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1.
Dermatology ; : 1-7, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484190

RESUMO

BACKGROUND/PURPOSE: Chronic inflammatory skin diseases have been shown to increase or predispose metabolic or vascular damage. However, little is known about systemic effects of the pro-inflammatory state of severe acne. We analyzed data of 85 patients at Lipid Outpatient Clinics (UNIFESP/EPM) who were treated for metabolic syndrome (MS). Medical history and physical examinations were performed in order to search characteristics of acne scars. METHODS: Patients' electronic records were accessed for one year. The ones presenting MS were evaluated by clinical examination in order to detect presence of acne scars. Clinical analysis comprised anamnesis, measurement of abdominal circumference, blood pressure, and body mass index (BMI). Laboratory tests included fasting glucose, CBC, serum levels of insulin, triglycerides, LDL, HDL, ALT, AST, urea, and creatinine. Statistical analysis consisted of prevalence (95% CI) of acne history/scars among patients treated at the Lipid Outpatient Clinics. The χ2 test, Pearson's test, or Fisher's exact test was used to evaluate the association of social and demographic data, clinical and lab exams with the presence of MS or acne scars. Statistical 5% significance level was adopted. RESULTS: Fifty-two patients confirmed having a medical history of acne, and 33 denied. Acne scars were found in 61.17%. There was no statistical difference between the groups according to medium value of BMI, hypertension, abdominal circumference, and serum levels of hemoglobin, leucocytes, platelets, triglycerides, LDL, HDL, AST, ALT, glycemia, creatinine, and urea. Twenty-seven out of the 52 patients with acne history presented acne scars, which symbolizes a 31.76% prevalence. This equals a 51.92% prevalence among all patients with acne history. There was no statistical difference among groups according to mean (±SD) in data such as family history, weight, BMI, hypertension, abdominal circumference, serum levels of hemoglobin, leucocytes, platelets, LDL, HDL, AST, ALT, glycemia, creatinine, and urea. A statistical difference in the triglyceride level was present, being elevated in patients with acne scars. DISCUSSION: Apart from the limitation (small sample size), a correlation between acne and MS could be suggested. The high prevalence of acne history/scars in patients treated for MS may indicate a possible correlation with any type of acne. This hypothesis may raise discussion about an association like the already proven risk of metabolic alterations in other inflammatory chronic dermatoses, such as psoriasis or rosacea, regardless of acne severity. We highlight the importance of early treatment and follow-up for patients with MS that could be observed in this study, as clinical and laboratory criteria were all within normal levels among patients from that specific outpatient clinic. Results can draw attention to evaluation of clinical and laboratory investigation related to risk of MS. It corroborates to early diagnosis and prevention of complications of MS. Further studies are needed to confirm our findings.

3.
Int J Dermatol ; 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30883707

RESUMO

BACKGROUND: Acne vulgaris is a chronic, multifactorial inflammatory skin disease involving the pilosebaceous unit. The prevalence of acne is high during adolescence and is known to persist into adulthood; however, the characteristics of adult acne have not been well established. In the adult population, acne has been associated with psychosocial repercussions impacting the quality of life of those who suffer it, especially in female patients. METHODS: This study assessed the demographic and clinical characteristics of 1,384 patients between the ages of 25 and 60 years from 21 countries in Latin America and the Iberian Peninsula, with the purpose of identifying parameters for the severity of the disease, its links to demographic, biological, social, and environmental factors, and potential triggers. RESULTS: Gender differences in severity and location of the lesions were identified. In a univariate analysis, the male gender, use of cosmetics, age of onset of adolescence, and signs of hyperandrogenism were associated with acne severity. CONCLUSIONS: The characteristics of adult acne may vary from those of adolescent acne, although the disease presentations are generally similar. Further research is needed to establish similarities and differences in manifestations of adult acne versus adolescent acne.

4.
An. bras. dermatol ; 94(1): 62-75, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-983728

RESUMO

Abstract: Background: Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution. Objective: To develop a guide for the clinical practice of adult female acne. Methods: A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne. Results: The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne. Conclusion: Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.

5.
An Bras Dermatol ; 94(1): 62-75, 2019 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30726466

RESUMO

BACKGROUND: Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution. OBJECTIVE: To develop a guide for the clinical practice of adult female acne. METHODS: A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne. RESULTS: The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne. CONCLUSION: Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.


Assuntos
Acne Vulgar/tratamento farmacológico , Acne Vulgar/etiologia , Adulto , Androgênios , Antibacterianos/uso terapêutico , Consenso , Fármacos Dermatológicos/uso terapêutico , Feminino , Humanos , Guias de Prática Clínica como Assunto , Qualidade de Vida , Fatores de Risco , Sebo
6.
Int J Dermatol ; 58(3): 365-373, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30706457

RESUMO

BACKGROUND: Sun exposure may lead to actinic keratoses (AKs), field cancerization, and skin cancer. Effective treatment of AKs and field cancerization is important. Oral and topical retinoids can be used for this purpose. To compare clinical, histological, and immunohistochemical effects of oral and topical retinoid for AKs and field cancerization on face and upper limbs of immunocompetent patients, as well as the impact on quality of life, safety, and tolerability. METHODS: This study compared 10 mg/day oral isotretinoin (ISO) to 0.05% tretinoin cream (TRE) every other night, associated with sunscreen (SPF 60). Patients of both genders, aged 50-75 years, underwent cryotherapy with liquid nitrogen for AKs at baseline and after 120 days when they were randomized into two groups, TRE (n = 31) and ISO (n = 30), for 6 months. Outcome measures were: number of AKs, histological (thickness of stratum corneum and epithelium) and immunohistochemical parameters (p53, Bcl-2 and Bax), dermatology life quality index (DLQI), and adverse events. RESULTS: Both treatments reduced the number of AKs (around 28%), the thickness of stratum corneum, and expression of p53 and Bax. By contrast, the epithelium thickness and Bcl-2 expression increased. There was no difference in the outcomes between TRE and ISO. Both treatments improved quality of life and were well tolerated with minimal side effects. CONCLUSIONS: Retinoids are effective and safe for field cancerization. Classical treatments for field cancerization (imiquimod and ingenol mebutate) are used for a short period; retinoids may be a good choice to intercalate with them and can be used continuously.


Assuntos
Antineoplásicos/uso terapêutico , Dermatoses Faciais/tratamento farmacológico , Isotretinoína/uso terapêutico , Ceratose Actínica/tratamento farmacológico , Tretinoína/uso terapêutico , Administração Cutânea , Administração Oral , Idoso , Antineoplásicos/administração & dosagem , Dermatoses Faciais/metabolismo , Dermatoses Faciais/patologia , Feminino , Humanos , Imuno-Histoquímica , Isotretinoína/administração & dosagem , Ceratose Actínica/metabolismo , Ceratose Actínica/patologia , Masculino , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Qualidade de Vida , Creme para a Pele/uso terapêutico , Neoplasias Cutâneas/metabolismo , Tretinoína/administração & dosagem , Proteína Supressora de Tumor p53/metabolismo , Extremidade Superior , Proteína X Associada a bcl-2/metabolismo
7.
An. bras. dermatol ; 93(6): 836-842, Nov.-Dec. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-973644

RESUMO

Abstract: Background: Brazil does not have a rosacea-specific quality of life questionnaire. Objectives: translation into Brazilian Portuguese, development of cultural adaptation, and validation of the RosaQoL disease-specific questionnaire for rosacea of any subtype. Methods: the recommended procedures for translation, cultural adaptation, and validation of an instrument were followed, and three interviews were conducted: baseline; seven to fourteen days after baseline; and at four to six months. The questionnaire was analyzed (with 95% confidence interval) for reliability by internal consistency (Cronbach's alpha); testretest reproducibility (intraclass correlation coefficient); responsiveness and validity. Results: terms of the original questionnaire were replaced to guarantee cultural and semantic equivalence. Validity was demonstrated by expressive correlations between the RosaQoL domains and by significance in the Jonckheere-Terpstra test (p≤0.05) between the scores of the RosaQoL domains and the participants' self-perception in relation to the disease. Reliability was acceptable; alpha coefficient ranged from 0.923 to 0.916 in the first and second applications of the RosaQoL, respectively, and the Intraclass Correlation Coefficient (ICC) ranged from 0.671 to 0.863 in the seven- to fourteen-day period. Responsiveness, measured by grouping participants into three categories based on self-perception of rosacea (better, worse or unchanged), was found for the "better" response group (p≤0.05). Study limitations: small sample; limited variety of screening sources. Conclusions: RosaQoL-BR (Brazil) was demonstrated as a reliable, valid and responsive questionnaire, with limitations, for individuals with any subtype of rosacea.

8.
Cochrane Database Syst Rev ; 11: CD009435, 2018 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-30484286

RESUMO

BACKGROUND: Acne vulgaris, a chronic inflammatory disease of the pilosebaceous unit associated with socialisation and mental health problems, may affect more than 80% of teenagers. Isotretinoin is the only drug that targets all primary causal factors of acne; however, it may cause adverse effects. OBJECTIVES: To assess efficacy and safety of oral isotretinoin for acne vulgaris. SEARCH METHODS: We searched the following databases up to July 2017: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO and LILACS. We updated this search in March 2018, but these results have not yet been incorporated in the review. We also searched five trial registries, checked the reference lists of retrieved studies for further references to relevant trials, and handsearched dermatology conference proceedings. A separate search for adverse effects of oral isotretinoin was undertaken in MEDLINE and Embase up to September 2013. SELECTION CRITERIA: Randomised clinical trials (RCTs) of oral isotretinoin in participants with clinically diagnosed acne compared against placebo, any other systemic or topical active therapy, and itself in different formulation, doses, regimens, or course duration. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 31 RCTs, involving 3836 participants (12 to 55 years) with mild to severe acne. There were twice as many male participants as females.Most studies were undertaken in Asia, Europe, and North America. Outcomes were generally measured between eight to 32 weeks (mean 19.7 weeks) of therapy.Assessed comparisons included oral isotretinoin versus placebo or other treatments such as antibiotics. In addition, different doses, regimens, or formulations of oral isotretinoin were assessed, as well as oral isotretinoin with the addition of topical agents.Pharmaceutical companies funded 12 included trials. All, except three studies, had high risk of bias in at least one domain.Oral isotretinoin compared with oral antibiotics plus topical agentsThese studies included participants with moderate or severe acne and assessed outcomes immediately after 20 to 24 weeks of treatment (short-term). Three studies (400 participants) showed isotretinoin makes no difference in terms of decreasing trial investigator-assessed inflammatory lesion count (RR 1.01 95% CI 0.96 to 1.06), with only one serious adverse effect found, which was Stevens-Johnson syndrome in the isotretinoin group (RR 3.00, 95% CI 0.12 to 72.98). However, we are uncertain about these results as they were based on very low-quality evidence.Isotretinoin may slightly improve (by 15%) acne severity, assessed by physician's global evaluation (RR 1.15, 95% CI 1.00 to 1.32; 351 participants; 2 studies), but resulted in more less serious adverse effects (67% higher risk) (RR 1.67, 95% CI 1.42 to 1.98; 351 participants; 2 studies), such as dry lips/skin, cheilitis, vomiting, nausea (both outcomes, low-quality evidence).Different doses/therapeutic regimens of oral isotretinoinFor our primary efficacy outcome, we found three RCTs, but heterogeneity precluded meta-analysis. One study (154 participants) reported 79%, 80% and 84% decrease in total inflammatory lesion count after 20 weeks of 0.05, 0.1, or 0.2 mg/kg/d of oral isotretinoin for severe acne (low-quality evidence). Another trial (150 participants, severe acne) compared 0.1, 0.5, and 1 mg/kg/d oral isotretinoin for 20 weeks and, respectively, 58%, 80% and 90% of participants achieved 95% decrease in total inflammatory lesion count. One RCT, of participants with moderate acne, compared isotretinoin for 24 weeks at (a) continuous low dose (0.25 to 0.4 mg/kg/day), (b) continuous conventional dose (0.5 to 0.7 mg/kg/day), and (c) intermittent regimen (0.5 to 0.7 mg/kg/day, for one week in a month). Continuous low dose (MD 3.72 lesions; 95% CI 2.13 to 5.31; 40 participants; one study) and conventional dose (MD 3.87 lesions; 95% CI 2.31 to 5.43; 40 participants; one study) had a greater decrease in inflammatory lesion counts compared to intermittent treatment (all outcomes, low-quality evidence).Fourteen RCTs (906 participants, severe and moderate acne) reported that no serious adverse events were observed when comparing different doses/therapeutic regimens of oral isotretinoin during treatment (from 12 to 32 weeks) or follow-up after end of treatment (up to 48 weeks). Thirteen RCTs (858 participants) analysed frequency of less serious adverse effects, which included skin dryness, hair loss, and itching, but heterogeneity regarding the assessment of the outcome precluded data pooling; hence, there is uncertainty about the results (low- to very-low quality evidence, where assessed).Improvement in acne severity, assessed by physician's global evaluation, was not measured for this comparison.None of the included RCTs reported birth defects. AUTHORS' CONCLUSIONS: Evidence was low-quality for most assessed outcomes.We are unsure if isotretinoin improves acne severity compared with standard oral antibiotic and topical treatment when assessed by a decrease in total inflammatory lesion count, but it may slightly improve physician-assessed acne severity. Only one serious adverse event was reported in the isotretinoin group, which means we are uncertain of the risk of serious adverse effects; however, isotretinoin may result in more minor adverse effects.Heterogeneity in the studies comparing different regimens, doses, or formulations of oral isotretinoin meant we were unable to undertake meta-analysis. Daily treatment may be more effective than treatment for one week each month. None of the studies in this comparison reported serious adverse effects, or measured improvement in acne severity assessed by physician's global evaluation. We are uncertain if there is a difference in number of minor adverse effects, such as skin dryness, between doses/regimens.Evidence quality was lessened due to imprecision and attrition bias. Further studies should ensure clearly reported long- and short-term standardised assessment of improvement in total inflammatory lesion counts, participant-reported outcomes, and full safety accounts. Oral isotretinoin for acne that has not responded to oral antibiotics plus topical agents needs further assessment, as well as different dose/regimens of oral isotretinoin in acne of all severities.

9.
An Bras Dermatol ; 93(6): 836-842, 2018 Nov/Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30484528

RESUMO

BACKGROUND: Brazil does not have a rosacea-specific quality of life questionnaire. OBJECTIVES: translation into Brazilian Portuguese, development of cultural adaptation, and validation of the RosaQoL disease-specific questionnaire for rosacea of any subtype. METHODS: the recommended procedures for translation, cultural adaptation, and validation of an instrument were followed, and three interviews were conducted: baseline; seven to fourteen days after baseline; and at four to six months. The questionnaire was analyzed (with 95% confidence interval) for reliability by internal consistency (Cronbach's alpha); testretest reproducibility (intraclass correlation coefficient); responsiveness and validity. RESULTS: terms of the original questionnaire were replaced to guarantee cultural and semantic equivalence. Validity was demonstrated by expressive correlations between the RosaQoL domains and by significance in the Jonckheere-Terpstra test (p≤0.05) between the scores of the RosaQoL domains and the participants' self-perception in relation to the disease. Reliability was acceptable; alpha coefficient ranged from 0.923 to 0.916 in the first and second applications of the RosaQoL, respectively, and the Intraclass Correlation Coefficient (ICC) ranged from 0.671 to 0.863 in the seven- to fourteen-day period. Responsiveness, measured by grouping participants into three categories based on self-perception of rosacea (better, worse or unchanged), was found for the "better" response group (p≤0.05). STUDY LIMITATIONS: small sample; limited variety of screening sources. CONCLUSIONS: RosaQoL-BR (Brazil) was demonstrated as a reliable, valid and responsive questionnaire, with limitations, for individuals with any subtype of rosacea.

11.
J Dtsch Dermatol Ges ; 16(10): 1185-1194, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30248242

RESUMO

Today we see more cases of acne after adolescence, with a greater prevalence in females than males. Adult female acne has a distinct clinical presentation and is associated with a number of specific pathophysiological features and gender-specific triggers. The psychological impact of acne is generally significant and largely underestimated; stress during professional and private life, anxiety and sleep quality, in particular, have a reciprocal relationship with disease susceptibility and severity. It is essential to compare with males. Acne in females often causes greater distress in adults than in adolescents. The impact of disease may therefore be greater for female patients, triggering higher levels of psychosocial anguish and increasing the likelihood of sequelae such as skin picking and the risks of cutaneous superinfection, scarring and PIH and acne recurrence. The management of adult female acne should encompass not just medical treatment of the symptoms, but also a comprehensive, holistic approach to the patient as a whole, her individual lifestyle factors and the impact of acne on her quality of life. Future management of this disease should aim to improve patient adherence to therapy and to develop validated outcomes of treatment regarding overall skin appearance and quality of life.

12.
Eur J Dermatol ; 28(3): 343-350, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30105991

RESUMO

BACKGROUND: Adapalene has been previously evaluated as a treatment for actinic keratosis (AK) and solar lentigines and shown to improve signs of photoaging. OBJECTIVES: To evaluate whether adapalene 0.3% gel is non-inferior to tretinoin 0.05% cream as treatment for photoaged skin. MATERIALS & METHODS: An investigator-blinded, parallel-group comparison study was conducted in Brazil. Subjects were randomised in a 1:1 ratio to receive, once daily, adapalene 0.3% gel or tretinoin 0.05% cream. Subjects were evaluated at Weeks 1, 4, 8, 12, 16, 20 and 24, based on clinical signs of cutaneous photoaging, histopathological and digital morphometric findings, as well as safety and tolerability. RESULTS: A comparison of clinical efficacy showed that both treatments did not differ significantly regarding clinical evaluation of the following criteria: global cutaneous photoaging, periorbital wrinkles, ephelides/melanosis, forehead wrinkles, and AK. CONCLUSION: Adapalene 0.3% gel showed non-inferior efficacy to tretinoin 0.05% cream as treatment for photoaged skin, with a similar safety profile. Adapalene 0.3% gel may therefore be considered a safe and effective option for the treatment of mild or moderate photoaging.


Assuntos
Adapaleno/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Envelhecimento da Pele/efeitos dos fármacos , Tretinoína/administração & dosagem , Adapaleno/efeitos adversos , Adulto , Fármacos Dermatológicos/efeitos adversos , Estudos de Equivalência como Asunto , Feminino , Géis , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Envelhecimento da Pele/patologia , Creme para a Pele , Luz Solar/efeitos adversos , Tretinoína/efeitos adversos , Raios Ultravioleta/efeitos adversos
15.
Artigo em Inglês | MEDLINE | ID: mdl-29440921

RESUMO

Acne is a multifactorial and inflammatory disease of pilosebaceous follicles, which affects most adolescents. Recent epidemiological data revealed a difference in adults affected by this disease. Women have a high prevalence and incidence when compared with men, especially after 25 years of age. In contrast to what was initially thought, most of these patients do not present endocrinopathy capable of leading to the development of the lesions. When present, polycystic ovarian syndrome is the main cause. However, in these cases, acne is rarely the only dermatological manifestation; hirsutism and acanthosis nigricans are often present. The majority of the normoandrogenic acne patients present a history since adolescence, but in many cases the lesion distribution and intensity change with time. There is often a typical localization of the lesions in the lower third of the face and lateral region of the neck. Another interesting feature is related to the impact on quality of life (QoL), which is always intense. Often there are signs of depression, even when the lesions are mild. As most adult patients are women, in addition to the conventional options, there is also hormone treatment. Combined oral contraceptives and spironolactone are good options. Knowing more about the particularities in etiopathogenesis, impact on QoL, and specific treatment options is important to all dermatologists who face the challenge of treating acne in adults.

16.
An Bras Dermatol ; 92(3): 363-366, 2017 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29186249

RESUMO

The tretinoin peel, also known as retinoic acid peel, is a superficial peeling often performed in dermatological clinics in Brazil. The first study on this was published in 2001, by Cuce et al., as a treatment option for melasma. Since then, other studies have reported its applicability with reasonable methodology, although without a consistent scientific background and consensus. Topical tretinoin is used for the treatment of various dermatoses such as acne, melasma, scars, skin aging and non-melanoma skin cancer. The identification of retinoids cellular receptors was reported in 1987, but a direct cause-effect relation has not been established. This article reviews studies evaluating the use of topical tretinoin as agent for superficial chemical peel. Most of them have shown benefits in the treatment of melasma and skin aging. A better quality methodology in the study design, considering indication and intervention is indispensable regarding concentration, vehicle and treatment regimen (interval and number of applications). Additionally, more controlled and randomized studies comparing the treatment with tretinoin cream versus its use as a peeling agent, mainly for melasma and photoaging, are necessary.


Assuntos
Abrasão Química/métodos , Ceratolíticos/administração & dosagem , Envelhecimento da Pele/efeitos dos fármacos , Dermatopatias/tratamento farmacológico , Tretinoína/administração & dosagem , Humanos
17.
An Bras Dermatol ; 92(5): 689-693, 2017 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29166508

RESUMO

Acne is a chronic, immune-mediated, inflammatory disease with high prevalence among adolescents. By compromising face, thorax and back, with the risk of permanent scars, it has a negative impact on the quality of life. Effective, safe and early treatment is the key to remission, while decreasing the risk of physical and/or emotional sequelae. The Iberian-Latin American Group of Acne Studies joined professionals with expertise and developed a practical therapeutic algorithm, adapted to the reality of Latin American countries, Spain and Portugal. This article intends to disseminate it with an updated review on a rational, safe and effective acne treatment.


Assuntos
Acne Vulgar/terapia , Algoritmos , Consenso , Humanos , América Latina , Portugal , Espanha
18.
An. bras. dermatol ; 92(5): 689-693, Sept.-Oct. 2017. graf
Artigo em Inglês | LILACS-Express | ID: biblio-887028

RESUMO

Abstract: Acne is a chronic, immune-mediated, inflammatory disease with high prevalence among adolescents. By compromising face, thorax and back, with the risk of permanent scars, it has a negative impact on the quality of life. Effective, safe and early treatment is the key to remission, while decreasing the risk of physical and/or emotional sequelae. The Iberian-Latin American Group of Acne Studies joined professionals with expertise and developed a practical therapeutic algorithm, adapted to the reality of Latin American countries, Spain and Portugal. This article intends to disseminate it with an updated review on a rational, safe and effective acne treatment.

19.
J Dermatol Sci ; 88(2): 199-206, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28855068

RESUMO

BACKGROUND: In vivo confocal Raman spectroscopy is a non-invasive method to assess either the epidermis or the dermis composition. Few studies have focused on dermis collagen alterations through intrinsic aging and photoaging. OBJECTIVE: This study evaluated the in vivo Raman spectra from the dermis of a photoexposed site versus a non-photoexposed region in different age groups, and evaluated the correlation between peak intensities and age, photoaging score and the amount of collagen assessed with histology and high frequency ultrasound (HFUS). METHODS: Fifteen volunteers aged 28-82 years were divided into three groups according to forearm photoaging degree. In vivo Raman spectra from the dermis were collected on the dorsal forearm (chronically photoexposed skin) and on the proximal medial arm (non-photoexposed skin). Cross-sectional images of the skin were obtained using a 20MHz ultrasound unit exactly on the same sites, which were further submitted to punch biopsies for histologic study (collagen I immunohistochemistry, picrosirius red staining and Verhoeff). Principal Component Analysis (PCA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA) were taken in the spectral region of 796cm-1-996cm-1 to determine its potential to discriminate between different groups. The Spearman rank correlation coefficient of individual peak intensities and ratios with age, clinical score and the amount of collagen assessed by ultrasound and histology were calculated. RESULTS: PCA of pairs of groups and OPLS-DA could discriminate the intrinsically from the photoaged skin and the young group from the elderly one, with important contribution of the 938cm-1 and 855cm-1 peaks intensities. The intensity of the peaks in 855cm-1 and/or 938cm-1 presented moderate correlation with age (rho=0.579, p=0.049) and moderate to high inverse correlation with HFUS echogenicity (rho=-0.710, p=0.010) and collagen I immunohistochemistry (rho=-0.833, p=0.005) in the non-photoexposed region. The I1275/I1450 intensities ratio presented moderate to high correlation coefficients with age (rho=-0.730, p=0.007), photoaging score (rho=-0.594, p=0.042), HFUS echogenicity (rho=0.760, p<0.001) and histology (collagen I immunohistochemistry (rho=0.643, p=0.024), picrosirius (rho=0.773, p=0.005) and Verhoeff (rho=-0.727, p=0.011)) in the photoexposed site. CONCLUSION: The wavenumber region between 798 and 994cm-1 is useful for the analysis of dermal collagen alterations through the intrinsic aging process, while photoaging is better assessed by the I1275/I1450 intensities ratio. This is the first skin aging study to show a correlation between Raman peaks and the amount of collagen assessed by HFUS and histology.


Assuntos
Colágeno Tipo I/análise , Derme/química , Luz/efeitos adversos , Envelhecimento da Pele/efeitos da radiação , Análise Espectral Raman/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colágeno Tipo I/química , Derme/anatomia & histologia , Derme/diagnóstico por imagem , Derme/efeitos da radiação , Feminino , Antebraço , Humanos , Microscopia Confocal/métodos , Pessoa de Meia-Idade , Ultrassonografia/métodos
20.
An. bras. dermatol ; 92(3): 363-366, May-June 2017.
Artigo em Inglês | LILACS-Express | ID: biblio-886957

RESUMO

Abstract The tretinoin peel, also known as retinoic acid peel, is a superficial peeling often performed in dermatological clinics in Brazil. The first study on this was published in 2001, by Cuce et al., as a treatment option for melasma. Since then, other studies have reported its applicability with reasonable methodology, although without a consistent scientific background and consensus. Topical tretinoin is used for the treatment of various dermatoses such as acne, melasma, scars, skin aging and non-melanoma skin cancer. The identification of retinoids cellular receptors was reported in 1987, but a direct cause-effect relation has not been established. This article reviews studies evaluating the use of topical tretinoin as agent for superficial chemical peel. Most of them have shown benefits in the treatment of melasma and skin aging. A better quality methodology in the study design, considering indication and intervention is indispensable regarding concentration, vehicle and treatment regimen (interval and number of applications). Additionally, more controlled and randomized studies comparing the treatment with tretinoin cream versus its use as a peeling agent, mainly for melasma and photoaging, are necessary.

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