Vitamin C, or L-ascorbic acid, is the most abundant antioxidant in human skin and its topical replacement has proven relevant, since this reservoir is consumed by external aggression, and it is used in the prevention and treatment of skin aging. This review was based on bibliographic research in the PubMed and LILACS databases and two consensus meetings between the authors to analyze the evidence for its topical use. The highest level of evidence of skin activity has been found in the pure and stabilized form of ascorbic acid. Derivatives, carriers, and nanoformulas are being developed, however further clinical and comparative studies are needed.

Keywords: Ascorbic Acid; Antioxidants; Skin Aging; Hyperpigmentation; Cosmeceuticals.

Techniques for removing adipose tissue are always of great interest, and among many described, the applications of sodium deoxycholate (DS) or deoxycholic acid, known as intralipotherapy, have stood out in recent years, following approval by the FDA for the treatment. of submental fat, due to the ease of application and short downtime. The objective of this study was to elucidate, through the available literature, the most frequently asked questions in this regard, and demonstrate that it is an effective and safe alternative for the treatment of localized fat.

Keywords: Atrophy; Adipose Tissue; Fat Body.

Periungual warts are the most common tumors of the periungual region, primarily affecting children and adolescents. Caused by human papillomavirus (HPV), they can lead to cosmetic disfigurement in patients. There are several therapeutic options for the treatment of this condition, and the choice of treatment depends on the number of warts, patient age, immune status, and skill of the dermatologist. Given the high recurrence rate and numerous therapeutic possibilities, this review article provides a comprehensive summary of the condition, with a particular focus on treatment modalities.

Keywords: Warts; Nail Diseases; Papillomavirus Infections.

INTRODUCTION: The search for minimally invasive aesthetic procedures to improve non-facial skin laxity has been increasing annually. The biostimulator poly-L-lactic acid stands out as one of the most versatile products for aesthetic procedures in this field.
OBJECTIVE: To develop a systematic assessment framework tool to guide treatment decision-making for skin laxity in extra-facial areas, since there are no reports regarding how to select the most appropriate patients for non-invasive body shaping with biostimulators to date.
METHODS: The authors developed the tool described herein based on their collective experience with treatment of extra-facial skin laxity with poly-L-lactic acid.
RESULTS: This assessment method collates input from four fundamental factors: somatotype/morphotype, skin quality/severity of laxity, distribution and quantity of adipose tissue, and nutritional and hormonal profile.
CONCLUSIONS: Each aspect of the framework has been developed to optimize decision-making and tailor the clinical experience for each patient, enabling clinicians to select the most favorable candidates for biostimulator use, leading to more predictable and optimized outcomes.

Keywords: Rejuvenation; Classification; Skin Aging.

INTRODUCTION: The demand for laser procedures in dermatology is increasing, and topical anesthetics are widely used to reduce pain, enhance patient comfort, and improve treatment outcomes. Despite their frequent use, the evaluation of pain perception during diode laser hair removal using topical anesthetics has not been extensively studied.
OBJECTIVE: This study aimed to compare the analgesic effects of a commercial 4% lidocaine formulation (Dermomax ®, Aché Pharmaceutical Company, São Paulo, Brazil) with a compounded formulation containing 23% lidocaine and 7% tetracaine (Artpharma Pharmaceutical Company, São Paulo, Brazil) during LightSheer® diode laser hair removal procedures.
METHODS: A total of 74 women aged between 14 and 65 years underwent a total of 256 laser hair removal procedures. Sixty minutes before the procedure, the two anesthetic formulations were applied: the commercial 4% lidocaine on one half of the treatment area, and the compounded 23% lidocaine with 7% tetracaine on the other half. The treated areas included axillae, face, legs, and groin. The side of the body on which each formulation was applied, as well as the side to be treated first with the laser, were randomly assigned in a double-blind manner. Pain intensity was assessed using a Visual Analog Scale (VAS). Data were analyzed by comparing VAS scores across the different treatment areas.
RESULTS: Statistically significant differences in pain perception were found in all evaluated regions. The compounded formulation resulted in lower pain scores compared to the commercial formulation. No adverse effects were reported.
CONCLUSIONS: The compounded anesthetic formulation containing 23% lidocaine and 7% tetracaine was more effective in providing analgesia than the commercial 4% lidocaine product (Dermomax^®) for diode laser hair removal.

Keywords: Pain; Anesthetics; Laser Therapy.

INTRODUCTION: The use of natural ingredients in skincare products has gained increasing attention due to the harmful effects and environmental risks associated with synthetic compounds.
OBJECTIVE: This growing concern has driven research into photosynthetic organisms as sustainable and eco-friendly sources of effective ingredients. Natural extracts — particularly those derived from plants, algae, and cyanobacteria — have drawn significant interest in the cosmetics industry. Cyanobacteria stand out for their low cultivation requirements, rapid growth, and ability to produce a wide range of bioactive metabolites, making them a sustainable and cost-effective resource.
METHODS: This study evaluated the effects of natural pigments — phycocyanin and phycoerythrin — extracted from Spirulina platensis and Nostoc sp. on three cosmetic products: soap, anti-acne face wash, and hand sanitizer gel. After culturing the cyanobacteria, the pigments were extracted, purified, and coated with chitosan as a stabilizer. These coated pigments were then used to formulate the cosmetic products, which were assessed for viscosity, pH, stability, antioxidant activity, and antibacterial properties.
RESULTS: The results showed that phycocyanin and the combined pigment content were higher in the anti-acne face wash and soap, whereas phycoerythrin and the total pigment concentration were greater in the hand sanitizer gel.
CONCLUSION: This study demonstrates the potential of cyanobacterial pigments to produce stable, enriched cosmetic products, offering sustainable and effective alternatives to synthetic ingredients.

Keywords: Cyanobacteria; Microwaves; Microbiology.

INTRODUCTION: Warts are a viral skin condition caused by the human papillomavirus (HPV), which can lead to disfigurement, embarrassment, and frustration. No single treatment has been shown to guarantee complete eradication.
OBJECTIVE: To evaluate and compare the effectiveness of topical potassium hydroxide (KOH) 40% and trichloroacetic acid (TCA) 40% in the treatment of plantar warts, based on clinical and dermoscopic outcomes, as well as to assess side effects and patient satisfaction.
METHODS: An interventional comparative study was conducted involving 33 patients with plantar warts. Lesions were divided into two groups: Group A received topical TCA 40%, and Group B received topical KOH 40%. All patients were evaluated both clinically and through dermoscopy.
RESULTS: Both treatment groups showed statistically significant clinical and dermoscopic improvement (p < 0.001 for both). Complete dermoscopic clearance without recurrence over a 2-month follow-up period was more frequent in the KOH group (88.6%).
CONCLUSION: Topical TCA and KOH were similarly effective. KOH, in particular, proved to be both effective and safe, making it a promising adjunct treatment for plantar warts alongside destructive and immunotherapeutic methods.

Keywords: Papillomaviridae. Warts. Controlled Clinical Trial

INTRODUCTION: Vitiligo is a dermatological condition that causes loss of skin pigmentation, significantly affecting patients' quality of life due to social stigma. Despite various therapeutic approaches, including topical treatments, systemic therapies, and phototherapy, many cases remain refractory.
OBJECTIVE: To report a series of cases to evaluate the effectiveness of autologous melanocyte grafting using the micropunch technique.
METHODS AND RESULTS: We selected 9 patients with stable and refractory vitiligo, totaling 15 surgeries. Of these, 93.3% showed some degree of repigmentation in the treated area, with the formation of a pigmentation halo around the grafts, as observed in post-surgical photographic follow-up. The inner arm was the most frequently used donor area (60%). The complications were minimal: 1 patient (6.7%) developed hypertrophic scarring in the donor area; 3 patients (20%) developed the "cobblestone appearance" in the recipient area, with 1 case resolving spontaneously after 6 months. There was also partial graft loss in 1 patient (6.7% of surgeries).
CONCLUSION: The results indicate that the micropunch technique is a viable and safe alternative for managing stable vitiligo, offering a new therapeutic option for cases refractory to conventional treatments.

Keywords: Vitiligo; Transplantation, Autologous; Skin Pigmentation.

Merkel cell carcinoma is a rare and aggressive cutaneous neuroendocrine cancer that occurs on sun-damaged skin in older White patients. It typically manifests as a solitary plaque or nodule in the head and neck region. We report an unusual presentation of Merkel cell carcinoma in a black patient who simultaneously developed two primary tumors located in the trunk region.

Keywords: Carcinoma, Merkel Cell; Immunohistochemistry; Neuroendocrine Tumors; Upper Extremity.

The appearance of the upper third of the face is a key indicator of aging and plays a significant role in communication by conveying non-verbal information. Different surgical techniques have been described for the rejuvenation of this region, with transfollicular subcutaneous forehead and brow lift enabling excellent results by lowering the hairline, reducing forehead height, softening forehead and glabellar rhytids, raising the eyebrows, and improving pseudodermatochalasis. This technique offers the advantages of reduced risk of nerve injury and excellent scalp scar camouflage.

Keywords: Dermatologic Surgical Procedures; Rejuvenation; Rhytidoplasty; Skin Aging; Surgery, Plastic.

Halo, cockade, eczematous, and targetoid hemosiderotic nevi are known as target nevi, classified as melanocytic nevi with special features and often mimic melanoma. This communication aims to demonstrate clinical manifestations, dermoscopic patterns, and reflectance confocal microscopy findings in 4 patients with different types of target nevi.

Keywords: Dermoscopy; Microscopy, Confocal; Melanoma; Nevus, Halo.

Eruptive vellus hair cyst is a rare condition resulting from the abnormal development of vellus hair follicles, leading to the formation of multiple follicular papules. While it can appear on the face, only five cases specifically located in the periorbital region have been described in the literature. Its treatment is challenging, particularly in the case we report here due to the peculiar location of the lesions, which increases the risk of postoperative scarring and dyschromia. We present a report that addresses the challenging diagnosis and successful treatment of a rare case of eruptive vellus hair cyst located in the periorbital region.

Keywords: Follicular Cyst; Eyelids; Surgical Procedures, Operative.

Several surgical techniques are available for the treatment of keloids on the earlobes. Depending on the size, depth, duration, and morphology of the lesion, the procedure can pose significant challenges for the dermatologic surgeon, as these factors are associated with a higher risk of recurrence and local deformities. We report two cases in which total excision with fistulectomy was performed, yielding favorable aesthetic outcomes.

Keywords: Keloid; Ear; Case Reports; Ambulatory Surgical Procedures.

Prominent ears are a common congenital deformity, affecting around 5% of the population, in addition to harming self-esteem and psychological well-being. To report a case of closed otoplasty in a 37-year-old patient who was dissatisfied with the results of an open otoplasty performed in childhood, with recurrence and erasure of the antihelix. The closed, incisionless technique was performed with local anesthesia and Mustardé percutaneous sutures, creating the antihelix with no need for incisions. The procedure was performed in an outpatient setting, with sutures buried under the skin and no apparent stitches, followed by the use of an immobilization bandage at night for 2 months. The surgery was completed in approximately 30 minutes per ear, with no complications. The patient reported mild to moderate pain in the first few days, which was relieved with analgesics. No complications, such as hematomas or keloids, were observed at the 2- and 24-month follow-up visits. The patient was highly satisfied with the aesthetic result and modeling of the antihelix. Closed otoplasty proved to be an effective and safe alternative for correcting prominent ears, with significant aesthetic and psychological benefits. It is suitable for cases of mild to moderate deformity.

Keywords: Surgery, Plastic; Anesthesia; Minor Surgical Procedures.

Skin cancers affecting the eyelid can be a reconstructive challenge due to the complexity of the local anatomy. In addition to precise eradication of the tumor, maximal preservation of the skin is essential for both functional and cosmetic outcomes. Transposition flaps represent an excellent reconstructive option, as they require few incisions and, when well planned, do not cause ectropion, a key consideration in this topography. We describe a case series of lower eyelid reconstructions adjacent to the tarsus following Mohs micrographic surgery, using transposition flaps.

Keywords: Surgical Flaps; Mohs Surgery; Skin Neoplasms; Eyelids; Eyelid Neoplasms.

Blepharoplasty is often the first facial aesthetic surgery sought by patients. However, in cases of more advanced aging, blepharoplasty alone may not achieve the desired aesthetic result, requiring the combination of additional rejuvenation techniques. Phenol-croton oil peeling is an excellent adjunct to eyelid surgery, as it effectively addresses deep rhytides. This case report describes a patient treated with combined upper and lower blepharoplasty and full-face phenol-croton oil peel, resulting in a highly satisfactory facial rejuvenation outcome.

Keywords: Blepharoplasty; Phenol; Croton Oil; Rejuvenation.

Glomus tumor is a rare, benign neoplasm typically found in areas with a high concentration of glomus bodies. It presents with a characteristic clinical triad: paroxysmal pain, cold sensitivity, and localized tenderness. We report the case of a patient with clinical suspicion of a glomus tumor, in which transillumination played a crucial role in diagnosis, surgical planning, and rapid pain relief. This case highlights the importance of maintaining a high index of clinical suspicion and the utility of transillumination for both diagnosis and therapeutic planning – particularly in settings where high-frequency ultrasound or magnetic resonance imaging is not readily available.

Keywords: Glomus Tumor; Transillumination; Nail Diseases; Surgical Procedures, Operative.

At the beginning of dermal filler use, which started with fat grafts, a variety of products were tested for this purpose, from temporary to permanent fillers. The decision to use polymethyl methacrylate (PMMA) as a permanent dermal filler should be considered with caution.

Keywords: Polymethyl Methacrylate; Plastics; Cosmetic Industry.

Fish-related injuries (ichthyism) are common among fishermen. The mandi catfish (Pimelodus maculatus) is a freshwater species that uses, as a defense mechanism, the insertion of spines equipped with venom glands, characterizing an active venomous ichthyism. In a series of 200 ichthyism cases recorded in rivers and lakes across Brazil, approximately 40% were caused by mandi catfish and other catfish species. We report the case of a patient with a "nonhealing wound" on the left leg for 5 months following local trauma. The initial diagnosis of squamous cell carcinoma was later revised to a foreign body reaction caused by the spine of the mandi catfish.

Keywords: Foreign-Body Reaction; Wounds and Injuries; Carcinoma, Squamous Cell; Fishes, Poisonous.

Scrotodynia, or genital dysesthesia, is characterized by chronic scrotal pain lasting at least 3 months, with no identifiable etiology despite thorough investigation. Although it is considered a relatively common condition, the lack of effective therapeutic options significantly impacts the quality of life of affected patients. We report a successful and sustained treatment for scrotodynia with botulinum toxin in a 69-year-old patient who had not responded to appropriately dosed oral medications for chronic pain.

Keywords: Male Urogenital Diseases; Botulinum Toxins; Pain, Intractable.