratosis, using one tube of methyl aminolevulinate cream for up to four patients.
Methods: Ten patients were selected to undergo daylight photodynamic therapy at the Centro de Dermatologia Dona Libânia, located in the city of Fortaleza (CE), Brazil. Curettage was performed on the actinic keratosis and a methyl aminolevulinate cream based chemical filter was applied across the face.
Results: One tube of methyl aminolevulinate cream was enough for treating up to four patients with multiple facial actinic keratoses, whereas studies suggest the use of at least one gram to treat one face completely.
Conclusion: It was possible to conclude when administering daylight photodynamic therapy, an amount of less than one gram of methyl aminolevulinate cream in the treatment of facial actinic keratoses is a dosage sufficient to obtain an effective clinical response.
Keywords: KERATOSIS, ACTINIC; PHOTOCHEMOTHERAPY; ECONOMICS, PHARMACEUTICAL
Surg Cosmet Dermatol. 2016;8(3):250-254.Abstract PDF Portuguese PDF English Text Portuguese Text English
Aspiration curettage of sweat glands is a minimally invasive surgical technique for the treatment of axillary hyperhidrosis. It is safe and easy to perform, offers a high success rate and comparatively few side effects. It is generally well tolerated by patients and requires a reduced recovery time when compared to other surgical modalities.
Keywords: HYPERHIDROSIS; SURGERY; CURETTAGE
Surg Cosmet Dermatol. 2016;8(3):256-258.Abstract PDF Portuguese PDF English Text Portuguese Text English
Juvenile xanthogranuloma is a form of non Langerhans cell histiocytosis that mainly affects children. It usually emerges as asymptomatic yellow-brownish papules. The diagnosis is clinical and confirmed by histology. Due to its trend to involute, treatment is usually not recommended. Dermoscopy arises as a noninvasive diagnostic tool that reveals a typical pattern for this condition.
Keywords: XANTHOGRANULOMA, JUVENILE; DERMOSCOPY; HISTIOCYTOSIS, NON-LANGERHANS-CELL
Surg Cosmet Dermatol. 2016;8(3):260-261.Abstract PDF Portuguese PDF English Text Portuguese Text English
To make compressive dressings that are capable of preventing hematoma during the recovery period, after surgery on the scalp is a challenge. These dressings can be especially problematic to perform in the vertex region, due to the difficult adhesion of the hypoallergenic tape in that site. The authors introduce a good option for compressive dressings for use after surgeries on the scalp.
Keywords: COMPRESSION BANDAGES; AMBULATORY SURGICAL PROCEDURES; HEAD; SCALP
Surg Cosmet Dermatol. 2016;8(3):262-265.Abstract PDF Portuguese PDF English Text Portuguese Text English
W-plasty is a commonly used technique in facial cosmetic surgery to camouflage the straight line of a scar into a regularly irregular pattern. It consists of excising a series of consecutive small triangles of skin on each side of the scar, and imbricating the resultant triangular flaps, producing a "zig-zag" effect. This procedure is particularly useful on long, wide, curved, contracted, or anti-tension line scars of the forehead, cheeks, chin, and nose. We report the usefulness of this technique in an unaesthetic postsurgical facial scar.
Keywords: CICATRIX; DERMATOLOGIC SURGICAL PROCEDURES; SURGICAL FLAPS; RECONSTRUCTIVE SURGICAL PROCEDURES
Surg Cosmet Dermatol. 2016;8(3):266-270.Abstract PDF Portuguese PDF English Text Portuguese Text English
The Merkel cell carcinoma is a rare and highly aggressive neuroendocrine skin tumor. The purpose of this paper is to warn of the possibility of this diagnosis, usually not considered as an initial hypothesis in cutaneous neoplasias. The authors describe two cases of elderly female patients with complaints of a single erythematous nodule on the face. The diagnoses of basal cell carcinoma and amelanotic melanoma were considered. The presence of telangiectasias was evident at dermoscopy. The incisional biopsy's histology evidenced Merkel cell carcinomas. This neoplasia typically occurs in Caucasian patients with over 65 years of age, emerging as an erythematous-purplish nodule of rapid growth, with immunohistochemistry being essential for the diagnosis.
Keywords: SKIN NEOPLASMS; CARCINOMA, MERKEL CELL; NEUROENDOCRINE TUMORS; IMMUNOHISTOCHEMISTRY
Surg Cosmet Dermatol. 2016;8(3):271-273.Abstract PDF Portuguese PDF English Text Portuguese Text English
Basal cell carcinoma is the most frequent malignant skin tumor. Its incidence has been increasing, leading to the emergence of a public health problem. The common delay in seeking treatment hampers tumor removal. The objective of this paper was to report a case of two synchronous basal cell carcinomas on the face and the challenge of their surgical resolution. Good aesthetic and functional outcomes were obtained using the rotation flap technique and a complex reconstruction of the hemiface. Surgical reconstruction constitutes a challenge for the surgeon, who should prioritize the oncologic cure while preserving the functionality and aesthetic appearance, when possible.
Keywords: CARCINOMA, BASAL CELL; SURGICAL FLAPS; SKIN NEOPLASMS
Surg Cosmet Dermatol. 2016;8(3):274-276.Abstract PDF Portuguese PDF English Text Portuguese Text English
Keloids have functional, aesthetic and psychological impacts that can influence the patients' quality of life. Moreover, given the high rate of recurrence – particularly in large lesions located in the anterior thoracic region – they are more difficult to treat. This paper reports a successful treatment for keloids in this area using a new technique that combines intense pulsed light, botulinum toxin type A and the conventional treatment with injection of corticosteroids.
Keywords: KELOID; INTENSE PULSED LIGHT THERAPY; BOTULINUM TOXINS, TYPE A; ADRENAL CORTEX HORMONE
Surg Cosmet Dermatol. 2016;8(3):278-279.PDF Portuguese PDF English Text Portuguese Text English