Introduction: Brittle nails or nails that do not grow are relatively frequent complaints in the dermatological practice, nonetheless there are few studies on how nutrition influences these symptoms.
Objective: To evaluate the possible influence of nutritional supplementation for improving the nail plate's resistance and growth.
Methods: Forty-five patients complaining of fragile/brittle nails were observed for 16 weeks under recommended daily intake of a nutritional supplement containing vitamins and trace elements, having undergone clinical and subjective evaluations in Weeks 8, 12 and 16.
Results: There were improvements in the parameters strength, resistance, growth and nail integrity from Week 8, with further progress after continued use of the supplement, allowing the conclusion that this treatment led to noticeable improvement of the nail plate's quality.
Conclusions: The nutritional supplement evaluated was safe and effective in improving the signs of nail weakening, including loss of resistance and reduction of growth rate.

Keywords: NAIL DISEASES; NUTRIENTS; KERATINOCYTES

Introduction: Although the intradermal melanocytic nevi are benign lesions, many patients seek for dermatologists for their excision. However, there are no studies about the best method for this procedure.
Objective: To compare in a randomized clinical trial the excision of intradermal melanocytic nevi in the face for shaving and elliptical excision with suture
Methods: Patients with intradermal melanocytic nevi on the face were selected for removal by shaving or ellipse, randomly. The results were described regarding patient satisfaction and photographic records evaluated by a blinded physician.
Results: 18 patients underwent excision of intradermal melanocytic nevi. The mean scar size after six months of the procedure was of 8,11mm for the excision in ellipse and 2,92mm for the shaving (p < 0.05). The mean score of the patients after six months was 9.67 (ellipse) and 9.57 (shaving) (p = 0.8). The mean by the blinded physician was of 7.78 (ellipse) and 7.86 (shaving) (p = 0.91). 28.6% of patients undergoing shaving had recurrence of the nevus.
Conclusions: The two forms are of excision are equivalent concerning patients satisfaction and the judgment of medical team about the aesthetic results of the scar. However, ellipse with suture excision has the advantage of having a lower relapse.

Keywords: NEVUS, INTRADERMAL; AMBULATORY SURGICAL PROCEDURES; SKIN; THERAPEUTICS

Introduction: The treatment of sagging skin in body areas is still a big challenge, as there are few aesthetic procedures aiming to improve it.
The poly-L-lactic acid (PLLA) is an injectable synthetic polymer of the alpha-hydroxy acids family, which injection into the deep dermis or superficial hypodermis induces a local and gradual reaction, with synthesis of new collagen by the fibroblasts and consequent increase of dermal thickness.
Purpose: Evaluate the effects of poly-L-lactic acid on the sagging skin of the body.
Methods: Fourteen patients with sagging in gluteal region underwent two applications of poly-L-lactic acid with a 45 days interval between them. We performed an initial clinical evaluation and after six months of the second application, photos before and after six months of treatment, questionnaires answered by the patient and by the evaluating physician and ultrasound examination of all patients to assess the increase of dermal thickness. The adverse effects observed were also evaluated.
Results: In patient's opinion, 85% presented improvement of general appearance of the skin and 71% noticed improvement of sagging. For the evaluating physician, 100% of patients presented improvement of general appearance of the skin and improvement of sagging, but in different degrees and not proportional to the initial degree of severity. There was no significant side effects in the period evaluated.
Conclusions: The results are promising and should be confirmed with studies with a larger sample size.

Keywords: CUTIS LAXA; SKIN; BUTTOCKS

Introduction: The evolution of filling techniques allowed a three-dimensional approach to the face: nowadays volumetric restoration is more important than grooves.
Objective: Description of an unpublished technique of facial volumization through the injection of filler in the supra-auricular region, with a detailed review of the regional anatomy.
Methods: A retrospective case-control study was conducted in patients presenting skin mobility in the temporo-parietal region. The injection of Hyaluronic Acid for volumetric replacement was done using cannulae, bolus and fan techniques in the supra-auricular region, limited antero-superiorly by the area of ¿¿hair implantation and inferiorly by the tragus. The patients were evaluated clinically, photographed and had their data analyzed by statistics.
Results: 152 women and 13 men aged 24 to 84 years were treated between July and September 2016. The volume of Hyaluronic Acid used in the patients ranged from 0.6 to 2.6 ml. In 8 cases local edema was observed due to hematoma during application, that was controlled by digital compression. Significant improvement of the facial contour was observed.
Conclusion: The use of fillers in the supra-auricular region allows a three-dimensional approach and promotes static and dynamic rejuvenation of the entire face.

Keywords: DERMAL FILLERS, HYALURONIC ACID; REJUVENATION

Introduction: Male androgenetic alopecia, has high prevalence and causes great discomfort in patients. The platelet-rich plasma generates an environment acts to create a suitable microenvironment for tissue repair and possibly prolongs the anagen phase of the hair follicles.
Objective: To evaluate the safety, efficacy and viability of the PRP use for the treatment of male androgenetic alopecia. Methods: We selected 08 male patients with androgenetic alopecia. Participants had the side of the scalp randomized scalp to receive PRP or placebo. 3 were performed monthly applications.
Results: Patients who received treatment realized some degree of improvement especially as regards the fall. The results were obtained through the analysis dermatoscopic was evaluated as "trichoscale". We observed an increase of anagen hairs, down telogen hairs and vellus wires and increase terminal wires. The results were statistically significant as the reduction of vellus wires and increase of terminals wires.
Conclusions: This study showed a clinical improvement observed for photos as well as positive results documented by analysis "trichoscale". There was statistical significance of data obtained especially after the first month of treatment.

Keywords: ALOPECIA; PLATELET-RICH PLASMA; MEN

Filler injections are among the most popular cosmetic procedures performed worldwide. Although fillers have a safety profile, there has been a rise in litigation as a result of treatments in the USA. In the Brazilian scenario, the number of non-surgical procedures has increased in the past years, mainly due to the increase of filler options available in the Brazilian market, as well as in the type of professionals allowed to perform injectable procedures. Therefore we sought to review the related literature regarding semi-permanent and temporary fillers adverse effects and outline a practical guide for complications avoidance, diagnosis and management.

Keywords: GRANULOMA; ISCHEMIA; ESTHETICS; HYALURONIC ACID; DERMIS; SUBCUTANEOUS FAT; BIOFILMS; INFECTION

Adverse reactions associated with drugs presenting cutaneous manifestations are among the most common, expressing itself with multiple clinical aspects and causing significant morbidity. The fixed drug eruption (FDE) is a common adverse reaction with cutaneous involvement and is associated with the use of numerous drugs. Dipyrone is a drug with analgesic and antipyretic effects prescribed widely used in Brazil, however, it is known for its potential to triggering adverse reactions, including the FDE. This report shows an EMF case related to the use of dipyrone, with unique clinical presentation and correlate the clinical, histopathological and dermatoscopic found.

Keywords: DERMOSCOPY; FACE; PATHOLOGY

Repairing surgical defects of the nasal tip is challenging, mainly because of the lack of freely mobile skin available peripherally. The Peng flap is a one-stage cutaneous flap that circumvents this difficulty by recruiting skin from the nasal dorsum and sidewall regions. The design produces a tridimensional shape perfectly adapted to the conFiguretion of the nasal tip and allows for an inconspicuous closure of the defect. Herein, we describe a modified version of a Peng flap in a single-stage procedure, performed in three patients subjected to excison of basal cell carcinomas.

Keywords: NOSE; NOSE NEOPLASMS; CARCINOMA, BASAL CELL; SURGICAL FLAPS

The skin flaps are surgical techniques particularly useful to aesthetic repair in cases of extended excision and/or unusual sites, as in the ear. Many skin flaps options were already reported, resulting in variable results of the theoretical knowledge and practical experience of the surgeon. This article aims to describe two successful cases of ear reconstruction with the use of anterior and posterior flaps and to review the current literature.

Keywords: SURGICAL FLAPS; EAR; CARCINOMA, BASAL CELL

Exogenous Ochronosis is a rare skin disease. It is usually associated with the topical use of hydroquinone, resulting in a grayish or bluish black hyperpigmentation due to dermal deposition of ocher pigment. There is no gold standard treatment and the therapeutic options are generally not effective. We report a case of a patient with exogenous achronosis after use of Hydroquinone, treated with CO₂ Laser and showing very good results.

Keywords: HYDROQUINONES; LASER THERAPY; OCHRONOSIS

Dermatofibrosarcoma protuberans is an uncommon and relapsing fibrohistiocytic tumor of intermediate malignancy. Its rarest variant is known as atrophic, morphea type or dermatofibrosarcoma non protuberans and its clinical diagnose is difficult. There are not well established dermatoscopic criteria, so the diagnosis is histopathologic. There are advances in immunohistochemical and genetic that help the diagnosis and complete surgical excision. It is reported a case of atrophic dermatofibrosarcoma in a 27 years patient ant it is reviewed the clinical, dermoscopic, histological and genetic aspects.

Keywords: DERMOSCOPY; NEOPLASMS; DERMATOFIBROSARCOMA

Inflammatory acne lesions may cause unaesthetic scars. Several treatments have been described to ameliorate its appearance. Will be described the treatment with subcision in two patients with acne and dystrophic crateriform facial scars. The female patient performed Microneedling in the same session of subcision. There was good clinical outcome in the treated areas of both patients after three monthly sessions.

Keywords: CICATRIX; ACNE VULGARIS; CASE REPORTS

The evolution in surgical techniques for treatment of vitiligo has been producing extremely satisfying results in patients with stable vitiligo, without Köebner phenomenon and resistants to other types of treatment. Many techniques are available and should be used accordingly to the patient and to the dermatologist experience to optimize the results.

Keywords: VITILIGO, SURGERY, TRANSPLANTATION, DERMATOLOGIC SURGICAL PROCEDURES

Introduction: Hyperhidrosis is a common disease characterized by excessive sweating. Several treatment options are described as axillary liposuction and laserlipolysis.
Objective: To compare the effectiveness of two treatment methods for axillary hyperhidrosis – one exclusively surgical (liposuction) and the other employing invasive laser therapy (laserlipolysis) – using a prospective, comparative study with a one-year follow up.
Methods: Liposuction was carried out in the right axilla, while laser lipolysis was performed in the left axilla. The evaluation was conducted using the starch-iodine test, comparative histological analysis and patient self-assessment questionnaires.
Results: Twelve patients took part in the study. The starch-iodine test indicated decreased sweating in all patients within one year after the procedures, while the histological analyses showed absence or reduction of the secreting ducts and acini on both sides and in all cases. After one year of follow-up, the patient's satisfaction index measured by the questionnaires remained positive in all cases, with 75% asserting maximum satisfaction, and 25% reporting difference between the sides (better results were described in the right hand side axilla).
Conclusions: Both techniques showed similar effectiveness after one year of follow-up. Laserlipolysis had a lower frequency of postoperative complications.

Keywords: LASERS; LASER THERAPY; DERMATOLOGY; DERMATOLOGIC SURGICAL PROCEDURES

Introduction: In the dermatologic surgery practice, Mohs micrographic surgery is of great value in the excision of cutaneous neoplasias. Nevertheless, in certain types of neoplasia, immunohistochemistry can increase diagnostic accuracy.
Objective: To describe the use of Mohs micrographic surgery associated to immunohistochemistry and evaluate their effectiveness regarding traditional methods.
Method: Mohs micrographic surgery was performed in 5 cases of diverse cutaneous neoplasias. Tissue evaluation with hematoxylin-eosin and immunohistochemistry were carried out intraoperatively.
Results: There was greater prevalence of elderly female patients with higher frequency of recurred basal cell carcinomas in the face. In all cases it was possible to perform immunohistochemistry in the frozen specimen. In most cases, primary closure was carried out in the first stage of the Mohs surgery, without postoperative complications.
Conclusion: The combination of the two techniques can increase the procedure's sensitivity, guaranteeing the presence of free margins, leading to fewer recurrences and allowing the preservation of a greater amount of neoplasia-free tissue.

Keywords: MOHS SURGERY, IMMUNOHISTOCHEMISTRY, SKIN NEOPLASMS

Introduction: Numerous techniques have been described to treat the earlobe aging. Surgical and nonsurgical methods as peelings, CO₂ laser and fillings have been proposed to produce collagen remodeling.
Objective: The objective of this retrospective clinical study was to evaluate the effectiveness of microneedling assisted radiofrequency for earlobe aging.
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: Twelvy patients aged between 48 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 75% in four patients, 100% in eigth patients. Post-inflammatory hyperpigmentation was observed ten to 15 days after the treatment in five patients, though it was reversed after clinical treatment.
Conclusion: This new procedure emerges as an alternative treatment for earlobe aging.

Keywords: EAR CARTILAGE; PULSED RADIOFREQUENCY TREATMENT; REJUVENATION

Injectable fillers have long been used for cosmetic purposes and in HIV induced lipodystrophy patients. A foreign body granuloma may be a side effect of the application of absorbable products/temporary and most often the nonabsorbable/permanent fillers. It is not possible to predict the formation of these granulomas, and it may occur regardless of the application technique. In this article we describe the surgical treatment of a patient with multiple granulomas caused by intradermal injection of PMMA in the face, with poor response to conservative treatments, and severe psychosocial impairment due to this unsightly and disfiguring complication.

Keywords: POLYMETHYL METHACRYLATE; GRANULOMA; AMBULATORY SURGICAL PROCEDURES

The nevus sebaceous of Jadassohn is a congenital benign hamartoma of the skin that occurs more frequently in the scalp, but can also arise in the face. Due to its potential for malignization, exeresis is often required. Lesions located in the scalp are challenging to surgeons because of the anatomical characteristics of this body site, namely scarcity and inelasticity of the adjacent skin. In the present report, the authors describe a case of excision of a nevus sebaceous of Jadassohn located in the scalp, using a bilateral rotation flap – a very straightforward and versatile technique, excellent for reconstructing difficult topographies such as the scalp – for the closure of the surgical wound.

Keywords: AMBULATORY SURGICAL PROCEDURES; NEVUS, SEBACEOUS OF JADASSOHN; SURGICAL FLAPS