Histological changes in facial melasma after treatment with triple combination cream with or without oral tranexamic acid and/or microneedling: A randomised clinical trial

Background: Melasma is an acquired dyschromia with several histologic alterations in the epidermis, basement membrane and upper dermis. The treatment of melasma is challenging due to the irregular response and chronicity of the disease. To date, there are no curative strategies, largely due to the limited understanding of the intrinsic effects of each treatment. Objectives: The objective of the study was to evaluate the histological changes promoted by triple combination cream, with or without complementary treatment with microneedling and oral tranexamic acid, in the treatment of melasma. Methods: A factorial, randomised, controlled and evaluator-blinded clinical trial was performed involving 64 women with facial melasma, divided in four groups, who underwent 60 days of treatment with triple combination cream alone (control group) or combined with two monthly microneedling sessions (microneedling group), TA 250 mg twice daily (tranexamic acid group), or both tranexamic acid group and microneedling group. The participants underwent biopsy of the area with melasma at inclusion (D1) and D60. The primary outcomes were the variation (D1 × D60) between the variables: Thickness of the epidermis and stratum corneum, stratum corneum compaction and solar elastosis; melanin density in the epidermis and upper dermis; proportion between the extension of the nonintact and intact basement membrane zone; mast cell count in the upper dermis; melanocyte count in the basal layer, pendulum melanocyte count and melanocyte area; immunostaining density of vascular endothelial growth factor; stem cell factor and keratinocyte growth factor. Results: One participant in the TG discontinued tranexamic acid due persistent headache; and herpes simplex occurred in three patients after microneedling. The groups showed a 24% (CI95%: 17–35%; P < 0.01) reduction in epidermal melanin density. There was no change in dermal melanin density or the area of melanocytes after treatment. There was an overall 25% (CI95%: 7–42%; P < 0.01) reduction in the number of pendulum melanocytes, especially in the microneedling and tranexamic acid group, that presented a 41% (CI95%: 7–73%; P < 0.01) reduction. The extension of the nonintact basal membrane relative to the intact basal membrane decreased after treatment, especially in microneedling group and microneedling and tranexamic acid group. There was an increase of 13% (CI95%: 5–21%; P = 0.02) in epidermal thickness and 6% (CI95%: 0–22%; P = 0.04) thinning of the stratum corneum in the groups. All groups showed stratum corneum compaction. Solar elastosis improved only in the microneedling group and microneedling and tranexamic acid group. Vascular endothelial growth factor immunostaining increased 14% (CI95%: 4–24%; P = 0.03) in the groups; and stem cell factor increased only in microneedling group. There was no change in the number of mast cells, CD34 and keratinocyte growth factor immunostaining. Limitations: The site of biopsy may not represent all of the facial melasma and the immunohistochemical sensitivity of the cytokines does not have a stoichiometric relationship with proteins. Conclusion: A greater thickness of the epidermis is associated with melasma bleaching. Dermal melanin seems to have no impact on melasma prognosis. Damage to the skin barrier and stimulus of angiogenesis should be avoided in the treatment of melasma. Microneedling complements the topical treatment of melasma by improving patterns of skin photoaging. Oral tranexamic acid complements the topical treatment of melasma by inhibiting the stem cell factor.

Cienciometria: uma ferramenta para inserção da Dermatologia brasileira na produção científica mundial / Scientometrics: a tool for the insertion of Brazilian Dermatology in the world scientific production

Introdução: foi verificada a produção científica brasileira em Dermatologia no cenário internacional pela Cienciometria (segmento da Sociologia sobre aspectos quantitativos da ciência). Objetivo: é plausível afirmar que a inserção do Brasil na produção científica internacional pode e deve ser realizada a partir de uma perspectiva mais estratégica, sendo necessário observar a produção de documentos indexados em Scopus na área de Dermatologia e temas relacionados de forma mais minuciosa. Métodos: por meio de pesquisa exploratória, quanti-quali indutiva na plataforma Scopus - plataforma digital que reúne mais de 25 mil artigos científicos e disponibiliza ferramentas analíticas para extrair resultados e tendências no campo da pesquisa -, foi possível obter dados quantitativos sobre a produção científica brasileira em Dermatologia geral e em seis dermatoses proeminentes. Resultados: foi possível extrair análise a fim de apontar as dermatoses mais importantes atualmente na literatura e os autores relacionados, comparar os dados brasileiros com os de outros países que se destacam na literatura científica em Dermatologia e elaborar e justificar as estratégias efetivas de inserção internacional da produção científica da Dermatologia brasileira

Introduction: The Brazilian scientific production in Dermatology in the international scenario was verified by scientometrics (Sociology segment on quantitative aspects of science). Objective: The insertion of Brazil in the international scientific production scenario can and should be conducted from a more strategic perspective, and it is necessary to observe the production of documents indexed in Scopus in the Dermatology area and related topics in a more detailed way. Methods: Through exploratory, inductive, quantitative, and qualitative research on the Scopus platform ­ a digital platform comprising more than 25 thousand scientific articles and analytical tools to extract results and trends in the field of research, it was possible to obtain quantitative data on Brazilian scientific production in General Dermatology and six prominent dermatoses. Results: It was possible to analyze and point out the most prominent dermatoses currently in the literature and the related authors, compare Brazilian data with those from other countries that stand out in the scientific literature in Dermatology, and elaborate and justify effective strategies for the international insertion of Brazilian Dermatology scientific production.

Effectiveness of sunscreens and factors influencing sun protection: a review

Abstract The effectiveness of sun protection depends directly on the photo-protective product employed, the way it is used and the amount applied. Many studies report that sunscreens are often applied incorrectly, at amounts much lower than those recommended for the sun protection factor (SPF) specified on the label. When not used properly, the effectiveness of the product against sun exposure damage is reduced. Currently, sunscreens are available in a variety of different formulations and types, such as stick (bar), aerosol, cream, lotion, oil, tanning formulations and makeup. However, developing an effective stable photo-protective formula that can be correctly applied regardless of type poses a challenge, as effectiveness is dependent on several factors. Factors influencing effectiveness include sun exposure conditions (direct or indirect), level of protection (SPF), amount of product applied, maximum exposure period before reapplication, product type (spray, lotion, etc.), layer thickness required, coverage, and ability to spread and permeate into the skin. Studies comparing the effectiveness of different forms of sunscreens, the amount of product applied by consumers and SPF and UVA protection determined by validated methodologies, are lacking. Therefore, the objective of this study was to review the available literature on the topic and discuss the effectiveness of sunscreen formulations and factors influencing sun protection. This review was carried out on the scientific databases MEDLINE, PubMed and Scielo. Of the many publications retrieved, thirty-nine articles most relevant for this review were selected.

Ocular surface changes in the treatment of rosacea: comparison between low-dose oral isotretinoin and doxycycline / Alterações da superfície ocular no tratamento da Rosácea: comparação entre isotretinoína oral em baixa dosagem e doxiciclina

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.

Adult female acne: a guide to clinical practice

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.

Rosacea-specific quality of life questionnaire: translation, cultural adaptation and validation for Brazilian Portuguese

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.

Algorithm for acne treatment: Ibero-Latin American consensus

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.

Tretinoin peel: a critical view

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.

Tratamento da acne vulgar moderada a grave com isotretinoína oral similar ao produto referência / Treatment of moderate to severe acne vulgaris with an oral isotretinoin similar to the reference product

Introdução: Acne vulgar é doença inflamatória crônica dos folículos pilossebáceos. O tratamento deve ser precoce e efetivo para evitar cicatrizes e repercussões psicossociais, sendo a isotretinoína droga de escolha para casos moderados ou graves. Objetivos: Avaliar eficácia, segurança e tolerabilidade de uma isotretinoína similar ao produto referência. Métodos: Estudo bicêntrico, de intervenção terapêutica, incluindo 50 participantes, de 13 a 35 anos de idade, com acne moderada ou grave, usando isotretinoína 0,5mg/kg/dia, até 120mg/kg. A eficácia foi avaliada por meio da contagem de lesões, escala de avaliação global do investigador (IGA), satisfação do paciente e aplicação do questionário de qualidade de vida específico para acne (Acne Qol). Segurança e tolerabilidade foram avaliadas pela análise de eventos adversos e por exames laboratoriais. Resultados: A idade média foi 20 anos, sendo 70% homens, com redução de 99% das lesões ao final do tratamento e remissão total das lesões em 91,5% dos participantes. A escala IGA reduziu 98% no escore ao final do tratamento. Todos os pacientes se declararam satisfeitos, com significativa melhora na qualidade de vida. Os eventos adversos foram semelhantes aos descritos na literatura. Conclusões: A isotretinoína avaliada mostrou-se igualmente eficaz, segura e bem tolerada quando comparada aos dados publicados referentes ao produto-padrão.

Introduction: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles. Treatment should be early and effective to prevent scarring and psychosocial effects, and isotretinoin is the drug of choice for moderate or severe cases. Objective: To assess efficacy, safety and tolerability of an isotretinoin similar to the reference product. Methods: A bicentric study, with therapeutic intervention was conducted, including 50 participants aged 13 to 35 years, with moderate to severe acne, using isotretinoin 0.5 mg/kg/day up to 120 mg/kg. Efficacy was assessed through lesions counting, the investigator's global assessment (IGA) scale, patient satisfaction and application of the quality of life questionnaire specific for Acne (Acne Qol). Safety and tolerability were assessed by analysis of adverse events and laboratory tests. Results: Mean age was 20 years, 70% of participants were men, with a reduction of 99% of lesions after treatment and complete remission of lesions in 91.5% of participants. IGA scale reduced 98% in the score after treatment. Also, 100% of participants declared to be satisfied, with significant improvement in quality of life. Adverse events were similar to those described in the literature. Conclusion: The assessed isotretinoin was equally effective, safe and well-tolerated when compared with published data of the standard product.

Tretinoin-based formulations - influence of concentration and vehicles on skin penetration

Tretinoin is used in the management of acne and it is part of a gold standard treatment for photoaging. It has also been reported as an agent for superficial chemical peeling in highly concentrated formulations with few considerations about skin penetration. The aim of this study was to evaluate the influence of drug concentration and vehicles currently used on skin penetration of tretinoin. In vitro permeation tests were carried out using Franz diffusion cells fitted with porcine ear skin and 10% aqueous methanol in the receptor compartment. Formulations studied, cream or hydroalcoholic dispersion, containing 0.25%, 1% and 5% of tretinoin were placed in the donor compartment for six hours. Tretinoin concentration in skin layers was measured by high performance liquid chromatography. The largest amount of tretinoin from both vehicles was detected in stratum corneum with significant differences among the three concentrations. The hydroalcoholic dispersion was the best vehicle. Significant amounts of tretinoin were found even in deep layers of epidermis. The formulation with 0.25% tretinoin showed better results when considered the amount of tretinoin on skin in terms of percentage. Finally, skin penetration of tretinoin was influenced by vehicle and concentration of this drug used in formulation.

A tretinoína é usada no tratamento de acne e é considerada como padrão de ouro para o tratamento do fotoenvelhecimento. Em altas concentrações, é relatada como um agente para peeling químico superficial, com poucas considerações sobre a penetração na pele. O objetivo deste estudo foi avaliar a influência da concentração do fármaco e os veículos comumente usados na penetração cutânea da tretinoína. Testes in vitro de penetração foram realizados com células de difusão de Franz equipados com pele da orelha de porco e 10% de solução aquosa de metanol no compartimento receptor. As formulações estudadas, creme ou dispersão hidroalcoólica, contendo 0,25%, 1% e 5% de tretinoína foram colocadas no compartimento doador, durante seis horas. A concentração da tretinoína foi medida por cromatografia líquida de alta eficiência. A maior quantidade de tretinoína foi detectada no estrato córneo com diferenças significativas entre as três concentrações. A dispersão hidroalcoólica foi o melhor veículo. Quantidades significativas de tretinoína foram encontradas nas camadas profundas da epiderme. A formulação com 0,25% de tretinoína mostrou melhores resultados em termos de porcentagem penetrada na pele. Por fim, a penetração de tretinoína na pele foi influenciada pelo veículo e pela concentração desta utilizada na formulação.

Longitudinal evaluation of manual lymphatic drainage for the treatment of gynoid lipodystrophy

BACKGROUND: The gynoidlypodystrophy, known as cellulitis or cellulite, refers to a condition that gives the skin an undulating and uneven appearance, affecting 80-90% of women after puberty. OBJECTIVES: to investigate the efficacy and safety of manual lymphatic drainage for cellulite management. METHODS: this was an open, prospective, intervention study including 20 women aged from 20 to 40 years. Fourteen sessions of manual lymphatic drainage were performed once a week on lower limbs and buttocks. RESULTS: Fifteen women completed the study. A significant improvement on quality of life was observed (p=0.018). A significant reduction (p=0.023), estimated at 0.3±0.8 cm, in hip circumference was found, but no difference was found in thighs circumference (p>0.05). A significant reduction elastic recuperation of skin on buttocks, which means skin elasticity worsening, was observed. All measures obtained by ultrasound images showed no changes (p>0.05). CONCLUSION: manual lymphatic drainage was safe but not effective as an isolated approach for cellulite management. Further randomized, controlled or comparative studies about manual lymphatic drainage for cellulite control, as unique or combined therapeutic modality, are necessary. .

Acne vulgaris: prevalence and clinical forms in adolescents from São Paulo, Brazil

BACKGROUND: Acne is a common disease in adolescents, but there are no epidemiological data for acne in Brazil. OBJECTIVES: To estimate the prevalence and degree of acne in adolescents from Sao Paulo and study socio-demographic factors, family history and lifestyle, associated with the disease. METHODS: Cross-sectional study with 452 adolescents aged between 10 and 17 (mean=13.3 years), students from elementary and high school, examined by 3 independent evaluators. RESULTS: 62.4% were female, 85.8% white and 6.4% were aged 14. The prevalence was 96.0% and increased with age - all students over 14 had acne. The most prevalent form of acne was comedonal (61.1%), followed by mild (30.6%) and moderate (7.6%) papular-pustular, which affected mostly the face (97.5%). About half of the adolescents reported family history for acne in mother or father, and 20.6% reported previous treatment for acne. There was a higher chance of presenting non-comedonal acne with increased age (p<0.001). DISCUSSION: The prevalence of acne in adolescents varies widely due to the clinical features and diagnostic methods used. Adolescents whose brothers/sisters had acne (OR=1.7-p=0.027) and those over 13 (OR=8.3-p<0.001), were more likely to have non-comedonal acne. CONCLUSION: This study showed high prevalence of acne in adolescents from Sao Paulo, predominantly the comedonal form on the face, with a higher chance of presenting non-comedonal acne with increased age. .

Acne-specific quality of life questionnaire (Acne-QoL): translation, cultural adaptation and validation into Brazilian-Portuguese language

BACKGROUND: many studies about the psychosocial impact of acne have been reported in international medical literature describing quality of life as a relevant clinical outcome. It is well known that the patient's perception about the disease may be different from the physician's evaluation. Therefore, it is important to use validated instruments that turn the patient's subjective opinion into objective information. OBJECTIVES: to translate into Brazilian-Portuguese language and to culturally adapt a quality of life questionnaire, the Acne-Specific Quality of Life Questionnaire (Acne-QoL), as well as to evaluate its reliability and validity. METHODS: measurement properties were assessed: 1) validity: comparison between severity and Acne-QoL domain scores, correlations between acne duration and Acne-QoL domain scores, and correlation between Acne-QoL domain scores and SF-36 components; 2) internal consistency: Cronbach's α coefficient; 3) test-retest reproducibility: intraclass correlation coefficient and Wilcoxon test. RESULTS: Eighty subjects with a mean age of 20.5 ± 4.8 years presenting mild (33.8%), moderate (36.2%) and severe (30%) facial acne were enrolled. Acne-QoL domain scores were similar among the different acne severity groups except for role-social domain. Subjects with shorter acne duration presented significant higher scores. Acne-QoL domains showed significant correlations, both between themselves and with SF-36 role-social and mental health components. Internal consistency (0.925-0.952) and test-retest reproducibility were considered acceptable (0.768-0.836). CONCLUSIONS: the Brazilian-Portuguese version of the Acne-QoL is a reliable and valid satisfactory outcome measure to be used in facial acne studies. .

Perforating granuloma annulare mimicking papulonecrotic tuberculid / Granuloma anular perfurante simulando tuberculide papulo-necrotica

A case is reported of a patient presenting lymph node tuberculosis and cutaneous lesions resembling papulonecrotic tuberculid, but histologically compatible with perforating granuloma annulare and which responded satisfactorily to antituberculous therapy. This is probably one of the first reports of the association of perforating granuloma annulare and tuberculosis, and it is important therefore to highlight the relevance of this disorder in the differential diagnosis of papulonecrotic tuberculid and to raise the hypothesis that this entity should also be considered to be a variant of tuberculid.

Os autores relatam o caso de uma paciente com tuberculose ganglionar e lesões cutâneas clinicamente sugestivas de tubercúlide pápulo-necrótica, porém com histopatologia compatível com granuloma anular perfurante, e que apresentaram melhora após tratamento para a tuberculose. Trata-se, possivelmente, de um dos primeiros relatos da associação de granuloma anular perfurante com tuberculose, salientando a importância desta entidade no diagnóstico diferencial da tubercúlide pápulo-necrótica e levantando a possibilidade da mesma ser considerada, também, uma variante de tubercúlide.

Retinoids for prevention and treatment of actinic keratosis / Retinoides para a prevencao e tratamento das queratoses actinicas

Actinic keratosis is a common cause of dermatological consultations and it presents a strong association with squamous cell carcinoma. Many substances are used for treatment and prevention, such as retinoids. Nevertheless, many studies on retinoids emphasize their application in treating and preventing non melanoma skin cancers. In this article, we reviewed studies about systemic and topical retinoids used with immunocompetent patients and organ transplant recipients with actinic keratosis, as primary or secondary outcomes. The majority of these papers pointed to a reduction in actinic keratosis count after treatment with retinoids. However, studies need to be better-defined in order to address the lack of a standardized dose, the absence of control groups, the low number of patients and short follow-up periods. Blind, randomized and controlled clinical trials with adequate sample sizes, specifically focused on actinic keratosis, are needed to clarify the real benefit of topical and/or oral retinoids. Comparison of efficacy and safety between oral and topical retinoids in the prevention and treatment of non-melanoma skin cancers and actinic keratosis is an essential pre requisite to establish new strategies to control these conditions. .

A queratose actínica é uma causa comum de consultas dermatológicas e apresenta forte associação com o carcinoma espinocelular. Muitas substâncias são utilizadas para seu tratamento e prevenção, assim como os retinoides. Entretanto, muitos estudos sobre retinoides salientam seu uso no tratamento e prevenção de cânceres de pele não melanoma. Neste artigo, nós revisamos estudos que avaliam o uso dos retinoides sistêmicos e tópicos para pacientes imunocompetentes e imunossuprimidos com queratoses actínicas, como desfechos primários e secundários. A maioria destes estudos mostra redução na contagem das queratoses actínicas após o tratamento com retinóides. Além disso, ajustes no delineamento dos estudos deveriam ser feitos quanto à falta de padronização da dose, ausência de grupos controle, número pequeno de pacientes e tempo curto de seguimento. Ensaios clínicos cegos, randomizados e controlados com tamanho amostral adequado tendo como alvo específico as queratoses actínicas são necessários para esclarecer o real benefício dos retinoides tópicos e/ou orais. A comparação da eficácia e segurança entre os retinoides orais e tópicos na prevenção e tratamento dos cânceres de pele não melanoma e queratoses actínicas é um pré-requisito essencial para o estabelecimento de novas estratégias para o controle destas condições.

Evidências sobre o tratamento da acne / Evidence about the treatment of acne

Na terapêutica atual da acne vulgar, muitas opções amplamente praticadas carecem de respaldo em estudos de melhornível de evidência científica. O objetivo desta revisão narrativa é apresentar o que há de mais recente no tratamentotópico e sistêmico da acne vulgar. São enfatizadas as informações de revisões sistemáticas e de ensaios clínicos combom desenho metodológico, obtidas a partir de busca sistematizada nas principais bases de dados em medicina. Háimportantes questões referentes à conduta clínica diante da acne que ainda requerem embasamento em evidênciascientíficas consistentes, entre elas: a dose e a duração ideais do tratamento com antibióticos orais, sem que ocorraindução de resistência bacteriana, e a segurança da isotretinoína oral.

How to design and write a clinical research protocol in Cosmetic Dermatology* / Como desenhar e escrever um protocolo de pesquisa clínica em Cosmiatria

Cosmetic Dermatology is a growing subspecialty. High-quality basic science studies have been published; however, few double-blind, randomized controlled clinical trials, which are the major instrument for evidence-based medicine, have been conducted in this area. Clinical research is essential for the discovery of new knowledge, improvement of scientific basis, resolution of challenges, and good clinical practice. Some basic principles for a successful researcher include interest, availability, persistence, and honesty. It is essential to learn how to write a protocol research and to know the international and national regulatory rules. A complete clinical trial protocol should include question, background, objectives, methodology (design, variable description, sample size, randomization, inclusion and exclusion criteria, intervention, efficacy and safety measures, and statistical analysis), consent form, clinical research form, and references. Institutional ethical review board approval and financial support disclosure are necessary. Publication of positive or negative results should be an authors' commitment.

Cosmiatria é uma sub-especialidade em grande crescimento. Estudos em ciência básica de alta qualidade têm sido publicados; ao contrário, existem poucos estudos clínicos duplo-cegos, randomizados e controlados, que constituem o maior instrumento para medicina baseada em evidência nessa área. A pesquisa clínica é essencial para a descoberta de novos conhecimentos, melhora das bases científicas, solução de desafios e boa prática clínica. Para ser um pesquisador bem sucedido, os princípios básicos são interesse, disponibilidade, persistência e honestidade. É essencial aprender como escrever um protocolo de pesquisa e conhecer as regras regulatórias nacionais e internacionais. Um protocolo de pesquisa clínica completo deve incluir questão, fundamentos, objetivos, metodologia (desenho, descrição das variáveis, tamanho da amostra, randomização, critérios de inclusão e exclusão, intervenção, parâmetros de eficácia e segurança e análise estatística), termo de consentimento livre e esclarecido, ficha clínica e referências. A aprovação do Comitê de Ética em Pesquisa e a declaração do financiamento são imprescindíveis. A publicação de resultados positivos ou negativos deve ser um comprometimento dos autores.

Evidence on acne therapy / Evidencias sobre o tratamento da acne

Among the current treatments available for acne vulgaris, many widely practiced options lack support from studies at the best level of scientific evidence. The aim of this narrative review was to present the very latest information on topical and systemic treatments for acne vulgaris. Information from systematic reviews and well-designed clinical trials, obtained through a systematic search of the major medical databases, is emphasized. There are important issues regarding the clinical management of acne that still lack consistent grounding in scientific evidence. Among these are the optimum dose and duration of treatment with oral antibiotics that can be given without inducing bacterial resistance, and the safety of oral isotretinoin.

Na terapêutica atual da acne vulgar, muitas opções amplamente praticadas carecem de respaldo em estudos de melhor nível de evidência científica. O objetivo desta revisão narrativa é apresentar o que há de mais recente no tratamento tópico e sistêmico da acne vulgar. São enfatizadas as informações de revisões sistemáticas e de ensaios clínicos com bom desenho metodológico, obtidas a partir de busca sistematizada nas principais bases de dados em medicina. Há importantes questões referentes à conduta clínica diante da acne que ainda requerem embasamento em evidências científicas consistentes, entre elas a dose e a duração ideais do tratamento com antibióticos orais, sem que ocorra indução de resistência bacteriana, e a segurança da isotretinoína oral.

Tratamento de queloide: comparação entre infiltrações intralesionais com 5-fluorouracil, corticosteroide e 5-fluorouracil associado a corticosteroide / Keloid treatment: comparative intralesional injections of 5-fluorouracil, corticosteroid and 5-fluorouracil combined with corticosteroid

O queloide representa proliferação fibrosa exagerada da pele após injúria. É considerado de difícil tratamento, com baixa eficácia de medidas isoladas, demandando, na maioria dos casos, combinações de técnicas. Descreve-se caso de cicatriz queloidiana na região pubiana em incisão cirúrgica de miomiectomia. A cicatriz foi dividida em três partes tratadas com infiltração intralesional de 5-fluorouracil, corticosteroide e 5-fluorouracil associado a corticosteroide