Hydroquinone has been used as a whitening agent for more than 50 years, however its safety and toxicity have been questioned in the last two decades. In the present literature review, it is possible to verify that its carcinogenic and mutagenic potential in humans has not been proven to date. In addition, the population is in fact much more exposed to hydroquinone than commonly perceived, via both cosmetic compounds (e.g. hair dyes) and foods (e.g. pear, beverages and coffee). Therefore, prescribing hydroquinone as a depigmenting agent in concentrations of up to 4% is safe and devoid of systemic consequences.

Keywords: HYDROQUINONE; TOXICITY; MELANOSIS; SAFETY

Introduction: In the last decade, the use of hyaluronic acid fillers for facial enhancement has increased in Latin America. Hyaluronic acid fillers are considered relatively safe with a low incidence of adverse events. Because adverse events are not seen frequently in clinical practice or have been potentially underreported, there is a need for more guidance on the diagnosis and treatment of Hyaluronic acid-related adverse events. Objective: To provide an enhanced understanding of hyaluronic acid-related adverse events and to propose recommendations for their diagnosis and treatment. Methods: A 25-member multi-disciplinary expert panel meeting of Latin-American physicians was convened in Sao Paulo, Brazil to discuss what is known about hyaluronic acid-related adverse events and to provide insights based on clinical experience. Recommendations and algorithms were developed through a consensus process. Results: The panel categorized hyaluronic acid-related adverse events based on 3 time frames of onset (immediate, early and Late) and proposed a new term for adverse events that display persistent, intermittent, delayed Swelling (PIDS). Algorithms were created for diagnosis and treatment for each time frame. Conclusions: The new consensus algorithms for time-related diagnosis and treatment of hyaluronic acid-related adverse events will provide guidance for best practices in the clinical use of hyaluronic acid fillers.

Keywords: COSMETIC TECHNIQUES; DERMAL FILLERS; HYALURONIC ACID; INFLAMMATION; SUBCUTANEOUS INJECTIONS

Introduction: Melasma is a pigmentation disorder that mainly affects women of childbearing age with high phototypes. Polypodium leucotomos has antioxidant, photoprotective and immuno-modulatory activity, and can be considered as an adjunctive treatment for melasma.
Objective: To evaluate the efficacy, in relation to quality of life and objective improvement, of the use of Polypodium leucotomos in the treatment of melasma.
Methods: Prospective and individualized study. Nine volunteers with melasma were submitted to treatment with Polypodium leucotomos for 45 days. MELASQoL, DLQI and MASI scores were calculated at the beginning (D0) and 45 days after (D45). Analysis of variance ANOVA with Tukey post-test for comparison be-tween D0 and D45 (p <0.05).
Results: All patients were females, mean age of 37.18 ± 6.78 years. Family history of melasma in 55.6%; 88.9% with unprotected photoexposure and use of estrogen. After 45 days of treatment with Polypodium leucotomos there was a significant reduction of ME-LASQoL and DLQI (p <0.05) and improvement of MASI in 55.6% of the patients.
Conclusions: There was improvement of MASI in 55.6% of patients after 45 days of treatment. In spite of the slight improvement in MASI, there was a reflex in the improvement of quality of life scores (DLQI and MELASQoL).

Keywords: MELANOSIS; POLYPODIUM; QUALITY OF LIFE; INDICATORS OF QUALITY OF LIFE

Introduction: The use of hyaluronic acid fillers (HA) for esthetic corrections has exponentially grown in recent years. Skin ultrasound (US) is an effective method to identify the filler and its complications. A particular type of adverse effect, characterized by late, persistent edema of an intermittent nature, has been lately observed. Objective: To describe a delayed complication due to easy HA fillers, named by the authors as Persistent, Intermitent Delayed Swelling (PIDS). Methods: From October 2016 to July 2017, US examinations performed at Cavallieri Clinic were selected and referred for evaluation of post-filler complications. Questionnaires were sent to requesting physicians for clinical data collection. Results: Of 108 exams, 33 cases of local subcutaneous edema associated with the presence of HA fillers were identified. Episodes of edema were referred to as recurrent, in the previously affected area, or at another injection site. Conclusion: The authors propose a specific nomenclature: PIDS to refer to this late adverse reaction to HA fillers, which includes delayed and intermittent local swelling, triggered by specific conditions, that persists for as long the HA remains in the subcutaneous tissue.

Keywords: DERMAL FILLERS; HYALURONIC ACID; ADVERSE EFFECTS; SKIN ULTRASOUND

Introduction: Non-melanoma skin cancer is among the most frequent neoplasms in Brazil and is deemed a public health problem. Initial diagnosis is based on clinical suspicion and includes dermoscopy. Confirmation is carried out via histological analysis. Dermoscopy also contributes to the demarcation of tumor safety margins. Objective: To analyze the accuracy of dermoscopy in the diagnosis of non-melanoma skin cancer and its effectiveness in defining the lateral margins of these tumors in excisional biopsies. Methods: Comparison of the dermoscopy-based diagnostic hypothesis with the final histological outcome and involvement of lateral margins. Results: The data relating to a total of 70 lesions suspicious of non-melanoma skin cancer arising from a group of 50 patients were evaluated from 2015 to 2017. The comparison of the diagnostic hypothesis with the final histological outcome after excisional biopsy, indicated success rates of 79.6% for suspected cases of basal cell carcinoma and 23.8% for squamous cell carcinoma. Safety margins were observed in 74% of basal cell carcinomas and in 60% of squamous cell carcinomas. Conclusions: The diagnosis of non-melanoma skin cancers depends on experienced dermatologists and pathologists, with the interaction between these professionals being crucial. Dermoscopy has contributed in a more significant way to the diagnosis of basal cell carcinoma when compared to that of squamous cell carcinoma.

Keywords: SKIN NEOPLASMS; DIAGNOSIS, DIFFERENTIAL; MARGIN

Introduction: Currently there is a growing demand for non-invasive therapies aimed at treating facial aging. Non-ablative fractional lasers lead to excellent outcomes, with reduced side effects. Objective: To evaluate the facial rejuvenation achieved by 1,340nm non-ablative fractional laser using a single pass at high energy versus three passes at medium energy, through a prospective comparative study. Methods: Twenty patients with facial aging were treated with 2 or 3 laser sessions with 4-week intervals. The right hemiface was treated with three passes of 1,340nm non-ablative fractional laser at a fluence of 90 mJ, pulse duration of 5ms and 100 mtz/ cm2. The left hemiface was treated with a single pass of the same laser at a fluence of 120 mJ, pulse duration of 5ms and 100 mtz/cm2. The evaluated variables were spots, wrinkles, porphyrins and overall appearance. Results: The patients (n = 20) were evaluated during 6 to 24 months. The photographic evaluations demonstrated a significant improvement of the spots on the right hand side and wrinkles on the right and left hand sides. Eighteen of the 20 patients reported satisfaction with the treatment. Conclusion: 1,340nm non-ablative fractional laser was proven as a modern, safe and effective alternative for facial rejuvenation. For spots, the triple passes at medium energy protocol led to a superior response. However, regarding wrinkles there was no difference between the single pass at high energy and triple pass at medium energy protocols.

Keywords: LASER; REJUVENATION; FACIAL AGING; FACE

Introduction: Depressed acne scars always arise as a therapeutic challenge. Fractional lasers, surgical approaches and chemical peels have attempted to offer acceptable aesthetic results, however it is still difficult to determine the ideal treatment. Objective: To evaluate the efficacy of Percutaneous Collagen Induction with needles (IPCA^®) associated with Pulsed Radiofrequency with Multineedles (RFPM^®) in depressed acne scars. Methods: Retrospective study of the safety and effectiveness of the technique through the evaluation of results based on a satisfaction questionnaire answered by the patients and the clinical and photographic assessment carried out by a dermatologist. Results: Thirteen patients (aged between 21 and 37 years) who had undergone the combination treatment were evaluated. All (100%) reported satisfaction with the outcomes, while in the comparative evaluation of photographs yielded an improvement rate of 50% in 2 patients and of 70% in 6 patients. Conclusion: This new therapeutic proposal arises as an alternative in the treatment of depressed acne scars.

Keywords: SCARS; PULSED RADIOFREQUENCY TREATMENT; COLLAGEN

Introduction: In the Brazilian public health system, the current demand for dermatological procedures is greater than the offer, resulting in a waiting list of patients bearing dermatoses to be treated surgically. Aimed at reducing that waiting list, a collective effort of surgical procedures was carried out in the tertiary public health service. The corresponding data on the patients and lesions is disclosed in the present study. Objective: To assess the profile of the patients – and respective skin lesions – who are awaiting to undergo dermatological procedures. Methods: A simple descriptive profile analysis of the patients, treated dermatoses and procedures performed was carried out. Results: Thirty-one patients (aged between 21 and 95 years, mean = 63.7 years). Seventeen (54.83%) were women and 14 (45.17%) were men. Thirty-eight lesions were treated: 21 neoplastic (carcinomas and melanomas), 8 pre-neoplastic (actinic keratoses) and 9 non-neoplastic (nevi, keloid and neurofibroma). Conclusions: The present article is relevant due to the fact it identifies cases and patients awaiting dermatological surgical procedures in the public health system. Based on it, a better planning of public health strategies in the dermatological field should be possible. Also, it highlights the importance of the dermatologist physician’s action in the public health, diagnosing and treating pre-neoplastic and neoplastic lesions.

Keywords: DERMATOLOGY; AMBULATORY HEALTH SERVICES; HEALTH CENTERS; POPULATION STUDIES IN PUBLIC HEALTH; PUBLIC HEALTH; PUBLIC HEALTH ADMINISTRATION; NEOPLASMS; MELANOMA; CARCINOMA; CARCINOMA, BASAL CELL

Introduction: Photoprotectors are the active ingredients of sunscreens with the capability of protecting the skin against UV radiation. An increasing number of such photoprotection ingredients have been launched in the marketplace, causing sunscreens' formulas to become increasingly varied. Objective: To list the main active photoprotection ingredients contained in formulations commercially available in Brazil, as well as to document the presence of other ingredients contained in sunscreens. Methods: The authors inspected four drugstores in the city of Rio de Janeiro, Brazil, and analyzed the formulas of the SPF 30 sunscreens available. The active photoprotector substances found in all formulations were listed and the percentage of each of them was compared to those contained in all sunscreens evaluated. The presence of plant extracts and antioxidants was also documented. Results: Thirty commercially available SPF 30 sunscreens were found in different drugstores, having their formulas analyzed. Within this sample, there were 17 different active photoprotection principles, of which titanium dioxide was the most frequently found, followed by bis-ethylhexyloxyphenol methoxyphenyl triazine. Conclusion: The present study lists the profiles of photoprotection active principles found in the main sunscreens on sale in Brazil and provides data for further evaluation of changes in these profiles over time, as new sunscreens are launched in the marketplace.

Keywords: PHOTOPROTECTORS; SUNSCREENS; PHOTOPROTECTION; ULTRAVIOLET RAYS

The use of skin flaps for covering lesions is a better option than skin grafts, due to the diversity of the receptor area after the tumor’s resection and the greater degree of safety. For better results, the lesion’s location and extent, as well as the safety of the vascularization, should also be taken into account. Three resections were performed, with different coverage techniques. The patients had excellent development, without necrosis or dehiscence.

Keywords: RECONSTRUCTIVE SURGICAL PROCEDURES; SURGICAL FLAPS; FREE TISSUE FLAPS; PLASTIC SURGERY; SKIN DISEASES

The presence of foreign bodies located on the skin, their size, constitution and precise location are often not perceptible on dermatological clinical examination. Despite their benign nature, the presence of foreign bodies in the skin is associated to high morbidity. High frequency ultrasonography has been widely used in different areas of Dermatology. Technological development and the introduction of devices offering high frequency and high resolution makes this method useful in identifying and guiding the removal of foreign bodies located in the skin. The authors describe a case where high frequency ultrasonography was used to identify and remove a rayfish stinger.

Keywords: ULTRASOUND; ULTRASSONOGRAPHY; FOREIGN BODY; SURGERY

Sporotrichosis is a disease caused by the dimorphic fungus Sporothrix spp. The number of cases has been increasing, notedly in the city of Rio de Janeiro, Brazil, where it is now considered a public health problem. The recommended treatment employs antifungals, however in case of persistence of the lesions or when there is contraindication, cryosurgery is an option, since the fungus is sensitive to extreme temperatures. The authors report 3 cases of sporotrichosis treated for longer than 6 months with itraconazole and/or potassium iodide, all yielding incomplete response and where cryosurgery was successfully used as an adjuvant treatment.

Keywords: SPOROTRICHOSIS; OPPORTUNISTIC INFECTIONS; CRYOSURGERY

Second case report in the literature regarding beard alopecia observed after the third session of injections of 1% deoxycholic acid for reduction of submental fat.

Keywords: ALOPECIA; SUBCUTANEOUS FAT; DEOXYCHOLIC ACID

Herpes zoster outbreaks following minor procedures have been documented recently in literature. Since the use of botulinum toxin is nowadays spread in several medical areas for different purposes, it is crucial to study its side effects and complications. Literature review revealed 65 cases of zoster reactivation following minor procedures, and three cases related to BTA injections (two for facial lines treatment and one for chronic migraine). In our case, a 43 year old healthy woman had herpes zoster on the face and scalp after receiving BTA injections for cosmetic purpose, with complete recovery after anti-viral treatment.

Keywords: HERPES ZOSTER OPHTHALMICUS; HERPES ZOSTER; BOTULINUM TOXINS, TYPE A; DERMATOLOGIC SURGICAL PROCEDURES

Lichen sclerosus is a chronic dermatosis, usually anogenital and mainly affecting pos-menopausal women. The use of topical corticosteroids is the mainstay of medical treatment. Other treatments are topical testosterone, calcineurin inhibitors, photodynamic therapy, cryotherapy, antibiotic therapy and laser therapy. In this article, five patients with vulvar lichen sclerosus which had no response to treatment with topical clobetasol, had good results when treated with fractional Erbium:YAG laser 2940.

Keywords: LASER THERAPY; VULVAR LICHEN SCLEROSUS; 17-HYDROXYCORTICOSTEROIDS

Vitiligo is a hypopigmentation disorder that is characterized by macules and selective destruction of functional epidermal melanocytes. It is characterized by defilements and circumscribed depigmented patches. Vitiligo affects around 0,5% about 0.5% -2% of the general population worldwide, and is not observed preference for sex and ethnicity. The goals of treatment are repigmentation of vitiligo and stabilization of depigmentation process. We report the case of a 53-year-old female patient who underwent underwent experimental stem cell therapy with autologous biologically expanded stem cells isolated from hair follicle, holding three sessions with three months apart. The vitiligo affected area was relatively decreased in density with a rare repigmentation pattern.

Keywords: STEM CELLS; VITILIGO; THERAPEUTICS