RESUMO
BACKGROUND: Constitutional periorbital dark circles (PDC) are common in skin of color and represent a therapeutic challenge. OBJECTIVE: To summarize the experience of the International Peeling Society on the safety and effectiveness of deep chemical peeling in the treatment of constitutional PDC. MATERIALS AND METHODS: Multi-institutional, retrospective case series (1990-2020) of constitutional PDC treated by deep chemical peeling. Descriptive analysis by age, sex, Fitzpatrick phototype, phenol-croton formula, degree and durability of improvement, and complications. RESULTS: Fifty-five phenol-croton oil peels were performed in 52 patients: 3 patients received a second peel for periorbital rhytids 72 to 84 months after the first peel. 92% (48/52) of patients were women; the median age was 46 years (range, 23-68 years). 89% (46/52) of patients were Fitzpatrick III-IV. Most common formula included phenol 60% to 65% and croton oil 0.6% to 0.7%. 89% (49/55) of peels demonstrated >50% clinical improvement. The median duration of improvement was 24 months (range, 1.5-168 months), and 69% (36/52) of patients demonstrated ongoing improvement at the last follow-up. 4% (2/55) of peels exhibited complications of persistent erythema that resolved without scarring. CONCLUSION: Based on its safety and effectiveness, deep chemical peels are a treatment of choice for constitutional PDC.
Assuntos
Abrasão Química , Croton , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Óleo de Cróton , Estudos Retrospectivos , FenóisRESUMO
The number of nonsurgical anti-aging procedures have increased in recent years. Reasons for this trend are various: The World Wide Web distributes an immense amount of information throughout the world within seconds, which in turn generates a great demand on information. Active and aggressive medias, which were almost absent 50 years ago, have made our society ambitious; the perception of which is attractive, desirable, and sexy gets globalized. In addition, our lifestyle has changed with the fast-growing offer of leisure activities. Wrinkles, fat deposits, and sun-damaged skin do not fit into our neat society. The increasing demand for aesthetic treatments has prompted many physicians without any knowledge in aesthetic medicine to offer various nonsurgical aesthetic treatments with the danger that aesthetic dermatology stands to lose its scientific relevance. Evidence-based medicine should be applied not only in medical procedures but also in aesthetic dermatology.
RESUMO
For a long period the therapeutic modalities to treat focal hyperhidrosis (HH) were very limited. Due to this the problem of focal HH was delt with stepmotherly. Nowadays we can consider BTX as the therapy of choice for axillary HH after topical treatment with aluminium salts have failed. The amount of successful reports on botulinum toxin (BTX) in the treatment of focal HH brought a change and the interest for this specific disorder grew. This article gives details on anatomy and physiology of sweating and mechanism of BTX. Further distinctive syndromes associated with HH, which all can be treated with BTX like localized unilateral hyperhidrosis (LUH), Ross' Syndrome and Frey' Syndrome are presented. A diagnosis of primary HH is usually based on the patients's history, typical younger age and visible signs of excessive sweating. Before treatment it is important to objectify focal HH with performing sweat tests such like Minor starch test and/or gravimetry. The total number of sweat glands is somewhere between 2 and 4 million and only about 5% are active at the same time, indicating the enormous potential for sweat production. The eccrine sweat gland is a long-branched tubular structure with highly coiled secretory portion and a straight ductular portion. Sweat is produced by clear and dark cells and is a clear hypotonic, odorless fluid. In response to nerve impulses, Acetylcholine (ACh) is released from the presynaptic nerve endings and then binds to postsynaptic cholinergic receptors presumably present in the basolateral membrane of the clear cells. This activates a complex in- and efflux of electrolytes creating the hypotonic sweat. Injection of BTX leads to temporary chemodenervation with the loss or reduction of activity of the target organ. BTX is consisted of a heavy and a light chain. The structural architecture of BTX comprises three domains-L, H(N) and H(C)-each with a specific function in the mechanism of cell intoxication. The heavy chain is responsible for binding to the nerve cell, whereas the light chain catalyzes the proteolysis of one of the three SNARE proteins (Snap-25, Vamp or Syntaxin) depending to the serotype of BTX (7 serotypes A-G). Once cleaved by BTX, the SNARE proteins cannot become part of the complex capable of mediating the vesicle membrane fusion and therefore prevents the release of ACh and hence transmission of the nerve impulse.
Assuntos
Hiperidrose/tratamento farmacológico , Glândulas Sudoríparas/anatomia & histologia , Axila , Toxinas Botulínicas/química , Toxinas Botulínicas/uso terapêutico , Toxinas Botulínicas Tipo A/química , Toxinas Botulínicas Tipo A/uso terapêutico , Humanos , Fármacos Neuromusculares/uso terapêutico , Glândulas Sudoríparas/efeitos dos fármacos , Glândulas Sudoríparas/fisiologia , Sudorese/fisiologia , Sudorese Gustativa/tratamento farmacológico , SíndromeRESUMO
The pathogenesis of palmoplantar hyperhidrosis (HH) remains unknown. A causative therapy is therefore not possible yet. Step by step treatment for palmoplantar HH is advised. This includes: topical aluminium salts, tap water iontophoresis (TWI), botulinum toxin (BTX) injections and endoscopic thoracoscopic sympathectomy (ETS). The mechanism of action of TWI has been previously studied but is still not completely understood. A widely accepted hypothesis is that the anodal current causes accumulation of H(+) within the sweat duct. It is presumed that this causes an unknown lesion in the acrosyringium that inhibits sweating. TWI is non-invasive, safe, well tolerated, efficient and cheap. The patient can perform the therapy at home without medical assistance. TWI remains the best treatment for palmoplantar HH that has defied aluminium salts. This article provides a review of the literature concerning TWI, including its historical development, its mechanism of action and its indication and also describes the method of administration of this helpful treatment.