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1.
Int J Cosmet Sci ; 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33728691

RESUMO

OBJECTIVE: Differences in skin physiology and lifestyle among people can influence the skin damage caused by solar radiation. Photoprotection habits play an important role to prevent skin photoaging. Thus, the objective of the present study was to evaluate the skin changes resulting from solar exposure in young men by skin imaging techniques. METHODS: Twenty-three male, aged 18-28 years, with and without photoprotection habits participated in the study. Instrumental measurements in terms of dermis thickness and echogenicity (20 mHz ultrasound - DermaScanC® ), morphological and structural skin characterization (Reflectance Confocal Microscopy - VivaScope® 1500) and high-resolution imaging (Visioface® ) were performed in the malar region of the face. RESULTS: Pigmentation disorders, telangiectasia, wrinkles and lower dermis echogenicity were observed in the skin of subjects without photoprotection habits. Reflectance Confocal Microscopy images showed an irregular honeycomb pattern (35%), polycyclic papillae (40%) and coarse collagen fibres (35%), which are related to photoaging. CONCLUSION: Sun exposure without photoprotection results in a loss of dermal echogenicity and changes in the epidermis structure and collagen fibres regardless of chronological age. Thus, the study adds data for a discussion about correct photoprotection habits among young people and can help to increase the use of sunscreens for male public.

5.
An. bras. dermatol ; 95(supl.1): 53-69, Nov.-Dec. 2020. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1152779

RESUMO

Abstract Background: Rosacea is a chronic inflammatory disease of the skin, relatively more frequent in women over 30 with a low phototype and proven genetic predisposition. Although its etiology is unknown and possibly multifactorial, the immunological abnormality, associated with neurovascular dysregulation and triggering factors, are important elements in its pathophysiology, which lead to the main changes of inflammation, vasodilation, and angiogenesis that are responsible for the clinical manifestations. Despite the lack of cure, numerous therapeutic options are available for the different clinical presentations of the disease, with satisfactory responses. Objective: To reach a consensus, with recommendations from experts, on the therapeutic management of rosacea suitable to the Brazilian setting. Methods: The study was conducted by five specialized dermatologists from university centers, representatives of the different Brazilian regions, with experience in rosacea, who were appointed by the Brazilian Society of Dermatology. Based on the adapted DELPHI methodology, the experts contributed through an updated bibliographic review of the scientific evidence, combined with personal experiences. Results: The group of experts reached a consensus on the relevant aspects in the therapeutic management of rosacea, providing information on epidemiology, pathophysiology, triggering factors, clinical condition, classification, quality of life, and comorbidities. Consensus was defined as approval by at least 90% of the panel. Conclusion: Despite the impossibility of cure, there are several therapeutic alternatives specific to each patient that provide excellent results, with chances of total improvement and long periods of remission, promoting a positive impact on quality of life. This consensus provides detailed guidance for clinical practice and therapeutic decisions in rosacea.

6.
An. bras. dermatol ; 95(supl.1): 19-38, Nov.-Dec. 2020. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1152780

RESUMO

Abstract Background: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. Objective: To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. Methods: Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. Results: With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. Conclusions: Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated.

7.
Skin Res Technol ; 2020 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-33368720

RESUMO

BACKGROUND AND OBJECTIVE: There is no validated instrument to assess the clinical severity of striae distensae. Here, we aimed to develop a striae distensae severity scale. MATERIAL AND METHODS: After a Delphi-based consensus, 15 items related to striae severity were assessed in 110 areas (breasts, abdomen, and buttocks) from 45 participants. The items were analyzed through a partial least squares model to select the most important variables. To assess the reliability of the scale, 43 areas were retested. RESULTS: Of the 110 areas evaluated, 34 were breasts, 24 abdomens, and 52 buttocks. Striae were considered mild in 30% of the evaluations, moderate in 33%, severe in 21%, and extremely severe in 16%. The final model was composed by: width of the widest striae, width of the striae with the most frequent pattern, atrophy, number of affected quadrants, distribution (multiple or isolated), hypo or hyperchromia and topography. The scores of the scale demonstrated a high correlation with the clinical classification (rho = 0.77). There was a high agreement in the scores from the reassessed areas (intraclass correlation coefficient = 0.90). CONCLUSION: An objective and reliable scale to assess the clinical severity of striae distensae on the breasts, abdomen, and buttocks was developed.

8.
An Bras Dermatol ; 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33172727

RESUMO

BACKGROUND: Rosacea is a chronic inflammatory disease of the skin, relatively more frequent in women over 30 with a low phototype and proven genetic predisposition. Although its etiology is unknown and possibly multifactorial, the immunological abnormality, associated with neurovascular dysregulation and triggering factors, are important elements in its pathophysiology, which lead to the main changes of inflammation, vasodilation, and angiogenesis that are responsible for the clinical manifestations. Despite the lack of cure, numerous therapeutic options are available for the different clinical presentations of the disease, with satisfactory responses. OBJECTIVE: To reach a consensus, with recommendations from experts, on the therapeutic management of rosacea suitable to the Brazilian setting. METHODS: The study was conducted by five specialized dermatologists from university centers, representatives of the different Brazilian regions, with experience in rosacea, who were appointed by the Brazilian Society of Dermatology. Based on the adapted DELPHI methodology, the experts contributed through an updated bibliographic review of the scientific evidence, combined with personal experiences. RESULTS: The group of experts reached a consensus on the relevant aspects in the therapeutic management of rosacea, providing information on epidemiology, pathophysiology, triggering factors, clinical condition, classification, quality of life, and comorbidities. Consensus was defined as approval by at least 90% of the panel. CONCLUSION: Despite the impossibility of cure, there are several therapeutic alternatives specific to each patient that provide excellent results, with chances of total improvement and long periods of remission, promoting a positive impact on quality of life. This consensus provides detailed guidance for clinical practice and therapeutic decisions in rosacea.

9.
An Bras Dermatol ; 2020 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-33036809

RESUMO

BACKGROUND: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. OBJECTIVE: To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. METHODS: Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. RESULTS: With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. CONCLUSIONS: Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated.

10.
Dermatol Surg ; 46 Suppl 1: S54-S61, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32976172

RESUMO

BACKGROUND: Calcium hydroxylapatite (CaHA) is effective for dorsal hand rejuvenation. Higher dilutions are used for biostimulation with fewer side effects. OBJECTIVE: To evaluate the efficacy and safety of 2 techniques of diluted CaHA injection for dorsal hand treatment. METHODS: A prospective, evaluator-blinded study was performed to compare (side-to-side) techniques for treating the dorsum of the hands with diluted CaHA: deep fat lamina or subdermal injection. Fifteen women with aging grades between 1 and 3 on the MHGS (Merz hand grading scale) were enrolled and followed up for 24 weeks. The outcomes were a histological analysis of collagen, skin viscoelasticity, high-frequency ultrasound parameters, MHGS score, and the global aesthetic improvement scale (GAIS) score. RESULTS: Improvement in the MHGS and GAIS scores (p < .01) was observed, with no difference between techniques (p > .05). Skin viscoelasticity measures and ultrasonography for dermal parameters improved for both treatments (p < .01). The mean total collagen density increased from the baseline for both techniques (p < .01). Pain during the procedure as well as adverse effects within the follow-up did not differ between treatments (p > .4). The overall satisfaction was 12% greater for the subdermal technique (p < .05). CONCLUSION: Diluted CaHA improves the skin quality of aging hands with a safe profile, without substantial differences between the techniques.

11.
Int J Dermatol ; 59(12): 1531-1536, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32864760

RESUMO

OBJECTIVE: To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women. Topical 5% cysteamine is an antioxidant and tyrosinase inhibitor that has been shown to be effective in the treatment of melasma. However, to date, no study has compared the performance of topical cysteamine to hydroquinone for facial melasma. METHODS: A quasi-randomized, multicenter, evaluator-blinded clinical trial was conducted on 40 women with facial melasma who were submitted to the nightly application of 5% cysteamine (CYS) or 4% hydroquinone (HQ) on hyperpigmented areas for 120 days. Both groups were required to use tinted sunscreen (SPF 50; PPD 19). Subjects were assessed at the inclusion and after 60 and 120 days of treatment for mMASI, MELASQoL, and the difference in colorimetric luminosity between melasma and the adjacent unaffected skin. The Global Aesthetic Improvement Scale was used to assess the difference in the appearance of the skin through standardized photographs. RESULTS: The mean reduction of the mMASI scores was 24% for CYS and 41% for HQ (P = 0.015) at 60 days, and 38% for CYS and 53% for HQ (P = 0.017) at 120 days. The photographic evaluation revealed up to 74% improvement for both groups, without statistically significant difference between them (P = 0.087). The MELASQoL score showed a progressive decrease for both groups over time, despite the greater reduction for HQ after 120 days (P = 0.018). Colorimetric assessment disclosed progressive depigmenting in both groups, without statistically significant difference between them (P > 0.160). No severe adverse effects were identified in either group. Erythema and burning were the most important local adverse effects with cysteamine, although their frequency did not differ between groups (P > 0.170). CONCLUSION: Cysteamine proved to be safe, well-tolerated, and effective, despite its inferior performance to hydroquinone in decreasing mMASI and MELASQoL in the treatment of melasma.

12.
Expert Rev Clin Pharmacol ; 13(8): 885-897, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32744074

RESUMO

INTRODUCTION: Acne is a chronic, inflammatory, and immune mediated disease of pilosebaceous unit, highly prevalent in adolescents. It involves face, trunk, and back; may leave scars and affect quality of life. Early, effective, and safe treatment is the key for disease resolution. Oral isotretinoin is the unique treatment for cure or prolonged remission for moderate and severe acne, preventing psychosocial impact and scars. It inhibits sebaceous glands activity and has anti-inflammatory and immunoregulatory properties. AREAS COVERED: We performed a comprehensive literature search on PubMed database, up to March 2020, regarding oral isotretinoin for acne treatment. We synthetized data about acne pathogenesis and mechanism of action, efficacy, and safety of isotretinoin. EXPERT OPINION: This drug is effective, despite common, controllable, and reversible mucocutaneous side effects. Serious adverse events are rare and represent individual reactions. Teratogenicity is the most severe, requiring rigorous control. We believe that no other therapeutic option, even topicals combined to oral antibiotics accomplish same results. Recurrence after treatments other than isotretinoin is the rule, prolonging risk of scars, compromising skin appearance, and causing emotional distress in teenagers. If there is no absolute contraindication, isotretinoin should be the first line treatment for moderate to severe inflammatory acne.

14.
Arq. bras. oftalmol ; 83(2): 109-112, Mar.-Apr. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1088962

RESUMO

ABSTRACT Purpose: To compare the impact of ocular changes between systemic treatment with doxycycline and low-dose oral isotretinoin in patients with moderate-to-severe papulopustular rosacea. Methods: Patients were randomized to receive either isotretinoin 0.3-0.4 mg/kg (group A) or doxycycline 100 mg/day (group B) for 16 weeks. Ocular symptoms were searched and evaluated, including best-corrected visual acuity (BCVA), Schirmer test, breakup time, rose bengal staining score, and meibomian gland dysfunction grading. The patients were retested at the end of treatment. Results: The present study included 39 patients (30 females and 9 males). Best-corrected visual acuity was > 20/30 in >90% of patients in both groups and did not change after treatment. After treatment, improvement in ocular symptoms and meibomian gland dysfunction was more pronounced in group B (p<0.05); the other parameters did not reach statistical significance. Conclusion: Doxycycline improved meibomian gland dysfunction, ocular symptoms, and ocular surface in patients with rosacea. Even though some patients experienced worsening meibomian gland dysfunction and symptoms, no subject experienced any serious complications after administration of low-dose isotretinoin.


RESUMO Objetivos: Comparar o impacto das alterações oculares entre o tratamento sistêmico de doxiciclina e isotretinoína em baixa dosagem em pacientes com rosácea papulopustulosa moderada a grave. Métodos: Os pacientes form randomizados para receber isotretinoína 0,3 a 0,4 mg/kg (grupo A) ou doxiciclina 100mg/dia (grupo B) por 16 semanas. Os sintomas oculares foram pesquisados e avaliados, incluindo melhor acuidade visual corrigida, teste de Schirmer, tempo de ruptura do filme lacrimal, coloração de rosa bengala e graduação da disfunção de glândula de Meibomius. Os pacientes foram novamente testados no final do tratamento. Resultados: O presente estudo incluiu 39 pacientes (30 mulheres e 9 homens). A melhor acuidade visual corrigida foi >20/30 em >90% dos pacientes em ambos os grupos e não se alterou após o tratamento. A melhora dos sintomas oculares e da disfunção de glândula de Meibomius foi mais pronunciada no grupo B (p<0,05) após o tratamento; as demais variáveis não atingiram significância estatística. Conclusão: A doxiciclina melhorou a disfunção de glândula de Meibomius, os sintomas oculares e a superfície ocular de pa cientes com rosácea. Mesmo que alguns pacientes tenham piorado a disfunção e os sintomas da glândula de Meibomius, nenhum indivíduo apresentou complicações graves após a admi nistração de baixas doses de isotretinoína.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Isotretinoína/administração & dosagem , Doxiciclina/administração & dosagem , Rosácea/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Disfunção da Glândula Tarsal/tratamento farmacológico , Antibacterianos/administração & dosagem , Índice de Gravidade de Doença , Acuidade Visual , Administração Oral , Resultado do Tratamento , Rosácea/fisiopatologia , Olho/efeitos dos fármacos , Disfunção da Glândula Tarsal/fisiopatologia , Glândulas Tarsais/efeitos dos fármacos
16.
Arq Bras Oftalmol ; 83(2): 109-112, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31778446

RESUMO

PURPOSE: To compare the impact of ocular changes between systemic treatment with doxycycline and low-dose oral isotretinoin in patients with moderate-to-severe papulopustular rosacea. METHODS: Patients were randomized to receive either isotretinoin 0.3-0.4 mg/kg (group A) or doxycycline 100 mg/day (group B) for 16 weeks. Ocular symptoms were searched and evaluated, including best-corrected visual acuity (BCVA), Schirmer test, breakup time, rose bengal staining score, and meibomian gland dysfunction grading. The patients were retested at the end of treatment. RESULTS: The present study included 39 patients (30 females and 9 males). Best-corrected visual acuity was > 20/30 in >90% of patients in both groups and did not change after treatment. After treatment, improvement in ocular symptoms and meibomian gland dysfunction was more pronounced in group B (p<0.05); the other parameters did not reach statistical significance. CONCLUSION: Doxycycline improved meibomian gland dysfunction, ocular symptoms, and ocular surface in patients with rosacea. Even though some patients experienced worsening meibomian gland dysfunction and symptoms, no subject experienced any serious complications after administration of low-dose isotretinoin.


Assuntos
Antibacterianos/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Doxiciclina/administração & dosagem , Isotretinoína/administração & dosagem , Disfunção da Glândula Tarsal/tratamento farmacológico , Rosácea/tratamento farmacológico , Administração Oral , Adulto , Idoso , Olho/efeitos dos fármacos , Feminino , Humanos , Masculino , Disfunção da Glândula Tarsal/fisiopatologia , Glândulas Tarsais/efeitos dos fármacos , Pessoa de Meia-Idade , Rosácea/fisiopatologia , Índice de Gravidade de Doença , Resultado do Tratamento , Acuidade Visual , Adulto Jovem
17.
Sao Paulo Med J ; 137(4): 363-368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31691769

RESUMO

BACKGROUND: Acne needs to be treated early to prevent negative psychosocial impacts. In severe or moderate forms, which tend to leave scars, oral isotretinoin is the first-line therapy. However, concern about its adverse events, especially in developed countries, delays effective treatment. In contrast, isotretinoin is widely prescribed in Brazilian private clinics. OBJECTIVES: To describe the use of isotretinoin for treating acne in a Brazilian public hospital, and to analyze whether its prescription is effective or belated. DESIGN AND SETTING: Retrospective cohort study in a public hospital. METHODS: Clinical and therapeutic data were obtained from the medical records of patients who were undergoing or had undergone acne treatment with isotretinoin in this hospital's general dermatology outpatient clinic over the last seven years, up to April 2018. RESULTS: 1526 medical records from patients with acne were analyzed. Isotretinoin was prescribed for 279 patients (18.28%) with mild (1.19%), moderate (57.37%), severe (35.85%) or conglobata (5.57%) forms of acne vulgaris. Sequelae of acne were present at the start of most of these patients' treatment. An initial daily dose of 20 mg was usually prescribed. The average initial dose/weight ratio was 0.33 mg/kg/day. The average total dose/weight ratio was 127.61 mg/kg. There were only a few cases of laboratory abnormalities. CONCLUSION: Sequelae of acne at the onset of treatment reveal delayed indication of isotretinoin, which can have negative psychosocial impacts on quality of life. Isotretinoin should be indicated early to prevent this. Its use is supported by its lack of laboratory alterations and controllable adverse events.


Assuntos
Acne Vulgar/tratamento farmacológico , Isotretinoína/administração & dosagem , Adulto , Estudos de Coortes , Feminino , Hospitais Públicos , Humanos , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
19.
Dermatology ; 235(6): 456-462, 2019.
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.


Assuntos
Acne Vulgar/epidemiologia , Cicatriz/epidemiologia , Síndrome Metabólica/epidemiologia , Acne Vulgar/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Cicatriz/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
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