Granuloma annulare and necrobiosis lipoidica in a patient with HNF1A-MODY

SUMMARY Maturity-onset diabetes of the young (MODY) is a heterogeneous group of monogenic forms of diabetes mellitus with distinct clinical features. Clinical dermatological phenotypes in MODY patients are very rare in literature. This report describes a patient with HNF1A-MODY presenting with necrobiosis lipoidica (NL) and granuloma annulare (GA). A 39-year-old asymptomatic woman, with atypical diabetes diagnosed at age 17, has a confirmed HNF1A mutation on exon 2 (c.392G>A, p.R131Q), classified as Pathogenic by the ACMG guidelines. She has reasonable metabolic control using oral anti-diabetic medications and has no chronic diabetic complications. Clinical and histologic diagnoses of both NL and GA were made. We discuss these conditions and their association with MODY.

Granuloma annulare and necrobiosis lipoidica in a patient with HNF1A-MODY.

Maturity-onset diabetes of the young (MODY) is a heterogeneous group of monogenic forms of diabetes mellitus with distinct clinical features. Clinical dermatological phenotypes in MODY patients are very rare in literature. This report describes a patient with HNF1A-MODY presenting with necrobiosis lipoidica (NL) and granuloma annulare (GA). A 39-year-old asymptomatic woman, with atypical diabetes diagnosed at age 17, has a confirmed HNF1A mutation on exon 2 (c.392G>A, p.R131Q), classified as Pathogenic by the ACMG guidelines. She has reasonable metabolic control using oral anti-diabetic medications and has no chronic diabetic complications. Clinical and histologic diagnoses of both NL and GA were made. We discuss these conditions and their association with MODY.

Managing the Aesthetic Patient

wide variety of therapeutic options, some challenges have arisen: designing an adequate treatment plan, electing the most suitable procedures for the patient, taking into consideration the rheological characteristics of the products, considering the amount needed to achieve a natural look, but also defining the safest way to deliver the treatment. Aging of the facial structural tissue layers occurs at a different pace and the requirements for the aesthetic approach of a 30-year-old patient are different from a 60-year-old patient. A group of twelve experts in minimally invasive injectable procedures sought to identify common changes observed in different age groups in order to help in establishing a plan of treatment for patients of different ages. The individualized aesthetic plan should consider the main pillars of the aesthetic treatment -- aging process, facial assessment, and facial anatomy, to identify and systematize common changes observed in different age groups, as well as the safest and most reproducible techniques, especially for new injectors. J Drugs Dermatol. 2019;18(1):92-102.

Subcisão e microagulhamento: relato de dois casos / Subcision and microneedling therapy: report of two cases

As lesões inflamatórias da acne podem resultar em cicatrizes permanentes, e vários tratamentos são propostos para reduzir sua aparência. Relatam-se os casos de dois pacientes, um homem e uma mulher com cicatrizes de acne distróficas, distensíveis retráteis e crateriformes na face, em que se optou pelo uso da subcisão nas áreas cicatriciais. Na paciente do sexo feminino foi associado na mesma sessão o microagulhamento. Houve bom resultado clínico nas áreas tratadas dos dois pacientes após três sessões mensais.

Inflammatory acne lesions may cause unaesthetic scars. Several treatments have been described to ameliorate its appearance. Will be described the treatment with subcision in two patients with acne and dystrophic crateriform facial scars. The female patient performed Microneedling in the same session of subcision. There was good clinical outcome in the treated areas of both patients after three monthly sessions.

Quimioabrasão para tratamento de rugas periorais: avaliação clínica e quantificação das células de langerhans epidérmicas / Chemabrasion for the treatment of perioral wrinkles: clinical analysis and epidermal Langerhans cells qualifi cation

Introdução: As técnicas ablativas oferecem bons resultados no rejuvenescimento da região perioral, mas acarretam alterações imunológicas locais. Objetivos: Avaliar a efi cácia e a segurança da quimioabrasão, no rejuvenescimento da região perioral, e quantifi car as células de Langerhans epidérmicas nos períodos pré e pós-operatório. Material e Métodos: Foi realizada a aplicação de ácido tricloroacético a 35%, seguida de dermabrasão manual com lixas d'água na região perioral, em 12 pacientes, sem antecedentes de infecção por herpes simples. O acompanhamento clínico e fotográfi co foi realizado 30 dias e 12 meses após a cirurgia. Técnicas de imuno-histoquímica quantifi caram as células de Langerhans antes e 30 dias após. Resultados: Todas as pacientes apresentaram melhora da pele da região perioral e redução da quantidade das células de Langerhans, após 30 dias (p = 0,002). Três desenvolveram herpes simples. Conclusões: A quimioabrasão oferece bons resultados para o tratamento de rugas periorais, e, após 30 dias, as células de Langerhans permanecem em menor número.

Introduction: Skin photoaging can be treated with ablative therapies that cause immunological changes to the skin. Objectives: To evaluate the results of chemabrasion in the treatment of perioral wrinkles and the change in number of Langerhans cells. Material and Methods: Application of 35% trichloroacetic acid followed by manual dermabrasion using waterproof sandpaper, in 12 female patients with perioral wrinkles and results were then examined 30 days and 1 year later. Immunohistochemistry was used to measure Langerhans' cells which were counted before treatment and 1 month post-treatment. Results: Improved perioral photoaging and reduced number of Langerhans' cells (p = 0.002) were seen in all patients. Conclusions: Chemabrasion provides effective results in the treatment of perioral wrinkles but Langerhans cells remain low for 30 days after therapy.