The ear is a structure with anatomical peculiarities. It is located in an area exposed to trauma and susceptible to a series of dermatoses that are often underdiagnosed by dermatologists and deserve attention. A literature review was carried out including the embryology and anatomy of the auricular pavilion, as well as the diagnosis and treatment of traumatic lesions of physical nature and due to changes in temperature, among others.

Keywords: Anatomy; Ear; Ear diseases

Viral warts are one of the most prevalent dermatoses. The clinical picture varies from a single lesion with spontaneous cure to multiple recalcitrant lesions. Bleomycin sulfate is a cytotoxic action drug approved for the chemotherapeutic treatment of some malignancies. There are a number of studies that have been carried out during the last 45 years demonstrating its usefulness in dermatology, especially in intralesional therapy for viral warts, meaning it is an excellent option for lesions in difficult-to-handle topographies and for cases that do not respond to other approaches.

Keywords: Bleomycin; Drug therapy; Viral wart

Introduction: Retinoic acid in peeling solution is widely used in the treatment of photoaging. To date, the degree of sterility of these solutions or the safety of their use in skins whose integrity has been lost through microneedling interventions is unknown.
Objectives: To evaluate the bactericidal potential of 3% and 5% retinoic acid in peeling solution, with and without a colored vehicle, as well as the safety and tolerance to its administration immediately after application with microneedles.
Methods: Samples of 3% and 5% retinoic acid solution, with and without a colored vehicle, prepared by two dispensing pharmacies (A and B) were exposed to Pseudomonas aeruginosa and Staphylococcus aureus colonies. These solutions were used as drug delivery agents after percutaneous induction of collagen with needles.
Results: The samples evaluated in D0, D30, D60 and D90 indicated the presence of bactericidal capacity of the tested agents. The use of the solutions following intervention with microneedles was well tolerated and yielded satisfactory results.
Conclusion: The retinoic acid peeling solution can be safely used following procedures that lead to a loss of integrity of the skin barrier. The absence of adverse effects and good results yielded by the procedure suggest that the association of microneedling and retinoic acid peeling is an innovative, reproducible and safe proposal.

Keywords: Chemexfoliation; Therapeutics; Tretinoin

Introduction: Juvenile dermatomyositis (JDM) is a systemic disease that affects children’s proximal musculature and skin. The ulcerated stage of the disease is a therapeutic challenge.
Objective: To evaluate the improvement of ulcerated stage of JDM caused by the use of cell therapy.
Methods: Co-culture of autologous fibroblasts and keratinocytes, application of these cells in ulcers in conjunction with fibrin glue, and placement of chitosan-alginate or chitosan-xanthan membrane on the lesions.
Results: Less than 12 hours after therapy, the patient reported complete cessation of pain and, within 2 days, healing tissue emerged. Some of the ulcers were almost completely healed by the end of the 1st week, and some of the calcinoses disappeared. This technique does not cure the disease, however it improves the patient’s quality of life, and it is possible to cryopreserve healthy cells to treat new lesions. Given the fact that the cells are of autologous origin, the risk of rejection is eliminated. Furthermore, this procedure does not require debridement of the lesions or hospitalization.
Conclusions: The application of autologous cultures of fibroblasts and keratinocytes in ulcers is already considered an effective treatment in patients with burns and other skin wounds, and has now also been proven effective in the treatment of wounds in JDM.

Keywords: Calcinosis; Cell-and tissue-based therapy; Dermatomyositis; Fibroblasts; Keratinocytes; Polysaccharides; Wound healing

Introduction: Multiple approaches and the use of different surgical strategies seem to contribute to the goal of obtaining more satisfactory outcomes in rhytidoplasty. In light of this, liposculpture has been progressively becoming more relevant as an alternative to improve those outcomes, adding greater final aesthetic value to the procedure.
Objectives: To evaluate outcomes obtained in patients who underwent the association of rhytidoplasty and facial liposculpture.
Methods: Fourteen patients underwent classical Pitanguy rhytidectomy associated with liposuction in specific areas of the face, having been subsequently followed up for 12 months. Seventeen volunteers used the Antell & Orseck method to evaluate the postoperative outcomes.
Results: Of the 14 patients evaluated, 9 (64.2%) were classified as having experienced excellent outcomes, while 3 (21.4%) had moderate outcomes, and 2 (14.2%) had poor outcomes. None of the patients experienced outcomes rated as perfect or undesirable.
Conclusions: Rhytidoplasty associated with facial liposculpture is an important alternative for the treatment of facial aging, leading to satisfactory, safe and long lasting results.

Keywords: Cervicoplasty; Rejuvenation; Rhytidoplasty

Introduction: Latanoprost has been shown to have potential for the treatment of hair loss evidenced by increased thickness and length of eyelashes and hypertrichosis that can be observed when it is used in the periorbital region.
Objective: To evaluate the effectiveness of latanoprost, used isolatedly or in associations, for reducing hair loss and/or stimulating its growth in patients bearers of telogen effluvium or androgenic alopecia.
Methods: A comparative, double-blind study was carried out during 180 days, with 6 groups: G1 - placebo, G2 - 5% minoxidil, G3 - 5% minoxidil + 0.005% latanoprost, G4 - 0.005% latanoprost, G5 - 5% minoxidil + 0.010% latanoprost, G6 - 0.010% latanoprost. The total and percentage count of hair strands was carried out based on phototrichogram in the anagen and telogen phases.
Results: There was improvement in G2 (total number of hair strands, number of anagen strands in D92 and D180), G3 (total number of hair strands and number of anagen hair strands in D242), G4 (total number of strands in D182, and number of anagen hair strands in D92 and D182), and G5 (total number of hair strands in D182, percentage of telogen and anagen hair strands and number of anagen hair strands in D92 and D182). Treatment of G6 did not yield significant difference regarding the placebo.
Conclusions: The treatments with 5% minoxidil, 5% minoxidil + 0.005% latanoprost, 0.005% latanoprost, 5% minoxidil + 0.010% latanoprost were shown effective in controlling hair loss and in increasing the total number of hair strands.

Keywords: Alopecia; Hair; Minoxidil

Introduction: The number of cases of cutaneous carcinoma has been steadily increasing, which calls for the necessity of improving cost effective health strategies aimed at preventing that disease and related complications.
Objective: To perform a cross-sectional study with data collected directly from the participants, through the application of a questionnaire.
Methods: Once the data was collected, the bivariate logistic regression was used to calculate the odds ratio (OR) and the 95% confidence interval (CI) between the independent variables and the risk behavior, which corresponded to the non-daily use of sunscreen and/or other photoprotection method. The sample consisted of 200 students – of which 50% studied mathematical sciences and 50% studied biological sciences.
Results: There was no significant difference between the students' behavior according to the different science field they were studying. Women presented lower risk behavior as compared to men (OR = 0.07; CI 95% = 0.01 - 0.56).
Conclusions: Most university students do not protect themselves adequately when exposed to the sun, with this risk behavior being lower in women. Actions aimed at photo-educating students are important.

Keywords: Disease prevention; Skin; Solar radiation; Students

Introduction: Managing pain during the performance of dermatological procedures is a challenge. Several topical anesthetics are available for use prior to carrying out minimally invasive treatments.
Objective: To evaluate the efficacy of topical anesthetics for reducing the pain during dermatological procedures and to compare the effectiveness of two different anesthetics using the visual numeric pain scale.
Methods: Twenty-five patients underwent facial dermatological procedures after the application of two commercial preparations: one containing 7% lidocaine and 7% tetracaine (applied in one hemiface) and the other containing 4% lidocaine. Each of the preparations was applied in one hemiface. Pain intensity was assessed using the Visual Numeric Pain Scale (VNS) at the end of the procedure.
Results: Eighty-four percent of the patients reported a lower pain score in the hemiface that received the commercial preparation containing 7% lidocaine and 7% tetracaine. The mean pain score in the hemifaces that received the 4% lidocaine preparation was 7.3, while that computed for the hemifaces that received the 7% lidocaine and 7% tetracaine preparation was 5.3.
Conclusions: Topical anesthetics are effective and safe for pain reduction in dermatological procedures, with the commercial preparation containing 7% lidocaine and 7% tetracaine was more effective than the one containing 4% lidocaine.

Keywords: Anesthesia; Anesthesia, local; Dermatologic surgical procedures; Minimally invasive surgical procedures; Pain perception; Pretreatment

Introduction: The use of nutraceutical products in the treatment of chronic telogen effluvium of non-specific cause – associated or not with signs and symptoms of nail plate frailty – has been proposed in the literature. Supplementation of nutrients and trace elements that are crucial to follicle’s metabolism seems to be linked to this effect.
Objective: To evaluate the efficacy of a nutraceutical containing vitamins A, C, E and B complex, folic acid, iron, niacin, biotin, zinc and calcium pantetonate, among others, in the treatment of telogen effluvium associated with the brittle nails syndrome.
Methods: A clinical, prospective, open and monocentric study was carried out with the evaluation of 62 volunteers. Clinical evaluation measurements – based on digital phototrichogram and imaging – were performed at the baseline, and at 45 and 90 days after the use of the studied product.
Results: At the end of the study, a statistically significant (p <0.05) reduction of 31.56% in the number of telogen strands could be observed, coupled with a significant improvement in clinical parameters related to hair and nails. The instrumental evaluation based on image analysis showed a 36.63% reduction in nail desquamation, which, although not statistically significant, has shown benefits in the absolute outcome.
Conclusions: The use of nutraceuticals was proven effective in the treatment of telogen effluvium associated with the brittle nails syndrome.

Keywords: Alopecia; Dietary supplements; Nails

The diagnosis of pigmented facial lesions is considered challenging since benign and malignant lesions might have similar clinical and dermoscopic features – especially in the early stages of the lesion – entailing that it is often difficult to identify lentigo maligna lesions in the face. In this way, confocal reflectance microscopy has the potential to become a useful tool both in the diagnosis and surgical planning of lentigo maligna.

Keywords: Dermoscopy; Hutchinson's melanotic freckle; Keratosis, actinic; Melanoma; Microscopy, confocal

There are many procedures for the rejuvenation of the cervical region. Nevertheless, the most invasive ones – such as the rhytidectomy – can lead to relatively large unaesthetic scars. In contrast, noninvasive procedures – such as the classic absorbable lifting threads – have no significant effect on the treatment of the most evident platysmal bands. Aiming at solving the problem of short durability linked to the lifting threads and eliminating the undesirable submental scar caused by rhytidoplasty, a less invasive technique is described for the treatment of cervical laxity. This technique can be used isolatedly in patients with small amounts of skin redundancy, or associated to mini face lifts in patients with considerable sagginess.

Keywords: Cosmetic techniques; Dermatologic surgical procedures; Esthetics; Lifting; Mandible; Neck muscles; Rejuvenation; Rhytidoplasty

The purse-string suture is one of the several repair options in dermatologic surgery. Its main indications are round or oval wounds on the trunk and limbs.
The authors describe the combination of purse string suture and second intention healing for a surgical defect after removal of a basal cell carcinoma on the temple.
The purse-string suture is an important closure method that may yield good results in selected cases. Although it is more often indicated on the trunk and limbs, it may be performed on the temple to avoid more complex repair.

Keywords: Suture techniques; Wound closure techniques; Wounds and injuries

Basal cell carcinoma (BCC), also known as basal cell epithelioma, is the most frequent epithelial neoplasm in the dermatological practice, being more common in men. The authors report the case of a 75-year-old female patient with a BCC in the concha, anti-helix and triangular fossa regions of the right ear. The lesion was completely excised, including the cartilage. The surgical defect was repaired by means of a "saloon door" flap, which yields good aesthetic and functional outcomes. The posterior auricular flap is a versatile option for partial reconstruction of defects in the ear.

Keywords: Carcinoma, basal cell; Skin neoplasms; Surgical flaps

Cutaneous ischemia, caused by arterial embolism, is one of the vascular adverse events resulting from the application of hyaluronic acid. Early application of hyaluronidase will lead to the successful degradation and reversal of the condition – which might be severe and cause harm to the patient. The authors report cases with suspected arterial occlusion in which degradation was performed with hyaluronidase at different timepoints. This analysis has evidenced that the degradation time and the procedure’s effectiveness are correlated to the intervention timepoint.

Keywords: Dermatology; Ischemia; Reperfusion

Systemic oral medications – such as cyclosporine (CYA) or methotrexate (MTX) – for the treatment of psoriasis have limited bioavailability due to incomplete gastrointestinal absorption and first-pass hepatic metabolism. Moreover, they are associated with adverse effects. The application of CYA or MTX using the microinfusion of drugs into the skin method (MMP^®) for the treatment of psoriasis vulgaris yielded a therapeutic response with significant reduction of lesions, and absence of side effects. In the present report, the authors describe 4 cases of psoriasis vulgaris treated using the MMP^® method, with the application of CYA or MTX.

Keywords: Cyclosporine; Methotrexate; Psoriasis

Both microneedling and ablative fractional laser can be used for the treatment of scars. The present article reports the case of a female patient who had the first half of a perioral scar treated with ablative fractional CO2 laser, and the second half treated with microneedling, using a 2mm roller. Outcomes were superior in the half treated with laser.

Keywords: Cicatrix; Collagen; Lasers