INTRODUCTION: The use of botulinum toxin has become one the essential cosmetic procedures performed in the world.
OBJECTIVE: To identify patterns of muscle contraction of the forehead, glabellar complex, and orbicularis oculi muscle in patients from southern Brazil, establishing their epidemiology and possible associations between them.
METHODS: One hundred and one patients who sought treatment with botulinum toxin for the forehead, glabella, and periocular lines between 2012 and 2016 were included. Analyzes were made using digital photographs taken during a medical consultation before applying the products., The subjects received with different brands of botulinum toxin, according to the patients’ or the doctors’ preference
RESULTS: The most common contraction patterns were complete frontal, glabellar in converging arrows, and complete periocular. Women represented 94.1% of patients. Most patients were between 31 and 50 years old, with an average of 44.57 years. More frequent patterns in each area were more frequently associated.
CONCLUSIONS: The study shows the main muscle contraction patterns of the upper third of the face in 101 patients, as well as their clinical characteristics, comparing them with previously published articles. Studies on muscle contraction patterns can assist in the safer and more rational use of the products available, avoiding waste and complications.

Keywords: Muscle contraction; Skin aging; Face; Facial muscles; Botulinum toxins type A

INTRODUCTION: Fibrosing Frontal Alopecia (FFA) is a form of scarring alopecia, in which patients have an irreversible loss of hair follicles, especially in the frontal and temporoparietal regions. The etiopathogenesis is not fully understood, although hypotheses about genetic, hormonal, and behavioral factors, such as the use of sunscreen and facial moisturizers, have already been described.
METHODS: A case-control study was conducted using an objective questionnaire with 33 questions. Sixty women were evaluated, 30 diagnosed with FFA, and 30 not affected by the disease.
RESULTS: The mean age of the sample was 64 years old. 76.7% of patients with FFA and 23.3% of controls used facial sunscreen and the difference was statistically significant (p<0.001). Also, the use of facial moisturizer was significantly higher in patients with alopecia (63.3%) when compared to controls (33.3%; p=0.038). The frequency of use of regular soap on the face was significantly lower in patients with FFA (46.7%) when compared to the control group (83.3%; p=0.006).
CONCLUSION: Results suggest a possible association between FFA and the use of facial products, such as sunscreen and moisturizer, in this population. All patients were menopausal, reinforcing the hormonal relationship with the disease.

Keywords: Alopecia; Contraceptives oral combined; Finasteride; Menopause; Tamoxifen

Basal cell carcinoma (BCC) is the most common skin cancer. When located in the nasal region, reconstructing the defect resulting from its exeresis can become very challenging for the dermatological surgeon. The snail flap (SF) technique can be used to correct defects, mainly on the nose’s lateral wall, but we use it in a modified way to close the nasal wing injury. In both cases, the results were satisfactory, cosmetically and functionally.

Keywords: Carcinoma basal cell; Surgical flaps; Nose

Although little reported in daily practice, the use of systemic retinoids can cause changes in the shape, color, and texture of hair shafts. We report a case of a patient treated with isotretinoin for acne vulgaris who experienced new growing curly hair. Such hair changes are recognized during therapy with oral retinoids; however, isotretinoin-induced modifications on the hair fiber curvature are extremely rare.

Keywords: Hair; Isotretinoin; Pharmacological treatment

Riziform bodies are structures in the synovial fluid or attached to the synovium, which macroscopically resemble rice grains. They are common in patients with rheumatoid arthritis and result from a chronic inflammation. They are found in 25% of aspiration procedures or joint surgery. However, there are still no publications reporting its presence in the subcutaneous tissue. We report for the first time the occurrence of riziform bodies in the subcutaneous plane of the palmar region in a patient with rheumatoid arthritis, confirmed by sonographic and anatomopathological examination, successfully treated with surgical drainage, without recurrences after two years of follow-up.

Keywords: Abscess; Rheumatoid arthritis; Dermatopathies; Hand dermatoses; Outpatient Surgical Procedures; Surgical Diagnostic Techniques

Microneedling has traditionally been used to induce collagen formation. Scalp microneedling has been seen to stimulate the capillary cycle and anagen phase, but studies demonstrating histopathological changes after this procedure are lacking. Here we present the case of a 37-year-old woman with a 15-year history of female pattern alopecia, with diffuse hair thinning prominent in the frontoparietal region and hair miniaturization seen in dermoscopy. The patient’s condition remained stable for seven years with use of spironolactone and topical minoxidil. The patient underwent three scalp microneedling sessions at monthly intervals. Histopathological analysis was conducted before the sessions and one month after the last session. Despite slight clinical and dermoscopic improvement, the alopecia pattern remained the same, without significant changes in follicle count after the interventions. Neither inflammation nor fibrous tracts were observed after the procedure. The histopathological analysis is essential to assess the safety of scalp microneedling in the short and long term, investigate signs such as inflammation and fibrosis, and determine the effectiveness of this procedure in treating alopecia. Studies with a more significant number of cases are necessary.

Keywords: Alopecia; Pathology; Treatment outcome

Acral amelanotic melanoma is rare and can mimic many entities, such as eccrine poroma, squamous cell carcinoma, plantar wart, and chronic ulcers. Due to the variety of possible differential diagnoses, it is a challenging and frequently late diagnosis. Dermoscopy features can help in early diagnosis. The dermatologist should keep this diagnosis in mind when faced with a pink, progressively growing, irregularly shaped lesion, mainly if located on the hands and feet.

Keywords: Dermoscopy; Melanoma amelanotic; Skin neoplasms; Oncology; Foot ulcer

Merkel cell carcinoma is a rare and aggressive neuroendocrine skin tumor usually presenting as a single lesion in the head or neck region. We report a case of atypical topography and presentation, with multiple and simultaneous tumors on the left leg of rapid progression associated with palpable inguinal lymphadenopathy and diagnostic confirmation by histopathology and immunohistochemistry. Exeresis of the left inguinal lymph node and skin lesions with a safety margin was performed.

Keywords: Carcinoma Merkel cell; Merkel cells; Merkel cell polyomavirus

INTRODUCTION: Actinic keratoses are premalignant lesions with a risk of transformation to invasive squamous cell carcinoma. There is no identified correlation between clinical classification and histological grade of these lesions.
OBJECTIVES: To correlate the clinical characteristics of actinic keratoses of the forearms and back of the hands with the degree of histological atypia (Keratinocyte Intraepidermal Neoplasia); to develop and validate a clinical severity scale correlated with the histological grade of actinic keratoses.
METHODS: Cross-sectional study with 162 actinic keratoses clinically evaluated for diameter, erythema, infiltration, hyperkeratosis, and exulceration and 34 lesions with different patterns were biopsied. Clinical features were correlated with the degree of histological atypia and p53 and Ki-67 expression.
RESULTS: Only the diameter of the lesions was significantly correlated with the degree of atypia (p=0.04), and only the erythema, hyperkeratosis, and the diameter linked with the immunohistochemical markings. A clinical score including diameter, hyperkeratosis, and exulceration was developed, which associated significantly with the degree of atypia (Spearman’s Rho=0.43; p=0.01).
CONCLUSIONS: A score composed of diameter, hyperkeratosis, and exulceration correlated with the histological grade of actinic keratoses of the upper limbs was developed.

Keywords: Carcinoma in situ; Carcinoma squamous cell; Keratosis actinic; Skin diseases

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare tumor with an estimated incidence rate of 0.23 cases/1,000,000 people per year. A 60-year-old man presented a scalp lesion in 2017. Initially, it was not possible to perform a histopathologic diagnosis. In 2018, surgical biopsy and immunohistochemistry of the local skin recurrence indicated a diagnosis of PCACC (treatment was surgery and radiotherapy). In 2020, a new local tumor recurred and was surgically resected. The patient had systemic metastases (pulmonary metastases) and underwent chemotherapy. Currently, the pulmonary metastases are stable. The PCACC has progressed to pachymeninges.

Keywords: Carcinoma adenoid cystic; Scalp; Neoplasm metastasis; Skin neoplasms

Blue nevus is a benign lesion arising from dermal melanocytes containing large amounts of melanin. The agminated variant presents a cluster of blue nevus lesions with linear or blaschkoid distribution. We report two cases of patients with agminated blue nevus that developed on previous acne scars, and dermoscopy helped a lot in the differential diagnosis. This is the first occurrence found in the literature of agminated blue nevus that appeared on a previous scar, which may have occurred by chance or as a result of the collagen remodeling process inherent to the healing process.

Keywords: Scar; Collagen; Dermoscopy; Nevus blue

Low-grade fibromyxoid sarcoma (LGFS) is a rare, indolent spindle cell sarcoma with a risk of recurrence and metastasis. We report the case of a 34-year-old man with a tumor in his thumb that had recurred after excision eight years ago, with slow and progressive growth. The pathological examination was suggestive of SFBG, and we proceeded with the disarticulation of the phalanx. The patient remains in follow-up, with no evidence of metastases. Although rare, it is essential to recognize the diagnosis of an LGFS with its potential risk of recurrences and metastases, especially as a differential diagnosis of acral soft tissue tumors.

Keywords: Dermatology; Neoplasms; Sarcoma

Pemphigus vegetans is considered a rare clinical variant of Pemphigus vulgaris and is associated with recurrent lesions that can evolve into extensive vegetative plaques that are difficult to resolve. Surgery may be an alternative in the complementary treatment of lesions resistant to classical therapy. There is a shortage of literature that shows the surgical technique and the postoperative results of the approach to pemphigus vegetans, making the communication of this case relevant. We present the case of a patient with the Hallopeau type of pemphigus vegetans successfully treated with tangential exeresis followed by secondary intention healing of large retroauricular projections.

Keywords: Pemphigus; Dermatologic surgical procedures; Treatment outcome

Sarcoidosis is a systemic granulomatous disease with skin involvement in 10% to 25% of cases. This skin condition has been associated with previous trauma, including the use of skin fillers. We present the case of a patient with an erythematous plaque on the nasal dorsum with 12 months of evolution and a history of previous facial fillings with polymethylmethacrylate and hyaluronic acid. Skin biopsy showed a granulomatous inflammatory process with an epithelioid pattern and multinucleated giant cells, characteristic of cutaneous sarcoidosis. Sarcoidosis can occasionally manifest without systemic involvement and may be associated with the previous use of long-term tissue fillers.

Keywords: Hyaluronic acid; Dermatology; Polymethyl methacrylate; Dermal fillers; Sarcoidosis

Retronychia is an inflammatory onychopathy characterized by the disordered growth and stacking of nail plates, associated with an imbalance in the matrix production of plaques, which tend to overlap. This condition may be associated with trauma, evolving with an inflammatory reaction along the proximal nail fold and granulation tissue formation. We report the case of a patient with retronychia in the left hallux, submitted to surgical treatment after failure of therapeutic responses with previous clinical treatments. The surgical approach led to the avulsion of the overlapping nail plates and the excision of voluminous granulation tissues, achieving adequate postoperative evolution.

Keywords: Nail diseases; Nails; Nails ingrown

Cutaneous diffuse large B-cell lymphoma, leg type, is a rare, aggressive, and poorly prognostic neoplasm. It corresponds to 10-20% of cutaneous B-cell lymphomas and mainly affects the lower limbs of older women. We report the case of an 81-year-old woman with painful, fast-growing nodules and tumors in her left leg. Histopathological and immunohistochemical findings, associated with the absence of extra-cutaneous involvement during staging, concluded the diagnosis of cutaneous diffuse large B-cell lymphoma, leg type. The rarity of this limphoma, its typical clinic and epidemiology, and the excellent response to treatment motivated this report.

Keywords: Immunohistochemistry; Diffuse; Lymphoma non Hodgkin; Lymphoma large B-cell, Neoplasms; Therapeutics

BACKGROUND: The microneedling technique and the transdermal drug delivery are indicated to treat acne scars.
OBJECTIVE: Evaluation of the microneedling technique associated with the drug delivery of the epidermal growth factor (EGF).
METHODS: Randomized double-blind clinical trial of 30 patients divided into two groups: (1) - two microneedling sessions with a 30-day interval, (2) - two microneedling sessions with the same interval but associated with EGF drug delivery. The patients were evaluated clinically (global acne scarring grading system - Goodman and Baron) global acne scarring grading system via multispectral image and through self-perception questionnaires. The statistical analysis (Student T-test, SNK test, analysis of variance) was performed with the SisVar software (UFLA, 1996).
RESULTS: The groups were homogeneous regarding age, gender, and phototype. Clinical assessments showed a reduction in severity scores for both groups. The multispectral analysis revealed a decrease in porphyrins (p = 0.0296) and an improvement in skin texture in group 2 subjects.
CONCLUSION: Microneedling therapy was effective and safe for the acne scars treatment, and EGF demonstrated to be a promising strategy as well.

Keywords: Acne vulgaris; Cicatrix; Skin

Local flaps are an excellent option for repairing the excision of skin tumors, where the primary closure of the defect would cause aesthetic and functional impairment. The rhomboid (Limberg) flap is a simple and versatile transposition flap that can be applied widely with good cosmetic and vascularization results. The retrospective analysis of a case series using the Limberg flap to reconstruct defects resulting from tumor resections proved to be easy to perform, with excellent evolution and vascular viability.

Keywords: Carcinoma basal cell; Skin neoplasms; Surgical flaps; Surgical oncology

Keloids (K) and hypertrophic scars (HS) are highly prevalent, but their treatment is still challenging. Several treatments are beneficial to treat K/HS, but there is still no protocol or algorithm to address scars following an organized step-by-step and justifying each type of treatment in the scar phases.This study aims to present an algorithm to treat keloids/scars. It has been used for several years in our clinic and helps organize several therapies to treat scars. Combined, these sequences of treatments lead to progressive improvement in K and HS.

Keywords: Acne keloid; Hypertrophic scar; Keloid.

BACKGROUND: The increased demand for cosmetic facial treatments is a universal reality, with Brazil being the second country in the world that performs them the most. Quality of life questionnaires can help assess results more objectively and reveal data not yet explored in the scientific literature. For this, the process of translation, adaptation and validation of questionnaires is necessary for the universalization of data.
OBJECTIVE: To translate, adapt and validate a specific questionnaire for the assessment of facial cosmetics procedures into the Portuguese language spoken in Brazil.
METHODS: After choosing the SROE (Skin Rejuvenation Outcome Evaluation) questionnaire, the translation process started. A literal translation was performed, with subsequent synthesis of the versions. After, reverse translation and final validation by a team of experts were carried out. The data obtained were statistically analyzed for validation.
RESULTS: The final version was called "Avaliação dos Resultados de Rejuvenescimento da Pele" (ARRP). The Cronbachs a resulted in values above 0.70, showing good internal consistency. The Intraclass Correlation Coefficient was 0.995 (p<0.001).
CONCLUSIONS: The values obtained validate the ARRP questionnaire, translated into Brazilian language and culture, which aims to evaluate the results and impact on the quality of life of facial cosmetics procedures.

Keywords: Cross-cultural comparison; Patient health questionnaire; Quality of life

Reconstruction with grafting for defects resulting from the removal of squamous cell carcinoma in the lower limbs is a great challenge for the dermatological surgeon. A very thin skin for the receiving area, the inhomogeneity of the local vascularization and the transient venous insufficiency make it difficult to integration of the grafted skin in these regions. For the success of this type of procedure, some techniques can be used to repair these difficulties, such as an elastic compressive dressing that we use in the first postoperative days of a total skin graft on the foot and leg, with good results

Keywords: Carcinoma squamous cell; Foot; Leg; Graft survival

Filling with hyaluronic acid using a pen that injects with vacuum pressure in the lips region became popular due to not using needles, but it presents risks like any minimally invasive procedure. We present a case of injection of hyaluronic acid with this device in the labial region, which resulted in a subocclusion of the inferior labial artery. It is known that the use of pressure can offer a lower precision than the methods already used classically. Therefore, it is important to warn about the risks of this device, which despite not using needles, presents the same risks of complications.

Keywords: Dermal fillers; Hyaluronic acid; Lip

In this cross-sectional study, we compared the diagnosis made through teledermatoscopy with histopathological diagnosis. Conventional and dermoscopic photos of 31 pigmented lesions were taken and sent to an experienced dermatologist using the WhatsApp^® Messenger application. A dermatopathologist excised and examined all lesions. The global accuracy of mobile teledermatoscopy was 90.32%. Regarding the ability of teledermatoscopy to define malignancy of the pigmented lesion, the specificity was 81.8% and the sensitivity was 100%. Our results provide additional evidence of the reliability of mobile teledermatoscopy with high sensitivity and accuracy.

Keywords: Dermoscopy; Teledermatology; Telemedicine

INTRODUCTION: Skin cancer is one of the most prevalent neoplasms, and melanoma is its most aggressive form. It is responsible for most deaths due to its high metastatic potential. The early diagnosis affects the patients’ prognosis and can be encouraged by educating the population regarding self-examination of the skin and recognition of salient characteristics of the lesions.
OBJECTIVES: To evaluate the impact of an educational video intervention on skin cancer with the application of a questionnaire before and after the intervention.
METHODS:Prospective quasi-experimental study that included patients assisted in the dermatology service of a public hospital in Belo Horizonte.
RESULTS: 196 patients were included. Although most participants recognized the importance of monitoring with a dermatologist (81.1%), most were unaware of melanoma (70.9%). There was a significant change in knowledge about skin neoplasms, especially regarding the ABCDE mnemonic (P<0.01).
CONCLUSIONS: The educational intervention contributed to increasing significantly the participants’ knowledge about skin cancer. With the contact restrictions imposed by the COVID-19 pandemic, actions that disseminate information and encourage self-examination of the skin become even more essential for early diagnosis.

Keywords: Knowledge; Dermatology; Education; Melanoma; Skin neoplasms

Female pattern hair loss (FPHL) is one of the most frequent complaints in dermatological practice. It affects up to 50% of climacteric and postmenopausal women. Despite multiple therapies available nowadays, some patients are refractory to conventional treatments, requiring the association of second-line therapies to obtain good aesthetic results. This paper aims to show the advantages of microneedling of the scalp for such cases by reporting the case of a 48-years-old patient who failed to the association of topical minoxidil and oral finasteride therapy.

Keywords: Alopecia; Attachment disorder; Combined modality therapy; Hair diseases

INTRODUCTION: Progressive Facial Hemiatrophy, also known as Parry Romberg Syndrome, is a rare form of linear scleroderma. The management of facial atrophy sequelae is challenging.
OBJECTIVE: This study aims to evaluate for the first time in literature the effectiveness of the calcium hydroxylapatite (CaHa) filler in the jawline reshaping of a patient with Parry Romberg Syndrome.
CASE REPORT: A 15-year-old woman with progressive atrophy of the right side of the face due to Parry Romberg Syndrome. After disease control, the patient’s main complaint was facial asymmetry, mainly in the jawline region.
DISCUSSION: CaHa is a biocompatible injectable filler that is gradually resorbed and replaced by fibrovascular stroma, mainly formed for new collagen, in a process that occurs without any immunological reaction. This safety profile makes CaHa a good choice for correcting stable scleroderma defects.
CONCLUSION: This report concludes that CaHa filler biocompatibility and suitability for the jawline correction are also applicable in reconstructive procedures for stable scleroderma, safely and minimally invasively, with optimal aesthetic results. The method must be programmed case-by-case, and a regular follow-up is also recommended.

Keywords: Scleroderma localized; Facial hemiatrophy; Dermal fillers

A wide range of dermal fillers is now available for use in the beauty industry. We present a case of a 33-year-old woman with complications after hyaluronic acid injection by a non-medical practitioner. Two weeks after the injection, bilateral sinus pain, fever, and burning sensation occurred in the cheek area. She underwent a detailed diagnosis revealing Attagenus larva in the paranasal sinus. Despite treatment, the symptoms remained. Thus, hyaluronidase was administered in the infraorbital area, obtaining a full remission.

Keywords: Hyaluronic acid; Nasal cavity; Dermatology; Larva; Dermal fillers.

Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease where there is a mutation in the tumor suppressor gene, with a greater predisposition to neoplasms, especially of the gastrointestinal tract. The first manifestations begin during childhood with the presence of mucocutaneous melanosis and, later, gastrointestinal hamartomatous polyps. We describe a case of a young woman whose initial PJS manifestation started during her childhood with cutaneous melanosis. Three sessions with the Q-switched 1064nm Nd:YAG and 532nm KTP lasers were performed to treat the melanosis with excellent results and without recurrence.

Keywords: Lasers; Lentigo; Peutz-Jeghers syndrome

In the aging process, the intracellular routes that regulate collagen homeostasis are influenced by the exposome, resulting in its degradation and decreased synthesis, leading to sagging skin. Current evidence indicates that oral collagen supplementation may promote wrinkles reduction in the eye area, wound healing, skin elasticity and hydration improvement, enhancement of cellulite, some dermatitis, and nails fragility. Large-scale and methodologically more robust studies are still needed to consider the use of oral collagen as an effective adjuvant treatment to different dermatological conditions.

Keywords: Collagen; Skin; Dietary supplements

The present study is a scientometric analysis aiming to verify the scientific production about radiofrequency in facial wrinkles. The databases used were the Web of Science and Pubmed. We searched the literature for all articles with the terms "Radiofrequency", "Facial", and "Wrinkle" in the title, abstract, or keywords. For each study, we analyzed the following scientometric indicators: publication number per year, name of the journal, authors, impact factor, country of publication, and type of study.

Keywords: Aging; Aesthetic equipment; Plasma

Eruptive vellus hair cyst is a rare and benign dermatological condition in the development of vellus-type hair follicles. It affects mainly children and young adults, and is characterized by multiple asymptomatic papules, especially on the trunk. We report the case of a 33-year-old white man who presented multiple erythematous papules and pustules located on the trunk for about five years, refractory to topical treatments for acne. Dermoscopy revealed oval lesions with eccentric exulceration and rare protruding filiform structures. We established the diagnosis of eruptive vellus hair cyst based on the findings of dermoscopy and histopathological examination.

Keywords: Cysts; Acneiform eruptions; HIV

INTRODUCTION: Skin cancer is the most frequent malignant neoplasm in Brazil. Its prognosis is directly related to early diagnosis and institution of adequate treatment. The Skin Cancer National Awareness Campaign (SCNAC) is an essential tool to prevent and detect malignant skin lesions.
OBJECTIVES: To investigate the incidence of skin cancer and the accuracy of dermoscopy in patients assessed at the SCNAC.
METHODS: We conducted a retrospective cohort study using directly the data collected from the population assisted at the SCNAC day in 2016, 2017, and 2018 at Clinical Center of the Universidade de Caxias do Sul (CECLIN-UCS).
RESULTS: Of the 634 patients included, 105 were referred for biopsy with histopathological study of the lesion. Dermoscopy was suggestive of a malignant lesion in 55 cases. Biopsy diagnosed malignant lesions in 43 patients and benign lesions in 32 patients. Thus, the sensitivity and specificity of the test were 86% and 50%, respectively. The accuracy of dermoscopy in identifying malignant lesions over the three years of the campaign was around 70%.
CONCLUSIONS: Dermoscopy in SCNAC has a good level of sensitivity and specificity when correlated with final histopathological results.

Keywords: Dermatology; Dermoscopy; Observational study; Skin neoplasms; Health promotion

Onychocryptosis is a frequent nail disease, which most commonly affects the toes. It has some variants, including the little known "Harpoon Nail". The diagnosis is usually clinical, and the treatment is surgical, with different techniques described in the literature. We report the case of a 25-year-old man with a harpoon nail on the left hallux and the surgical method used for treatment with excellent results

Keywords: Nail diseases; Nails ingrown; Hallux

Dermoscopy is a practical, non-invasive tool that can be used to distinguish tinea nigra from other lesions that appear macroscopically similar, including acral nevus. Under dermoscopy, tinea nigra presents with a pattern of spiculated gray-brown pigment deposition, whereas acral nevus most often presents as brown pigment deposition in a parallel furrow pattern.

Keywords: Dermoscopy; Nevus; Tinea

Primary cutaneous B-cell lymphomas are non-Hodgkin lymphomas presenting only in the skin and represent 25% of all primary cutaneous lymphomas. Based on their clinical behavior, they are classified into indolent and intermediate forms. Treatment of indolent forms includes surgery, radiotherapy, and, in extensive disease, rituximab. We report a case of a 57-year-old woman with a single nodule in the left arm treated with surgical excision with 5-mm security margins, without relapse after 36 months. Surgery is a therapeutic option in these lymphomas without compromising disease-free survival.

Keywords: Lymphoma B-Cell; Lymphoma B-Cell marginal zone; Lymphoma non-Hodgkin; Surgical oncology

Neurothekeomas are rare, benign dermal tumors of presumed fibrohistiocytic lineage. They present multiple differential diagnoses, making their identification challenging at the dermatological and anatomopathological examination. We report the case of a 28-year-old man who presented a hardened papule growth on the left upper eyelid with histopathology and immunohistochemistry suggestive of neurothekeoma.

Keywords: Eyelid neoplasms; Neurothekeoma; Case reports

Modern hair transplant is constantly evolving. We intend to demonstrate our techniques and methodologies, and especially to describe the dynamics of the entire surgical process of the FUE (Follicular Unit Extraction), technique, from the discussion of the surgical strategy with the patient and evaluation of the donor area to extraction and implantation. The dermatologist must understand the complexity of the procedure and the need for adequate training to achieve a good surgical result.

Keywords: Alopecia; Hair; Hair follicle; Transplant donor site

The search for aesthetic procedures aimed at the loss of submental definition is increasing. A correct diagnosis is imperative for successful treatment and the reduction of complications. Localized adiposity, skin flaccidity, and loss of bone structure are the main findings. A treatment algorithm was discussed in this review, remembering, of course, the possibility of combined and sequential treatments for better results.

Keywords: Deoxycholic acid; Collagen; Neck; Chin; Adipose tissue; Hydroxyapatites

In recent years, there has been an increasing trend toward the search for nature-friendly cosmetics without chemical or synthetic ingredients, thus boosting sales of products within this market niche. Currently, the term clean beauty refers to products that do not contain ingredients with unknown impacts on our bodies or that are potentially harmful to the environment. However, the definition of green beauty products, as well as vegan, natural, or organic products, is not regulated by ANVISA. Therefore, this study aimed to review these definitions to facilitate the medical understanding of the subject.

Keywords: Beauty; Cosmetics; Beauty products; Green chemistry Technology

BACKGROUND: The SARS-CoV-2 infection has spread worldwide rapidly since its identification at the end of 2019. Globally, until April 2021, there have been more than 150 million confirmed cases of Covid-19, including over 3 million deaths. Therefore, a race was promptly started to produce an effective vaccine against the new virus. Botulinum toxin injection remains the leading non-surgical cosmetic procedure worldwide, with a high rate of efficacy and patient satisfaction.
AIMS: This study aims to analyze the association between the SARS-CoV-2 vaccine and the immediate botulinum toxin response.
MATERIALS AND METHODS: This was an observational, retrospective, and multicenter study. Data were collected between April and June 2021, and a medical record review of 71 patients from 27 to 76 years old treated with botulinum toxin injection.
RESULTS AND CONCLUSION: There were no meaningful changes in the immediate outcome of patients vaccinated for Covid-19 and botulinum toxin. However, it is vital to underline that follow-up and further studies are needed to define whether the Covid-19 vaccine can alter the duration of effect and efficiency of the botulinum toxin.

Keywords: Covid-19; Botulinum toxins type A; Vaccination

INTRODUCTION: The Brazilian scientific production in Dermatology in the international scenario was verified by scientometrics (Sociology segment on quantitative aspects of science).
OBJECTIVE: The insertion of Brazil in the international scientific production scenario can and should be conducted from a more strategic perspective, and it is necessary to observe the production of documents indexed in Scopus in the Dermatology area and related topics in a more detailed way.
METHODS: Through exploratory, inductive, quantitative, and qualitative research on the Scopus platform – a digital platform comprising more than 25 thousand scientific articles and analytical tools to extract results and trends in the field of research, it was possible to obtain quantitative data on Brazilian scientific production in General Dermatology and six prominent dermatoses.
RESULTS: It was possible to analyze and point out the most prominent dermatoses currently in the literature and the related authors, compare Brazilian data with those from other countries that stand out in the scientific literature in Dermatology, and elaborate and justify effective strategies for the international insertion of Brazilian Dermatology scientific production.

Keywords: Impact production; Dermatology; Database; Science

We present a case of delayed-type hypersensitivity to hyaluronic acid (HA)-based filler on the face following the Pfizer booster in a Moderna-vaccinated individual. It is the first known case of treatment of the delayed-type hypersensitivity reaction with hyaluronidase following Covid vaccination. Hyaluronidase is a viable option to treat this reaction, particularly for patients who may not benefit from systemic treatment options. With an anticipated fourth round of vaccine boosters on the horizon, there may be an increased incidence of cutaneous adverse events, including the reaction discussed.

Keywords: COVID-19; SARS-CoV-2; Inflammation; Dermal fillers; Hypersensitivity, Delayed; Hyaluronic acid

Pilomatricoma is a benign skin tumor derived from the hair follicle. It has a varied etiology, and the traumatic one is often described as a triggering factor. The surgical treatment is curative and, therefore, the choice. We report a case of an atypical clinical presentation pilomatricoma – an ulcerated nodule topped by a central hematic crust, with peripheral telangiectasias probably triggered by the HPV vaccination. The ultrasound examination suggested the possibility of a chronic inflammatory granuloma, although the histopathological examination was definitive and confirmed the diagnosis of pilomatricoma.

Keywords: Papillomavirus vaccines; Hair follicle; Ultrasonography, Doppler; Skin neoplasms

INTRODUCTION: Plant extracts and actives derived from plants were developed to improve and enhance the skin healing process including Triticum aestivum L. (Triticum vulgare).
PURPOSE: To evaluate the effect of whole grain extract (EGTA-PR) and aqueous extract (EATA-FI) of Triticum aestivum L., on ex vivo skin healing.
METHODS: Skin fragments obtained from elective plastic surgery were subjected to tissue damage and treated with extracts for eight days for histological evaluation of re-epithelialization and immunofluorescence for epidermal growth factor (EGF).
RESULTS: EGTA-PR and EATA-FI accelerated the re-epithelialization process in human skin culture submitted to tissue injury. Additionally, we observed increased EGF protein labeling after treatment with EGTA-PR.
CONCLUSION: EGTA-PR showed a better performance in re-epithelialization when compared to EATA-FI, as it presented a higher protein labeling for EGF in human skin culture. Likewise, the histological results showed that the dermal redensification obtained with EGTA-PR was visually superior to that observed with EATA-FI. The results obtained are promising and corroborate the several biological actions already reported in the literature for Triticum aestivum L. extract in tissue healing stages.

Keywords: Regeneration; Epidermal growth factor; Triticum; In vitro techniques; Wound healing

NK/T cell lymphoma is a rare, aggressive, non-Hodgkin tumor that is closely related to the Epstein-Barr virus. It has a poor prognosis and poor response to treatments. We report the case of a 91-year-old woman with a history of injury in the nasal region for three months. Histological study showed diffuse infiltration of the dermis by small and atypical lymphoid cells and positive immunohistochemistry for Ki-67, CD30, and CD3 (cytoplasmic). Due to the fast growth of the lesion and the high morbidity of the neoplasm, the patient was referred to the hospital for assistance but died before starting treatment.

Keywords: Epstein-Barr Virus Infections; Lymphocytes; Medical oncology; Extranodal T-NK Cell Lymphoma; Lethal Midline Granuloma

Cutaneous angiosarcoma is a rare cancer with a poor prognosis that affects mainly elderly men. It is related to chronic exposure to sunlight, chronic lymphedema, and procedures using radiation. We report a case of a 62-year-old man with a progressively growing violaceous tumor in the left temporal region. Dermoscopy showed erythematous areas of different shades, pseudo-follicular openings structures, and rosettes. The biopsy and the immunohistochemical study confirmed the diagnosis of cutaneous angiosarcoma. The patient is currently undergoing chemotherapy treatment in the oncology service with significant improvement of the lesion.

Keywords: Dermoscopy; Hemangiosarcoma; Skin neoplasms

This study conducted a systematic review of studies on the relationship between androgenic alopecia and metabolic syndrome. We performed a comprehensive review of databases including PubMed, Web of Knowledge, Google Scholar, Scopus, and Embase, and extracted relevant articles published from 2010 to 2018. The case reports, review articles, or studies lacking full-text articles were excluded. We examined nine studies for the meta-analysis step. The results showed a significant relationship between alopecia and metabolic syndrome (OR = 2.81; CI 95% = 2.16-3.66; I2 = 73%; P = 0.0003). There is a significant correlation between androgenic alopecia and metabolic syndrome.

Keywords: Alopecia; Systematic review; Metabolic syndrome; Hair diseases; Insulin resistance; Review hair

BACKGROUND: Microneedling was initially introduced for skin rejuvenation. This review analyzes the current literature on microneedling techniques, efficacy, and safety for vitiligo treatment.
METHODS: An extensive PubMed search was performed to identify literature on microneedling therapy for vitiligo. Case reports, case series, and clinical trials were included.
RESULTS: All 14 articles evaluated showed improvement of lesions after microneedling treatment. Combination of microneedling and topical tacrolimus, 5-FU, topical calcipotriol and betamethasone, NB-UVB with or without PDT, and triamcinolone acetonide solution yielded more efficacy than microneedling monotherapy.
CONCLUSION: Microneedling is a safe and efficient technique and an adjuvant treatment for vitiligo treatment.

Keywords: Vitiligo; Efficacy; Evaluation of the efficacy-effectiveness of interventions; Review; Rejuvenation; Dermatology; Depigmentation; Needling

The cheek is the largest anatomical unit of the face. In this area, surgical skin cancer treatment must aim for its complete eradication and the best aesthetic-functional result. A 69-year-old woman presented with a 3.5 cm tumor in the left cheek for three years. Biopsy showed moderately differentiated squamous cell carcinoma. We performed an A-T flap, where the surgical defect corresponded to the “A” and the junction of the inferior orbital, nasofacial, and nasolabial grooves, to the top of the “T”. The patient evolved without recurrence and had an excellent aesthetic-functional aspect.

Keywords: Skin neoplasms; Carcinoma, Squamous cell; Zygoma; Surgical flaps; Reconstructive surgical procedures.

Keloid scars affect different populations, compromising patients’ quality of life. The literature presents several treatments. The study aimed to conduct an integrative review of systematic review articles and/or meta-analyses addressing keloid treatment in the PubMed, LILACS, MEDLINE, and Cochrane databases from 2015 to 2021. After identification and following the selection and eligibility criteria, 24 articles were included for qualitative review. We observed that the difficulty in evaluating recurrence affected different keloids treatment modalities, still presenting many failure rates and the need for further studies.

Keywords: Keloid; Scar, hypertrophic; Scar; Clinical procedures; Review; Systematic reviews as topic.

Squamous cell carcinoma (SCC) is the second most common skin cancer. When it is located in the lower eyelid region, the reconstruction of the resulting defect can be challenging for the dermatological surgeon, due to the local cosmetic and functional peculiarity. We report the use of an upper eyelid transposition flap for lower eyelid reconstruction with satisfactory results, both in terms of aesthetics and the resulting functionality

Keywords: Carcinoma; squamous cell; Surgical flaps; Eyelids; Eyelid neoplasms

Intravascular endothelial hyperplasia, or Masson’s tumor, is a benign vascular lesion with no well-defined pathogenesis. The response to vascular damage is believed to be one of the main reasons for its development. It is a typically painless injury, solitary, with slow evolution. This report aims to describe a case of Masson’s tumor in an unusual place, the hallux nail matrix, and discuss its main characteristics.

Keywords: Hyperplasia; Hallux; Endothelium, Vascular.

Chondroid syringoma, also known as a cutaneous mixed tumor, is a rare benign neoplasm originating from the sweat glands, composed of epithelial structures immersed in a myxochondroid stroma. It usually presents as a solid, single tumor located on the face or neck with a chronic and asymptomatic course. We report the case of a 75-year-old woman with a slightly elevated lesion on the forehead, whose diagnosis was defined by histopathological analysis.

Keywords: Adenoma, pleomorphic; Eccrine glands; Neoplasms.

We developed a narrative literature review on the association of fat grafting and hair transplantation using the Follicular Unit Extraction (FUE) technique in scalp scars. Data were collected from studies found in Medline, Lilacs, and IBECS databases. Bibliographical records of several authors who researched mesenchymal cells in adipose tissue were cited, describing the techniques used. The conclusion was that the two-stage hair transplantation technique, with previous fat transplantation, is effective, according to the reviewed articles.

Keywords: Stem Cells; Mesenchymal Stromal Cells; Adipose Tissue; Hair transplantation

INTRODUCTION: Melanoma comprises 3% of all skin tumors and can produce metastasis with high mortality.
OBJECTIVE: To analyze the temporal behavior of mortality from skin melanoma in the capitals of Northeast Brazil from 2001 to 2017.
METHODS: We conducted an ecological time series study involving all deaths due to melanoma registered in the capitals of the Northeast region of Brazil from 2001 to 2017. Crude and standardized rates by the world and Brazilian populations were analyzed. We obtained the indicators from the National Cancer Institute (INCA). The regression model by inflection points was used in the statistical analysis, calculating the annual variation and the average annual variation percentages.
RESULTS: There were 954 deaths from melanoma. The three rates analyzed showed a linear growth trend over the time series: proportional mortality increased from 2.1% to 8.28% (AAPC 6.0%; p<0.02), the crude mortality grew from 0.22 to 0.64/100 thousand (AAPC 5.0%; p<0.01) and the mortality adjusted by the world population in the capitals of the Northeast rose from 0.28 to 0.61/100 thousand (AAPC 2.7%; p<0.01).
CONCLUSION: Mortality from melanoma grew in the Northeastern capitals, with inequality between the sexes and according to the capitals.

Keywords: Epidemiology; Melanoma; Mortality; Skin neoplasms.

Basaloid follicular hamartoma (BFH) is a rare and benign adnexal tumor that resembles basal cell carcinoma (BCC) and may present with different clinical manifestations. A mutation in the PTCH gene, involved in Gorlin-Goltz syndrome, could be associated with the pathogenesis of this neoplasm. We describe the case of a 7-year-old girl with multiple papules on her face.

Keywords: Hamartoma; Carcinoma, Basal cell; Genes, Tumor suppressor.