Vascular anomalies correspond to a broad spectrum of changes that fall into two main groups: 1) vascular tumors, which represent proliferative lesions, and 2) vascular malformations, caused by ectasia in vessels, whether capillary, venous or lymphatic.This article reviews the main vascular anomalies observed in dermatological practice, their main classifications and available treatments, focusing on the use of lasers and intense pulsed light to lighten cutaneous vascular lesions, especially those resulting from malformations.

Keywords: vascular Malformations; Hemangioma; Vascular neoplasms; Laser therapy; Intense pulsed light therapy; Dermatology

The cutaneous field cancerization corresponds to an area of skin chronically exposed to the sun. It contains actinic keratoses and other skin signs of photodamage caused by ultraviolet radiation. This field comprises the genetic alterations that form the basis of the process of cutaneous carcinogenesis. Actinic keratoses have the potential to be stable for years, to regress spontaneously or to become invasive carcinomas. There is a consensus in the literature that the treatment of the entire field cancerization is more effective than treating just isolated lesions since it is not possible to predict which of these lesions will evolve to invasive cancer. It is also effective in the prophylaxis and treatment of the existing clinically imperceptible incipient lesions. There are several therapeutic options for individualized actinic keratoses and the field cancerization, from self-applied topical drug therapies to interventional and surgical therapies.

Keywords: Actinic keratoses; Skin cancerization field; cutaneous carcinogenesis; squamous cell carcinoma

INTRODUCTION: Identifying the causes of periorbital hyperpigmentation is crucial in selecting the best treatment. The identification of transcriptional profiles that may be related to hyperpigmentation around the eye area could contribute to a new approach in the treatment of periorbital hyperpigmentation – the gene therapy.
OBJECTIVE: This study aims to assess the transcriptional profile of melanogenesis, and genes related to enzymatic antioxidants in skins with periorbital hyperpigmentation.
METHODS: Based on clinical evaluation, 49 healthy volunteers were classified with or without periorbital hyperpigmentation. Genetic profiles of melanogenesis-related genes: microphthalmia-associated transcription factor (MITF), pro-opiomelanocortin (POMC), melanocortin 1 receptor (MC1R), tyrosinase (TYR), tyrosinase 1-related protein (TYRP1), and intracellular antioxidants - glutathione reductase (GR), glutathione peroxidase 1 (GPx-1), glutathione s-transferase (GST-1) - were determined by the polymerase chain reaction technique in real-time.
RESULTS: MITF, TYR, and TYRP1 gene expressions were significantly higher in the periorbital hyperpigmentation group (p<0.01). GR, GPx-1, and GST-1 gene expressions were comparable between the groups with and without periorbital hyperpigmentation.
CONCLUSIONS: The results of this study suggest that MITF is the primary regulator of melanin deposition in skins with periorbital hyperpigmentation. Up-regulated MITF is closely associated with increased TYR and TYRP1.These findings are essential in proposing a new therapeutic approach in the treatment of periorbital hyperpigmentation.

Keywords: Hyperpigmentation; Melanins; Microphthalmia-associated transcription factor

INTRODUCTION: Melasma is a highly common dermatosis that has numerous therapeutic alternatives but tends to be a therapeutic challenge due to its refractory and relapsing nature.
OBJECTIVE: Comparison between intense pulsed light with pulse-in-pulse mode (IPL-PIP) and retinoic acid peel (RAP) for melasma treatment.
METHODS: We conducted six bi-weekly IPL-PIP sessions in the left hemiface and three-monthly RAP sessions in the right hemiface.The Melasma Area and Severity Index (MASI) and MelasQol questionnaires were applied before and one month after the last treatment session.
RESULTS: We observed a reduction of approximately 33% in hemiface MASI with RAP and of 35% in hemiface with IPL-PIP, showing significant improvement of melasma with both methods.There was no statistically significant difference between the two groups. Both practices were well tolerated by patients, but RAP had more reports of adverse events than IPL-PIP.There was a substantial improvement in the quality of life of the patients with both therapeutic methods.
CONCLUSIONS: RAP and IPL-PIP are effective in treating melasma and improving patients' quality of life.There was no statistical difference between the methods concerning lesion clearance and quality of life of patients.

Keywords: Chemexfoliation; Light; Melanosis; Retinoids

INTRODUCTION: During aging, the skin undergoes structural, cellular, and molecular changes that alter its mechanical properties as well as its biological and physiological functions.These changes manifest as loss of elasticity, and turgor, with consequent appearance of fine wrinkles, lines, and creases that are difficult to resolve, being considered a therapeutic challenge.
OBJECTIVE: To describe the technique of applying cohesive polydensified matrix hyaluronic acid for the treatment of superficial wrinkles.
MATERIALS AND METHODS: In this retrospective and observational study, the technique of superficial and transverse application to superficial wrinkles with cohesive polydensified matrix hyaluronic acid was performed in women with this type of wrinkles in the perioral, periorbicular and lateral regions of the face, which did not disappear after treatment with botulinum toxin, facial volumization with fillers and technology.The study was conducted over 22 months between 2016 and 2018.The degree of improvement was assessed by a questionnaire applied to the patients who observed paired standardized photographs taken in the previous period and one month after the treatment.
RESULTS: The technique was performed on 40 women aged 55 to 80 years, whose response to the evaluation questionnaire was improved between 90% and 100% after one month of treatment.
CONCLUSIONS: The technique of superficial and transverse application to wrinkles with cohesive polydensified matrix hyaluronic acid proved to be an excellent option for the treatment of affected areas, without significant adverse events and/or Tyndall effect, with a high degree of patient satisfaction.

Keywords: Hyaluronic acid; Skin aging; Skin care

INTRODUCTION: Facial aging occurs due to loss of facial volume and altered skin texture. Hyaluronic acid fillers are the main non-surgical tools used to recover the volume loss, since, besides filling, they act as skin remodeling.
OBJECTIVE: To describe a new facial rejuvenation technique with hyaluronic acid: delta V lifting. Through this technique, we seek not only to fill in areas with volume deficits but mainly to stimulate tissue regeneration through the interaction between hyaluronic acid and superficial subcutaneous tissue, the main application plan.
METHODS: A retrospective observational study assessing 200 patients treated with 2 ml of hyaluronic acid at a concentration of 23 mg/ml in a single therapy session with the delta V lifting technique.
RESULTS: 87% of patients rated the result as “great improvement” and 13% as “good improvement” according to the Global Aesthetic Improvement Scale. Also, they all reported progressive improvement of the result until the moment of return within one month after the procedure.
CONCLUSIONS: The delta V lifting technique was effective in bringing satisfactory aesthetic results with a minimal amount of hyaluronic acid. The interaction between hyaluronic acid and adipose tissue is believed to be involved in optimizing results.

Keywords: Hyaluronic acid; Rejuvenation; Techniques

INTRODUCTION: Melasma is an acquired pathology secondary to hypermelanosis, recurrent, and often refractory to therapy, despite several treatment options. Microneedling is mainly indicated for refractory cases since it is an invasive method with the mechanism of action not yet fully understood for this indication.
OBJECTIVE: To compare the response to melasma treatment between a group that received only microneedling and another treated with microneedling combined with drug delivery.
METHODS: Twenty patients participated in the study: seven received only microneedling and 13 received microneedling followed by drug delivery of lightening serum in three sessions, with monthly intervals. The results between the groups were compared regarding improvement of the Melasma Area and Severity Index (MASI), texture and reduction of skin pore diameter; presence of erythema, crusting and peeling; improvement of melasma extension and tone.
RESULTS: The group that received microneedling combined with drug delivery had the most favorable results in improving texture, decreasing skin pore diameter, and improving melasma extension and tone. MASI improvement occurred in both groups, in similar percentages.
CONCLUSIONS: According to the present study, both therapies are promising for melasma treatment.

Keywords: Comparative study; Therapeutic approachs; Treatment outcome; Evaluation of results of therapeutic interventions

INTRODUCTION: Raynaud's phenomenon (RP) is an exaggerated physiological response of the extremity vessels, mainly to cold and stress. Patients refractory to clinical treatment or intolerant to its adverse events may be treated with local injection of botulinum toxin (BTX).
OBJECTIVE: To describe the experience of botulinum toxin use in severe cases of RP.
METHODS: Observational, descriptive, retrospective, and unicenter study of case series of severe RP treated with BTX-A, from 2011 to 2015. Parameters of pain, numbness, color, and stiffness were scored by visual analogical scale (VAS) and tabulated and compared before and after the treatment.
RESULTS: Total pain improvement in 71.4% of cases and partial improvement in 28.6%. Numbness disappeared in 57.1% of cases and improvement in 42.9%. There was a total regression of stiffness in 57.1% of cases and partial improvement in 28.6%. The color was completely reversed in 57.1% of the patients. There was ulceration healing in the only case in with they were present. Ischemic attacks were reduced in 85,7% of cases. No complications occurred.
CONCLUSIONS: This study suggests that the use of BTX-A in patients with severe RP is a promising therapeutic option.

Keywords: Raynaud disease; Botulinum toxins; Botulinum toxins, type A

Nasal surgical defects resulting from the removal of non-melanoma skin cancer represent a challenge for the surgeon due to the anatomical complexity and the high functional and aesthetic relevance of the region.The purpose of this paper is to demonstrate the jigsaw puzzle advancement flap. Resection of basal cell carcinoma was performed in the patient's perialar region, followed by the reconstruction with the jigsaw puzzle advancement flap, with excellent aesthetic and functional results.The presented technique is useful and not yet widespread, and it should be part of the dermatological surgeon's arsenal in the reconstruction of surgical defects located in the nasal ala-perialar region.

Keywords: Nose; Reconstructive surgical Procedures; Surgical flaps

INTRODUCTION: Hidradenitis supurativa (HS) is a chronic skin disease whose mechanism is not yet fully understood. It has a direct impact on the quality of life of affected patients, but there is no well-established therapy for its treatment.
OBJECTIVE: To assess the quality of life of patients diagnosed with HS on adalimumab using the Dermatology Life Quality Index (DLQI) questionnaire.
METHODS: Information was collected from patients with HS on adalimumab and standard DLQI questionnaires were applied before the beginning of treatment and at least 12 weeks after.
RESULTS: Of the three patients included, two presented decreased DLQI. Of these two, one showed significant improvement after treatment with adalimumab. The third patient showed worsening of this index.
CONCLUSIONS: The impact of hidradenitis supurativa on the quality of life of affected patients is significant and is related to factors other than adequate therapy. Life habits such as smoking and alcoholism, as well as the presence of other comorbidities, probably impact these indices. Affected patients should be assessed globally to determine the actual impact on the quality of life related to the disease in question. Thus, we suggest further studies with a larger number of patients.

Keywords: Hidradenitis suppurativa; Quality of life; Indicators of quality of life

Onychomycosis is the nail disease responsible for 50% of onychopathies. The most common clinical form is distal and lateral onychomycosis. The dermoscopic finding of subungual hyperkeratosis in “ruin appearance” in the nail free margin is a relevant diagnostic clue and, when present, suggests the diagnosis of onychomycosis.

Keywords: Dermoscopy; Nail diseases; Onychomycosis

The application of botulinum toxin to patients with sequelae of Bell's palsy is a beneficial adjuvant therapy for the reduction of synkinesia and facial asymmetries. Bell's palsy is the most common cause of facial nerve paralysis.After the paralysis phase of the facial muscles, the condition may evolve with facial asymmetry and synkinesia. In the treatment of synkinesia, punctual injections into the orbicularis and platysma muscles relieve the spasms. Selective application to the unaffected hemiface aims to reduce facial asymmetry and its negative social impact, with improved quality of life.

Keywords: Facial paralysis; Bell palsy; Botulinum toxins, type A; Rehabilitation; Quality of life

Nevus lipomatosus cutaneous superficialis is an uncommon dermatosis in which the adipose tissue is present ectopically in the dermis.This condition is clinically divided into two variants: classical and solitary.The first is characterized by soft, pedunculated, cerebriform, skin-colored or yellowish papules or nodules, mainly involving the pelvic region.The latter is observed as a solitary or sessile papule. Treatment with surgical excision is usually enough. Nevus lipomatosus cutaneous superficialis may be associated with other conditions such as multiple lipomas, as in our case.

Keywords: Nevus; Dermis;Adipocytes; Lipoma

Lip reconstruction after tumor excision is challenging because the results must be functional and cosmetic. In this context, Mohs micrographic surgery (MMS) is essential in ensuring maximum tissue preservation, with lower recurrence rates and the possibility of less complicated reconstructions.We report three cases of lip tumors treated with Mohs surgery, whose reconstruction was performed with island advancement flaps (V-Y).The relevance of the correct management of this type of tumor is discussed,highlighting the use of Mohs surgery and V-Y advancement flap,which provide satisfactory aesthetic and functional results.

Keywords: Lip neoplasms; Mohs surgery; Surgical flaps

Neck appearance is one of the indicators of a person's biological age. Conventional rhytidoplasty has been the standard treatment for correction of cervical aging. Some patients, especially men, show evident changes in the neck, with excess skin and/or fat in the anterior cervical region, but with little flaccidity of the face. Cervical facelift, combined with zetaplasty, is a surgical option for rhytidoplasty and treats excess skin, fat, and platysma bands. It can be performed under local anesthesia, presenting low morbidity, rapid recovery, and high level of satisfaction.

Keywords: Rhytidoplasty; Rejuvenation; Cervicoplasty; Neck