Background: It has been proposed that thermal water can be used as an anti-inflammatory and mild hydrating agent in the preparation of skincare formulations. However, due to the complex process and strict quality control associated with its extraction from the ground, an oligoelements complex that mimics the effects of thermal water on skin is being used instead. Objective:To evaluate the stability and effects of thermal water and its oligoelements in the formulation of cosmeceuticals, as well as their immediate effects on the skin. Methods: An aqueous gel, a gel cream and an emulsion were prepared with and without the addition of oligoelements and submitted to physical stability analysis.The more stable preparations were tested on study subjects’ forearms. The objective evaluation of the effects on the skin’s texture and hydration was conducted according to biophysical and image analysis techniques before, immediately after and 2 hours after application. Questionnaires assessed participants’ subjective perceptions of the various formulations.The possible anti-inflammatory effects were not evaluated. Results: The effects of the more stable gel formulations were assessed on 15 study subjects.The gels increased the content of the aqueous corneum stratum, while the waters only produced an improvement of the skin’s texture. Conclusion: The results obtained from the subjective and objective analyses coincided and suggested the usefulness of the oligoelements complex in cosmeceutical products for moisturizing the skin.

Keywords: TRACE ELEMENTS, COSMETICS, WETTING AGENTS

Background: Striae are linear atrophic plaques associated with overstretching the skin (commonly called stretch marks). Urogenital dystopia is the displacement of a pelvic organ from its original site due to alterations in or relaxation of the pelvic supporting structures. Histopathologic studies have revealed similarities in the irregularity of the distribution patterns of collagen fibers located in the striae’s tissue and in the pelvic floor of patients suffering from pelvic relaxation or prolapse. Objective: To evaluate the prevalence of striae in patients with and without pelvic relaxation syndrome, in order to assess the association between the two conditions. Methods: Female patients with genital dystopia and healthy controls were administered an 80-question instrument specifically designed for this study and received a physical examination to determine whether there is a link between striae and genital dystopia. Results: No statistically significant difference was observed in the prevalence of striae in patients with genital dystopia (n=35) compared with controls (n=94), suggesting there is no association between the two conditions. Conclusion: The association between striae and genital dystopia, previously suggested by other authors, was not verified in this study. Since striae are not a risk factor for pelvic relaxation, it is necessary to investigate other clinical markers that will enable preventive measures and the reduction of costs associated with the surgical treatment of prolapse.

Keywords: SKIN, UTERINE PROLAPSE, URINARY INCONTINENCE, COLLAGEN

Introduction: Muscle activity at the glabella causes wrinkles that are perpendicular to muscle contraction. Such wrinkles are currently treated with botulinum toxin. However, interpersonal local contraction variations are revealed during facial animation. Although a great number of articles on this topic have been published, the patterns of glabellar contraction have not yet been adequately studied and classified. Objective: To identify and classify the glabellar contraction patterns found in the population undergoing cosmetic treatment with botulinum toxin. Methods: Retrospective photographic analysis of 30 patients receiving botulinum toxin for the treatment of glabellar wrinkles.The contraction patterns were identified and classified based on the prevalence of lowering, approximation, or lifting movements at the glabella. Results: Five patterns were identified: 1) "U," 2) "V," 3) "Omega," 4) "Converging Arrows,” and 5) "Inverted Omega." The classification method allowed indentifying the most important muscles in each contraction pattern. Conclusion: There are interpersonal variations in facial animation. The classification of glabellar wrinkles enables a more accurate, individualized treatment with botulinum toxin. The most heavily used muscles receive higher doses or are injected into a larger number of sites. Those less solicited muscles are left untreated or receive lower doses, allowing for more effective and natural results.

Keywords: CLASSIFICATION, BOTULINUM TOXINS, REJUVENATION

Introduction: Constitutional infraorbital hyperchromia (commonly called under-eye circles) is a common dermatosis that is difficult to treat. Objective:To evaluate the clinical improvement of constitutional infraorbital pigmentation resulting from the application of a series of five 10% thioglycolic acid gel peeling sessions. Methods: Patients were administered five successive 10% thioglycolic acid gel peel sessions, in 15-day intervals. In the first session, the product was left on for two minutes, with three minutes added in each subsequent session, culminating with 15 minutes of contact in the last session. Fifteen days after the last session, a satisfaction scale ranging from 0 (lack of improvement) to 10 (total improvement) was administered to the patients, to the dermatologist investigating the peelings, and to a blindevaluator medical doctor (a dermatologist that had not had taken part in the treatment sessions). Results: Study subjects (n=10) were females aged 24-50.The average clinical satisfaction presented by the patients, the investigator, and the blind-evaluator were 7.8, 7.6 and 6.8, respectively, with no statistically significant differences among them (p=0.065). Conclusion: The serial application of 10% thioglycolic acid gel peels is a safe, efficient, and costeffective treatment for constitutional infraorbital pigmentation.

Keywords: CHEMEXFOLIATION, EYE, HYPERPIGMENTATION, EYELID DISEASES

Introduction: Fractional ablative procedures offer more robust results, with shorter recovery time and lower risk of adverse effects compared to non-fractional ablative methods. Objective: To evaluate the effects of a new fractional ablative technology employing Erbium laser(2,940nm) in facial photoaging. Methods: Female patients with moderate facial photodamage were subjected to treatment with a 2,940nm fractional Erbium laser (Palomar Inc., Burlington MA).The parameters varied from 5 to 9 mJ/µb, with pulses of a duration from 250 microseconds to 5 milliseconds.Two to six passes with a 50% overlap were carried out.The clinical evaluations occurred 3 days, 1,4,8 and 12 weeks, and 15 months after the procedure.Three dermatologists who were not involved in the study evaluated the global improvement of the photodamage before and 3 months after the procedures, by reviewing digital pictures, and classified the results according to the following scale: grade 1 = improvement less than 25%; grade 2 = improvement of 26% to 50%; grade 3 = improvement of 51% to 75% and grade 4 = improvement from 76 to 100%. Results: Female patients (n =12), aged 48 to 78 were studied.After 3 months, 23% of the patients were classified as grade 3, 55% as grade 2 and 22% as grade 1. Significant improvement (grade 2) was observed in 78% and 63% of the periorbital and perioral wrinkles, respectively.Two patients developed transitory post-inflammatory hyperpigmentation. Conclusion: The fractional Erbium laser was shown to be effective and safe in the treatment of moderate photoaging.

Keywords: ERBIUM, LASERS, ABLATION TECHNIQUES, REJUVENATION, LASER THERAPY

Special considerations are necessary to contemplate any surgical procedure during pregnancy. Dermatologic surgeons must consider the best approach in order to minimize risks and provide optimal care to the mother and fetus. Nonemergency treatments should be postponed until after childbirth. When surgery is required, it is prudent to apply techniques and drugs that are well documented in the specialized literature.

Keywords: PREGNANT WOMEN, PREGNANCY, DRUG TOXICITY, AMBULATORY SURGICAL PROCEDURES

The theme of surgical prophylaxis is widely discussed by dermatologists; however, there is a lack of consensus regarding both opinions and published studies.A review of papers relating to the use of antibiotics and antivirals in prophylaxis was conducted in order to organize the existing data and provide dermatologists with a better foundation for making decisions.The literature review was performed using Medline and Cochrane Library databases. ecommendations of prophylaxis in several common situations in the dermatologist''''''''s daily experience, in addition to suggestions of prophylactic medications, were made based on these studies.The critical and evidence based approach in medicine provides support to the decision making process. Nevertheless, dermatologists should neither dismiss their own clinical experience nor underestimate the physician''''''''s individual ability to conduct the clinical analysis of patients.

Keywords: ANTIBIOTIC PROPHYLAXIS, SURGERY, DERMATOLOGY

The partial regression of cutaneous melanoma is a frequent event. Nevertheless, complete regression is a rare and difficult to diagnose condition.We report three cases of regressed cutaneous melanoma (RCM) whose initial biopsies did not reveal melanoma and in which the diagnosis was based on the presence of metastasis. There is no consensus about the prognosis of RCMs. Some authors relate a higher prevalence of metastasis, coinciding with our cases'''''''' outcomes, where the RCM had the worst prognosis due to the tumors'''''''' aggressiveness or to the difficulty in establishing an early diagnosis and staging. We have concluded that the regression of melanoma complicates the diagnosis, staging and formulation of a worst-case scenario prognosis. Excisional biopsy should always be the first choice.

Keywords: MELANOMA, NEOPLASM REGRESSION, SPONTANEOUS, NEOPLASM METASTASIS, PROGNOSIS

A técnica de reconstrução de defeitos localizados na ponta nasal é desafiadora para a cirurgia dermatológica pelo fato de haver pouca pele adjacente disponível e limitada mobilidade. Este relato demonstra que é possível mobilizar a pele adjacente para recobrir o defeito usando retalho com pedículo miocutâneo unilateral que permite maior movimentação e não distorce a simetria do nariz.

Keywords: RETALHOS CIRÚRGICOS, NARIZ, ENXERTO DE PELE

Keratoacanthoma may be easily mistaken with squamous cell carcinoma, both clinically as well as histopathologically. However, only keratoacanthoma can regress spontaneously.We report a case of a patient with a exophytic, ulceraded, infiltrated lesion in their scalp that was initially diagnosed as a keratoacanthoma. The histopathologic examination confirmed the presence of squamous cell carcinoma, and the tomography of the skull showed that the cancer had spread within the cranium. A surgical excision with wide margins and rotation flap was conducted, followed by adjuvant chemotherapy and radiotherapy treatments.There are a great number of accounts of squamous cell carcinoma erroneously diagnosed as keratoacanthomas in the specialist literature, illustrating the difficulty in differentiating between them.While there is no established effective method to distinguish between the two conditions, surgical excision should be the treatment of choice.

Keywords: CARCINOMA, SQUAMOUS CELL, KERATOACANTHOMA, SURGERY

Non-surgical techniques used in the rejuvenation of the periorbital region, notably regarding injections of hyaluronic acid for the correction of depressed areas. However, in spite of the good results brought by these described techniques and products, there are still complications linked to their use, such as color alterations, irregularities in the surface of the skin, local edema, and long time of recovery. In an attempt to abate those undesirable effects, thirty patients were treated with a filler of low hyaluronic acid concentration, slowly and sequentially depositing small drops in a superficial plane, reminding a string of beads, with the subsequent application of digital pressure. This technique of easy application, has presented good aesthetical results and lower risk of undesirable effects and complications.

Keywords: HYALURONIC ACID, ORBIT, REJUVENATION