Chromoblastomycosis is a chronic granulomatous infection caused by dematiaceous fungi with varied clinical presentations, which may represent a therapeutic challenge. In this report, we present a case of chromoblastomycosis in a localized form, with a long evolution, in an elderly patient, resistant to previous drug therapies, successfully treated by the association of a physical method with systemic pharmacological treatment, which allowed the use of a reduced dose of the drug.

Keywords: Chromoblastomycosis; Cryosurgery; Itraconazole

Eccrine syringofibroadenoma (EFAS) is a rare benign tumor that originates from the eccrine sweat glands. It has a predilection for the extremities of elderly individuals and may arise in association with various acquired or hereditary diseases and neoplastic skin disorders. We report the case of a 48-year-old man who had been quadriplegic due to transverse myelitis for 30 years, with a rapidly progressive plantar tumor that was difficult to diagnose.

Keywords: Poroma; Neoplasms; Eccrine glands.

INTRODUCTION: Hidradenitis Suppurativa is a chronic inflamatory and relapsing disease. High levels of recurrence can persist even after wide local excision.
OBJECTIVE: Identify the main risk factors for postoperative complications of Hidradentis Suppurativa.
METHODS: We included journal articles with data from Google, Pubmed, Lilacs, and Scielo, in Portuguese and English, from 2000 to 2021.
RESULTS: The main risk factors that influence postoperative outcomes are related to surgical technique, disease severity, comorbidities, and adjuvant clinical therapy.

Keywords: Hidradenitis suppurativa; Risk factors; Postoperative complications

Kerion Celsi is an inflammatory variant of tinea capitis and is usually caused by Microsporum canis. Griseofulvin is the gold standard treatment, but FDA approves its use only for children up to two years. Even though it is rare in children younger than three years, tinea capitis can still occur, as in the case of the one-year-old child who was successfully treated with photodynamic therapy combined with curcumin, resulting in total remission.

Keywords: Infant; Curcumin; Photochemotherapy; Tinea capitis.

The labia majora become saggy with aging. Although filling with hyaluronic acid provides significant rejuvenation, it can also lead to the formation of true vulvar testicles if poorly indicated, especially in excessively flaccid vulvas, which do not support any further volumization. In these cases of excessive flaccidity, we believe that collagen biostimulators would be the best initial treatment, as their injection would lead to the replacement of dermal collagen and improvement in laxity, without a significant increase in volume. We have been using calcium hydroxyapatite, l-polylactic acid, and PDO threads since 2019, with good results.

Keywords: Vulva; Collagen; Genitalia, Female; Rejuvenation

Harlequin syndrome is a rare autonomic disorder characterized by anhidrosis and lack of unilateral flushing of the face, which may affect the cervical and thoracic regions. Paradoxically, there is compensatory flushing and sweating on the contralateral side to the alteration. It is idiopathic in most cases, but it can be congenital or secondary to structural or post-surgical iatrogenic lesions. Treatment is directed at the causative factor. We describe the case of a patient with a diagnosis of idiopathic Harlequin Syndrome with botulinum toxin application in the hemiface affected by compensatory symptoms with good therapeutic respons

Keywords: Hyperhidrosis; Blushing; Botulinum toxin type A

The preservation of the surgical margins marking is essential during Mohs micrographic surgery. However, skin degermation during antisepsis and the use of gauze during local anesthesia often remove these markings. The use of the protective film Cavilon^® 3M to fix the marking pen ink was effective in preserving the surgical map, allowing an accurate removal of the surgical specimen.

Keywords: Mohs surgery; Carcinoma, Basal cell; Carcinoma, Squamous cell; Excision Margins

Introduction: Acne Vulgaris is a skin disease that, with the advent of social media, has become more susceptible to the spread of unreliable information.
Objective: This study aims to characterize the influence of social media on the treatment choice for Acne Vulgaris without medical advice, identify complications of inadequate treatments, and highlight the most influential social media for this purpose and the life quality of these patients.
Methods: It is a descriptive cross-sectional study with a quantitative approach whose sample consisted of 306 social media users over 18 years of age. After signing the Informed Consent ("Termo de Consentimento Livre e Esclarecido - TCLE)" the data was collected through a self-administered form along with the questionnaire "Dermatology Life Quality Index - DLQI-BRA" via "Google forms" over 30 days. The data was then tabulated online and analyzed according to descriptive statistics.
Results: The results showed a great impact, especially from "Instagram", in the dissemination of content on the subject and highlighted the role of the dermatologist on social networks as the source of information chosen by the public.
Conclusions: The public was strict about the quality of the information, but there is still a need for greater insertion of trained professionals and information based on scientific evidence on social media.

Keywords: Acne vulgaris; Online social networking; Self medication; Quality of life; Dermatology

Extraskeletal Ewing sarcoma (EES) is a rare tumor that affects men between 10-20 years old and represents 25% of Ewing sarcomas. We report a case due to the previous diagnosis of a fast-growing lipoma to highlight the importance of histopathological diagnosis. A 14-year-old boy presented 10x10 cm tumor in the right shoulder for a year with ultrasonography suggesting lipoma. The lesion was excised and EES was confirmed by immunohistochemical analysis. EES diagnosis in young people is challenging compared to subcutaneous tumors, and histopathology is essential. The rapid progression of the tumor and high metastatic rates highlight the significance of early treatment.

Keywords: Sarcoma, Ewing; Neuroectodermal tumors; Sarcoma

Ferment filtrate (FF), a by-product of nutrient-rich yeast, is believed to be used cosmetically in East Asia since the 1970s. We systematically reviewed the topical effects of ferment filtrate on skin health and determined limitations in the available studies. Recent literature has shown evidence in reducing the baseline fluctuation of pore size, roughness, hyperpigmentation, and redness. However, these studies are limited in efficacy due to their small sample size, their confounding variables, and their limited generalizability. Because of the increase of cosmetic products containing this ingredient, critical analysis of the available and future literature is necessary to prevent consumer misinformation.

Keywords: Skin Diseases; Administration, Topical; Cosmetic Technology; Cosmetic Techniques

BACKGROUND: Acanthosis nigricans is a common dermatological disorder characterized by hyperpigmented and hyperkeratotic velvety skin lesions. It can be a manifestation of systemic disease.
OBJECTIVE: This study aims to evaluate the clinical and laboratory predictive factors in the treatment of pseudo-acanthosis nigricans.
PATIENTS AND METHODS: This study included 20 patients with pseudo-acanthosis nigricans from the outpatient clinic. All cases were subjected to fractional CO2 laser on the right side of the neck and glycolic acid peel 70% on the left side of the neck. Each patient was followed up for three and half months.
RESULTS: There was an overall improvement in area index, severity, and texture in the neck of cases with pseudo-acanthosis nigricans treated with fractional CO2 laser or Glycolic acid peel.
CONCLUSION: There was no statistical significance when comparing the effect of laser or peeling on different age groups and obese or overweight cases.

Keywords: Laser therapy; BMI-Age; Skin diseases

Localized scleroderma (linear morphea) is a rare disease that causes facial dystrophy and asymmetry in young women. We report the case of a 20-year-old female patient who was treated with novel composite fat grafts. After extracting lipoaspirate from deep subcutaneous fat, the microfat and the unfiltered nanofat were processed separately, and amalgamated, obtaining composite fat grafts. These were meticulously transplanted layer by layer to rebuild the subcutaneous tissue of the patient's face. After one year, a good volume of fat retention was observed with successful correction of asymmetry and restoration of facial balance.

Keywords: Ambulatory surgical procedures; Abdominal subcutaneous fat; Facial asymmetry; Subcutaneous injections; Localized scleroderma

INTRODUCTION: High-intensity focused electromagnetic field treatment (HIFEM) uses low-frequency electromagnetic waves to induce supramaximal muscle contractions, causing muscle hypertrophy and reducing fat.
OBJECTIVE: To evaluate the effects of a HIFEM treatment for the improvement of cellulite on the buttocks.
METHODS: Thirty patients were divided into two groups that received eight or 12 HIFEM sessions on the buttocks for six weeks. We assessed the improvement in cellulite and the buttocks' global appearance through the Cellulite Severity Scale (CSS), the Global Aesthetic Improvement Scale (GAIS), and a satisfaction questionnaire. Changes in body composition were evaluated through bioimpedance and hip circumference measurements.
RESULTS: Patients from both groups improved the global appearance of their buttocks. Cellulite lesions of some patients improved, but for most patients, the improvement wasn’t great enough to change the grade on the Cellulite Severity Scale. Patient satisfaction was high and adverse events were few, minor, and transitory.
CONCLUSION: The effects of HIFEM on cellulite are subtle, as this treatment modality cannot address the fibrous septa that cause the depressed lesions of cellulite. Nevertheless, HIFEM procedures can improve the buttocks’ global appearance, enhancing the patients’ subjective perception of their cellulite.

Keywords: Cellulite; Aesthetic equipment; Electromagnetic fields

BACKGROUND: Wrinkles and flaccidity in the periocular region are frequent complaints. Ablative fractional lasers (AFL) CO2 10600nm and Erbium: YAG 2940nm can induce neocollagenesis and contraction of collagen fibers.
OBJECTIVE: Our study aimed to observe the effectiveness of one session of dual mode Erbium:YAG 2940nm fractional laser to treat sagging, rhytids, and fat bags of the upper and lower eyelids.
METHODS: Seventeen patients with sagging, rhytids, and fat bags of the upper and lower eyelids underwent one session of Ablative fractional laser (AFL) 2940nm from the Etherea platform in dual mode. Photographic records were taken in the same environment before treatment and one month after the end of the protocol, and five dermatologists and plastic surgeons independent of the study assessed them objectively.
RESULTS: The improvements in the evaluation of rhytids, fine lines, and flaccidity were clinically and statistically significant with few adverse events such as edema, erythema, and desquamation. However, eyelid bags did not improve significantly.
CONCLUSION: A single session with the dual mode AFL Erbium:YAG tip 2940 can contribute to a significant improvement in rhytids, fine lines, and flaccidity of the periorbital area.

Keywords: Lasers; Rejuvenation; Blepharoplasty; Erbium

To simplify the procedure and increase lip augmentation safety, we have developed the KISS - Keep Injection Simple and Safe lip filler technique. To be simple, the method recommends only the evaluation of four anatomical parameters and the filling of five labial areas. To be safe, the injection is performed only in the supramuscular plane, using cannulas with a blunt tip, inserted in four entries: two in the upper lip and two in the lower lip. Fillers are injected in specific anatomical vectors for lips volumization, projection, contour improvement, and support of cupid’s bow and lip corners.

Keywords: Hyaluronic acid; Dermal fillers; Lip

BACKGROUND: The COVID-19 pandemic has expanded the use of social interaction technologies, connecting individuals virtually. This change has brought a new trend of dissatisfaction with appearance induced by social media, motivating the excessive search for aesthetic procedures.
OBJECTIVE: To assess the impact generated by the use of apps during the pandemic on the self-image of respondents by biological sex, age, and family income.
METHODS: We conducted a cross-sectional study with 350 participants, aged 18 years or older, residing in the state of São Paulo - Brazil, through online dissemination of an electronic form. The data obtained were tabulated and analyzed by chi-square and Cochran tests, crossing the variables income, age, and biological sex.
RESULTS: Of the total, 69.71% claim changes in the way they see themselves physically during the pandemic; 58.3% report that apps influence their self-image, as 70.6% of the answers are women between 18- 29 years old; 73.9% of women of all ages and incomes recognized the importance of skin for self-image, with this finding being discrepant among the age groups of men.
CONCLUSIONS: The use of apps during the pandemic impacted the self-image of the participants leading them to have a greater interest in obtaining future treatments and aesthetic procedures.

Keywords: Dermatology; Self-image; COVID-19; Social isolation

Polypodium leucotomos extract was first described in the literature 55 years ago, demonstrating anti-inflammatory action in dermatoses such as vitiligo and psoriasis. It is currently available as an oral and topical photoprotection agent in more than 26 countries to prevent and treat dermatoses resulting from solar radiation, such as polymorphous light eruption, melasma, actinic keratoses, skin cancer, and photoaging, among others. In Brazil, ANVISA registered the patented Polypodium leucotomos extract in 2012. After 10 years of its launch, its recommendation by Brazilian dermatologists is well established and is presented in this review paper.

Keywords: Solar radiation; Sunscreening agents; Polypodium

BACKGROUND: Pyoderma gangrenosum is a rare neutrophilic dermatosis with very low incidence and varied clinical presentation associated with different comorbidities. It is also a diagnostic-therapeutic challenge.
CLINICAL CASE: A 79-year-old woman presented 18 months of dermatosis evolution that began as a perianal pustule and progressed to a 20 cm in diameter ulcer. Due to her comorbidities, she received topic treatment with satisfactory evolution.
CONCLUSIONS: Pyoderma gangrenosum is frequently associated with a systemic disease. Consequently, it must be approached from a systemic perspective with the support of a multidisciplinary team to provide the most appropriate treatment.

Keywords: Pyoderma gangrenosum, Skin diseases, Peptic ulcer hemorrhage, Hypothyroidism

INTRODUCTION: Androgenetic alopecia impacts patients psychologically. Androgenetic alopecia is an androgen-dependent condition characterized by hair follicles miniaturization, shortened anagen phase, and prolonged telogen phase. The increasing search for hair therapies to improve this condition leads to the need for robust methods to compare the effectiveness of treatments, such as standardized photographs and clinical evaluation.
OBJECTIVE: This study comparatively assessed the efficacy of intradermotherapy associated or not with microneedling and application of sterile topical solution whose active components are Octapeptide-2, Copper tripeptide-1, Chondrus crispus extract, and Silanediol salicylate.
METHODS: Standardized photographs and patients’ clinical findings were compared per experimental group in a blind and paired manner by dermatologists, with attribution of scores referring to hair loss improvement.
RESULTS: The group treated with the therapeutic association obtained better results than the group treated with intradermotherapy alone (control), with 70% of patients showing improvement scores against 54%. There was a statistically significant difference between the treatment groups.
CONCLUSION: The therapeutic association of intradermotherapy with microneedling followed by topic treatment was significantly more effective in improving male hair loss compared to control.

Keywords: Alopecia; Photography; Hair preparations

Surgical wounds, when not amenable to primary healing, can be treated using surgical flaps or grafts, increasing surgery complexity and costs. Seeking to facilitate and optimize access to surgical treatment of malignant neoplasms of the skin, the dressing using the Figueiredo technique is a good therapeutic option due to its easy execution and reproducibility, low cost, and effectiveness. We report a series of cases using this technique after the excision of non-melanoma skin tumors in the extremities.

Keywords: Wound closure techniques; Surgical oncology; Skin neoplasms; Extremities

The first publications regarding aesthetic treatments with polydioxanone threads (PDO) date to 2015 and were preceded by the establishment of this polymer use for surgical sutures as a safe, less inflammatory option that brings superior final aesthetic-functional results. The present article describes a series of five patients that received PDO thread lifting for abdominal periumbilical laxity.

Keywords: Body contouring; Polydioxanone; Sutures; Esthetics; Cosmetic techniques; Dermatologic surgical procedures

Mohs micrographic surgery, created in 1930 by Frederich Mohs, is a world-renowned technique to treat skin cancers. Currently, it is used to treat basal cell and squamous cell carcinomas, ensuring excellent cure rates for patients. However, regarding the treatment of cutaneous melanoma, the use of Mohs surgery is not a consensus among specialists. This article aims to elucidate whether Mohs surgery is a safe and effective treatment for melanoma skin cancer.

Keywords: Melanoma; Mohs Surgery; Skin neoplasms; Treatment Outcome; Prognosis.

Aneurysmal dermatofibroma (ADF) is a rare benign tumor originating in the dermis. It is most common in the lower limbs of women over 30 years. Its etiology is unknown, and histopathological examination confirms the diagnosis. This paper presents a case of ADF with an exuberant presentation in a young female patient with a pedunculated tumor in the right pretibial region, measuring 12 cm in greatest diameter. This report aims to demonstrate an infrequent variant of dermatofibroma with significant growth and emphasize the importance of lesion excision and follow-up because of the high recurrence rate.

Keywords: Histiocytoma, Benign fibrous; Dermatology; Dermoscopy

INTRODUCTION: Many options for anogenital warts (AGWs) treatment are available. Recently, trichloroacetic acid (TAA) and liquid nitrogen (LN) began to be associated to treat AGWs.
METHODS: Randomized, parallel, controlled clinical trial involving patients with penile AGWs. Patients were treated with LN, TAA, or their combination and reevaluated after 28 days.
RESULTS: Among therapy with TAA, LN, and their combination, the clearance rate was 22.9% (95% CI: 8.6%-34.3%), 46.2% (95% CI: 30.8%-59.0%), and 25.7% (95% CI: 11.4%-37.2%), respectively.
DISCUSSION: All therapeutic options were effective. Though, there was no statistically significant difference between the groups.

Keywords: Nitrogen; Papillomavirus infections; Sexually transmitted diseases; Cryotherapy

Hormonal changes added to extrinsic exposure factors, including socio-environmental and lifestyle factors, affect the quality of life of climacteric women. Symptoms during the climacteric are variable, and most women are not aware that menopause affects the skin. Among the perceived changes, there is an increase in dryness, roughness, sagging, and atrophied skin. This article reviews the relationship between exposure and menopause, focusing on helping dermatologists to guide patients on preventive care and treatments to improve skin and quality of life in menopause.

Keywords: Menopause; Perimenopause; Postmenopause; Climacteric; Exposome; Skin aging

Small surgical defects of the lower lip can be reconstructed through direct closure. Full-thickness defects with more than 30% involvement require complex reconstructions with high morbidity. We report the case of a patient diagnosed with squamous cell carcinoma in the lower lip whose resection resulted in a surgical defect of 45% of the lower lip. The reconstruction combined two well-established techniques: unilateral myomucosal advancement flap and M-plasty. This association acted synergistically, enabling the closure of the surgical defect with easy execution, low morbidity, and excellent aesthetic and functional results.

Keywords:

Small surgical defects of the lower lip can be reconstructed through direct closure. Full-thickness defects with more than 30% involvement require complex reconstructions with high morbidity. We report the case of a patient diagnosed with squamous cell

Sclerosing lipogranuloma is a chronic granulomatous reaction in response to the injection of non-medical substances such as paraffin, silicone, or mineral oil into the skin. This report describes one case of a large defect on the penis following sclerosing lipogranuloma excision surgery that was successfully closed by a double reverse V- Y-plasty reconstruction. The surgery aimed to remove all affected tissue as soon as possible, preventing the persistent granulomatous process that leads to necrosis and severe penile deformity. The double reverse V- Y-plasty is a simple, single-stage procedure useful to reconstruct of a large defect on the penis.

Keywords: Granuloma; Sclerosing solutions; Surgery.

INTRODUCTION: The use of botanical extracts in dermatological treatments has received special attention in worldwide literature, especially for its antioxidant action. Different products containing Polypodium leucotomos and Pinus pinasters extracts are commercially available in industrialized presentations or compounding. However, in the second case, there is no standardization in the extraction process and there is a lack of data regarding the quantitative and qualitative content in the referred formulations that demonstrate its effectiveness and safety.
PURPOSES: to assess the different concentrations of actives in standardized and patented botanical extracts of Polypodium leucotomos (Fernblock^®) and Pinus pinaster (Pycnogenol^®), respectively, comparing them to products offered by compounding pharmacies.
METHODOLOGY: The products were assessed by high-performance liquid chromatography, and pharmacologically active markers were identified in peaks by retention time.
RESULTS: the concentrations of identified actives varied in the different products analyzed, being undetectable in many of them. Only industrialized products with standardized and patented extracts showed all the expected markers.
CONCLUSION: consistency was observed in specific products containing the patented extracts of Polypodium leucotomos (Fernblock^®) and Pinus pinaster (Pycnogenol^®), demonstrating the importance of standardization in extraction processes and studies on the efficacy and safety profiles.

Keywords: Antioxidants; Plant extracts; Flavonoids

Intense Pulsed Light (IPL) is an effective technology to treat vascular lesions, pigmented lesions, and photorejuvenation, among other indications. In the case of telangiectasia, its mechanism of action is based on photothermolysis of the vessels, inducing intravascular coagulation. We report three cases where IPL was used to treat telangiectasia in a surgical scar, showing good aesthetic results after three sessions.

Keywords: Cicatrix; Telangiectasis; Intense Pulsed Light Therapy; Erythema

Merkel cell carcinoma is a rare and aggressive cutaneous neuroendocrine cancer that occurs in the photodamaged skin of white and elderly patients, usually presenting as a solitary plaque or nodule in the head and neck region. When located in the lower palpebral area, reconstructing the defect resulting from its excision can become challenging for the dermatological surgeon due to the local cosmetic and functional peculiarity. We report the use of a bilobed flap for lower eyelid reconstruction with a satisfactory result, both in terms of aesthetics and the resulting functionality.

Keywords: Surgical flaps; Eyelids; Carcinoma, Merkel Cell; Case reports

We report a case of a 72-year-old man who underwent surgical excision of a keratoacanthoma centrifugum marginatum (KCM) located on the left forearm. It is an uncommon variant of keratoacanthoma, which can assume large dimensions (up to 20 cm) and does not tend to spontaneous regression. The lesion is usually single, with raised borders, and has progressive centrifugal growth associated with central healing and atrophy. Due to its rarity and lack of pathognomonic histopathological features, KCM can be a diagnostic challenge for dermatologists and pathologists.

Keywords: Keratoacanthoma; Neoplasms; Skin neoplasms

Reconstruction of the scalp after suspected skin lesions excision is a challenge. Tamir et al. described the three-point-advancement (Mercedes flap) to close circular wounds. These tissue advancements create triangles in the edges, which must be removed. However, extensive lesions do not allow the three points to join, preventing central closure. Valesky et al. described the central closure using total skin grafts made from the triangles. The literature lacks these case reports, making it difficult to incorporate them into surgical practice. We applied this modified technique to five patients with good aesthetic and functional results.

Keywords: Scalp; Surgical flaps; Plastic surgery procedures; Skin transplantation; Skin neoplasms

Anagen effluvium (AE) is a hair growth disorder that occurs due to a disturbance in the hair follicle cycling. The most common cause of AE is alopecia areata (AA). Autoimmune diseases like AA may develop after drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and are usually long-standing conditions. We report the case of a 17-year-old woman who developed a severe and abrupt AE after DRESS syndrome with a full and rapid recovery after two months of topical minoxidil.

Keywords: Alopecia; Alopecia Areata; Drug Hypersensitivity Syndrome; Case Reports

Exogenous ochronosis is a stigmatizing dermatosis characterized by asymptomatic, bluish-black, or grayish macules in photoexposed areas. Associated with the prolonged use of hydroquinone for the treatment of dyschromias, it has a broad therapeutic arsenal, but the results are unsatisfactory and/or costly. We report the case of a female patient with histologically proven exogenous ochronosis who underwent dermabrasion associated with the use of tretinoin and topical corticosteroids with surprising results after three months of follow-up to demonstrate the possibility of therapeutic success with a low-cost technique and an outpatient clinic procedure.

Keywords: Ochronosis; Therapeutics; Dermabrasion

INTRODUCTION: For religious reasons, a portion of the population does not expose their body, showing only the feet.
OBJECTIVE: This study aimed to meet the demand for treatments to rejuvenate the dorsum of the foot, observe the safety of using calcium hydroxyapatite and its results, and discuss the region anatomy.
METHODS: Sixty women with an average age of 63 years and skin phototypes from I to VI had the dorsum of their foot's age classified by types from I to VII, and were injected with 0.75 ml to 3 ml of calcium hydroxyapatite per patient in this region, in a single session. A dermatologist who did not participate in the treatment and the patients conducted the evaluation through photos.
RESULTS: The results were considered good to very good depending on the aging stage of the dorsum of the feet. Complications were limited to local edema and erythema. Follow-up lasted from six months to one year.
CONCLUSION: The injection of calcium hydroxyapatite into the dorsum of the feet, based on knowledge of the anatomy of this region and correct volume, could be considered a body area treatment.

Keywords: Calcium Hydroxyapatite; Foot; Anterior Compartment Syndrome; Collagen

INTRODUCTION: Acne is a chronic inflammatory disease of the pilosebaceous unit of multifactorial origin, which causes a significant impact on quality of life.
OBJECTIVE: Clinical trial assessing the superiority of efficacy of a treatment regimen with an oral probiotic associated with a fixed combination of adapalene 0.1% and benzoyl peroxide 2.5% compared to an oral placebo with the same topical treatment in patients with acne.
METHODS: This was a randomized, double-blind, placebo-controlled study conducted with 212 patients aged from 12 to 35 years. The study was divided into two phases of 90 days each. In the first phase, patients received treatment with adapalene 0.1% and benzoyl peroxide 2.5% associated with a probiotic (IT), or adapalene 0.1% and benzoyl peroxide 2.5% associated with placebo (CT). In the second phase (90 days), patients received only oral treatment with a probiotic or placebo. Efficacy criteria were: reduced Investigator Global Assessment (IGA) scale to 0 or 1 and reduced lesion count.
RESULTS: There was a significant difference in the proportion of participants with IGA 0 or 1 - the arm receiving the test treatment was superior to the control (p<0.05). Both treatments were safe and well tolerated.
CONCLUSION: In light of the evidence on efficacy and safety, treatment with probiotics should be considered as an adjuvant therapy for acne control.

Keywords: Acne vulgaris; Probiotics; Gastrointestinal microbiome

Notalgia Paresthetica (NP) is a sensory neuropathy characterized by itching, with or without a macule. The Botulinum Toxin A treatment may have beneficial effects on pruritus, possibly by inhibiting the substance P. This study aims to evaluate the benefits/limitations of Botulinum Toxin in NP treatment. The methodology consisted of the selection of publications in PubMed, filtered by predefined criteria. Five articles were compiled, and the results were favorable in four of them. The study concluded the effectiveness of Botulinum Toxin A treatment in most of the articles, especially in the pruritus improvement.

Keywords: Pruritus; Botulinum toxins type A; Hyperesthesia; Hyperpigmentation.

This integrative review included 22 studies aiming to identify the main conclusions regarding the use of total body photography for the diagnosis of melanoma. Thus, it demonstrated that the method could help in the early detection of melanoma, reducing unnecessary biopsies, identifying melanomas from new lesions, improving patient survival, and decreasing patient anxiety. However, it can be a high-cost method. Therefore, total body photography is a proficient tool in facilitating the monitoring and diagnosis of melanoma in patients at a certain risk.

Keywords: Melanoma; Diagnosis; Dermoscopy

The incidence of stoma complications ranges from 20-70%. Pseudoverrucous Epitheliomatous Hyperplasia (PEH) is a rare complication of the peristomal skin of unknown incidence, without protocol treatment, and with a significant impact on the patient's quality of life. There are numerous ways to treat peristomal lesions, mostly outpatient care. We report a case of peristomal PEH in which surgical intervention was performed using the shaving technique with very satisfactory aesthetic and functional results.

Keywords: Ileostomy; Colostomy; Hyperplasia

Since antiquity, chemical peelings are still widely used to treat skin aging. There are a variety of substances, techniques, and considerations for each type of peeling. However, this case series aims to present a non-described form of application of trichloroacetic acid (TCA) and retinoic acid to treat fine static wrinkles on the face. The technique consists of applying the TCA peeling directly to the facial rhytids and, subsequently, retinoic acid peeling all over the face for 6 hours.

Keywords: Chemexfoliation; Trichloroacetic acid; Skin aging; Chemical abrasion

Foreign body granuloma can occur after injection of filling substances into the dermis. We report a case of a 35-year-old woman who performed a self-injectable injection of a commercial serum for exclusively topical use containing hyaluronic acid in the region of the dark circles for aesthetic reasons. After the procedure, she presented a nodule in the lower right eyelid, which she judged to be an accumulation of product. Then she injected betamethasone + hyaluronidase ointment (Postec^®), evolving into a foreign body granuloma.

Keywords: Granuloma; Dermal fillers; Hyaluronic acid

Atopic dermatitis (AD) is a chronic skin disease whose hallmark is a deficient skin barrier. Current treatment consists of restoring this barrier using emollients, reported corticosteroids, and systemic medications in severe cases. This study aimed to evaluate the subdermal hyaluronic acid (HA) injection to treat AD. We applied HA to plaques of atopic dermatitis, and there was a global improvement in the lesions and skin elasticity after two weeks. There was no complete regression of the plaques; however, HA can be proposed as an adjuvant treatment option for key areas.

Keywords: Hyaluronic acid; Dermatitis, Atopic; Therapeutics

Basal cell carcinoma (BCC) is the most common skin cancer. Depending on its size and location, the reconstruction of the defect resulting can become very challenging for the dermatological surgeon. Shark Island Pedicle Flap (SIPF) technique is used for defects mainly in the alar or perialar nasal region, but we also use it in a modified way to close a large lesion defect in the cutaneous portion of the lip. We report two cases, one being the application of classic SIPF and the other a modified one, in which both results were satisfactory, both in terms of cosmetics and functionality.

Keywords: Carcinoma; Basal cell; Surgical flaps; Nose; Case reports

Pilomatrixoma is a benign tumor with differentiation to the hair matrix that can affect different regions of the skin. We report the case of a patient with an unusual presentation on the scalp, with warning signs for the possibility of a malignant variant of the tumor. We emphasize the importance of documenting atypical conditions that may permeate the practice of dermatologists and the need to rule out malignancies in the face of a change in the pattern of skin lesions, exulcerations, and bleeding, among other signs. The role of histopathology is fundamental for diagnostic definition and therapeutic management.

Keywords: Pilomatrixoma; Skin neoplasms; Hair diseases

Persistent Intermittent Delayed Swelling (PIDS) is an immune-mediated inflammatory reaction resulting from the interaction of immunological factors and the product's intrinsic characteristics. Such a reaction generally occurs after 30 days and persists while hyaluronic acid (HA) is in the area. We present through this case report a PIDS-type reaction that occurred five years after the injection of the product.

Keywords: Foreign body reaction; Dermal fillers; Hyaluronic acid

SUMMARY: Melanoma is the main cause of death in dermatology (it is an aggressive type of skin cancer being one of the main causes of cancer death) due to its high metastatic power. When detected in early stages, its surgical treatment can be curative. When detected in more advanced stages, its prognosis is reserved and can be lethal. During the period of the COVID-19 pandemic, many medical activities were suspended. There are few data in the literature evaluating the impact of the pandemic on the evolution of patients with melanoma.
OBJECTIVES: This study aimed to evaluate the impact of the COVID-19 pandemic on the epidemiological, clinical and histopathological aspects of melanomas diagnosed at the Instituto de Dermatologia Professor Rubem David Azulay (IDPRDA).
METHODS: This is an observational, retrospective and unicentric study, where the requests and histopathological reports of skin biopsies performed at IDPRDA between January 2018 and December 2021 were reviewed and their epidemiological and clinicopathological aspects were subsequently evaluated.
RESULTS: A significantly lower incidence of melanoma diagnosis was not found during the pandemic years, but patients were diagnosed at more advanced stages of the disease, which shows a delay in diagnosis due to Covid-19.

Keywords: Melanoma; COVID-19; Pandemics.

Atrophic acne scars result from an abnormal wound-healing response that can be treated with microneedling (MN). Insulin may play a role in wound healing. The effectiveness and safety of combining MN with topical insulin as an alternative therapy for atrophic acne scar revision have not yet been widely reported. We report the case of a 33-year-old woman with an atrophic acne scar on the middle third of her face. The patient was treated with MN and topical insulin for four sessions at two-week intervals. MN plus insulin can be considered an alternative for acne scar revision.

Keywords: Acne Vulgar; Insulina; Cicatriz; Hiperpigmentação

INTRODUCTION: The advent of squamous cell carcinomas (SCC) from chronic dermatoses is known but little explored. Although rare, tumors originating there have a worse prognosis, in part due to late diagnosis.
OBJECTIVES: This study aims to survey cases of squamous cell carcinoma developed on previous dermatoses diagnosed between 2000 and 2020 in a tertiary health service.
METHODS: This is a quantitative and retrospective study through biopsy reports survey and medical records review.
RESULTS: From an initial list of 11,249 histological reports compatible with squamous cell carcinoma, we obtained a final list of 10 patients. The study findings corroborate the literature regarding some known risk factors: abundant and chronic sun exposure, older than 50 years, lower skin phototypes, and immunosuppression. We also found a high frequency of smoking and lichenoid dermatoses (5/10 patients) in the studied population, including chronic cutaneous lupus erythematosus and hypertrophic lichen planus.
CONCLUSIONS: It is not possible to predict the primary risk factors for the development of squamous cell carcinomas regarding previous dermatoses, although there is a tendency for their appearance in lichenoid dermatoses and those with longer evolution.

Keywords: Skin diseases; Squamous cell carcinoma; Lupus erythematosus, Cutaneous; Lichen planus