Intense pulsed light is a device that emits high intensity, polychromatic, non-coherent and not collimated light. IPL versatility allows combining parameters to treat a variety of skin vascular and melanocytic lesions, epilation and non ablative photorejuvenation. This article describes classic and innovative indications for intense pulsed light use based on medical literature.

Keywords: INTENSE PULSED LIGHT THERAPY; SKIN DISEASES; COSMETIC TECHNIQUES

Introduction: Androgenetic alopecia is the most common type of hair loss in men and women. Nowadays, medication based treatments are the most frequently used nevertheless they yield poor results. More recently, the use of lasers has been proposed to treat this condition. At the same time, the infiltration of medications in the scalp has also been growing as a therapeutic option, although there are few scientific studies on this treatment modality.
Objective: To evaluate the results of using 1,550nm Erbium-Glass laser associated with the injection of active principles (minoxidil, finasteride, growth factors and a vitamin complex) for the treatment of male and female androgenetic alopecia.
Methods: A retrospective study was carried out with patients with androgenetic alopecia diagnosis, who underwent monthly sessions of the proposed combination therapy. The results were evaluated by means of comparative photographs taken before and after the treatment period and the assessment of the patients' opinion.
Results: Sixty-two patients were treated with 3 to 14 sessions; 48.39% of patients had mild improvement, and 46.77% had significant improvement. The vast majority (96.77%) was satisfied with the treatment. The patients who were very satisfied with the outcomes underwent a greater number of sessions (more than six, on average).
Conclusions: The association of 1,550nm Erbium-Glass laser therapy with the injection of active principles in the scalp is an effective and safe option for the treatment of androgenetic alopecia.

Keywords: ALOPECIA; LASERS; THERAPEUTICS

Introduction: The application of botulinum toxin in the perioral region is a minimally invasive procedure that leads to substantial improvement in the signs of aging in addition to increasing the volume of the lips. However literature on this procedure is still scarce.
Objective: To evaluate changes in shape and volume of the lips, as well as the patients' satisfaction after the application of botulinum toxin in perioral lines.
Methods: Nineteen patients underwent evaluation, photographic record and measurements following the application of botulinum toxin in the perioral region, being subsequently assessed for changes in the lips and satisfaction.
Results: Most of the patients rated their lips as moderately or significantly more attractive after the application of botulinum toxin (p = 0.039). Fifteen women deemed the changes in the lips as a major factor in the overall improvement of their faces.
Conclusions: The use of botulinum toxin in the perioral region leads to the elevation of the upper lip, causing the shortening of the philtrum and the extension of the vermilion. The application of botulinum toxin in the vermilion's border leads to the relaxation of the orbicularis muscle, favoring a more intense tonus effect arising from the upper lip lifting muscles. The patients' satisfaction with the appearance of their lips was evaluated by four additional questions (linked to the lip's shape, volume, attraction and beauty), receiving positive answers. Side effects were minimal.

Keywords: LIP; BOTULINUM TOXINS, TYPE A; BOTULINUM TOXINS

Introduction: Subcutaneous mycoses caused by dematiaceous fungi are classified according to their characteristics in the tissue: chromoblastomycosis (with the presence of fumagoid corpuscles), phaeohyphomycosis (with dematiaceous septate hyphae) and eumicetoma (with grains composed of septate hyphae). Several treatments are proposed, among them, surgical excision. Surgical treatment is more indicated in cases where there is localized infection and where excision is possible, yielding good therapeutic outcomes and low recurrence rates.
Objective: To describe the experience of a dermatological service in the surgical treatment of subcutaneous mycosis cases caused by dematiaceous fungi, discussing the surgical approach and its results.
Methods: A retrospective study was carried out with the descriptive analysis of cases treated from April 2014 to December 2016, at a dermatological clinic in the Brazilian Southeast city of São Paulo. All cases diagnosed with subcutaneous mycoses caused by dematiaceous fungi were included and surgically treated with total exeresis of the lesion.
Results: A total of 7 cases were analyzed – 2 eumicetomas, 1 chromoblastomycosis and 4 phaeohyphomycoses. Only one on the cases was not treated at an ambulatory surgical center. All cases progressed without sequelae or recurrences during the clinical follow-up.
Conclusions: When surgical treatment is possible, the exeresis of the lesion is a good therapeutic option in cases of subcutaneous mycoses caused by dematiaceous fungi.

Keywords: CHROMOBLASTOMYCOSIS; PHAEOHYPHOMYCOSIS; BACTERIAL INFECTIONS AND MYCOSES; MYCOSIS; MYCETOMA; AMBULATORY SURGICAL PROCEDURES; BLOODLESS MEDICAL AND SURGICAL PROCEDURES; HISTOLOGY; THERAPEUTICS

Introduction: Cryosurgery is a safe and effective treatment modality that uses liquid nitrogen for tissue destruction.
Objective: To demonstrate the effectiveness of cryosurgery in the treatment of hypertrophic granulation tissue in cutaneous wounds.
Methods: Cutaneous wounds with hypertrophic granulation tissue were treated with the nitrogen spray applied from a distance of 5cm from the area to be treated, at a 90º angle. The freezing time was two 5-second cycles and the number of sessions ranged from 1 to 3. The assessments of results were based on weekly clinical and photographic comparisons, as well on the measurement of the wound's and hypertrophic granulation tissue's areas using a planimeter, up until the healing process was completed. The results were statistically analyzed.
Results: Twenty patients with cutaneous wounds located on the head, trunk and limbs were treated. The average weekly percentage reduction compared to the baseline area was 32.5%. The results were statistically significant.
Conclusions: Cryosurgery is a practical, cost effective and non-invasive method and can be indicated for the treatment of hypertrophic granulation tissue in cutaneous wounds.

Keywords: GRANULATION TISSUE; CRYOSURGERY; THERAPEUTICS

Introduction: Overexposure of the skin to the sunlight can cause photoaging and promote the emergence of malignant neoplasms. Sunscreens are used to prevent these alterations and may occasionally cause adverse reactions in children and adults.
Objective: To analyze the frequency and types of adverse reactions caused by sunscreens in adults and children.
Methods: Data analysis of in vivo, non-invasive clinical studies performed at a clinical research institute.
Results: Data from 2,263 adults and 523 children were evaluated, with 13.92% and 4.44%, respectively, presenting some type of reaction.
Conclusions: Sunscreens are effective in preventing photoaging and skin cancer. Cosmetic formulations containing sunscreens may cause adverse reactions with low prevalence.

Keywords: SUNSCREENING AGENTS; CONTROL AND SANITARY SUPERVISION OF COSMETICS; SUN PROTECTION FACTOR; COSMETICS

Introduction: The use of nutraceutical products in order to attenuate signs of skin aging has been proposed in the literature. The stimulus to the synthesis of substances that support the dermis is one of the mechanisms linked to this effect.
Objective: To evaluate the effectiveness of a nutraceutical compound containing lutein, lycopene, vitamin C and manganese for the synthesis of collagen, elastin and hyaluronic acid.
Methods: An in vitro study was carried out based on the culture of human fibroblasts treated with the investigated product in different non-cytotoxic concentrations. The quantification of the elastin and collagen was performed with the assistance of spectrophotometric measurements. Hyaluronic acid was measure using a immunoenzymatic method.
Results: Cell cultures treated with the different concentrations of the product showed a significantly higher amount of synthesized collagen, elastin and hyaluronic acid as compared to the untreated culture (p <0.05).
Conclusions: The use of the nutraceutical compound containing lycopene, vitamin C, lutein and manganese has shown in vitro efficacy for stimulating the synthesis of collagen, elastin and hyaluronic acid, components that are crucial for providing the dermis' supporting structure, being responsible for the skin's firmness and elasticity.

Keywords: DERMATOLOGY; DIETARY SUPPLEMENTS; SKIN AGING

Introduction: The use of a median-frontal flap for nasal reconstruction was first described in 600 B.C., and it is still widely used for the reconstruction of nasal tumoral lesions.
Objective: To report the experience of a medical school's plastic surgery service in the use of this flap type.
Methods: A retrospective descriptive study was carried out with a series of 35 cases surgically treated from January 2005 to June 2015.
Results: The patients' mean age was 68.6 (± 10.8) years, with a predominance of the male gender (68.6%). The median-frontal flap was used for reconstruction after resection of tumors, with basal cell carcinoma being the most frequent.
Conclusions: The median-frontal flap is the ideal reconstructive choice for many patients, with good aesthetic and functional outcomes.

Keywords: SURGICAL FLAPS; RECONSTRUCTION; NOSE; NOSE NEOPLASMS

Introduction: Increased distance between the base of the nose and lip's vermilion is difficult to treat, and often there are restrictions for the use of botulinum toxin and cutaneous fillers.
Objective: To describe a new technique for the treatment of the upper lip ptosis.
Methods: A prospective pilot study was conducted with 15 female patients bearing increased distance between the base of the nose and the labial cutaneous-mucosal transition line. Five weekly sessions of intraoral non-ablative 2,940nm Er:YAG laser were performed. For the evaluation of outcomes, standardized records were performed with a 3D photographic camera, and comparative measurements of the philtrum's height and the nasolabial angle were taken before and after the treatment.
Results: There was a shortening ranging from 2 to 4 mm in the philtrum's measurements, and a decrease in the nasolabial angle, in addition to increased firmness of the skin in the upper lip.
Conclusion: Intraoral non-ablative 2,940nm Er:YAG laser can be a therapeutic option for the treatment of upper lip ptosis.

Keywords: AGING; LASERS; LIP

The concept of facial rejuvenation currently includes a three-dimensional perspective, which recognizes as signs of aging not only the loss of the skin's texture and the emergence of expression wrinkles, but also the volumetric losses secondary to bone remodeling and redistribution of facial fat. This article was aimed at reviewing the literature on poly-L-lactic acid for facial rejuvenation – including its indications, injection techniques, expected results and possible adverse effects – and offer practical guidelines, based on the authors' 12-year experience with the product.

Keywords: SKIN AGING; INJECTIONS; COLLAGEN

Lichen planopilaris is a rare disorder that belongs to the primary scarring alopecia type. The present study describes the case of a female patient bearing desquamative erythematous plaques and follicular plugs bilaterally in the frontoparietal region, associated with positive pull test. The biopsy's result was consistent with lichen planopilaris and the patient was treated with prednisone associated with clobetasol, with regrowth of the hair in the affected area. The treatment of this pathology is a challenge due to the lack of data on efficacy of therapies and constant recurrence. The picture is irreversible if not treated early. This paper describes a classic case of a case of lichen planopilaris with good therapeutic response, highlighting the importance of early diagnosis, due to the fact that most cicatricial alopecias do not produce scarring in their initial stage and should for this reason be managed as an emergency in trichology.

Keywords: ALOPECIA; EARLY DIAGNOSIS; LICHEN PLANUS

Hidradenitis suppurativa is a chronic inflammatory, recurrent and debilitating skin disease. Its etiopathogenesis involves follicular occlusion and genetic, environmental and immunological factors. Diagnosis is predominantly clinical, and the therapeutic approach is a major challenge due to its impact on the patient's quality of life. The surgical option is the most indicated in severe cases, nevertheless there is no consensus on the ideal treatment, as outcomes are diverse, and the aesthetic aspect after the procedure is generally unfavorable. This article was aimed at reporting a surgical option with primary wound closure, whose aesthetic result was superior to those derived from traditional techniques.

Keywords: HIDRADENITIS SUPPURATIVA; HIDRADENITIS; DERMATOLOGIC SURGICAL PROCEDURES; DERMATOLOGY; THERAPEUTICS

The Merkel cell carcinoma is a rare tumor of neuroendocrine and epidermal origin and with poor prognosis. It is classically associated with immunosuppression, exposure to the sunlight and, more recently, with the polyomavirus. It is positive for epithelial and neuroendocrine markers. The combined expression of these markers confirms the diagnosis. Polyomavirus tumors have an unfavorable prognosis. The authors report a case of Merkel cell carcinoma with atypical immunophenotype (CK20 negative) and aggressive behavior. The present report is aimed at highlighting the importance of dermatologists having knowledge of different immunophenotypes that may be associated with the Merkel cell carcinoma.

Keywords: CARCINOMA, MERKEL CELL; IMMUNOHISTOCHEMISTRY; MERKEL CELL POLYOMAVIRUS

Introduction: Introduction: Not focused ultrasound is a noninvasive alternative to improve body contour.
Methods: It's reported five cases treated with eight weekly sessions of not focused ultrasound on the abdomen.
Results: The treatment did not affect the routine of patients; it was comfortable and safe for most. There was a reduction in the thickness of the fat layer evaluated by ultrasound and in the circumferential measures in all patients, with clinical improvement evidenced in the photographic documentation especially in patients with lesser thickness of subcutaneous.
Conclusion: The device was safe, and was shown clear reduction in abdominal subcutaneous tissue.

Keywords: ADIPOSE TISSUE; ULTRASONIC THERAPY; ULTRASONOGRAPHY; ABDOMINAL SUBCUTANEOUS FAT

The Hailey-Hailey disease or familial benign pemphigus is a rare condition, characterized by vesicular lesions and erosions with a predilection for intertriginous areas associated with pain and burning sensation that affect the quality of life of patients. There are many topical and systemic treatments for the injuries that can temporarily promote partial or complete remission, but there is no curative treatment. Some treatment options with lasting results include dermabrasion and Erbium laser resurfacing (YAG or CO2). We report three cases of patients with recurrent lesions and limited responses to classical treatments, which showed significant clinical improvement after fractional CO₂ laser therapy.

Keywords: PEMPHIGUS, BENIGN FAMILIAL; LASER THERAPY; CARBON DIOXIDE

Intradermotherapy, also known as mesotherapy, is a non-surgical procedure, minimally invasive consisting of multiple applications of pharmacological substances diluted by intradermally or subcutaneously. Adversities already been reported after treatment mesoterápico as alopecia, lichenoid rash, oleoma, psoriasis induction and skin infections. There is scant scientific information on the subject, and few studies with more rigorous methodology of the efficacy and mechanism of action of intradermally. Knowing this, there was this article having a complicating account of this method in a patient of our service, and elucidate some of its benefits and other complications.

Keywords: MESOTHERAPY; ALOPECIA; HAIR DISEASES

Six patients underwent two sessions of microneedling associated to drug delivery on the face, hands or stretch marks, at three-week interval between sessions. Patients were evaluated using clinical analysis and objective measures. Compared to baseline, objective face analysis showed decrease in acne lesions and improvement in the skin texture. The evaluation of stretch marks showed great improvement, and face and hands presented excellent results compared to baseline. The association of microneedling to drug delivery for rejuvenation of the face and hands, and for the treatment of stretch marks presented promising results in our study.

Keywords: ADMINISTRATION, CUTANEOUS; HYALURONIC ACID; REJUVENATION; STRIAE DISTENSAE; TRANEXAMIC ACID; HYDROXYPROLINE

The sebaceous nevus of Jadassohn is a congenital hamartoma that may develop into a malignant cutaneous neoplasia. Photodynamic therapy is used to treat actinic keratoses and superficial or nodular basal cell carcinomas, and the cutaneous field cancerization can be observed using the Wood's lamp during the performance of the technique. This article describes a case of photodynamic therapy used in the treatment of a basal cell carcinoma, which developed on a sebaceous nevus, where the field cancerization was demonstrated through the use of Wood's lamp. The procedure is a non-surgical alternative for the treatment of the basal cell carcinoma, with excellent aesthetic outcome. The patient is on clinical follow-up, with absence of recurrence of the neoplasia 18 months after the treatment.

Keywords: CARCINOMA, BASAL CELL; NEVUS, SEBACEOUS OF JADASSOHN; PHOTOCHEMOTHERAPY