Low-dose oral isotretinoin for moderate to severe seborrhea and seborrheic dermatitis: a randomized comparative trial.

BACKGROUND: The efficacy of low-dose oral isotretinoin in the treatment of seborrhea and seborrheic dermatitis has been poorly investigated in randomized studies. OBJECTIVES: This study was designed to determine the efficacy and safety of low-dose oral isotretinoin in the treatment of moderate to severe seborrhea and seborrheic dermatitis on the scalp and/or face. METHODS: A randomized, comparative clinical trial, using two groups, was conducted over 6 months. Patients in Group ISO were treated with isotretinoin 10 mg every other day. In Group X, patients received antiseborrheic topical treatment. Patient opinion, investigator assessment, scalp pruritus, sebum production, and quality of life (QoL) comprised the efficacy outcomes. RESULTS: The intention-to-treat population comprised a total of 45 patients with mean ± standard deviation ages of 28.7 ± 5.8 years in Group ISO and 29.8 ± 6.5 years in Group X. The rate of sebum production significantly decreased in Group ISO. Patient opinion, investigator, and QoL assessments improved in both groups. CONCLUSIONS: Low-dose oral isotretinoin can be a therapeutic modality for moderate to severe seborrhea and seborrheic dermatitis.

A histologic study of adverse effects of different cosmetic skin fillers.

OBJECTIVE: This study was designed to describe the histologic aspects of the cutaneous and mucosal adverse reactions to fillers used for cosmetic purposes. METHODS AND MATERIALS: Eleven specimens of adverse reactions caused by Restylane, Artecoll, Metacril, New-Fill, Aquamid, and liquid silicone were processed and stained by hematoxylin-eosin and Alcian blue and submitted to polarized light. RESULTS: Most of the reactions were foreign-body granulomas. CONCLUSIONS: The type of granuloma and the characteristics of the agent were determined, contributing to the histologic identification of the material used. In the cases involving Restylane and Aquamid, it was possible to identify the material using Alcian blue stain and by the presence of necrosis. This stain was strongly positive in Restylane and faintly positive in Aquamid, and intense necrosis was observed in Aquamid cases. In the other cases the filler material itself was recognized and identified.

A randomized and controlled trial about the use of oral isotretinoin for photoaging.

Topical retinoids are used to treat photoaging; oral isotretinoin is gold standard for acne; "off label" indications, including photoaging, have been reported with insufficient evidence of efficacy. This is a randomized controlled phase II trial with clinical and histological assessment to evaluate efficacy and safety of oral isotretinoin for photoaging. Study population was comprised of 32 menopausal or sterilized women, aged 40-55, divided in 2 groups: A (21) received 20mg isotretinoin, 3 times per week, nightly moisturizer, and daily sunscreen, for three months; B (11) just moisturizer/sunscreen. Main outcome measures were: overall clinical assessment; profilometry, corneometer and elasticity tests in periocular regions and left forearm; before/after biopsies from left forearm in patients of B and in 10 randomly selected of A. Microscopic blinded evaluation of epidermal thickness, dermal elastosis, new collagen, p53 epidermal expression was performed by quantitative digital image analysis. All data were submitted to statistical analysis. Clinical evaluation showed slight improvement; profilometry, corneometer and skin elasticity tests presented significant difference in pre/post values (P = 0.001 to 0.028), but no differences between A/B. Histological findings and p53 expression were comparable between groups before treatment (P > 0.1); microscopic analysis showed no differences between groups for most variables, after treatment. Slight but significant difference between A/B for p53 with major reduction post isotretinoin [0.66+/-0.31 vs. 0.94+/-0.34 respectively (P = 0.04) was observed. There were minor side effects and no significant laboratory test alterations. We concluded that no significant clinical, microscopic changes but p53 epidermal expression reduction were observed. The role of ultra-violet induced p53 mutation in skin carcinogenesis reinforces retinoids chemoprevention. Oral isotretinoin seemed safe but not effective to treat photoaging. Caution should be considered for women prone to pregnancy. Further controlled studies are necessary.

5-Fluorouracil superficial peel for multiple actinic keratoses.

BACKGROUND: Chronically photodamaged skin usually presents with multiple, widespread, actinic keratoses (AKs), and treatment of the entire affected area is recommended. METHODS: We report our experience with a combination of Jessner's solution or 70% glycolic acid (GA) with 5% 5-fluorouracil (5-FU) solution for superficial pulse peeling used in the treatment of widespread AKs in 31 patients. Pulse peelings were performed at biweekly intervals. The endpoint for treatment was complete or maximum clearance of the lesions at clinical evaluation. Pre- and post-skin biopsy and histopathologic examination were performed in three patients for the purpose of demonstrating the pulse peel effects. RESULTS: All patients achieved a satisfactory result, including the complete regression, or at least 80% clearing, of AK lesions and an overall improvement of photodamaged skin. CONCLUSION: We consider this superficial 5-FU pulse peel to be a safe, well-tolerated, very effective, and highly inexpensive therapeutic option for the treatment of multiple, diffuse AKs. Its benefit/cost ratio will be of interest to public health services, mainly in developing countries.

The use of fluor-hydroxy pulse peel in actinic porokeratosis.

BACKGROUND: The use of Fluor-Hydroxy pulse peel (Drogaderma, Sao Paulo, Brazil) was reported by Katz to treat solar damage and actinic keratosis-associated lesions. OBJECTIVE: The objective was to use this combined treatment to produce therapeutic and cosmetic benefits in a patient with actinic porokeratosis. METHODS: A case of actinic disseminated porokeratosis was treated with a combination of a 70% glycolic peel and a 5% 5-fluorouracil solution (Drogaderma) every 2 weeks for 4 months. A biopsy was done before and after eight treatment pulses. RESULTS: Improvement in the appearance and texture of the treated areas and decreased dyskeratosis and epidermal atypia. CONCLUSION: The Fluor-Hydroxy pulse peel can be an effective alternative for the treatment of actinic porokeratosis.

Aneurisma da artéria carótida externa: uma condição rara diagnosticada durante uma consulta cosmética / External carotid artery aneurysm: a rare condition diagnosed in cosmetic consultation

O objetivo deste relato é mostrar a importância e alertar os dermatologistas que praticam a cosmiatria sobre a necessidade de se realizar um exame completo e minucioso de qualquer paciente, mesmo que ele só esteja interessado em tratamentos e/ou procedimentos cosméticos. Atualmente, essa é uma preocupação importante, pois muitas pessoas e alguns médicos estão envolvidos em uma busca exagerada pela beleza eterna. Essa é uma prática muito lucrativa para dermatologistas e cirurgiões plásticos. No entanto, não devemos nos esquecer que uma consulta dermatológica pode ser uma oportunidade para diagnosticar uma dermatose que passou despercebida ou identifi car sinais relacionados a desordens sistêmicas.

The aim of this report is to highlight and warn cosmetic dermatologists about the need of a full body complete examination regardless of the complain of any patient that seeks our evaluation, even when they ask only for cosmetic treatments and/or procedures. This is nowadays a very important concern as people and some physicians are involved in an exaggerated search for eternal beauty. This represents a very profi table practice for dermatologists and plastic surgeons. But we should never forget that a dermatologic consultation can be an opportunity to discover an unnoticed dermatosis or signs related to systemic diseases.

Melasma: [revisão] / Melasma: [review]

Melasma é uma hiperpigmentação adquirida que ocorre principalmente na face, em mulheres em idade fértil. As manchas podem variar de castanho-claro a marrom-escuro. A etiopatogenia não é completamente conhecida, mas inclui exposição à radiação ultravioleta, predisposição genética, gravidez, uso de anticoncepcionais e terapia de reposição hormonal.O tratamento do melasma permanece um desafio para o dermatologista, devido à sua natureza recorrente e recidivante.Os vários despigmentantes existentes atuam em diferentes estágios da produção da melanina e, portanto, as terapias combinadas são mais eficientes. A hidroquinona permanece como padrão-ouro. Recentemente, tornou-se disponível, comercialmente, uma combinação tripla que associa, num mesmo produto, hidroquinona 4%, ácido retinóico 0,05% e acetonido de fluocinolona 0,01%. Estes componentes atuam de forma sinérgica, diminuindo os respectivos efeitos colaterais, tornando a fórmula mais segura e eficiente.Outro aspecto importante é a necessidade de proteção solar de amplo espectro, diária e contínua, sem a qual o clareamento não é atingido e as recorrências são mais freqüentes.

Radiofreqüência e infravermelho: [revisão] / Radiofrequecy and infrared: [review]

Com o avanço da tecnologia há demanda cada vez maior por procedimentos minimamente invasivos de rejuvenescimento, como a radiofreqüência (RF) e a luz infravermelha (IR), que oferecem uma opção não cirúrgica para o tratamento da flacidez cutânea. A RF se baseia no aquecimento volumétrico controlado da derme profunda, enquanto a epiderme é preservada através de sistemas de resfriamento, levando a contração imediata do colágeno e neocolagênese tardia. A luz infravermelha é uma fonte de energia alternativa utilizada para promover a retração da pele. A água atua como cromóforo-alvo, permitindo um aquecimento uniforme da derme. A seleção adequada do paciente e o manejo cuidadoso da sua expectativa são fundamentais, uma vez que os resultados clínicos obtidos com RF e IR ainda apresentam baixa previsibilidade e reprodutibilidade e não são equivalentes aos de uma cirurgia plástica. Porém, são técnicas não invasivas e podem oferecer alternativas para o tratamento não cirúrgico da flacidez cutânea.