Five-alpha reductase inhibitors — finasteride and dutasteride — are drug classes that have antiandrogenic properties. These drugs are commonly used to treat benign prostatic hyperplasia and androgenic alopecia. The U. S. Food and Drug Administration (FDA) has approved finasteride in 1991 for benign prostatic hyperplasia, and in 1997 for male androgenetic alopecia. In 2002, dutasteride was approved by the FDA only for benign prostatic hyperplasia, and is currently approved in Japan and South Korea for treating male androgenetic alopecia. The authors offer a comprehensive and up-to-date review on this drug’s efficacy and safety.

Keywords: Alopecia; Androgens; Finasteride; Secondary effect; Dutasteride; Alopecia/therapy

Knowledge, diagnostic ability and surgical skills for approaching diverse cutaneous conditions in the auricular region are parts of a dermatologist physician’s daily routine. In the second part of this review article, will be approached the benign neoplasms of the auricular region, describing their particularities and ideal methods of treatment.

Keywords: Ear; Nevus; Cysts; Keloid

Introduction: Acne vulgaris is an inflammatory disorder that affects the pilocebaceous gland with high prevalence among young adults. Studies have suggested that FFA may influence acne vulgaris. However, the pathogenesis of acne is not yet fully known.
Objective: To analyze the correlation between free fatty acid and acne vulgaris severity level.
Methods: Forty-three female high school students with mild, moderate, and severe acne were included in this study. Free fatty acid level, represented by palmitic acid level, was measured using gas chromatography and PCR examination was conducted to detect Propionibacterium acnes. Mann-Whitney test was used to analyze the median palmitic level difference between groups with different acne vulgaris severity. A p-value <0.05 was considered as significant.
Results: Fourteen patients (32.6%) had mild acne vulgaris, while 14 and 15 patients had moderate and severe acne vulgaris, respectively. The severe and moderate acne group showed significantly higher palmitic acid level compared to the mild acne group (p<0.05). The level of palmitic acid was not associated with the presence of P. acnes.
Conclusions: Increased palmitic acid level was found to be associated with acne severity. Thus, FFA levels may be used as a marker to determine acne vulgaris severity

Keywords: Acne vulgaris; Fatty acids, nonesterified; Polymerase chain reaction; Propion-ibacterium acnes

Introduction: The number of women seeking treatment for androgenetic alopecia has increased during the last decade. Likewise, a greater amount of therapeutic options and methods for evaluating treatment efficacy have also become available. In face of this, it is necessary to develop simple and objective methods to quantitatively evaluate the effectiveness of hair treatments.
Objective: To validate a quantitative method that evaluates the effectiveness of treatments for hair loss.
Methods: Comparison of standardized photographs obtained before and after the treatments, analyzed by a software that provides automatic calculation of the area of hair loss in square pixels. This calculation is based on the contrast perceived between bright (hair loss) and dark (normal amount of hair) regions of the scalp, and allows estimating the area that is not covered by hair, thus quantifying the effectiveness of the treatments.
Results: The method is effective for assessing the affected area in patients with both initial and advanced degrees of hair loss.
Conclusions: The proposed method allows evaluating the effectiveness of diverse types of treatments for telogen effluvium and androgenetic alopecia in a rapid, straightforward and cost effective manner.

Keywords: Alopecia; Hair; Methodology; Methods

Introduction: Diabetes is a frequent pathology that has universal distribution. The incidence of the type 2 of this condition has been increasing with obesity. Early detection of dermatological, vascular, orthopedic and neurological origin pathologies helps the diagnosis and treatment of the diabetic foot.
Objective: To evaluate the feet of pre-diabetic and diabetic patients bearers of onychomycosis using thermography, aiming at identifying the vascular, neurological and orthopedic impairment, as well as following up the clinical development.
Methods: Capture of infrared images at baseline and after cold stimulus test, using an infrared sensor in a controlled environment.
Results: This examination allowed the suspicion of peripheral neuropathy of fine fibers to be raised, as well as to verify areas of footwear pressure and to evaluate the progression of Charcot foot.
Conclusions: Infrared imaging associated with dermatological examination can be a propaedeutic tool for the early identification of vasomotor alterations in the soles, even in asymptomatic patients.

Keywords: Diabetic foot; Diabetes Mellitus; Thermography

Introduction: Rosacea is a chronic facial condition characterized by erythema, edema, telangiectasias, papules and possibly pustules and nodules. There are four subtypes: erythematous-telangiectatic rosacea (I), papulopustular rosacea (II), phymatous rosacea (III) and ocular rosacea (IV). Its pathogenesis is multifactorial, and the treatments, diverse.
Objective: To demonstrate the effect of botulinum toxin in the improvement of flushing and erythema in patients with erythematous-telangiectatic rosacea.
Methods: Six patients with Subtype I rosacea were selected in the Dermatology Department’s outpatient clinic of a university medical service. The patients received applications of botulinum toxin type A (dilution of 100 units to 5 ml of saline solution), with intradermal injections of 0.2 to 0.5 units per point in the affected region. Evaluations were carried out after one, two, three and six consecutive months.
Results: There was improvement of the facial erythema and flushing during the three months following the application, with symptoms returning around the sixth month after the treatment, in line with the estimated duration of toxin effectiveness.
Conclusions: There was improvement of the patients' symptoms and satisfaction, and it was deemed a treatment of easy application, associated with a low index of adverse effects and prolonged duration of outcomes.

Keywords: Botulinum Toxins, Type A; Erythema; Quality of Life; Rosacea

Introduction: Photoaging and melasma are frequent dermatological complaints. Confocal reflectance microscopy (CRM) is a recent technique that can be used for diagnostic evaluation of these dermatoses.
Objectives: To evaluate the characteristics of the epidermis and dermis containing pigmentary alterations caused by photodamage and melasma with the assistance of CRM, and compare the findings linked to these changes with the perilesional region.
Methods: A pilot study was conducted with eight female individuals (aged 38 to 50 years, Fitzpatrick phototypes from II to IV) with clinical diagnoses of photodamage (n = 4) and melasma (n = 4) in the facial malar region. The perilesional and lesional regions were compared regarding the thickness of the stratum corneum and viable epidermis, the depth of the interpapillary crests, and the presence of hyper-refractive structures.
Results: The pigmentary alterations in the photodamaged skin revealed a morphological pattern — such as an increase in the depth of the interpapillary ridges in the lesion region — typical of solar lentigo. In the lesional region of volunteers bearing melasma, it was possible to observe the presence of dendritic cells in the epidermis and melanophages in the dermis. All volunteers had hyper-refractive keratinocytes in the lesional epidermis region.
Conclusions: Considering the number of patients evaluated, it was possible to characterize and compare cutaneous pigmentary alterations caused by photodamage to those cause by melasma.

Keywords: Aging; Microscopy, confocal; Diagnosis

Introduction: Being healthy corresponds to a state of absolute well-being. Scars are examples of con- ditions that endanger patients’ emotional integrity, compromising their quality of life. Consequently, there are several therapeutic alternatives aimed at alleviating aesthetic disorders. Microneedling stimu- lates collagen production, improving the healing effect in the induced cutaneous injury.
Objective: to evaluate the effect of microneedling in the scars of surgically induced cutaneous wounds in rats.
Methods: Twenty-four male rats were distributed in five study groups. A surgically induced incision was inflicted on the animals’ dorsa in all study groups, with the healing processes being followed up until completion.The study groups GC-14 and GC-30 served as controls for the groups GCM-14 and GCM-30, respectively
Results: Reepithelialization and absence of granulation tissue were identified in 100% of the groups. Regarding the proportion of fibrosis, mean reductions of 19% and 4% were observed in GCM-14 and GCM-30, respectively. There was a stimulus to the production of type I and III collagen in the groups that underwent microneedling, with a greater amount of type I collagen in GCM-14 (62.1%) as compared to its control (37.8%).
Conclusions: Microneedling was effective in stimulating increased production of collagen fibers in 14 days, suggesting this treatment tends improve scars.

Keywords: Cicatrix; Collagen; Models, animal

Introduction: Wrinkles, sagging, changes in texture and skin pigmentation in the periorbital region are common complaints in dermatologic practices. Several treatment options, including fractional radiofrequency, which has been shown safe and effective, have been described.
Objective: To compare outcomes and side effects after the use of two types of electrodes coupled to a radiofrequency device, used for rejuvenating the eyelid region.
Methods: A comparative, randomized and blind clinical trial was carried out with patients bearing aging in the periorbital region. The patients were treated with two different electrodes (called standard tip and Lima 8 tip), which can be coupled to the same radioelectrosurgery device. The variables investigated were sagging, wrinkles, texture and firmness of the treated skin, in addition to the presence of adverse effects. Thirty days after the last session, patients answered to a satisfaction questionnaire, having been photographed for clinical assessment.
Results: The patients treated with both tips experienced considerable satisfaction with the improvement of sagging and wrinkles. The variable firmness presented worse satisfaction indices, with a disadvantage for the standard tip. Important edemas emerged after the use of both tips; nevertheless ecchymosis occurred most frequently and lasted longer with the Lima 8 tip. Hyperpigmentation was more frequent and longer lasting with the standard tip, however without statistically significant difference.
Conclusions: The two tips were equally effective for the treatment of sagginess, wrinkles and skin texture in the periorbital region. The patients treated with the Lima 8 tip had higher satisfaction indices regarding the skin’s firmness, experiencing a higher incidence of ecchymosis, as well as a longer duration of that side effect.

Keywords: Eyelids; Pulsed radiofrequency Treatment; Skin aging

Introduction: Lesions in fingers and toes are frequent in the dermatological practice, and diagnosis is feasible in the majority of cases after a thorough anamnesis and physical examination.
Objective: To draw a profile of the most prevalent lesions in toes and fingers that were surgically approached by the dermatologic surgery team, at a dermatologic referral service, as well as to evaluate the classification of these lesions, their distribution among age groups and genders, and the correlation between clinical suspicion and anatomopathological diagnosis.
Methods: A retrospective observational study was performed with 344 patients, and the evaluation of 367 surgical procedures.
Results: The analysis showed that most of the procedures were performed in female adults, with the left hallux being the most affected location in the studied sample. It was also verified that the majority of the procedures were linked to lesions of traumatic nature, with biopsy/excision and canthoplasty/canthotomy being the most accomplished procedures.
Conclusions: The results of the present study contribute to the planning and design of future dermatological care.

Keywords: Ambulatory surgical procedures; Fingers; Toes

Non-melanoma skin cancer is the most common type of neoplasia. Basal cell carcinoma is the most common cancer of them, the incidence of which is steadily increasing, implying an important public and financial health issue. The authors present the case of a patient with an extensive basal cell carcinoma affecting part of the external auditory canal and auricular concha, treated with a combination of surgical techniques: flap-plasty associated with second intention closure of the external auditory canal. Due to the excellent aesthetic and functional outcomes, this technique should be considered as a therapeutic option for auricular lesions.

Keywords: Carcinoma, Basal cell; Dermatology; Ear neoplasms; Ear, external; Surgical flaps

Factitious panniculitis can be triggered by subcutaneous injections of substances linked to esthetic procedures. A case diagnosed and treated as chronic erythema nodosum manifested nodule five years later, with the anatomopathological study suggesting atypical lipomatous tumor. After resection of the lesion, histology showed steatonecrosis, compatible with lobular panniculitis. Magnetic resonance imaging examination revealed the presence of a liquid substance in the gluteal region, favoring the diagnostic suspicion of factitious panniculitis. The patient admitted to having undergone silicone injection in this region in the past, with additional findings arising from the histological review confirming this hypothesis. The late complication linked to injections of cutaneous filling material motivated the present study.

Keywords: Erythema chronicum migrans; Panniculitis; Silicones

Vitiligo is an acquired pigmentation disorder characterized by the development of well-defined achromic macules in the skin. It is deemed stable when no new lesion emerges or when pre-existing lesions do not undergo changes for at least one year. In these cases, surgical treatment is an important therapeutic option. Punch micrografting is the most commonly performed melanocyte transplantation technique, resulting in excellent repigmentation. The authors describe a variation of this technique using even smaller and finer grafts (consisting of epidermis and thin dermis), in order to achieve aesthetical outcomes that are better than those obtained with the traditional technique, especially when treating areas with significant aesthetic impairment.

Keywords: Melanocytes; Transplantation; Vitiligo

The nasal region is a frequent site of cutaneous tumors, and repairing defects in this region can be a great surgical challenge due to the need to restore their structural, functional and aesthetic properties. The present study describes the implementation of an A-T flap as an option for reconstructing surgical wounds secondary to the excision of basal cell carcinomas in the nasal tip.

Keywords: Carcinoma, Basal Cell; Nose; Surgical flaps

Adequate healing of surgical wounds is influenced by the operative technique, the presence of postoperative complications and the patient's life habits. We report the case of a patient submitted to excision of basal cell carcinoma by Mohs micrographic surgery and reconstruction with palpebral cutaneous grafting. In the postoperative period there was graft necrosis due to poor perfusion of the surgical bed imputed to smoking. Smoking interferes with plasma embolization and graft neovascularization, as well as promoting oxidative stress and endothelial dysfunction. The surgeon should counsel the cessation of smoking for at least four weeks prior to the procedure in order to avoid further risks of complications.

Keywords: Carcinoma, basal cell; Graft survival; Mohs surgery; Necrosis; Smoking

Described by Jadassohn and also known as organoid nevus, nevus sebaceous is considered a hamartoma that exhibits follicular, sebaceous, eccrine and apocrine malformations of varying degrees. Between 10% and 30% of patients with sebaceous nevi of Jadassohn are at risk of developing cutaneous or adnexal neoplasia during adulthood. The authors describe the case of a patient with nevus sebaceous of Jadassohn associated with multiple tumors (benign and malignant) of different strains, highlighting the importance of the dermatologist physician’s knowing this entity and how to perform an examination of the scalp.

Keywords: Carcinoma, Basal Cell; Hamartoma; Neoplasms; Nevus sebaceous of Jadassohn