Six-Month Comparative Analysis Monitoring the Progression of the Largest Diameter of the Sweating Inhibition Halo of Different Botulinum Toxins Type-A.

BACKGROUND: Excessive sweating is a clinical condition that can be improved with type-A botulinum toxin (BTX-A). OBJECTIVES: To evaluate and compare the largest diameter of sweating inhibition halo (SIH) of 5 different commercially available BTX-A, in five different doses, in a 6-month-long clinical evaluation. METHODS: Twenty-five adult female volunteers were injected in the dorsal trunk area with both 100 units (100UI) and 500 units (500UI) BTX-A products, reconstituted in a ratio of 1:2.5 IU, respectively. Products were applied in five different concentrations (1:2.5U, 2:5U, 3:7.5U, 4:10U, and 5:12.5U). After 30, 60, 90, 120, 150, and 180 days, a starch-iodine test was performed to obtain the largest diameter of each SIH. RESULTS: The higher the number of units used, the larger the SIH p < 0.05 for all BTX-A. However, Botox®, Botulift®, Dysport®, and Prosigne® have pretty likewise SIH along the study, with some few differences for some doses and months between one and another. However, Xeomin® is the BTX-A with the smallest SIH, in comparison with all others, in any dose and period. CONCLUSIONS: Differences were observed among all brands of BTX-As, based on dose and time after injection. Xeomin® provides the smallest SIH in comparison with others BTX-A.

Stewart Treves Syndrome.

Stewart-Treves Syndrome is characterized by the presence of lymphangiosarcoma on limb extremities. Rare, it occurs in 0.5% of patients who have undergone radical mastectomy with axillary node dissection. The main cause is chronic lymphedema with endothelial and lymphatic differentiation, with no direct relationship to breast cancer. Seven years after a radical right-side mastectomy with lymph node dissection and adjuvant therapy, the patient developed a lesion on her right arm. The dermatological examination revealed an erythematous nodule with bleeding surface on chronic right forearm lymphedema. After the biopsy, a lymphangiosarcoma on chronic lymphedema was diagnosed. Infrequent, this syndrome is relevant because of its associated mortality. Early diagnosis is important to improve survival and reduce complications.

Tratamento de micose fungoide com fototerapia UVB de banda estreita (UVB-NB) / Treatment of mycosis fungoides with narrow-band UVB phototherapy (NB-UVB)

O linfoma cutâneo de células T (LCCT) compreende um grupo heterogêneo de neoplasias de linfócitos T que se apresentam de diversas formas clínicas, histológicas, imunofenotípicas e evolutivas. Micose fungoide (MF) é a forma mais comum de LCCT e corresponde a 50% de todos os linfomas cutâneos primários. A variante hipocrômica da micose fungoide apresenta características epidemiológicas próprias, sendo rara em pacientes caucasianos, atingindo faixas etárias precoces, apresentando evolução na maioria das vezes benigna. O tratamento de eleição para MF é terapia direcionada à pele nos estágios iniciais, enquanto a terapia sistêmica fica reservada para os casos mais avançados. Dentre as terapias descritas, a fototerapia é um dos métodos mais utilizados atualmente para fases iniciais de MF pelos bons resultados apresentados e menor efeito colateral em relação aos demais. Recentemente muitos relatos têm mostrado que UVB-NB é efetiva para o tratamento de estádios precoces de MF. Descrevemos um caso de MF em uma adolescente no estágio IA da doença, apresentando resposta satisfatória com o tratamento com UVB-NB, duas vezes por semana.

Stewart Treves Syndrome

Stewart-Treves Syndrome is characterized by the presence of lymphangiosarcoma on limb extremities. Rare, it occurs in 0.5% of patients who have undergone radical mastectomy with axillary node dissection. The main cause is chronic lymphedema with endothelial and lymphatic differentiation, with no direct relationship to breast cancer. Seven years after a radical right-side mastectomy with lymph node dissection and adjuvant therapy, the patient developed a lesion on her right arm. The dermatological examination revealed an erythematous nodule with bleeding surface on chronic right forearm lymphedema. After the biopsy, a lymphangiosarcoma on chronic lymphedema was diagnosed. Infrequent, this syndrome is relevant because of its associated mortality. Early diagnosis is important to improve survival and reduce complications.

Mycobacterium chelonae cutaneous infection in a patient with mixed connective tissue disease.

Around 50 mycobacteria species cause human disease. Immunosuppressive states predispose to non-tuberculous mycobaterium infection, such as Mycobacterium chelonae: AFB, non-tuberculous, fast growth of low virulence and uncommon as a human pathogen. It may compromise the skin and soft tissues, lungs, lymph nodes and there is also a disseminated presentation. The diagnosis involves AFB identification and culture on Agar and Lowenstein-Jensen medium base. A 41-year-old female with MCTD (LES predominance) is reported, presenting painless nodules in the right forearm. She denied local trauma. Immunosuppressed with prednisone and cyclophosphamide for 24 months. Lesion biopsy has demonstrated positive bacilloscopy (Ziehl-Neelsen stain) and M.chelonae in culture (Lowenstein-Jensen medium base), therefore clarithromycin treatment has been started (best therapy choice in the literature).

Mycobacterium chelonae cutaneous infection in a patient with mixed connective tissue disease

Around 50 mycobacteria species cause human disease. Immunosuppressive states predispose to non-tuberculous mycobaterium infection, such as Mycobacterium chelonae: AFB, non-tuberculous, fast growth of low virulence and uncommon as a human pathogen. It may compromise the skin and soft tissues, lungs, lymph nodes and there is also a disseminated presentation. The diagnosis involves AFB identification and culture on Agar and Lowenstein-Jensen medium base. A 41-year-old female with MCTD (LES predominance) is reported, presenting painless nodules in the right forearm. She denied local trauma. Immunosuppressed with prednisone and cyclophosphamide for 24 months. Lesion biopsy has demonstrated positive bacilloscopy (Ziehl-Neelsen stain) and M.chelonae in culture (Lowenstein-Jensen medium base), therefore clarithromycin treatment has been started (best therapy choice in the literature).

Estudo clínico para a avaliação das propriedades clareadoras da associação de ácido kójico, arbutin, sepiwhite® e achromaxyl® na abordagem do melasma, comparada à hidroquinona 2% e 4% / Evaluation of the whitening properties of combined kojic acid, arbutin, sepiwhite® and achromaxyl® vs. 2% and 4% hydro- quinone in the treatment of melasma

Introdução: Melasma é alteração cutânea comum e adquirida, de curso prolongado e tratamento muitas vezes refratário, gerando impacto psicológico negativo na vida dos acometidos. Objetivos: Avaliar a eficácia, segurança e tolerabilidade da combinação tópica de ácido kójico, arbutin, sepiwhite® e achromaxyl ® em comparação à hidroquinona a 2% e a 4% na abordagem do melasma facial. Métodos: Estudo clínico mono-cego, comparativo, monocêntrico, com 120 voluntárias, fototipos I a IV de Fitzpatrick, entre 18 e 50 anos de idade, divididas em grupo A (n = 40; Blancy® 2 vezes ao dia), grupo B (n = 40; hidroquinona 2% à noite) e grupo C (n = 40; hidroquinona 4% à noite), que usaram os produtos durante 90 dias consecutivos. Foram realizadas avaliações clínicas (classificação e quantificação do melasma) e fotográficas, além do questionário de impacto à qualidade de vida e avaliação global deeficácia. Resultados: Cento e duas voluntárias (85%) finalizaram o estudo, (grupo A = 34, grupo B = 33, grupo C = 35). A métrica do Masi teve redução estatisticamente significante ao longo do estudo para os três Grupos (p-valor < 0,001). Conclusão: O uso tópico da associação de ácido kójico, arbutin, sepiwhite® e achromaxyl ® demonstrou ser eficaz e seguro na abordagem do melasma, apresentando-se como alternativa no arsenal terapêutico dessa dermatose recalcitrante e inestética.

Introduction: Melasma is a common, acquired, long-lasting skin disorder that is often resistant to treatment and causes negative psychological effects on patients. Objectives: To evaluate the efficacy, safety, and tolerability of the topical combination of kojic acid, arbutin, sepiwhite® and achromaxyl ® compared to 2% and 4% hydroquinone in the treatment of facial melasma. Methods: A single-blind, comparative, monocentric clinical study with 120 volunteers (aged 18-50, I to IV Fitzpatrick skin types) was conducted. The study population was divided into 3 groups: Group A (n = 40; Blancy®, 2 times a day), Group B (n = 40, 2% hydroquinone at night), and Group C (n = 40, 4% hydroquinone at night), and instructed to use the study product for 90 consecutive days. Clinical (classification and quantification of melasma) and photographic evaluations were carried out, and a questionnaire assessed the impact on the patients' quality of life and the products' general efficacy. Results: Most volunteers (n = 102, 85%) completed the study (Group A = 34, Group B = 33, Group C = 35). The Melasma Area Severity Index metrics presented a statistically significant decrease (i.e., improvement) throughout the study in all three groups (p-value < 0.001). Conclusion: The topical use of the kojic acid, arbutin, sepiwhite® and achromaxyl® combination proved to be an effective and safe alternative for treating melasma.

Resultado de 360 das de uso de suplemento oral à base de proteína marinha, acerola concentrada, extrato de semente de uva e extrato de tomate em mulheres posrtadoras de envelhecimento cutâneo / Treating cutaneous aging in women, with an oral supplement based on marine protein, concentrated acerola, grape seed extract and tomato extract, within 360 days

Introdução: O envelhecimento cutâneo atinge ou atingirá todas as pessoas, e seu tratamento representa um desafio clínico. Objetivo: Avaliar efeitos cutâneos do uso de um suplemento oral a base de proteína marinha, acerola concentrada e extratos de semente de uva e tomate por 360 dias em portadoras de fotoenvelhecimento cutâneo. Métodos: Quarenta e cinco voluntárias usaram dois comprimidos diários do referido suplemento por 360 dias consecutivos. Avaliações clínicas (por parte dos investigadores e das voluntárias), ultrassonográficas e fotográficas foram realizadas a cada 30 dias. Resultados: Trinta e três voluntárias (73,3%) concluíram o estudo. A melhora clínica foi evidenciada pelos investigadores e voluntárias após 30 dias de uso do suplemento oral, o que resultou em ganho estatístico ao longo do tempo (p<0,05). Após 330 dias, constatou-se a tendência à estabilização dos resultados (p=0,05). Pela análise ultrassonográfica, percebeu-se aumento na densidade dérmica das áreas fotoexpostas (132,3%; p<0,001) e das fotoprotegidas (51,9%; p=0,001). Encontraram-se melhorias estatisticamente significativas nos quesitos rugas, linhas finas, melanoses solares, outras hipercromias, eritema, hidratação, viço, oleosidade, suavidade ao toque e aparência geral da pele através da análise médica; segundo a autoavaliação das voluntárias, obteve-se melhoria no padrão das rugas, linhas finas, melanoses solares, outras hipercromias, eritema, hidratação, viço, oleosidade, suavidade ao toque e aparência geral da pele. Conclusão: O uso de suplementação oral à base de proteína marinha, acerola concentrada e extratos de semente de uva e tomate por longo prazo (360 dias) mostra-se boa abordagem sistêmica adjuvante para o fotoenvelhecimento cutâneo.

Introduction: Cutaneous aging affects (or will affect) all people at some point in their life, and its treatment represents a clinical challenge. Objective: To evaluate the cutaneous effects of an oral supplement based on marine protein, concentrated acerola and extracts of grape seed and tomato in women with cutaneous aging. Methods: Forty-five volunteers used 2 daily tablets of the supplement for 360 consecutive days. Clinical evaluations (carried out by both the investigator physicians and by the volunteers), ultrasonographic and photographic examinations were carried out every 30 days. Results: Thirty-three volunteers (73.3%) completed the study. Clinically significant improvement was verified by the investigator physicians and the volunteers after 30 days of using the oral supplement (p < 0.05). The results were maintained after 330 days (p ¿ 0.05). The ultrasonographic analysis demonstrated increases in the dermal density of the photoexposed (132.3%; p < 0.001) and photoprotected areas (51.9%; p ¿ 0.001). Through medical analysis, statistically significant improvements were found in the following criteria: wrinkles, fine lines, solar melanoses, other hyperchromias, erythema, hydration, radiance , sebum, smoothness and overall appearance of the skin. Through thevolunteers' self-evaluation, improvements in the wrinkles' pattern, fine lines, solar melanoses, other hyperchromias, erythema, hydration, radiance, sebum, smoothness and overall appearance of the skin were reported. Conclusion: The long-term use (360 days) of an oral supplement based on marine protein, concentrated acerola andextracts of grape seed and tomato was proven to be a good adjuvant systemic approach for treating cutaneous aging.

Caso para diagnóstico / Case for diagnosis

A sarcoidose é uma doença sistêmica crônica idiopática caracterizada histologicamente por um acúmulo de fagócitos mononucleares e células gigantes, que levam à formação de granulomas não-caseosos em diversos órgãos. O envolvimento cutâneo ocorre, em aproximadamente, 25 por cento dos casos, sendo representado por lesões específicas e não-específicas. Apresentamos caso raro de sarcoidose com lesões cutâneas papulosas e umbilicadas e envolvimento pulmonar.

Sarcoidosis is a chronic idiopathic disorder characterized by the accumulation of mononuclear phagocytes with the formation of noncaseating granulomas in multiple organs. Cutaneous involvement occurs in 20-25 percent of cases and specific and nonspecific lesions are observed. We reported a rare case of umbilicated papular sarcoidosis with pulmonary involvement.

[Case for diagnosis]. / Caso para diagnóstico.

Sarcoidosis is a chronic idiopathic disorder characterized by the accumulation of mononuclear phagocytes with the formation of noncaseating granulomas in multiple organs. Cutaneous involvement occurs in 20-25% of cases and specific and nonspecific lesions are observed. We reported a rare case of umbilicated papular sarcoidosis with pulmonary involvement.