Campo eletromagnético focado de alta intensidade para o tratamento da celulite / High-intensity focused electromagnetic field treatment for cellulite

Introdução: O tratamento com campo eletromagnético focado de alta intensidade (HIFEM) usa ondas eletromagnéticas de baixa frequência para induzir contrações musculares, causando hipertrofia muscular e reduzindo a gordura subcutânea. Objetivo: avaliar os efeitos de um tratamento com HIFEM na celulite nos glúteos. Métodos: trinta mulheres foram recrutadas e randomizadas em 2 grupos que receberam 8 ou 12 sessões de HIFEM na região dos glúteos. A celulite foi avaliada utilizando a Cellulite Severity Scale, a Global Aesthetic Improvement Scale e um questionário de satisfação. Mudanças na composição corporal foram avaliadas com bioimpedância e medidas da circunferência do quadril. Resultados: a aparência global da região glútea das pacientes melhorou com o tratamento. Houve melhora na celulite de algumas pacientes, mas para a maioria a melhora não foi grande o suficiente para resultar em uma mudança de classificação na Cellulite Severity Scale. A satisfação foi alta e os eventos adversos foram poucos, não-graves e transitórios. Conclusão: os efeitos do tratamento com HIFEM na celulite da região glútea são sutis. Contudo, este tratamento é capaz de melhorar globalmente a aparência da região glútea, melhorando a percepção das pacientes sobre a gravidade de sua celulite

Introduction: High-intensity focused electromagnetic field treatment (HIFEM) uses low-frequency electromagnetic waves to induce supramaximal muscle contractions, causing muscle hypertrophy and reducing fat. Objective: To evaluate the effects of a HIFEM treatment for the improvement of cellulite on the buttocks. Methods: Thirty patients were divided into two groups that received eight or 12 HIFEM sessions on the buttocks for six weeks. We assessed the improvement in cellulite and the buttocks' global appearance through the Cellulite Severity Scale (CSS), the Global Aesthetic Improvement Scale (GAIS), and a satisfaction questionnaire. Changes in body composition were evaluated through bioimpedance and hip circumference measurements. Results: Patients from both groups improved the global appearance of their buttocks. Cellulite lesions of some patients improved, but for most patients, the improvement wasn't great enough to change the grade on the Cellulite Severity Scale. Patient satisfaction was high and adverse events were few, minor, and transitory. Conclusion: The effects of HIFEM on cellulite are subtle, as this treatment modality cannot address the fibrous septa that cause the depressed lesions of cellulite. Nevertheless, HIFEM procedures can improve the buttocks' global appearance, enhancing the patients' subjective perception of their cellulite.

Cellulite cervico-faciale à l'hôpital national Ignace Deen de Conakry: résultats d'une étude de 5 ans / Cervico-facial cellulitis at the Ignace Deen hospital in Conakry: results of a 5-year study

Introduction : La cellulite cervico-faciale est une diffusion cellulaire d'un foyer infectieux vers les tissus cellulo-adipeux du cou et de la face, avec une prédominance des anaérobies et des germes commensaux de la flore orale. L'objectif de ce travail était de contribuer à l'amélioration de la prise en charge de cellulites cervico-faciales à l'Hôpital National Ignace Deen. Méthodes : Il s'est agi d'une étude rétro-prospective de type descriptif sur une période de cinq (5) ans (01 janvier 2017 au 31 décembre 2021) réalisée aux services d'ORLCCF et d'Odontostomatologie/CMF de l'Hôpital National Ignace Deen de Conakry. Résultats : 97 patients qui présentaient une cellulite cervico-faciale, soit une fréquence de 4,36% ont été inclus. La tranche d'âge de 21 à 30 ans était la plus représentée soit 40,21%. L'âge moyen était de 33 ,15 ± 13,97 ans avec des extrêmes de 1 et 65 ans. Le sex-ratio était de 1,30. La tuméfaction douloureuse était le principal motif de consultation soit 98,97%. Les Anti-Inflammatoires Non Stéroïdiens étaient le facteur le plus présent chez 85 patients soit 78,35%. L'état général était peu satisfaisant chez 94 patients soit 96,91%. Une cellulite suppurée a été retrouvée chez 82,47% patients. Le traitement était médico-chirurgical chez 85 patients soit 87,63%. L'évolution était bonne chez 90 patients soit 92,78%. Conclusion : La cellulite cervico-faciale est une urgence médicochirurgicale qu'il faut savoir diagnostiquer et prendre en charge dans les meilleurs délais. Non traitée, elle peut engager le pronostic vital.

Introduction: Cervico-facial cellulitis is a cellular diffusion of an infection to the cellulo-adipose tissues of the neck and face, with a predominance of anaerobic and commensal germs of oral flora. The objective of this work was to contribute improving the management of cervicofacial cellulitis at Ignace Deen National Hospital. Methods: This was a five (5) year (01 January 2017 to 31 December 2021) descriptive retro-prospective study conducted at the ENT-RTC and Odontostomatology / FJA departments of the Ignace Deen National Hospital in Conakry. Results: 97 patients who presented cervico-facial cellulitis, i.e. a frequency of 4.36%, were included. The 21- 30 age group was the most represented, either 40.21%. The average age was 33.15 ± 13.97 years with extremes of 1 and 65 years. The sex ratio was 1.30. Painful swelling was the main reason for consultation, 98.97%. Non- Steroidal Anti-inflammatory Drugs were the most common factor in 85 of our patients, either 78.35%. The overall condition was unsatisfactory in 94 of our patients, either 96.91%. Suppurated cellulitis was found in 82.47% of our patients. Treatment was medico-surgical in 85 patients, either 87.63%. The evolution was good in 90 patients, either 92.78%. Conclusion: Cervico-facial cellulitis is a medical and surgical emergency that must be diagnosed and managed as soon as possible. If left untreated, it can trigger a vital prognosis.

Cellulite diffuse cervico-thoracique d'origine dentaire compliquée de pyothorax: à propos d'un cas au centre hospitalier universitaire Tenganogo (Burkina Faso) / Cervico-thoracic cellulitis of dental orgin complicated with pyothorax: about a case at the teaching hospital of Tenganogo (Burkina Faso)

Introduction: Les cellulites diffuses cervico-faciales sont des infections à extension rapide des loges cellulo-graisseuses de la face, le plus souvent d'origine dentaire. Elles sont graves et potentiellement mortelles. Nous rapportons un cas de cellulite diffuse cervico-thoracique compliquée de pyothorax. L'objectif de cette observation est de montrer les difficultés thérapeutiques de ce cas rare dans un pays sous médicalisé. Observation: il s'est agi d'un patient de 30 ans sans antécédents pathologiques particuliers admis dans le mois de Mai 2022 aux urgences médico-chirurgicales du Centre Hospitalier Universitaire Tenganogo pour détresse respiratoire associée à une tuméfaction cervico-thoracique avec nécrose cutanée. Cette symptomatologie était consécutive à une odontalgie de la 36 qui évoluait depuis deux semaines avec notion d'automédication. Le diagnostic de cellulite diffuse cervico-thoracique d'origine dentaire a été posé. Devant la détresse respiratoire avec un syndrome d'épanchement pleural liquidien, la réalisation d'une radiographie thoracique de face a mis en évidence une pleurésie unilatérale gauche de grande abondance dont la ponction suivie du drainage a ramené 3500cc de liquide purulent nauséabond. Un prélèvement bactériologique a été effectué et le patient a bénéficié d'un traitement fait d'une bi-antibiothérapie probabiliste par voie injectable (amoxicilline 1g + acide clavulanique 125mg/8H et métronidazole 500mg/8H), d'une réanimation énergique associée à un drainage cervico-thoracique sous anesthésie générale. L'évolution a été favorable marquée par une bonne ré-expansion pulmonaire à la radiographie de contrôle au bout de deux semaines de traitement. Conclusion : les cellulites diffuses cervico-faciales sont des affections graves, redoutables et constituent de véritables urgences médicochirurgicales

Introduction: Cervico-facial diffuse cellulitis is a rapidly spreading infection of the cellulo-fatty loges of the face, most often of dental origin. They are serious and potentially fatal. We report a case of cervicothoracic diffuse cellulitis complicated by pyothorax. The objective of our study was to report our expérience in the management of this condition. Observation : this was a 30-years old patient with no particular pathological history admitted in May 2022 to the medical-surgical emergency room of the Tenganogo University for respiratory distress associated with a cervico-thoracic swelling with skin necrosis. This symptomatology was consecutive to an odontologia of tooth 36 which has been evolving for two weeks with the notion of self medication in whom the diagnosis of cervicothoracic diffuse cellulitis of dental origin was made. In front of the respiratory distress with syndrome of liquid pleural effusion, the realization of a thoracic radiolography of face showed a unilateral left pleurisy of great abondance whose drainage function brought back 3500 of nauseating purulent liquid. A bacteriological sampling was carried out and the patient benefited from a treatment made of a probabilistic biantibiotitherapy by injectable way (amoxicillin 1g + clavulanic acid 125mg/8h and metronidazol 500mg/8H), of an energetic resuscitation associated with an excision cervico-thoracic drainage under general anesthesia. The evolution was favorable. Conclusion: diffuse cervico-facial cellulitis are serious, dreadful affections and constitue real medical and surgical emergencies.

Computed tomography analysis of fascial space involvement demonstrates correlations with laboratory tests, length of hospital stays and admission to the intensive care unit in odontogenic infections

Abstract Objectives: Odontogenic infections are frequent and can spread, leading to complications such as sepsis and the need for admission to an Intensive Care Unit (ICU). The purpose of this study was to perform a computed tomography analysis of the fascial space involvement and correlate with personal data, laboratory tests, length of hospital stays and admission to the ICU in patients with odontogenic infections who required hospitalization. Methods: Patients with odontogenic infections admitted between June 2017 and May 2018 were prospectively evaluated. The fascial spaces involved were studied using computed tomography with contrast. The possible correlations of tomographic findings with comorbidities, nutritional status, the causative tooth, laboratory tests, length of hospital stays and admission to the ICU were analyzed. Results: We identified 66 cases of odontogenic infections which were admitted in the period analyzed. The involvement of primary spaces (86.7%) predominated, followed by secondary ones (8.7%), and cervical (4.6%). The most frequently involved fascial spaces were submandibular (27.1%), buccal (20.8%), sublingual (18.3%), submental (16.7%), and others (17.1%). There were significant differences between laboratory tests (p < 0.001), mean hospital stays (p < 0.001), and admissions to the ICU (p < 0.001) depending on the number of fascial spaces involved. There was no influence of comorbidities, nutritional status, or causative tooth on fascial space involvement. Conclusion: There was a relationship between greater involvement of fascial spaces assessed by computed tomography and higher values of laboratory tests, more extended hospitalization stays and admission to the ICU. Level of evidence: Level 2b.

O uso da câmera termográfica no diagnóstico auxiliar do aspecto celulítico / The use of a thermographic camera in aiding the diagnosis of cellulite appearance

A celulite estética é uma disfunção caracterizada pela pele com aspecto de "casca de laranja" e tem afetado negativamente à autoestima e o convívio social de mais de 80% das mulheres pós-púberes. O conteúdo em questão cobre a escassez de estudos avaliativos na área da estética e favorece a padronização da técnica para avaliação dessa disfunção. O presente estudo teve o objetivo de verificar o uso da termografia como método auxiliar no diagnóstico de possíveis alterações circulatórias na região glútea, como em casos do aspecto celulítico e investigar a possibilidade de prevenção do seu agravamento. Trata-se de um estudo observacional, realizado com dezoito mulheres voluntárias de 18 e 35 anos, portadoras de estrias albas na região glútea, sem tratamento medicamentoso com substâncias fotossensíveis, ou em uso da isotretinoína, ou ainda em tratamento tópico específico na região de nádegas. As participantes foram divididas em 2 grupos, sendo o grupo 1 (imagens termográficas não uniforme) e grupo 2 (imagem termográfica uniforme). As avaliações do aspecto celulítico foram feitas através de fotografias convencionais, termografia e por 3 especialistas na área da fisioterapia dermatofuncional. Os resultados permitiram demonstrar que a gravidade da celulite não pode ser classificada apenas através de uma avaliação visual ou de questionários, pois, as participantes que não possuem a característica física da celulite, demonstraram na termografia, um comprometimento circulatório, que sugere um possível risco para adquirir a celulite. Portanto, esse estudo concluiu que um diagnóstico prévio através da câmera termográfica pode ajudar na prevenção dessa disfunção.

Aesthetic cellulite is a disorder characterized by the skin with an "orange peel" appearance and has negatively affected the self-esteem and social life of more than 80% of post-pubertal women. The content in question covers the scarcity of evaluative studies in the area of aesthetics and favors the standardization of a technique for evaluating this dysfunction. The present study aimed to verify the use of thermography as an auxiliary method in the diagnosis of possible circulatory alterations in the gluteal region, as in cases of cellulite appearance, and to investigate the possibility of preventing its worsening. This is an observational study, carried out with eighteen female volunteers aged between 18 and 35 years old, with striae alba in the gluteal region, without drug treatment with photosensitive substances, or using isotretinoin, or still applying any specific topical treatment on the buttocks. The participants were divided into 2 groups, which were group 1 (non-uniform thermographic images) and group 2 (uniform thermographic images). Assessments of the cellulite's appearance were performed through conventional photographs, thermography, and by 3 specialists in the field of dermatofunctional physiotherapy. The results showed that the severity of cellulite cannot be classified only through a visual assessment or questionnaires, since the participants who do not have the physical characteristic of cellulite, demonstrated through the thermography, a circulatory compromise, which suggests a possible risk in developing cellulite. Therefore, this study concluded that a previous diagnosis through a thermographic camera can help in the prevention of this dysfunction.

Efetividade da drenagem linfática manual associada a bandagem funcional na melhora clínica do fibro edema gelóide em gestantes: ensaio clínico, controlado e randomizado / Effectiveness of manual lymphatic drainage associated with functional banding in the clinical improvement of gynoid lipodystrophy in pregnant women: a clinical, controlled and randomized trial

No período gestacional, mulheres podem desencadear disfunções hormonais que induzem ao acúmulo de edema e nódulos fibróticos, favorecendo a formação de relevos cutâneos ocasionando sensação dolorosa. Sendo assim, este estudo visou comparar a efetividade da drenagem linfática manual com ou sem o uso da bandagem funcional no fibro edema gelóide (FEG) em gestantes no segundo e terceiro trimestre gestacional. Trata-se de um ensaio clínico randomizado, composta por três grupos: G1: Drenagem Linfática Manual (DLM); G2: DLM + Bandagem Funcional (BF); G3: Grupo Controle. Critério de inclusão: gestantes no segundo e terceiro trimestre, primípara e multípara e gestação de feto único. Realizou-se a DLM na região dos glúteos e membros inferiores e a BF aplicada da região inguinal em forma de teia direcionada a região medial dos glúteos, usando uma tensão superficial de 10%. Utilizou-se um protocolo de avaliação do fibro edema gelóide (PAPEG), anamnese, exame físico com inspeção, teste de preensão, teste de sensibilidade tátil (monofilamento de semmes ­ weinstein), avaliação da sensibilidade, grau, dor, recomendação e satisfação da paciente. Foram realizadas fotos da região do glúteo do antes e depois e avaliadas por 10 especialistas através da fotogrametria. Observou-se uma melhora clínica significativa no grupo drenagem e na associação com a bandagem quando comparado ao grupo controle pelos 10 especialistas. Houve uma melhora significativa nas notas dos especialistas nos grupos G1 e G2, quando comparado ao G3. Portanto, o presente estudo demonstrou uma melhora clínica no fibro edema gelóide das gestantes que receberam a DLM isolada, e na associação com a BF, quando comparado ao grupo controle.

During pregnancy, women can trigger hormonal dysfunctions that induce the accumulation of edema and fibrotic nodules, favoring the formation of rifted skin causing a painful sensation. Therefore, this study aimed to compare the effectiveness of manual lymphatic drainage with or without the use of functional bandages in gynoid lipodystrophy (GLD) in pregnant women in the second and third trimester. This was a randomized clinical trial, composed of three groups: G1: Manual Lymphatic Drainage (MLD); G2: MLD + Functional Bandage (FB); G3: Control Group. Inclusion criteria: pregnant women in the second and third trimester, primiparous or multiparous and a single fetus pregnancy. MLD was performed in the gluteal region and lower limbs, and FB was applied from the inguinal region in the form of a web directed to the medial gluteal region, using a surface tension of 10%. An evaluation protocol for gynoid lipodystrophy (EPGLD) with anamnesis, a physical examination with an inspection, a grip test, tactile sensitivity test (Semmes-Weinstein monofilament test), assessing the patient's sensitivity, grade, pain, recommendation, and satisfaction was used. Photos were taken of the gluteus region before and after and were then evaluated by 10 specialists through photogrammetry. There was a significant clinical improvement in the drainage group and in the association with the bandage when compared to the control group by the 10 specialists. There was a significant improvement in the scores of specialists in groups G1 and G2, when compared to G3. Therefore, the present study demonstrated a clinical improvement in gynoid lipodystrophy of pregnant women who received MLD alone, and in association with FB, when compared to the control group.

Effects of multi-directional oscillatory vibration in the treatment of cellulite and body remodeling / Efeitos da terapia vibro-oscilatória multidirecional no tratamento da celulite e remodelamento corporal

Abstract Introduction: Several technologies have been developed and optimized for the treatment of unaesthetic disorders. Among them is the oscillatory vibration therapy, a novel form of treatment based on the mechanical and physiological fundamentals of the vibration platform. Objective: The present study evaluated the efficacy of the oscillatory vibration therapy in the improvement of body contour remodeling and in the aspect of cellulite in women. Methods: This is a prospective longitudinal comparative study, in which the following evaluation tools are used: anthropometry, perimetry, adipometry, evaluation of skin viscoelasticity with Cutometer®, evaluation of the thickness of the hypodermis with diagnostic ultrasound and analysis of severity of cellulite (CSS). The evaluations occurred at the start and 1 week after the end of ten oscillatory vibration therapy. The results were analyzing using a paired student's t-test with interval confidence of 95% (PValue <0.05). Results: Thirty women took part in the research, with age of 33 ± 9 years, weight of 62 ± 11 kg, height of 1.66 ± 0.06 m, BMI of 22 ± 2 kg/m2. The measurements of perimetry, adipometry, analysis of subcutaneous tissue thickness by means of diagnostic ultrasound and analysis of skin viscoelasticity did not present significant alterations. However, the CSS variable of the right gluteus (7.3 ± 1.8 to 5.8 ± 1.6 ≤ 0.0001), left gluteus (7.2 ± 1.9 to 5.8 ± 1.6= 0.0001), right thigh (6.9 ± 1.9 to 5.6 ± 1.4 = 0.0004), left thigh (6.9 ± 1.9 to 5.6 ± 1.3 = 0.0004) and Celluqol® (59 ± 16 to 49 ± 16 = 0.022) presented significant difference. Conclusion: The multi-directional oscillatory vibration therapy is an effective and efficient therapy for the treatment of cellulite; however, for the treatment of body remodeling, it must be further evaluated and studied. (AU)

Introdução: Várias tecnologias vêm sendo desenvolvidas e otimizadas para o tratamento das afecções inestéticas. Dentre elas está a terapia vibro-oscilatória, uma nova forma de tratamento baseada na fundamentação mecânica e fisiológica da plataforma vibratória Objetivo: O presente estudo avaliou a eficácia da terapia vibro-oscilatória para melhora do remodelamento corporal e aspecto de celulite em mulheres. Métodos: Trata-se de um estudo clínico longitudinal prospectivo e comparativo, no qual se utilizaram as seguintes ferramentas de avaliação: antropometria, perímetria, adipometria, avaliação da viscoelasticidade da pele com Cutometer®, avaliação da espessura da hipoderme com ultrassom diagnóstico e análise da escala de severidade da celulite (CSS). As avaliações ocorreram no início e após 1 semana de término das dez sessões da terapia vibro-oscilatória. As análises estatísticas foram realizadas com o software Bioestat 5.0, utilizando o teste de normalidade de Lilliefor (P-valor > 0,05), teste paramétrico e teste T-Student da amostra pareada. Resultados: Trinta mulheres participaram da pesquisa, com média de idade de 33 ± 9 anos, peso médio de 62 ± 11 kg, altura média de 1,66 ± 0,06 metros, IMC médio de 22 ± 2 kg/m2 . As medidas de perímetria, adipometria, análise da espessura do tecido subcutâneo por meio de ultrassom diagnóstico e análise da viscoelasticidade da pele não apresentaram alterações significativas. Entretanto as variáveis de CSS glúteo direito (7,3 ± 1,8 para 5,8 ± 1,6 ≤ 0,0001), glúteo esquerdo (7, 2 ± 1,9 para 5,8 ± 1,6 = 0,0001), coxa direita (6,9 ± 1,9 para 5,6 ± 1,4 = 0,0004), coxa esquerda (6.9 ± 1,9 para 5,6 ± 1,3 = 0,0004) e Celluqol® (59 ± 16 para 49 ± 16 = 0,022), apresentaram diferença significativa. Conclusão: A terapia vibro-oscilatória multidirecional é uma terapia efetiva e eficaz para o tratamento da celulite, porém para o tratamento de remodelamento corporal ela deve ser mais bem avaliada e estudada. (AU)

Eficácia da massagem mecânica motorizada associada a cosmecêuticos no remodelamento corporal e aspecto da celulite / Efficacy of motorized mechanical massage associated with derma-cosmeceuticals in body remodeling and aspect of cellulite

Gordura localizada e celulite são as afecções estéticas que mais incomodam as mulheres nos dias atuais e as levam a busca de tratamentos estéticos. Por essa razão, o objetivo do presente estudo foi avaliar a associação da massagem mecânica motorizada com cosmecêuticos no tratamento da gordura localizada e celulite. Métodos: Trata-se de um estudo clínico longitudinal prospectivo e comparativo. Trinta e duas mulheres foram incluídas no presente estudo seguindo os critérios de elegibilidade e inelegibilidade, todos foram avaliados e reavaliados após dez sessões do protocolo de tratamento. Para análise dos dados foram utilizados testes Lilliefor's, teste t-student bicaudal pareado, teste t-student bicaudal para amostras heterocedásticas. Resultados: Trinta mulheres finalizaram o protocolo de tratamento. Obteve-se redução das medidas, de abdome superior (p < 0,032) e abdome inferior (p < 0,004) na adipometria; medidas de cintura (p < 0,008) e abdome inferior (p < 0,022) avaliadas pela perimetria; na análise do ultrassom houve redução da medida de abdome superior (p < 0,004), flancos (p < 0,021), posterior de coxa região de prega glútea (p < 0,006) e posterior de coxa região inferior (p < 0,0001). Conclusão: Diante dos resultados, conclui-se que o protocolo de tratamento com a associação da massagem mecânica motorizada e cosmecêuticos foram eficazes para a melhora do contorno corporal e a aparência da celulite. (AU)

Localized fat and cellulite are the aesthetic conditions which disturb women the most, in current times, and therefore lead them to search esthetic treatments. For this reason, the objective of this study was to evaluate the association of motorized mechanical massage with derma cosmeceuticals in the treatment of localized fat and cellulitis. Methods: This is a clinical prospective longitudinal study. Thirty-two women were included in the present study, following the criteria of eligibility and ineligibility, and they were all evaluated and re-evaluated after ten sessions of the treatment protocol. For data analysis, we used Lilliefors t-student tests, paired two-tailed test, for heteroscedastic samples. Results: Thirty women finalized the treatment protocol, and reduction of measures was obtained in the upper abdomen (p < 0.032) and lower abdomen (p < 0.004) in adipometry; waist measures (p < 0.008) and lower abdomen, (p < 0.022) evaluated by perimetry: in the ultrasound analysis, there was reduction of the upper abdomen measure (p < 0.004), flanks (p < 0.021), upper posterior thigh area (p < 0.006) and posterior thigh distal area (p < 0.0001). Conclusion: We concluded that the treatment protocol with the association of motorized mechanical massage was efficient in the improvement of the body contour and the aspect of cellulitis. (AU)

Estudo comparativo entre carboxiterapia e plasma rico em plaquetas em pacientes com fibroedema geloide / Comparative study between carboxitherapy and platelet-rich plasma in patients with cellulite

Introdução: O plasma rico em plaquetas (PRP) e a carboxiterapia são recursos que melhoram a circulação sanguínea e linfática favorecendo a reorganização do colágeno, e ambos são usados para tratar distúrbios como o fibroedema gelóide (FEG). Objetivo: Comparar a influência da carboxiterapia e do PRP sobre o FEG. Métodos: 20 voluntárias de idade média de 35,7 anos com FEG em graus III e IV na região posterior da coxa abaixo do glúteo foram divididas em grupos: Grupo carboxiterapia (GC) que recebeu a aplicação do gás de dióxido de carbono em via subcutânea e o grupo plasma rico em plaquetas (GPRP). As voluntárias coletaram 40 ml de sangue do membro superior para a preparação e coleta do PRP seguido de aplicação na área tratada bilateralmente, totalizando 6 sessões, duas vezes na semana, e avaliadas por questionário de satisfação e registro fotográfico. Resultados: Na análise qualitativa no grupo GPRP houve melhora da FEG, relevo cutâneo e aspecto da pele se comparado ao grupo GC. Na análise quantitativa houve maior satisfação com o corpo e conscientização alimentar em ambos os grupos. Conclusão: Apesar de o grupo GPRP ter diminuição do grau do FEG mais evidente, ambos os recursos mostraram melhora do aspecto da pele, influenciando na autoestima. (AU)

Introduction: Platelet rich plasma (PRP) and carboxytherapy are features that improve blood and lymphatic circulation, favoring the reorganization of collagen, and both are used to treat disorders such as cellulite. Objective: To compare the influence of carboxytherapy and PRP on EGF. Methods: 20 volunteers with an average age of 35.7 years old with cellulite levels III and IV in the posterior region of the thigh below the gluteus were divided into groups: Group of the carboxitherapy (CG) receiving carbon dioxide gas in subcutaneous route and platelet-rich plasma group (PRPG). The volunteers collected 40 ml of blood from the upper limb for preparation and collection of PRP followed by application to the bilaterally treated area, totaling 6 sessions twice a week, being evaluated by satisfaction questionnaire and photographic register. Results: In the qualitative analysis the PRPG group improved cellulite, cutaneous relief and skin appearance when compared to the CG group. In the quantitative analysis there was greater satisfaction with the body and food awareness in both groups. Conclusion: Although the PRPG group decreased more evidently the degree of EGF, both features showed an improvement in the skin appearance, influencing the self-esteem. (AU)

Nocardiosis linfocutánea en una niña sana, a propósito de un caso clínico / A clinical case of lymphocutaneous nocardiosis in a healthy infant / Um caso clínico de neocardiose linfocutânea numa menina saudável

Resumen: Las nocardiosis son infecciones poco frecuentes producidas por distintas especies del género Nocardia. Las dos especies más prevalentes son N. asteroides y N. brasiliensis. Presentan un amplio espectro de enfermedad, con formas locales o diseminadas, de evolución aguda, subaguda y/o crónica. Pueden causar enfermedad severa sobre todo en pacientes inmunodeprimidos. La infección de piel y partes blandas puede presentarse en personas inmunocompetentes y ocasionalmente en niños sanos. Se presenta el caso de una preescolar de 18 meses que presentó absceso de pie con adenoflemón inguinal derecho. El estudio microbiológico del material obtenido del drenaje de la lesión observó bacterias grampositivas de aspecto filamentoso, por lo que se planteó el diagnóstico preliminar de nocardiosis. Dicho diagnóstico se confirmó posteriormente con el cultivo bacteriológico. Recibió tratamiento con clotrimoxazol durante seis semanas por vía oral, con buena evolución, sin otras complicaciones. La valoración inmunológica inicial no mostró alteraciones. El seguimiento evolutivo de la paciente no evidencia alteraciones sugestivas de trastornos específicos de la inmunidad.

Summary: Nocardiosis is a rare infection. The two most prevalent species, N. asteroides and N. brasiliensis, can cause a broad spectrum of clinical diseases, which could be local or disseminated infections with an acute, subacute or chronic evolution. It can cause severe infections to immunocompromised patients, or even to healthy children, who can experience skin and soft tissue infections. This is the clinical case of a healthy 18-month-old girl with a foot abscess with right inguinal adenophlegmon. The microbiological study of the lesion drainage confirmed a diagnosis of Nocardia sp. She was treated with clotrimazole for 6 weeks and had no further complications. The initial immunoassay showed no abnormalities. The patient's evolutionary follow-up does not show alterations resulting from specific immunological disorders.

Resumo: A nocardiose é uma infeção pouco frequente produzida por diferentes espécies do gênero da Nocardia. As duas espécies mais prevalentes são N. asteroides e N. brasiliensis. Geram um amplo espectro de doenças, com formas locais ou disseminadas, de evolução aguda, subaguda e / ou crônica. Podem causar doença grave, especialmente a pacientes imunodeprimidos. A infecção da pele e dos tecidos moles pode acometer a pacientes imunocompetentes ou ocasionalmente a crianças saudáveis. Apresentamos o caso de uma paciente de 18 meses de idade que apresentou abscesso permanente com adenofleimão inguinal direito. O estudo microbiológico, obtido a partir da drenagem da lesão, mostrou bactérias gram-positivas de aspecto filamentoso compatível com o diagnóstico preliminar de nocardiose. Este diagnóstico foi posteriormente confirmado através duma cultura bacteriológica. Ela recebeu tratamento com Clotrimazol por 6 semanas por via oral, teve boa evolução, sem outras complicações. A avaliação imunológica inicial não mostrou alterações. O acompanhamento evolutivo da paciente não apresenta alterações que indiquem distúrbios específicos da imunidade.

Nanoemulsion containing caffeine for cellulite treatment: characterization and in vitro evaluation

The Ginoide Hydrolipodystrophy (GHLD), commonly known as cellulite, occurs in 80-90% of the female population after the puberty period and comes from a metabolic modification in the cutaneous adipose tissue. Caffeine has been used in topical formulations due to its lipolytic action. We studied a nanoemulsion (F3) containing caffeine with two surfactants (oleth-3 and oleth-20) by emulsification method by phase inversion temperature inversion (PIT). The polydispersion indices (PDI) showed the reduced deviation of 0.1. The mean droplet size was ~ 40 nm. The evaluated constant of Ostwald, in the refrigerator condition was the most favorable during the stability test. In the In Raman spectroscopy assay, the caffeine bands found in F3 were compatible with those found in the caffeine solution (1337, 652.5 and 558.2 cm-1). There was no interaction of caffeine anhydrous with other ingredients in nanoemulsion. In the in vitro safety assay the result of 1.4 ranked the F3 as slightly irritating. In the natural membrane, cutaneous permeation test (human skin) permeate concentrations did not exceed the saturation concentration of the PBS buffer (48.96 µg/3 mL). The caffeine solution and F3 permeated statistically equal, but the nanoemulsion visually and sensorially improved the caffeine precipitation.

Tratamento do fibro edema gelóide utilizando o ultrassom terapêutico associado a lecitina de soja e ginkgo biloba / Treatment of cellulite using therapeutic ultrasound associated with soy lecithin and ginkgo biloba

O fibro edema gelóide atinge a dermo-hipodérmica, alterando microcirculação e adipócitos. Consiste em uma infiltração edematosa do tecido conjuntivo, seguida de polimerização da substância fundamental que, infiltrando-se nas tramas, produz uma reação fibrótica consecutiva. Além de ser desagradável esteticamente, é uma das principais queixas de pacientes na fisioterapia dermato-funcional. O objetivo do estudo foi analisar a ação do gel de Ginkgo Biloba e lecitina de soja associado ao ultrassom terapêutico no tratamento do fibro edema gelóide. Esta pesquisa envolveu 8 mulheres com idade entre 20 e 30 anos, sedentárias, sem dietas, não fumantes, não usuárias de contraceptivo, de corticóides e com FEG grau II na região glútea. O ultrassom terapêutico utilizado obedecia aos seguintes parâmetros: 3 MHz, no modo de emissão contínuo e área efetiva de radiação de 3,5 cm², intensidade 1,4 w/cm2 , sendo aplicado por 10 minutos em cada área pré-marcada. Foram realizados 30 atendimentos, 3 vezes por semana nas dependências de uma faculdade de Teresina/PI. Para análise dos dados foram utilizados: a termografia, análise bioquímica dos exames de sangue, o protocolo de avaliação do fibro edema gelóide (PAFEG), fotos e questionário de satisfação das voluntárias. Os resultados confirmaram o benefício da associação do ultrassom terapêutico ao gel de Ginkgo Biloba e Lecitina de Soja no tratamento do fibro edema gelóide. (AU)

The cellulite affects the dermo-hypodermal layers, modifying microcirculation and adipocytes. It consists of an edematous infiltration of the connective tissue, followed by polymerization of the fundamental substance, infiltrating the plots and producing a fibrotic reaction. Besides being aesthetically unpleasant, is one of the main complaints of patients in physical therapy. The aim of this study was to analyze the action of the gel Ginkgo Biloba and Soy Lecithin associated with ultrasound in the treatment of cellulite. This study involved 8 women aged 20 to 30 years, sedentary, without diets, non-smoking, not using contraception or corticoids with cellulite grade II in the gluteal region. We used the therapeutic ultrasound with the following parameters: 3 MHz, in continuous emission mode and Effective Radiation Area (ERA) of 3.5 cm², intensity 1.4 W/cm², being applied for 10 min in pre-marked area. The patients were submitted to 30 sessions, 3 times a week at the University of Teresina/PI. For data analysis we used: thermal imaging, biochemical analysis of blood tests, the evaluation protocol of cellulite (PAFEG), photos and satisfaction questionnaire of volunteers. The results confirmed the benefit of the association of the ultrasound with gel Ginkgo Biloba and Soy Lecithin in the treatment of cellulite. (AU)

Microagulhamento associado a fatores de crescimento e vitamina C no tratamento de estrias, fibro edema gelóide e flacidez tissular na região glútea / Microneedling associated to growth factors and ascorbic acid in the treatment of cellulite, striae distensae and skin laxity in the gluteal region

O microagulhamento é usado no tratamento de diversas afecções estéticas promovendo estímulo de colágeno. O objetivo deste trabalho foi averiguar a eficácia da associação do microagulhamento a fatores de crescimento e a vitamina C em diferentes afecções estéticas na região glútea. Foram realizadas 4 sessões de microagulhamento com intervalo de 21 dias entre as sessões. Percebeu-se significativa melhora na flacidez tissular, no fibro edema gelóide (FEG) e nas estrias e o microagulhamento mostrou-se uma técnica segura e eficaz para tratementos dessas disfunções estéticas. (AU)

The microneedling is used in the treatment of several aesthetic affections promoting collagen stimulation. The objective of this study was to verify the efficacy of the association of microneedling, growth factors and ascorbic acid in aesthetic affections in the gluteal region. Four sessions of microneedling were performed with a 21-day interval between the sessions, in which a significant improvement on skin laxity, cellulite and striae distensae was observed in the result and proved that the microneedling is to be a safe and effective technique for treating these aesthetic dysfunctions. (AU)

Efficacy of Slimming Cream Containing 3.5% Water-Soluble Caffeine and Xanthenes for the Treatment of Cellulite: Clinical Study and Literature Review

BACKGROUND: Cellulite is a 'cottage cheese-like' cutaneous change caused by subcutaneous fat bulging into the dermis that usually leads to cosmetic problems. Slimming cream containing 3.5% water-soluble caffeine and xanthenes exhibits a lipolytic effect with penetration into the dermis. OBJECTIVE: To evaluate the efficacy and safety of slimming cream for the treatment of cellulite. METHODS: Fifteen subjects with cellulite applied slimming cream to the thighs and inner side of the upper arms twice daily for 6 weeks. Efficacy was assessed using a standard visual scale, changes in the circumferences of the thighs and upper arms, and patient satisfaction by a questionnaire at baseline, week 3, and week 6. Safety was assessed by inquiring about adverse events through questionnaires. RESULTS: The standard visual scale score improved significantly by 0.49 points (19.8%) at week 6. Thigh and upper-arm circumferences decreased by 0.7 cm (1.7%) and 0.8 cm (2.3%), respectively, at week 6. Slight itching and transient flushing were commonly reported, but no serious adverse event occurred. CONCLUSION: The slimming cream tested appears to be effective for the treatment of cellulitis without serious adverse effects. However, additional large clinical trials are required to confirm the efficacy and safety of slimming cream for the treatment of cellulitis.

04-4New perspectives for the employment of Brenta’s silt-clay in anticellulite treatments / 日本温泉気候物理医学会雑誌

<b>Introduction:</b> Brenta’s silt-clay (BrentaKer^®, EGAP, Italy) is a natural sediment containing minerals pertaining to Italian Dolomite Alps mountains, which is extracted from the catchment area of Brenta river. Particle-size distribution, mineralogical, chemical, tensiometric investigations with some observational findings open to new perspectives for its application in beauty & wellness field. On these basis, surface energy evaluations of tensiometric affinity with the skin by TVS modelling¹⁾ and in-vivo clinical studies of anti-cellulite properties of Brenta’s silt-clay were performed.<BR><b>Objectives: </b>The aim of this work was to evaluate the properties of the Brenta’s silt-clay in anti-cellulite cosmetic treatments. These properties were hypothesized on the basis of its tensiometric affinity for the skin, as determined by the Bio-adhesive TVS index¹⁾.<BR><b>Materials and Methods: </b>Surface energy studies were performed by contact angle method, using the DSA10-Kruss tensiometer (diiodomethane, FomblinHC/25^®PFPE, glycerine as liquid tests). Bio-adhesive TVS index levels were originated from overlapping Brenta’s silt-clay and skin’s tensiometric prints. γ-rays irradiated Brenta’s silt-clay (Oroscare, EGAP, Italy) was inserted in a formulation composed by demineralised water, diazolidinyl urea, carboxymethyl cellulose, carbomer, glycerine, phenoxyethanol. Clinical efficacy of Brenta’s silt-clay was tested versus placebo in 10 females with cellulite on their thighs and/or gluteus (degree 1-3, Nurberger and Muller scale) for 8 weeks considering (a) skin hydration value (Corneometer CM825, C&K, Germany), (b) vertical deformation, elasticity, skin extensibility (Cutometer MPA580, C&K, Germany), (c) thigh circumference (measuring tape), (d) microcirculatory flow (Flowmeter Periflux PF4001, Perimed, UK, (e) length of dermo-hypodermic junction (Ultrasound Scanner Dermascan C^®Ver.3, Cortex Technology, Germany), (f) skin smoothness (Skin replicas image analysis, Monaderm, France). <BR><b>Results:</b> In three subjects the Bio-adhesive TVS index showed maximal affinity between Brenta’s silt-clay (DC=17.8±4 mN/m, PC=32.0±4.6 mN/m, SFE=49.8 mN/m) and untreated skin (DC=13.5±4.1, PC=19.67±13.4, SFE=33.2±16.2), indicating that the surface energy of Brenta’s silt-clay was higher than that of the skin and suggesting its capability to modify skin’s selective permeability. After 4 (T1) and 8 (T2) weeks, the subjects treated with Brenta’s silt-clay were compared with respect to placebo. Derma-hypodermal junction length significantly decreased (-10.7%, p<0.05) in T1, whereas an increase of skin microcirculatory flow (+26.0%, p<0.05) and a decrease of the derma-hypodermal junction length (-16.8%, p=0.052) and of skin maximum average roughness (-4.2%, p=0.057) were observed in T2.<BR><b>Conclusions: </b>In subjects with cellulite blemish, the application of Brenta’s silt-clay is capable to increase skin blood micro-flow, improve dermo-hypodermal junction length and decrease skin maximum average roughness, suggesting its efficacy in anti-cellulite treatments. Bio-adhesive TVS index analysis suggests that this efficacy is probably related to its capability to modify skin’s selective permeability.

04-4 New perspectives for the employment of Brenta’s silt-clay in anticellulite treatments / 日本温泉気候物理医学会雑誌

Introduction: Brenta’s silt-clay (BrentaKer®, EGAP, Italy) is a natural sediment containing minerals pertaining to Italian Dolomite Alps mountains, which is extracted from the catchment area of Brenta river. Particle-size distribution, mineralogical, chemical, tensiometric investigations with some observational findings open to new perspectives for its application in beauty & wellness field. On these basis, surface energy evaluations of tensiometric affinity with the skin by TVS modelling1) and in-vivo clinical studies of anti-cellulite properties of Brenta’s silt-clay were performed. Objectives: The aim of this work was to evaluate the properties of the Brenta’s silt-clay in anti-cellulite cosmetic treatments. These properties were hypothesized on the basis of its tensiometric affinity for the skin, as determined by the Bio-adhesive TVS index1). Materials and Methods: Surface energy studies were performed by contact angle method, using the DSA10-Kruss tensiometer (diiodomethane, FomblinHC/25®PFPE, glycerine as liquid tests). Bio-adhesive TVS index levels were originated from overlapping Brenta’s silt-clay and skin’s tensiometric prints. γ-rays irradiated Brenta’s silt-clay (Oroscare, EGAP, Italy) was inserted in a formulation composed by demineralised water, diazolidinyl urea, carboxymethyl cellulose, carbomer, glycerine, phenoxyethanol. Clinical efficacy of Brenta’s silt-clay was tested versus placebo in 10 females with cellulite on their thighs and/or gluteus (degree 1-3, Nurberger and Muller scale) for 8 weeks considering (a) skin hydration value (Corneometer CM825, C&K, Germany), (b) vertical deformation, elasticity, skin extensibility (Cutometer MPA580, C&K, Germany), (c) thigh circumference (measuring tape), (d) microcirculatory flow (Flowmeter Periflux PF4001, Perimed, UK, (e) length of dermo-hypodermic junction (Ultrasound Scanner Dermascan C®Ver.3, Cortex Technology, Germany), (f) skin smoothness (Skin replicas image analysis, Monaderm, France). Results: In three subjects the Bio-adhesive TVS index showed maximal affinity between Brenta’s silt-clay (DC=17.8±4 mN/m, PC=32.0±4.6 mN/m, SFE=49.8 mN/m) and untreated skin (DC=13.5±4.1, PC=19.67±13.4, SFE=33.2±16.2), indicating that the surface energy of Brenta’s silt-clay was higher than that of the skin and suggesting its capability to modify skin’s selective permeability. After 4 (T1) and 8 (T2) weeks, the subjects treated with Brenta’s silt-clay were compared with respect to placebo. Derma-hypodermal junction length significantly decreased (-10.7%, p<0.05) in T1, whereas an increase of skin microcirculatory flow (+26.0%, p<0.05) and a decrease of the derma-hypodermal junction length (-16.8%, p=0.052) and of skin maximum average roughness (-4.2%, p=0.057) were observed in T2. Conclusions: In subjects with cellulite blemish, the application of Brenta’s silt-clay is capable to increase skin blood micro-flow, improve dermo-hypodermal junction length and decrease skin maximum average roughness, suggesting its efficacy in anti-cellulite treatments. Bio-adhesive TVS index analysis suggests that this efficacy is probably related to its capability to modify skin’s selective permeability.

Síndrome de Wells: uma dermatose reacional / Wells syndrome: a reactional dermatosis

A Síndrome de Wells é uma desordem cutânea rara, caracterizada clinicamente por placas enduradas semelhantes à celulite. Sua patogênese é desconhecida, mas a possibilidade de hipersensibilidade local foi proposta. Relatamos um caso de uma paciente de seis anos, que apresentava placas eritêmato-edematosas em membros inferiores, cuja histopatologia evidenciou infiltrado inflamatório misto com inúmeros eosinófilos de permeio em meio à degeneração da trama colágena eosinofílica ("figuras em chama"). A única anormalidade nos exames laboratoriais foi eosinofi lia. Esta paciente apresentava hipersensibilidade à picada de insetos. Verificou-se boa resposta ao corticoide tópico. A Síndrome de Wells é um provável estado cutâneo reacional a diversos estímulos e, portanto, cabe a investigação necessária. Na presente paciente, a picada de insetos parece ter sido o fator desencadeante

Wells syndrome is a rare skin disorder clinically characterized by hardened plaques similar to cellulite. Its pathogenesis is unknown, but the possibility of local hypersensitivity has been proposed. We report the case of a six-year-old who presented with erythematous and edematous lower limbs, whose histopathology showed a mixed inflammatory infiltrate with numerous intermingled eosinophils amid eosinophilic collagen degeneration ("flame figures"). The only abnormality in laboratory tests was eosinophilia. This patient had hypersensitivity to insect bites. There was good response to topical steroids. Wells syndrome is a likely cutaneous condition in reaction to various stimuli, and therefore the necessary investigation should be made. In this patient, insects' sting seems to have been the triggering factor

Antecedente de hipotiroidismo en pacientes consultantes por lipodistrofia (celulitis) / Hypothyroidism in women who consulted for lipodystrophy (cellulite)

La celulitis es una entidad que afecta a la mayoría de las mujeres. Existen varias teorías sobre su fisiopatología. Sabemos que la hormona tiroidea tiene un efecto a nivel cutáneo, y en nuestro país se ha reportado una mayor prevalencia de hipotiroidismo que en otros países. Objetivo: Comparar la prevalencia de hipotiroidismo en mujeres que consultaron para tratamiento de celulitis y/o flaccidez abdominal en un centro dermatológico de Santiago con la reportada en la literatura. Materiales y métodos: Se realizó un estudio retrospectivo con 122 pacientes evaluadas entre noviembre 2009 y enero 2012. Se excluyeron 25 por no contar con anamnesis completa. Los datos fueron obtenidos de la entrevista inicial, y de la ficha clínica cuando ésta estaba incompleta. Resultados: Se obtuvo una prevalencia de 19 por ciento, valor significativamente mayor (p<0,001)a la reportada en la literatura (6,8 por ciento en Chile y entre 5 por ciento y 10 por ciento en otros países).

Cellulite is an entity that affects most women. There are many theories about its physiopathology. It is known that the thyroid hormone has an effect on the skin, and there are reports of a higher prevalence of hypothyroidism in our country than elsewhere. Objective: Compare the prevalence of hypothyroidism in women who consulted for cellulite and/or abdominal flabbiness in a dermatologic clinic in Santiago, with the data reported in the literature. Materials and methods: We performed a retrospective study with 122 patients who consulted between November 2009 and January 2012, of whom 25 were excluded because of incomplete data. Information was obtained from the initial interview, and, if missing some data, from the clinical records. Results: We found a prevalence of 19 percent, which is significantly higher (p<0,001) than the value reported in the literature (6,8 percent in Chile, and between 5 percent and 10 percent elsewhere).

Avaliação da técnica de drenagem linfática manual no tratamento do fibro edema geloide em mulheres / Evaluation of manual lymphatic drainage technique in the treatment of Cellulite in women

Introdução: A drenagem linfática manual (DLM) é uma terapia utilizada no tratamento do fibro edema geloide (FEG). Objetivo: Analisar o efeito da DLM no tratamento do FEG. Métodos: Realizou-se uma avaliação no início e no fim do tratamento em 10 voluntárias com FEG, de grau I ao III, que constava de anamnese, inspeção, palpação, perimetria e testes específicos. Foram feitos registros fotográficos dos glúteos e das coxas superiores. A terapia constou de 10 sessões de DLM com duração de 60 minutos. Na análise de dados, utilizaram-se os testes t pareado, exato de Fisher e Wilcoxon, com nível de significância de p<0.05. Resultados: Houve diferença estatística no grau de satisfação das pacientes com o FEG. Não houve diferença significante no grau do FEG, porém constatou-se melhora clínica no aspecto da pele. Todas as pacientes relataram estar satisfeitas com o tratamento. Não houve diferença estatística na perimetria. Conclusão: A DLM demonstrou ser uma terapêutica coadjuvante no tratamento do FEG, com melhora da autoestima e da satisfação das pacientes.

Introduction: Manual lymphatic drainage (MLD) is a therapy used to treat cellulite. Objective: To analyze the effect of MDL in the treatment of cellulite. Methods: We conducted an evaluation at the beginning and end of treatment in 10 women with cellulite grade I to III, which consisted of anamnesis, inspection, palpation, perimetry and specific tests. Photographic records were made of the buttocks and upper thighs. The therapy consisted of 10 sessions of MLD lasting 60 minutes. In the data analysis used the tests paired t, Fisher exact and Wilcoxon with the significance level of p<0.05. Results: There were statistical differences in the degree of satisfaction of patients with cellulite. There was no significant difference in the degree of cellulite, but was found clinical improvement in skin appearance. All patients reported being satisfied with treatment. There was no statistical difference in perimetry. Conclusion: MLD proved to be an adjuvant therapy in the cellulite treatment, with improved self-esteem and satisfaction of patients.

Absceso de Muslo, Sepsis y Embarazo / Thigh of Abscess, Sepsis and Pregnancy

Las infecciones de piel y tejidos blandos son, junto con las infecciones de las vías respiratorias, las infecciones más frecuentes en clínica humana. Los gérmenes normalmente implicados son el Staphylococcus Aureus, Streptococcus spp, Pseudomona Aeruginosa y Enterococcus. De forma ocasional pueden formarse abscesos como resultado de la celulitis.Algunas complicaciones raras, pero graves incluyen la producción de fascitis necrotizante y bacteriemia. La celulitis causada por microorganismos Gram negativos generalmente ocurre a través de una fuente cutánea en un paciente inmunodeprimido, pero también puede desarrollarse a través de bacteriemia. A continuación presentamos el caso de una mujer de 17 años de edad, primigesta con 19 semanas de gestación, sin antecedente traumático, ni puerta de entrada evidenciable que ingresa por dolor intenso en muslo derecho, edematizado y con imposibilidad de movilización, compatible con celulitis, formación de absceso y sepsis. Se la trato según protocolo para el cuadro séptico, una vez identificado el absceso se realiza drenaje quirúrgico y antibioticoterapia para Escherichia Coli.

Infections of skin and soft tissues are along with respiratory tract infections, the most frequent infections in human clinical practice. The germs usually involved are Staphylococcus Aureus, Streptococcus spp, Pseudomonas Aeruginosa and Enterococcus. Occasionally abscesses may form as a result of cellulitis. Some rare but serious complications include necrotizing fasciitis production likewise spread into the bloodstream to other parts of the body. Cellulitis caused by Gram-negative organisms usually occurs through a cutaneous source in an immunocompromised pa-tient, but can al so develop through bacteremia. We present the case of a 17-year-old primigravida with 19 weeks of gestation, no history of trauma or gateway evident that complained of severe pain in his right thigh and inability edematous movilidación compatible with cellulitis, training of abscess and sepsis. As is the treatment protocol for sepsis, once identified the abscess is per-formed surgical drainage and antibiotic therapy for Escherichia coli.