Biomodulação celular: o futuro da Dermatologia / Cells biomodulation: the future of Dermatology

A evolução da Medicina tem permitido um conhecimento cada vez mais profundo de patologias e medicações envolvendo estruturas celulares e moléculas associadas. Em Dermatologia, começamos a desvendar a modulação celular associada ao uso de substâncias como a toxina botulínica, o ácido hialurônico, entre outros. Esta nova era nos permite compreender informações que vão além de uma visão macroscópica e explorar a interação celular, adquirindo-se conhecimento mais amplo para otimizar a terapêutica dermatológica.

The evolution of medicine has allowed an increasingly in-depth knowledge of diseases and medications, involving cellular structures and associated molecules. In dermatology, we begin to unveil cell modulation associated to the use of substances such as botulinum toxin, hyaluronic acid, among others. This new era allows us to comprehend information that goes beyond a macroscopic view and explore cell interaction, leading to a broader knowledge to optimize dermatologic treatment.

Transplante de melanócitos - Variação da técnica de microenxertia / Melanocyte transplantation ­ a variation of the micrografting technique

Vitiligo é desordem adquirida da pigmentação, caracterizada pelo desenvolvimento de máculas acrômicas bem definidas na pele. É considerado estável quando nenhuma lesão nova aparece ou quando lesões preexistentes não sofrem alterações ao longo de pelo menos um ano. Nesses casos o tratamento cirúrgico é importante opção terapêutica. A microenxertia por punch é a técnica de transplante de melanócitos mais comumente realizada, com ótima repigmentação. Descreve-se uma variação dessa técnica utilizando enxertos ainda menores e mais finos (que consistem de epiderme e derme fina), para buscar resultados esteticamente melhores do que os da técnica tradicional, principalmente ao tratar áreas com significativo acometimento estético.

Vitiligo is an acquired pigmentation disorder characterized by the development of well-defined achromic macules in the skin. It is deemed stable when no new lesion emerges or when pre-existing lesions do not undergo changes for at least one year. In these cases, surgical treatment is an important therapeutic option. Punch micrografting is the most commonly performed melanocyte transplantation technique, resulting in excellent repigmentation. The authors describe a variation of this technique using even smaller and finer grafts (consisting of epidermis and thin dermis), in order to achieve aesthetical outcomes that are better than those obtained with the traditional technique, especially when treating areas with significant aesthetic impairment.

Tumores de Koenen exuberantes: tratamento efetivo com amputação do aparelho ungueal e reconstrução com enxerto de pele de espessura total / Exuberant Koenen tumors: effective treatment with amputation of the nail apparatus and reconstruction with full thickness skin grafts

Introdução: A esclerose tuberosa é genodermatose autossômica dominante, classicamente caracterizada por angiofibromas faciais, placas fibróticas, fibromas periungueais, máculas hipocrômicas em formato de folhas e placa fibrosa frontal. Relato do caso: Paciente portador dessa doença, com tumores de Koenen em todos os leitos ungueais de mãos e pés, recorrentes ao tratamento convencional de exérese simples e eletrocirurgia. Foi realizada a amputação dos leitos ungueais seguida de reconstrução com enxerto cutâneo de espessura total. Conclusão: A amputação dos aparelhos ungueais e reconstrução por enxerto cutâneo de espessura total para casos agressivos, recorrentes ou que determinem alto grau de morbidade, pode ser uma opção terapêutica efetiva.

Introduction: Tuberous sclerosis is a dominant autosomal genodermatosis, classically characterized by facial angiofibromas, fibrotic plaques, periungual fibromas, leaf-shaped hypochromic maculae and fibrous frontal plaques. Case report: A patient bore this disease, with Koenen tumors in all nail beds of hands and feet, which were resistant to the conventional treatment ­ simple excision and electrosurgery. Amputation of the nail beds was performed followed by reconstruction with full thickness skin grafts. Conclusion: The amputation of the nail apparatus and reconstruction with full thickness skin grafts in aggressive, recurrent or high morbidity cases can be an effective therapeutic option.

Tratamento da alopecia androgenética: associação de laser Erbium Glass 1550nm e infiltração de ativos / Androgenetic alopecia treatment: associating 1550nm erbium-glass laser with drug injections of active principles

Introdução: A alopecia androgenética é a forma mais comum de perda de cabelos em homens e mulheres. As opções de tratamento com medicações são as mais utilizadas atualmente, embora tragam poucos resultados. Recentemente o uso do laser tem sido sugerido para tratar essa entidade. A infiltração de medicação no couro cabeludo também vem crescendo como opção terapêutica, apesar de existirem poucos trabalhos científicos sobre esse tratamento. Objetivo: Avaliar o resultado do uso do laser de Erbium Glass 1550nm associado à infiltração de ativos (minoxidil, finasterida, fatores de crescimento e complexo vitamínico) para tratamento da alopecia androgenética masculina e feminina. Métodos: Estudo retrospectivo de pacientes com esse diagnóstico, submetidos a sessões mensais da associação terapêutica proposta. Os resultados foram avaliados por meio de fotografias comparativas realizadas antes e após o período de tratamento e de pesquisa de opinião dos pacientes. Resultados: Foram tratados 62 pacientes, com sessões, cujo número variou de três a 14; 48,39% dos pacientes apresentaram melhora discreta, e 46,77% melhora importante. A maioria (96,77%) ficou satisfeita com o tratamento. Os pacientes muito satisfeitos realizaram maior número de sessões, em média mais de seis. Conclusões: A associação de laserterapia com Erbium Glass 1550nm e infiltração de ativos no couro cabeludo é opção eficaz e segura para o tratamento da alopecia androgenética.

Introduction: Introduction: Androgenetic alopecia is the most common type of hair loss in men and women. Nowadays, medication based treatments are the most frequently used nevertheless they yield poor results. More recently, the use of lasers has been proposed to treat this condition. At the same time, the infiltration of medications in the scalp has also been growing as a therapeutic option, although there are few scientific studies on this treatment modality. Objective: To evaluate the results of using 1,550nm Erbium-Glass laser associated with the injection of active principles (minoxidil, finasteride, growth factors and a vitamin complex) for the treatment of male and female androgenetic alopecia. Methods: A retrospective study was carried out with patients with androgenetic alopecia diagnosis, who underwent monthly sessions of the proposed combination therapy. The results were evaluated by means of comparative photographs taken before and after the treatment period and the assessment of the patients' opinion. Results: Sixty-two patients were treated with 3 to 14 sessions; 48.39% of patients had mild improvement, and 46.77% had significant improvement. The vast majority (96.77%) was satisfied with the treatment. The patients who were very satisfied with the outcomes underwent a greater number of sessions (more than six, on average). Conclusions: The association of 1,550nm Erbium-Glass laser therapy with the injection of active principles in the scalp is an effective and safe option for the treatment of androgenetic alopecia.

Erythroplasia of Queyrat treated with topical 5-fluorouracil

Abstract We report a 33-year-old male patient diagnosed with erythroplasia of Queyrat. The patient had an erythematous and eroded lesion affecting more than 50% of the glans associated with bleeding and local pain. Despite previous indication of penectomy, he was successfully treated with topical 5-fluorouracil.

Erythroplasia of Queyrat treated with topical 5-fluorouracil.

We report a 33-year-old male patient diagnosed with erythroplasia of Queyrat. The patient had an erythematous and eroded lesion affecting more than 50% of the glans associated with bleeding and local pain. Despite previous indication of penectomy, he was successfully treated with topical 5-fluorouracil.

Clouston Syndrome: 25-year follow-up of a patient

Abstract: Clouston syndrome is a rare genodermatosis that affects skin and annexes. It is a form of ectodermal dysplasia characterized by generalized hypotrichosis, palmoplantar hyperkeratosis and nail dystrophy. This paper reports a 25-year follow-up of a patient with Clouston syndrome, from childhood to adulthood, monitoring diagnosis and clinical course of the disease.

The association of fractional CO2 laser 10.600nm and photodynamic therapy in the treatment of onychomycosis.

BACKGROUND: Onychomycosis is a fungal infection of the nails caused in most cases by dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes. Despite numerous available antifungal drugs for therapy of this infection, the cure rate is low, with high rates of relapse after treatment and side effects. OBJECTIVES: To present a new option for the treatment of onychomycosis, in search of a more effective and rapid method than conventional ones. METHODS: Patients underwent two sessions of CO2 fractional laser 10.600nm associated with photodynamic therapy. Mycological and digital photography were performed before and after the treatment. RESULTS: McNemar test with continuity correction and degrees of freedom = 1: for clinical cure rate, 13.06, with p=0.00005; for mycological cure, 17.05, with p=0.00005; 72% felt fully satisfied with the procedure. CONCLUSIONS: The use of fractional CO2 laser 10.600nm associated with photodynamic therapy can be effective in the treatment of onychomycosis, decreasing the risk of systemic lesions that may be triggered with prolonged use of oral antifungals.

The association of fractional CO2 laser 10.600nm and photodynamic therapy in the treatment of onychomycosis

AbstractBACKGROUND:Onychomycosis is a fungal infection of the nails caused in most cases by dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes. Despite numerous available antifungal drugs for therapy of this infection, the cure rate is low, with high rates of relapse after treatment and side effects.OBJECTIVES:To present a new option for the treatment of onychomycosis, in search of a more effective and rapid method than conventional ones.METHODS:Patients underwent two sessions of CO2 fractional laser 10.600nm associated with photodynamic therapy. Mycological and digital photography were performed before and after the treatment.RESULTS:McNemar test with continuity correction and degrees of freedom = 1: for clinical cure rate, 13.06, with p=0.00005; for mycological cure, 17.05, with p=0.00005; 72% felt fully satisfied with the procedure.CONCLUSIONS:The use of fractional CO2 laser 10.600nm associated with photodynamic therapy can be effective in the treatment of onychomycosis, decreasing the risk of systemic lesions that may be triggered with prolonged use of oral antifungals.

Clouston Syndrome: 25-year follow-up of a patient.

Clouston syndrome is a rare genodermatosis that affects skin and annexes. It is a form of ectodermal dysplasia characterized by generalized hypotrichosis, palmoplantar hyperkeratosis and nail dystrophy. This paper reports a 25-year follow-up of a patient with Clouston syndrome, from childhood to adulthood, monitoring diagnosis and clinical course of the disease.

Associação de técnicas para manejo efetivo dos queloides / Association of techniques for effective management of keloids

Queloides constituem uma proliferação anormal de fibroblastos após injúria da pele que ultrapassam bordas da ferida, causando aparência inestética e grande prejuízo à qualidade de vida destes pacientes. Atualmente não há uma terapêutica combinada eficaz para redução das massas queloidianas, inibindo sua recidiva. Neste trabalho apresentamos uma série de casos tratados com uma associação de técnicas (excisão cirúrgica pela técnica de shaving, injeção intralesional de corticosteroide e/ou bleomicina, aplicação de placa de gel de silicone, luz intensa pulsada, laser de CO2 fracionado, laser Nd:YAG, laser Erbium:Glass e LED vermelho e infravermelho), atuando na fisiopatologia do queloide, que demonstraram resultados satisfatórios e duradouros...

Nanotechnology in dermatology.

The scientific community and general public have been exposed to a series of achievements attributed to a new area of knowledge: Nanotechnology. Both abroad and in Brazil, funding agencies have launched programs aimed at encouraging this type of research. Indeed, for many who come into contact with this subject it will be clear the key role that chemical knowledge will play in the evolution of this subject. And even more, will see that it is a science in which the basic structure is formed by distilling different areas of inter-and multidisciplinary knowledge along the lines of new paradigms. In this article, we attempt to clarify the foundations of nanotechnology, and demonstrate their contribution to new advances in dermatology as well as medicine in general. Nanotechnology is clearly the future.

Nanotechnology in Dermatology

The scientific community and general public have been exposed to a series of achievements attributed to a new area of knowledge: Nanotechnology. Both abroad and in Brazil, funding agencies have launched programs aimed at encouraging this type of research. Indeed, for many who come into contact with this subject it will be clear the key role that chemical knowledge will play in the evolution of this subject. And even more, will see that it is a science in which the basic structure is formed by distilling different areas of inter-and multidisciplinary knowledge along the lines of new paradigms. In this article, we attempt to clarify the foundations of nanotechnology, and demonstrate their contribution to new advances in dermatology as well as medicine in general. Nanotechnology is clearly the future. .

Estudo clínico para avaliação do filtro solar Filtrum FPS 50 Alta Proteção: avaliação cosmética / Clinical study of sunscreen SPF 50 Filtrum Alta Proteção: cosmetics assessment

Este estudo clínico foi realizado com Filtrum FPS 50 Alta Proteção em voluntários saudáveis. Realizou-se avaliação sensorial...

Uso do laser fracionado não ablativo NdYAP 1340nm no tratamento da acne nódulo cística resistente à isotretinoína / Use of nonablative fractional 1340nm NdYAP laser in the treatment of nodulocystic acne resistant to isotretinoin

Introdução: A acne é uma das afecções da pele mais prevalentes, representando constante desafio aos dermatologistas, principalmente em casos graves, como a acne nódulo- cística, que pode apresentar resistência ao tratamento medicamentoso. A terapia tradicional inclui medicamentos tópicos e orais, que nem sempre são eficazes e muitas vezes provocam resistência bacteriana e efeitos colaterais. O uso do laser no tratamento da acne inflamatória cresceu ultimamente devido à facilidade desse tipo de terapia, a sua eficácia clínica e aos mínimos efeitos adversos. Objetivo: Avaliar a ação do laser fracionado em pacientes com acne nódulo-cística resistente ao tratamento com isotretinoína. Métodos: Realização de sessões de laserterapia com Nd:YAP em nove pacientes. Avaliação do grau de satisfação dos pacientes e comparação de fotografias realizadas antes e após o tratamento por dermatologistas não vinculados ao estudo. Resultados: Redução média de 65% das lesões inflamatórias, satisfação de todos os pacientes submetidos ao tratamento e aprovação na avaliação realizada pelos dermatologistas. Conclusões: O laser fracionado Nd:YAP mostrou-se eficaz no tratamento da acne inflamatória, podendo representar nova opção terapêutica para essa patologia, principalmente para os pacientes que não respondem ao tratamento convencional.

Introduction: Acne is one of the most prevalent skin conditions, representing a constant challenge to dermatologists, especially in severe cases as nodulocystic acne, which can be resistant to medicament based treatment. Traditional therapy includes topical and oral drugs that are not always effective and often lead to bacterial resistance and side effects. The use of lasers in the treatment of inflammatory acne has increased lately due to the ease, clinical efficacy, and minimal side effects of this type of therapy. Objective: To evaluate the effects of fractional laser in patients with nodulocystic acne resistant to treatment with isotretinoin. Methods: Application of laser therapy sessions with Nd:YAP in 9 patients. Assessment of the degree of patient satisfaction and comparison of photographs taken before and after treatment by dermatologists not linked to the study. Results: Average reduction of 65% in inflammatory lesions, satisfaction of all patients who underwent treatment, and approval in the assessment carried out by dermatologists. Conclusions: The fractional Nd:YAP laser was proven effective in the treatment of inflammatory acne and may represent a new therapeutic option for this pathology, especially for patients who do not respond to conventional treatment

Técnica de correção de cicatrizes distensíveis de acne com ácido hialurônico, otimizada com iluminação de LED / Distensible acne scar correction using hyaluronic acid enhanced with LED lighting

Introdução: A melhor opção para tratamento das cicatrizes de acne distensíveis é o preenchimento, porém muitas dessas lesões não são adequadamente visualizadas na iluminação tradicional. Objetivo: Investigar se o foco de luz de LED favorece a realização da técnica de preenchimento com ácido hialurônico em cicatrizes de acne. Métodos: Doze pacientes foram tratados com e sem foco diagonal e posterior de luz de LED. Os próprios pacientes e dois médicos atribuíram percentual de melhora. As medianas dos percentuais de melhora atribuídos pelos pacientes foram 60% (sem LED) e 70% (com LED). Resultados: Medianas dos percentuais atribuídos pelos médicos foram 55%/65% (sem LED) e 70%/72,5% (com LED). Conclusão: o uso do foco de luz LED em posição diagonal e posterior otimiza os resultados e os índices de satisfação dos pacientes.

Introduction: The best option for treating distensible acne scars is cutaneous filling, however many such lesions cannot be seen properly under traditional lighting. Objective: To investigate whether an LED light spot helps in the technique of filling acne scars with hyaluronic acid. Methods: Twelve patients were treated with and without the diagonal and posterior focus of LED lighting. The patients themselves and two physicians deemed that the treatment has provided improvement. The median percentage of improvement attributed by the patients was 60% (without LED lighting) and 70% (with LED lighting). Results: The average median percentage of improvement attributed by the physicians was 55.0% / 65.0% (without LED lighting) and 70.0% / 72.5% (with LED lighting). Conclusion: The use of diagonal and posterior LED light spots enhances outcomes and patient satisfaction rates.

Hormônios no rejuvenescimento: revisão de sua real eficácia / Hormones in rejuvenation: a review of their true effectiveness

Os hormônios possuem grande importância no envelhecimento devido à diminuição de alguns durante esse processo. Dessa forma, existe a hipótese de que a reposição hormonal possa retardar o envelhecimento. Diante do crescente interesse em tratamentos rejuvenescedores que apresentem bons resultados, a terapia de reposição hormonal tem-se destacado no meio científico. Esta revisão analisa o papel do hormônio do crescimento, da melatonina, da desidroepiandrosterona e dos hormônios bioidênticos no rejuvenescimento. Buscamos, também, avaliar resultados de estudos de terapia de reposição hormonal, observando riscos e benefícios do uso desses hormônios considerados "fonte da juventude".

Hormones are very important in the aging process because some of their levels decrease. Therefore it can be hypothesized that hormone replacement therapy might slow aging. In light of the increasing interest in rejuvenating treatments that can yield good results, hormone replacement therapy has dawned in scientific circles. This review examines the roles of growth hormones melatonin and dehydroepiandrosterone, as well as those of bioidentical hormones in rejuvenation. The authors have also sought to evaluate the results of studies on hormone replacement therapy, considering the risks and benefits of using those hormones, which are seen as the "fountain of youth."