Eyelid defects resulting from skin cancer excision are common in the daily practice of dermatologic surgeons. The aim of this review is to summarize the most relevant methods for eyelid repair, proposing reconstructive algorithms for both lower and upper eyelids. Both algorithms were designed according with dichotomic decisions based on the thickness (partial- versus full-thickness) and the size of the eyelid defect (less than 1/3, less than 2/3 or larger than 2/3 of the eyelid length).

Keywords: Eyelids; Reconstruction; Eyelid Neoplasms; Eyelid Neoplasms/surgery; Cornea

Botulinum toxin has transient flaccid neuromuscular paralysis as its mechanism of action. Recent studies are identifying new ways to use botulinum toxin for a variety of purposes, both in the aesthetic and in the therapeutic field. This work aimed to conduct a literature review on these applications. In the aesthetic field, botulinum toxin has shown benefit in the treatment of hypertrophic scars, rejuvenation of the scrotal region, definition of the gastrocnemius muscle, and microdoses use. In the treatment of pathologies, the review has shown that botulinum toxin may be useful for the treatment of post-herpetic neuralgia and other pain syndromes, craniofacial hyperhidrosis, rosacea, and Hailey-Hailey disease.

Keywords: Botulinum toxins; Botulinum toxins, Type A; Esthetics; Pruritus; Rejuvenation; Cicatrix; Cicatrix, Hypertrophic

INTRODUCTION: Acne vulgaris is an inflammatory disorder of the pilosebaceous gland. Palmitic acid is one of the major types of free fatty acid and may play a role in acne pathogenesis. In addition, recent studies suggested that Staphylococcus epidermidis might be involved in acne.
OBJECTIVE: To explore the association between Staphylococcus epidermidis and palmitic acid in acne vulgaris.
METHODS: Forty-three high school students at an urban area in South Sulawesi, Indonesia, were included. The palmitic acid level was measured using gas chromatography and comedone was cultured to detect the microbiota profile. Mann-Whitney test was used to analyze the median palmitic level diference between groups with different acne vulgaris severity.
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 group showed significantly higher palmitic acid level compared with the mild group. Subgroup analysis of patients with moderate and severe acne vulgaris positive for S. epidermidis showed a significantly higher palmitic acid level compared with the mild group.
CONCLUSIONS: This result suggests that S. epidermidis may be associated with the palmitic acid level and may contribute to acne pathogenesis.

Keywords: Acne vulgaris; Staphylococcus epidermidis; Palmitic acid

INTRODUCTION: Idiopathic guttate hypomelanosis is an acquired leukoderma, whose available therapeutic options have inconsistent results.
OBJECTIVES: To evaluate the effect of isolated or combined ablative fractionated laser to drug delivery of piperine for treatment of idiopathic guttate hypomelanosis.
MATERIALS AND METHODS: In a prospective and comparative study, seven patients with idiopathic guttate hypomelanosis in the legs were elected, andfive lesions were selected on each leg of each. Both legs of each patient were submitted to two Er:YAG 2940nm laser sessions, followed by drug delivery of piperine 20% only in the right leg. Blind evaluators conducted the assessment through photographs and comparative measurements of the lesions.
RESULTS: The lesion size ranged from 0.2cm to 1.5 cm. Both treatments significantly reduced lesion size (p< 0.00008, right leg;p< 0.002, left leg). Thegeneralized estimating equation method showed that there was no statistical difference between the groups regarding the reduction of lesion size. The evaluation achieved better scores for the right leg (laser + piperine) (p=0.126).
CONCLUSION: Although statistically significant differences were not found between the side treated with laser and drug delivery versus the side treated only with laser, we believe that the technique may represent an option in the therapeutic arsenal.

Keywords: Administration, topical; Drug administration routes; Lasers

INTRODUCTION: The relationship between cardiovascular disease, insulin resistance and vitiligo has been evaluated in studies. However, there is still no consensus on the subject.
OBJECTIVES: To evaluate the relationship between insulin resistance and vitiligo, in addition to the prevalence of risk factors for cardiovascular disease, in adults with vitiligo when compared to the control group.
METHODS: Cross-sectional study with a control group. A convenience sample of consecutive patients aged 14 years and over was used. Patients and controls were assessed with laboratory tests and anthropometric measurements. The LAP, HOMA-IR, and HOMAβ indices were calculated.
RESULTS: We included 130 patients, 73 with a diagnosis of vitiligo and 57 controls. There were no significant differences between groups when LAP, HOMA-IR, and HOMAβ were evaluated. Among the risk factors for cardiovascular disease, systolic blood pressure was significantly higher in patients with vitiligo.
CONCLUSIONS:There was no higher prevalence of insulin resistance among patients with vitiligo. Regarding the risk factors for cardiovascular diseases, only systolic blood pressure was higher in patients with vitiligo. Further studies are needed to elucidate the prevalence of insulin resistance and cardiovascular risk factors in patients with vitiligo.

Keywords: Vitiligo; Skin diseases, Metabolism; Metabolic diseases; Insulin resistance

INTRODUCTION: Sclerotherapy is the most widely used method for the treatment of varicose veins of the lower limbs. The most common complication is the appearance of hyperchromic spots in the treated region. Pycnogenol^® has long been known as a phlebotonic, anti-inflammatory and skin depigmenting drug. Studies have already proven the efficacy of this drug in the prevention and treatment of post inflammatory hyperpigmentation.
OBJECTIVE: To evaluate the effectiveness of Pinus pinaster extract (Pycnogenol^®; PPE) in the prevention of hemosiderin deposits in human skin culture submitted to inflammatory stress.
METHODS: Fragments of human skin were stimulated with interleukin 1 alpha (IL-1 α) to induce an inflammatory response and, concurrently treated with PPE for further histological evaluation and hemosiderin semi-quantification.
RESULTS: The histological evaluation of skin fragments exposed to IL-1 alpha revealed a 26.6% higher hemosiderin density compared with the control group. Moreover, skin fragments incubated concomitantly with PPE showed significant reductions in hemosiderin deposits when compared with the group only exposed to the inflammatory microenvironment.
CONCLUSIONS: The results presented in this study showed an important effect of PPE (Pycnogenol^®) in the prevention of hemosiderin accumulation caused by inflammatory stress similar to the post-sclerotherapy process.

Keywords: Hemosiderin; Hyperpigmentation; Sclerotherapy

INTRODUCTION: The gold standard diagnosis of cutaneous melanoma is essentially histological. Dermoscopy adds to clinical examination improved sensitivity and specificity.
OBJECTIVE: To evaluate the histological profile of risk melanocytic lesions excised in a dermatology service.
METHODS: Case review through Excel spreadsheet and survey of dermoscopic, histological and topographic data (January 2017 to December 2018).
RESULTS: Data from 62 suspected melanoma lesions were evaluated in this period. The main histological results were: melanocytic nevi (37.1%), melanoma (19.35%), and dysplastic nevi (17.7%).
CONCLUSIONS: The positive predictive value for melanoma was 19.35%, considering the search for an early diagnosis in patients at risk.

Keywords: Neoplasms; Melanoma; Dermatology

INTRODUCTION: Vitiligo is a chronic acquired skin disease, which evolves with depigmentation. The control of disease activity is a therapeutic challenge. Systemic corticosteroids, in daily use or in pulse doses, are the most used treatment for the disease.
OBJECTIVE: To evaluate the effect of minocycline on the control over vitiligo activity compared with the corticosteroid therapy.
METHODS: Randomized clinical trial with 16 active vitiligo vulgaris patients, divided into two groups: MINO group: minocycline 100mg/day, orally, for three months; and CORT group: prednisolone 0.3mg/kg/day, orally, for two months, and 0.15 mg/kg/day in the third month. The patients were evaluated before and after the treatment by photographic records and evaluation of the scores obtained by the VIDA score (vitiligo disease activity score).
RESULTS: According to the photographic records, there was control of vitiligo activity in 100% of patients in the MINO group compared with 60% in the CORT group. In the comparison using the VIDA score, we noticed a statistically significant diference for both groups; however, we found that the reduction was greater in the MINO group, evidencing more effectiveness of minocycline in controlling the vitiligo activity.
CONCLUSION: This study demonstrated the efficacy of minocycline in the control of active vitiligo compared with a systemic corticosteroid regimen. Additional studies should be performed to confirm its efficacy.

Keywords: Vitiligo; Minocycline; Prednisolone

INTRODUCTION: Topical delivery of drugs is essential in Dermatology Due to the difficulty of permeation of the stratum corneum, drug delivery techniques have been highlighted. The use of non-specific formulations for this purpose makes raises the concern of possible adverse events and the microbiological safety of these formulations.
OBJECTIVE: To assess bacterial and fungal growth in anhydrous fluid serum through simple sterility test. Materials and METHODS: The simple sterility test was performed on an anhydrous serum containing lipophilic and hydrophilic active substances. This test was performed three months after the manufacture of the product.
RESULTS: The formulation studied was approved in the simple sterility test conducted three months after the manufacture of the product, even without the use of preservatives in the formulation.
DISCUSSION: The assessed formulation was approved in the sterility test possibly due to the fact that the serum vehicle has mineral and anhydrous origin, characteristics that do not favor the proliferation of microorganisms.
CONCLUSIONS: Although only the vehicle counting specific assets has been tested, the results of this study are promising and demonstrate the need for future studies broadly encompassing this subject.

Keywords: Drug Administration Routes; Brazilian Pharmacopeia; Skin Cream

Microneedling is an ambulatory surgical procedure that can be used for different indications with the objective of stimulating the production of collagen. Five cases were evaluated in the first 72 hours after the procedure by reflectance confocal microscopy in order to evaluate the pores lifetime.

Keywords: Collagen; Wound healing; Ambulatory surgical procedures

Acne is a common condition that often results in scarring. We propose a novel treatment of acne scarring using: 1- chemical reconstruction of skin scars (CROSS), mainly with carbolic acid, 2- blunt bi-level cannula subcision, and 3- microneedling. A total of 139 patients were treated from 2017- 2018, of which 89 (64%) were Fitzpatrick Skin Types IV-VI. This triple approach to treating acne scars resulted in consistent high satisfaction from patients and photographic evidence of improvement. A combination of CROSS (to stimulate neocollagenesis), subcision (to release dermal connective tissue tethering), and microneedling (to stimulate neocollagenesis) is effective for acne scar treatment.

Keywords: Acne vulgaris; Acne keloid; Cicatrix; Cosmetic techniques

A 74-year-old male patient came to medical consultation presenting a hyperpigmented stain near the lower left eyelid edge, with varying colors, between different shades of brown; the biopsy confirmed the diagnosis of lentigo maligna. Its location on the eyelid edge is rare. There is some divergence in the literature regarding the best method for its treatment. Non-surgical therapeutic options, such as imiquimod, have been suggested, as well as different variants in surgical management and required margins. In the case described, it was chosen to manage with conservative margins, preserving, the functionality of the area.

Keywords: Lentigo; Melanoma; Eyelid Neoplasms; Dermoscopy; Pathology, Surgical; Surgery, Plastic

Malignant melanoma is a melanocyte tumor responsible for more than 75% of skin cancer deaths. The rare variants of this pathology are responsible for 5% of the cases and may mimic other pathologies. We report the case of a patient with spitzoid melanoma and we discuss the dermoscopic, histopathological, and immunohistochemical findings, as well as the follow-up of this rare variant of melanoma.

Keywords: Melanoma; Nevus, epithelioid and spindle cell; Melanoma-specific antigens; Skin neoplasms; Dermoscopy

The reconstruction of defects involving up to 2/3 of the lip extension is challenging, considering the functional and aesthetic importance of this structure. There are several surgical techniques described for this purpose, highlighting the Abbé-Estlander flap, the Karapandzic flap, and the Bernard-Burrow- Webster flap. The choice of the best approach should consider the size and location of the defect as well as the comorbidities of the patient. The reverse Yu flap is an alternative to be considered in relation to other methods, allowing obtaining excellent cosmetic-functional results in general.

Keywords: Surgical flaps; Reconstruction; Lip

There are a few descriptions in the literature on surgical techniques for the closure of synchronous facial defects. We report three cases of patients with synchronous lesions on the face, which were reconstructed using the following types of flaps: Yin-Yang double-opposing rotation; Burrow's triangle advancement; and a combination of the dorsal nasal flap with the transposition flap. Reconstructions of synchronous facial defects represent challenges to dermatologic surgeons, especially when one of the lesions is located in the nose. In cases involving relatively small defects and not so far apart, there is the possibility of a single flap to close both defects.

Keywords: Surgical flaps; Mohs surgery; Carcinoma, basal cell