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.

Carcinoma de células de Merkel com imunofenótipo atípico: desafio diagnóstico / Merkel cell carcinoma with atypical immunophenotype: diagnostic challenge

O carcinoma de células de Merkel (CCM) é um tumor raro de origem neuroendócrina e epidérmica, de mau prognóstico. Está classicamente associado à imunossupressão, exposição solar e, mais recentemente, ao poliomavírus (MCPyV). Caracteristicamente, o carcinoma de células de Merkel apresenta positividade para marcadores epiteliais e neuroendócrinos. A expressão combinada desses marcadores é o dado que corrobora o diagnóstico. Tumores MCPyV- possuem prognóstico desfavorável. Relata-se um caso de carcinoma de células de Merkel com imunofenótipo atípico (CK20 negativo) e comportamento agressivo. Este relato se justifica para reforçar a importância do conhecimento, pelos dermatologistas, de diferentes imunofenótipos que podem estar associados ao carcinoma de células de Merkel.

The Merkel cell carcinoma is a rare tumor of neuroendocrine and epidermal origin and with poor prognosis. It is classically associated with immunosuppression, exposure to the sunlight and, more recently, with the polyomavirus. It is positive for epithelial and neuroendocrine markers. The combined expression of these markers confirms the diagnosis. Polyomavirus tumors have an unfavorable prognosis. The authors report a case of Merkel cell carcinoma with atypical immunophenotype (CK20 negative) and aggressive behavior. The present report is aimed at highlighting the importance of dermatologists having knowledge of different immunophenotypes that may be associated with the Merkel cell carcinoma.

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.