Introduction: Striae in pregnancy are caused by the rupture of collagen and elastic fibers, due to the distension of the skin.The dermal structures that allow the skin to expand – being responsible for the biomechanical properties of the skin such as firmness and elasticity – when ruptured, cause striae. Since pregnancy seems to change these properties in order to facilitate skin distension, there is a correlation between those parameters and the occurrence of striae during pregnancy. Objective: To investigate the correlation between the occurrence of striae and the skin''''''''s capacity to increase its elasticity. Methods: Skin firmness and elasticity was measured with a Cutometer MPA 580® device in order to investigate the occurrence of striae in 60 pregnant women. Results: A positive correlation between increased elasticity and the absence of striae was observed. Conclusions: There is a possible correlation between the occurrence of striae and the skin''''''''s capacity to increase dermal elasticity.

Keywords: PREGNANCY, DERMIS, RELAXIN

Introduction: The most common type of skin cancer is basocellular carcinoma, which frequently occurs on the face.Aesthetic and functional damage during treatment are of great concern to patients; Mohs Micrographic Surgery is a safe treatment that allows tissular preservation with minimum aes- thetic damage. Objective: To evaluate whether using Mohs Micrographic Surgery to treat basocellular carcinomas located in aesthetically important areas of the face preserves healthy tissue. Methods: Surgical procedures (n = 49) performed in the ABC Medical School in 2008 to treat tumors located in the peribuccal, periocular and alar areas, and in the ears,were evaluated.The tumors were classified according to clinical and histological features, and the surgical margins were analyzed and compared to those recommended by the literature.The patients were re-evaluated 2 years after treatment. Results: The margins removed by Mohs Micrographic Surgery were much smaller than those recommended for excisional surgery, with important tissular preservation. Conclusion: Mohs Micrographic Surgery permitted the preservation of healthy tissue (56-86%) in the treatment of basocellular carcinomas located in aesthetically important areas of the face, with minimal damage.Thus it is a safe therapeutic and aesthetical option in the treatment of facial basocellular carcinomas.

Keywords: MOHS SURGERY, CARCINOMA, BASAL CELL, ESTHETICS, FACE, SKIN NEOPLASMS

Introduction: Since patients with vitiligo are believed to be more susceptible to developing malignant neoplasias due to the lack of melanin in the affected skin, the use of sunscreens is critically important.
Objective: To evaluate the pattern of sunscreen usage in vitiligo patients.
Methods: A transverse study of vitiligo patients was conducted from August 2009 to April 2010. The following variables were studied using a questionnaire and physical examination: demographic data (gender, age, education level, and phototype); clinical characteristics of the condition (age at diagnosis, affected areas of the body, and clinical type); sunscreen use (frequency, protection factor, and duration of use); and habits of sun exposure.
Results: Of the 121 study subjects, 43 used sunscreen – mainly with sun protection factor 30 – on a daily basis.The variables associated with daily use were female gender (p = 0.001, OR = 4.76, 95% CI = 1.80-12.59) and recommendation by a dermatologist in the first medical visit (p = 0.047, OR=2.28, 95% CI = 1.01-5.28).
Conclusion: A pattern of sunscreen usage was determined for patients with vitiligo. In addition, it was verified that a dermatologist''''''''s recommendation to wear sunscreen had a statistically significant impact (p = 0.047, OR=2.28, 95% CI = 1.01-5.28).
Keywords: vitiligo; evaluation; sunscreening agents.

Keywords: VITILIGO, EVALUATION, SUNSCREENING AGENTS

Introdução: Molluscum contagiosum is a dermal viral infection commonly occurring in childhood. Although self-limited, this disease is contagious and involves complications such as pruritus, eczema and bacterial superinfection. A therapeutic approach is often required, and treatment selection depends on its effectiveness and patient tolerance.
Objective: Compare 3 treatments in children regarding efficacy, adverse effects and psychological impact, in efforts to customize the treatment approach.
Methods: Randomized, comparative and prospective study of patients aged 3 to 15, divided into 3 groups.The trunk and face were the most frequently affected sites. Group 1 was treated with 10% potassium hydroxide,Group 2 with a combination of salicylic and lactic acids, and Group 3 with curettage. Parental satisfaction regarding comfort and treatment cost was assessed in each group.
Results: Although some tendencies could be identified, the study did not detect statistical differences between the treatment groups. Group 1 experienced more pain, and a greater number of patients with complications at the end of the follow-up period. Group 3 patients were more cooperative in their treatment, since this method was the quickest and presented the fewest side effects, resulting in greater parental satisfaction. Discussion: Curettage (Group 3) and the combination of salicylic and lactic acids (Group 2) were equally effective, although the results for Group 2 were more gradual.
Conclusion: Treatment of this condition must be individualized, taking the patients’ preference, tolerance and availability of time into consideration.

Introdução: The Brazilian skin type is a result of the mingling of three ethnicities – European,African and native population. It is difficult to quantify the intensity of brown or vascular colorations with only a visual inspection. Photography assisted by a digital circular polarizing filter and special lighting allows a more accurate dermatologic examination.
Objective: To identify vascular patterns, texture and melanic pigmentations of the face, in groups of dermatologic patients, using polarized pictures.
Methods: Open prospective study, with traditional and polarized photographs of adult women. Digital pictures taken with a Canon T1i camera with different lens configurations (100 mm fixed macro lens without a polarizing filter and 60 mm fixed macro lens with a Hoya pro 1D circular polarizing filter) and the same lighting (two 140 flash heads against an indigo background) were compared.
Results: Polarized and traditional photographs of 34 women (n = 34) were analyzed. Patients were classified as Phototypes II (13), III (16), IV (4) and V (1), according to the Fitzpatrick scale. In 8 patients who reported facial erythema and edema after exposure to heat sources,vascularization was observed only in the polarized pictures.Additionally, melanic pigmentation (ephelides, melasma, and post-inflammatory hyperpigmentation) was observed in all patients, rosacea acne lesions in 1 patient, and inflammatory actinic keratosis in 1 patient. The examination was helpful in recommending treatments at home, intense pulsed light, photodynamic therapy,CO2 fractional laser, and in the follow-up of rosacea acne.
Conclusions: Medical photography using a circular polarizing filter is a tool for diagnosing and following up therapeutic treatments, being also useful for documenting skin phototypes II to V.
Keywords: photography; lighting; dermatology.

Introduction: The treatment of ingrown nails can be conservative or more invasive, including surgical methods. Surgical treatment through matricectomy is the most effective and can be performed mechanically or chemically.Although phenol is the most commonly used agent, trichloroacetic acid has led to satisfactory results in the partial chemical matricectomy of ingrown nails.
Objective:To describe the use of trichloroacetic acid as an option to treat ingrown nails. Methods: 33 patients were analyzed, with 37 ingrown nails subjected to matricectomy with 50% trichloroacetic acid following the partial exeresis of the nail plate. Acute phenomena were assessed in the immediate post-operative period. Treatment effectiveness regarding the recurrence of the ingrown nail in the treated site was assessed 7 to 24 months after the procedure.
Results: The treatment’s success rate was 70.72%. Light post-surgical exudation, the absence of tissular necrosis and good healing process were observed.
Conclusion: Trichloroacetic acid matricectomy is an effective treatment for ingrown nails: it causes few side effects, is easy to perform and has good resolution rates.

Introduction: Photodynamic therapy uses photochemical substances that selectively impregnate abnormal tissue and act as a sensitizing agent for the light.
Objective: To evaluate the clinical response, aesthetic results and side effects of applying photodynamic therapy using the photosensitizer methyl-aminolevulinate hydrochloride in actinic keratosis lesions, basal cell carcinomas, and Bowen’s disease.
Methods: After removing scales or crusts and impregnating the lesion with methylaminolevulinate hydrochloride, 632 nm (37 j/cm2) red light radiation was applied, at a distance of 5 to 8 cm from the skin, for 8 minutes.
Results: 102 patients (59 with actinic keratosis, 32 with basal cell carcinoma, and 11 with Bowen’s disease) were studied.After 12 weeks, only 14 patients (6 actinic keratosis, 6 basal cell carcinoma, and 2 Bowen’s disease) had incomplete results. The treatment yielded excellent aesthetic results.The main complications were 1 case of severe erythema and 1 case of important pustules and edema.
Conclusions: Consistent with the literature, this study confirms the efficacy of photodynamic therapy with methyl-aminolevulinate hydrochloride in the treatment of actinic keratosis lesions and non-melanocytic cutaneous neoplasias, with similar recurrence rates and better aesthetic results than conventional therapies.

In part 2 of this review article we will approach the subjects of musculature, vascularization, sensory and motor innervation, and lymphatic drainage of the face. A detailed understanding of these subjects is vital in order to correctly and efficiently apply botulinum toxin and fillers

The aging process causes significant changes to the face. Rhytidoplasty is a surgical procedure aimed at treating such changes. Understanding essential aspects of facial anatomy (including high-risk areas and the importance of the superficial muscular aponeurotic system), existing surgical techniques and potential major complications is crucial in order to recommend and conduct this procedure successfully. In order to meet increasing patient demands for ever improving outcomes, physicians must use adjuvant techniques.This article addresses these fundamental concepts, which are considered essential in rhytidectomy, emphasizing the potential benefit of a multidisciplinary approach involving dermatology and plastic surgery.

A clinical case of subungual squamous cell carcinoma, in which a tumor had been located in the medial fold of the left thumb for 4 years, is described in a 89-year-old male patient.The objectives of this study are to draw attention to the rarity of the subungual location of the tumor – highlighting the differences in diagnosis compared with benign lesions – and the importance of pain as a symptom, which may help diagnose the condition early and facilitate a better prognosis and lower morbidity. Additionally, we discuss the more frequently used therapeutic approaches, based on a review of the literature on radiation therapy, Mohs Micrographic Surgery and amputation.

Introduction: Exogenous ochronosis is characterized by asymptomatic black-bluish hyperpigmentation, typically located in the face, neck, dorsum and the extensor surfaces of the extremities. It most frequently results from using hydroquinone.
Objective: To highlight the use of several therapeutic modalities in order to obtain satisfactory treatment results.
Method: The treatment began with the application of Nd:YAG laser. Since there was no response, ultrapulse CO2 laser was indicated. Still without satisfactory results, a combination of intense pulsed light, microdermabrasion and chemical peels was carried out.
Results: The total resolution of the lesions was verified.
Conclusion: Exogenous ochronosis is difficult to treat, sometimes requiring the combination of several treatment methods.

Introduction: There are several techniques for the treatment of the body’s contour.The vast majority, however, are not very effective.We report our experience in the use of focused ultrasound in the treatment of localized fat in 120 patients.
Methods: 120 patients underwent 2 or 3 focused ultrasound sessions with 4-week intervals. The abdomen, hips, thighs, dorsum and infragluteal fold were the treated areas.
Results: After treatment, there was an average reduction of 4.95, 4.88 and 3 cm in the circumference of the abdomen, hips and thighs, respectively.
Conclusion: Focused ultrasound is a safe, effective and well tolerated procedure for remodelling areas of the body.

Over the last 20 years, a number of methods have been used for facial rejuvenation; there is currently a search for new technologies that can overcome flaws inherent in the procedure. With the fractioning of the CO2 laser, the technique has gained renewed prominence. Nevertheless, the expectation of an improved procedure that is as effective as traditional ablative resurfacing and 100% safe has not been met. Although fractional ablative resurfacing has proven to be a considerably valuable procedure, results do not match those of the traditional procedure. And while the fractioning of the laser decreases side effects, they must not be overlooked. In this article we describe in detail our personal experience, including possible side effects and how to avoid and treat them.

The reconstruction of defects resulting from the removal of facial tumors is always a challenge, given that the functional integrity of the treated area and the risk of retractions and unattractive scars must be carefully assessed. Grafts, often the best option in reconstruction, require that the donor and recipient areas present tissular similarities. The present study proposes the superior eyelid tissue as a good option in 12 patients with facial basal cell carcinomas and excess tissue in the superior eyelids.

Acne scars are a common however difficult to treat condition.There are a number of laserbased techniques for their correction; fractional CO2 lasers are currently the most frequently used. In order to obtain good results, interventions can, however, become considerably aggressive.Therefore,we propose a new fractional CO2 laser technique, performed only on acne scars.The objective is to optimize results with minimal side-effects.We have named it the CROLL Technique – in an analogy to the CROSS technique.We report 15 cases that were successfully treated using this technique.

A rosácea é doença crônica e prevalente. O peeling com ácido tricloroacético em baixas concentrações usado pelo paciente com gaze levemente umedecida é apresentado como tratamento de manutenção para a rosácea.