Skin quality and function drastically reduces with age due to chronological aging, photoaging, environmental factors and hormonal deficiencies. Decreased menopausal estrogen levels play a role in cutaneous atrophy, collagen and water content, loss of elasticity, skin wrinkling and deficiency of wound healing. Much research has been done to elucidate the beneficial effects of topical estrogen, which would have a more localized action on the skin without systemic side effects. The objective of this study was to review the relevant literature, demonstrating that this may be a safe and effective alternative for the treatment of women's skin in perimenopause.

Keywords: Estrogens; Phytoestrogens; Skin aging; Collagen; Antioxidants

It is noteworthy the range of facial treatments, with aesthetic purpose, with which we can preserve the balance of the shape or beauty of our patients. Fillers, botulinum toxin, laser, and other technologies are widely used in dermatology. Eyelids can also be treated with these and other therapeutic resources. However, herniation of the fat pockets of the upper eyelids does not present significant results with these methods. The advancement of techniques known as minimally invasive and other technologies does not satisfy the treatment of this facial aesthetic unit. Thinking about the global rejuvenation of the face, it is unlikely that we will achieve a result of excellence without acting on the eyelids. Upper blepharoplasty remains irreplaceable, and it is the treatment of choice for skin redundancy and herniation of fat pockets. This surgery, with a long history in Dermatology, has a unique and fundamental role in facial rejuvenation. In this study, we tried to demonstrate the surgical technique of superior blepharoplasty educationally and to prove its efficacy and safety, with good aesthetic and functional results. With full knowledge of this anatomical region and technical precepts, we recognize that we can perform it safely.

Keywords: Blepharoplasty; Surgery, plastic; Eyelids; Esthetics; Dermatologic surgical procedures; Rejuvenation

INTRODUCTION: The inflammation may play a critical role in the development of facial acne. Pro-inflammatory mediators, such as prostaglandins and leukotriene, have been implicated in the initiation of acne.
OBJECTIVE: This study aimed to evaluate the clinical efficacy and safety of 1% diclofenac gel compare with a placebo gel in the treatment of mild to moderate acne patients in 12 weeks. Methods: A 12 weeks, randomizing, double-blind, individual and split-face comparative trial was conducted in 24 volunteers. Patients with mild to moderate acne vulgaris, aged 18 to 30 years were enrolled. They received 2.5% benzoyl peroxide with 1% diclofenac gel and 2.5% benzoyl peroxide with placebo gel apply regularly at each side of the face.
RESULTS: 24 participants with mean (SD) age of 25.92 years were enrolled in the study. Statistically significant decrease in mean of comedone lesions was observed in 1% diclofenac gel group by acne lesion count at week 12 (P <0.05) superior than placebo gel. Moreover, post inflammatory hyperpigmentation also had statistically significant decrease superior to placebo group at week 4.
CONCLUSIONS: The 1% diclofenac gel topical treatment has shown good clinical efficacy and safety in decreasing facial comedones at week 12 and post-inflammatory hyperpigmentation in 4 weeks.

Keywords: Acne vulgaris; Diclofenac; Inflammation; Hyperpigmentation

Introduction: Silicone dressings and Triamcinolone injections are known to improve keloids and hypertrophic scars size, erythema, flexibility, and symptoms such as pain and itching. These treatments are non-invasive, inexpensive, and widely used as first or second-line therapy; however, studies comparing them are still lacking.
Objective: To compare silicone dressings, triamcinolone injections, and a combination group, to treat hypertrophic scars, at the same anatomical area, caused by the same mechanism of injury.
Materials and methods: In a prospective study, 12 patients with median-sternotomy scars were randomized into 3 groups (n=4 patients each): group 1, monthly triamcinolone injections; group 2, a combination of silicone dressings and triamcinolone injections; and group 3, silicone dressings. Patients were evaluated in monthly clinical appointments using the Vancouver Scale and the durometer. Immunohistochemistry and confocal microscopy for collagen types I and VI were performed in scar samples. The groups were compared using Kruskal-Wallis and Friedman tests, with p<0,05 indicating significance.
Results: The three treatments were effective in reducing the Vancouver scores. A difference between the three groups was observed at time 2 when triamcinolone was less effective. Group 2 showed an improvement on pigmentation (p = 0,042). Collagens types I and VI presented increased fluorescence throughout the superficial and deep dermis in untreated lesions, which decreased after the treatment. Although the number of patients is limited, this is the first prospective study addressing some of the major bias in scars treatment.

Keywords: Scar; Keloid; Silicone gel; Triamcinolone

INTRODUCTION: The nose is frequently affected by cutaneous carcinomas. Due to its functional and cosmetic importance, tumors on this location are preferably treated by Mohs micrographic surgery, which provides the highest cure rates. For repairing of surgical defects several options are available, including healing by second intention, primary closure, skin grafts, and flaps. In certain cases, one should consider a combination of methods.
OBJECTIVE: To describe the authors' experience in nasal reconstruction after Mohs surgery and to assess if the number of involved subunits influenced the use of combined repairs.
METHODS: Retrospective study of consecutive cases submitted to Mohs surgery and nasal reconstruction by one of the authors during a 3-year period.
RESULTS: 208 cases were included, and the most common repair method were flaps (n = 82). Combined methods were performed in 44/154 (29%) cases with involvement of only one nasal anatomical subunit and 29/54 (54%) cases with multiple nasal subunits involved.
CONCLUSIONS: The dermatologic surgeon should be familiar with different options for nasal reconstruction. The combination of repair methods was often performed, mainly for wounds that affected more than one nasal subunit.

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

INTRODUCTION: Androgenetic alopecia is characterized by the thinning and progressive hair loss due to the action of androgen hormones, causing the miniaturization of follicles and altering hair cycle.
OBJECTIVE: To assess the efficacy of a topical hair ampoule containing human follicle stem cells, in women with androgenetic alopecia.
METHODS: We used phototrichogram and image analysis to determine investigational product's efficacy compared to placebo after four months of treatment.
RESULTS: There was significant increase in the percentage of anagen hair (34.99%) and a decrease in the percentage of telogen hair (16.59%) for the treated group, what did not occur for the placebo group. There was significant increase in the scalp coverage for the treated participants after four months of product use (33.6%).
CONCLUSIONS: The topical investigational treatment was effective to improve hair loss in female androgenetic alopecia after four months of treatment.

Keywords: Alopecia; Hair; Clinical Trial; Hair Preparations

INTRODUCTION: Unaesthetic scars can trigger symptomatic, functional, aesthetic and emotional repercussions. Among the main treatments found today is microneedling.
OBJECTIVE: Prospective, quantitative study to evaluate the benefits of healing with a single microneedling session.
METHODS: A microneedling session was performed on scars of 28 patients. Before performing the procedure with cylinders containing 192 2.5 mm needles and 90 days later, scars are photographed in a standardized manner, having been applied on the Patient and Observer Scar Assessment Scale. Through the performed score, a quantitative evaluation by the analysis of the parameters, being vascularization, pigmentation, thickness, relief, malleability, surface area, pain, itching, color, stiffness, height and irregularity, in addition to the patient's total score and general opinion. and the observer.
RESULTS: All variables obtained improvement, except pain, emphasizing malleability and height. In addition, the overall opinion of the patient and the observer shows 51% improvement.
CONCLUSIONS: Microneedling is a safe, inexpensive, minimally invasive treatment that delivers experimental results in a single session.

Keywords: Cicatrix; Scales; Therapeutics

INTRODUCTION: Lentigo maligna is a subtype of melanoma in situ, which affects sun-exposed areas. On the face, it can have a clinical and dermoscopic appearance similar to several benign pigmented lesions. Differential diagnosis between them is fundamental for the appropriate therapeutic and should be made by histopathological analysis. Excisional biopsy is the gold standard, but in large, unresectable lesions or in difficult anatomical sites, it can have aesthetic or functional implications. In these cases, shave biopsy appears to be a safe and reliable alternative.
OBJECTIVE: To describe an appropriate shave biopsy technique, discuss its results and indications in the outpatient routine of the dermatologist.
METHODS: Sixteen patients with suspected : Lentigo maligna on the face and scalp were selected. Inclusion criteria were older than 18 years, lack of diagnosis and previous treatment, flat lesions larger than 8 mm and suggestive clinical and dermatoscopic signs. The approach performed was shave biopsy.
RESULTS: The diagnosis of : Lentigo maligna was confirmed in 25% of the cases, and a widening of margins presented compatible results in 100% of them.
CONCLUSIONS: Shave biopsy seems to be a suitable alternative for flat lesions without clinical and dermoscopic criteria of vertical growth.

Keywords: Acne Vulgaris; Diclofenac; Inflammation; Hyperpigmentation

INTRODUCTION: Photoprotection is indicated to reduce the exposure to cutaneous actinic damage and it is important to prevent skin cancer. The face is the most irradiated area of the body and is also where skin cancers most commonly occur.
OBJECTIVE: To evaluate the amount of sunscreen applied and its facial coverage in patients previously diagnosed with skin cancer, treated at a Brazilian public institution.
METHODS: Quasi-experimental study involving 40 patients undergoing skin cancer follow-up. Participants were asked to apply sunscreen on their face, as usual, and the mass used was measured. After, participants were photographed under Wood's light to evaluate the homogeneity of the sunscreen´s coverage, and facial sunscreen coverage failure.
RESULTS: Fourteen (35%) participants applied an estimated amount lower than recommended (2mg/ cm2). The regions with smallest coverage were the ears and the "H" area of the face.
CONCLUSIONS: The insufficient or heterogeneous sunscreen application on face, neck and ears may promote a false perception of protection, leading to irresponsible exposure. As the population ages and the incidence of skin cancers increases, it is essential to stimulate photoprotection, with appropriate information, especially among high-risk individuals.

Keywords: Sunscreening Agents; Skin Neoplasms; Sunburn; Sunlight

Angiokeratomas are vascular malformations constituted by telangiectasia of preexisting vessels. They are not classified as angiomas. It is the rarest variant of angiokeratomas, with few cases in the literature. The mechanism of development of these lesions has not yet been fully elucidated. Small lesions can be treated with electrosurgery, curettage, or cryosurgery. Larger lesions require deep surgical excision, and depending on the size and depht of the lesion, direct closure, flap, or grafting. CO2 or argon laser are considered other treatment options. In this case report we describe a classic case of circumscribed angiokeratoma, with onset at birth, and progressive growth.

Keywords: Ambulatory surgical procedures; Dermatology; Vascular malformations

Janus kinase inhibitors have changed the therapeutic paradigm of severe alopecia areata therapy. Some patients are refractory to dosage escalating. In this article, we describe the applicability of adjuvant oral minoxidil therapy.

Keywords: Alopecia; Alopecia Areata; Hair Janus Kinases; Minoxidil

Systemic sclerosis is a disease of unknown cause, is a rare pathology that, when not treated in time, produces severe damage to the facial aesthetic anatomy causing a significant impact on the quality of life. The case of a 54-year-old woman, with a history of systemic sclerosis of 25 years of evolution, and who was stable from her disease over four years ago. The patient consults for resolution of her facial deformity, which is why she proceeds to perform minimally invasive low-risk procedures such as transcutaneous blepharoplasty and fillings with hyaluronic acid obtaining aesthetically adequate results.

Keywords: Blepharoplasty; Hyaluronic acid; Scleroderma, diffuse

Pincer nail deformity is characterized by excessive transverse over curvature of the nail. A 58-year-old woman came with a complaint of pincer nail accompanied by swelling and pain in the last 1 month due to frequent use of narrow shoes. We performed a surgical intervention indicated to treat pain, inflammation, interference with wearing shoes, and cosmetic embarrassment using an inverted T incision method with osteophyte removal. This case showed that the surgical approach did not require a long time to be conducted, presenting brief healing time, minimal pain, and excellent cosmetic outcome.

Keywords: Osteophyte; Ambulatory surgical procedures; Nails, malformed

Isolated keloid treatment has variable and often unsatisfactory results. The combination of therapies has proven to be an effective alternative mainly for recalcitrant cases. Surgical excision and immediate postoperative electron beam irradiation is an effective alternative in healing and reducing the recurrence rate of these lesions. The authors describe a patient with recalcitrant bulky keloid who had a good therapeutic outcome.

Keywords: Ear; Keloid; Radiotherapy