Microagulhamento versus microcorrente galvânica associada ao peeling químico em estrias albas / Microneedling versus galvanic microcurrent associated with chemical peel in striae alba

Introdução: As estrias são as lesões elementares de pele que acometem mais o sexo feminino. Podem ser decorrentes de múltiplas etiologias, como fatores genéticos, hormonais e mecânicos. As principais formas de tratamento incluem as técnicas de microagulhamento, galvanopuntura e peeling químico. Objetivo: Comparar a influência da utilização do microagulhamento e da microcorrente galvânica associada ao peeling químico sobre a aparência de estrias albas na região glútea de mulheres jovens. Métodos: Realizou-se em 11 mulheres de fototipo de pele II a V de acordo com Fitzpatrick, com idade média de 22,18 ± 2,04 anos, com estrias albas na região do glúteo, as quais foram divididas em dois grupos: microagulhamento (GM) (N = 6) e microcorrente galvânica associada ao peeling químico (GMgP) (N = 5) e foram avaliadas por imagens do pré e pós-tratamento. Resultados: Foi possível observar melhora do aspecto das estrias em ambos os grupos, contudo, avaliando qualitativamente, o grupo GM obteve melhores resultados. Conclusão: Foi possível perceber melhores resultados utilizando a técnica de microagulhamento, tanto em relação a tolerância da dor e adesão ao tratamento, quanto em relação a aparência e textura das estrias. (AU)

Efeitos estéticos e de autoestima do peeling para manchas faciais em idosas / Aesthetic and self-esteem effects of peeling for facial spots in elderly women

Introdução: O processo de envelhecimento da pele é inevitável e contínuo, decorrente de mudanças bioquímicas, morfológicas e fisiológicas, que acomete a estética cutânea, impactada por fatores intrínsecos e extrínsecos. Este processo de envelhecimento gera: linhas de expressão, flacidez, rugas e manchas, provocando baixa da autoestima, levando ao isolamento social comprometendo a qualidade de vida. Objetivo: Identificar a influência do peeling químico Lumix Peel® - Peeling Sequencial Intensivo, no tratamento de manchas faciais e na melhora da autoestima de pacientes idosas. Métodos: O estudo foi composto por 20 idosas; coletou-se o perfil sociodemográfico, as condições da pele e caracterização da mancha. Respondeu-se um questionário de Autoimagem e Autoestima juntamente com registro fotográfico antes e após o tratamento. Na terceira etapa, foram realizadas sessões do Protoloco Lumix Peel® no tratamento de clareamento de manchas. Resultados: Os resultados mostraram que 100% das idosas tratadas apresentaram clareamento geral das manchas faciais e perceptível suavização das linhas de expressão. No que se refere à autoestima e autoimagem, todas as idosas afirmaram melhora após o tratamento. Conclusão: O protocolo de tratamento estético facial resultou em melhorias das condições gerais da pele das idosas, influenciando positivamente na autoestima e autoimagem das idosas. (AU)

Introduction: The aging process of the skin is inevitable and continuous, due to biochemical, morphological and physiological changes, that affect the cutaneous esthetics, being impacted by intrinsic and extrinsic factors. This aging process generates lines of expression, sagging, wrinkles and blemishes, causing low self-esteem, leading to social isolation compromising the quality of life. Objective: To identify the influence of the chemical peeling Lumix Peel® - Intensive Sequential Peeling, in the treatment of facial spots and in the improvement of the self-esteem of elderly patients. Methods: The sample was composed of 20 elderly women; the sociodemographic profile, the skin conditions and the characterization of the spots were collected. A self-concept and selfesteem questionnaire was used along with photographic records before and after treatment. In the third stage, sessions of the Protocol Lumix Peel® were carried out in the treatment of bleaching of spots. Results: The results showed that 100% of the treated elderly presented general bleaching of the facial spots and significant smoothing of the expression lines. About selfesteem and self-image, all the elderly women reported improvement after treatment. Conclusion: The protocol of esthetic facial treatment resulted in improvements of the general conditions of the skin of the elderly, positively influencing the self-esteem and self-concept of the elderly. (AU)

Complicaciones y manejo de procedimientos dermatoestéticos: una actualización para el dermatólogo / Complications associated with cutaneous aesthetic procedures: an update for the dermatologist

En las últimas décadas se han desarrollado nuevas técnicas e indicaciones de los procedimientos estéticos mínimamente invasivos, presentando cada vez mejores resultados con un alto nivel de seguridad, sin embargo, estos no se encuentran exentos de complicaciones, las que pueden ser transitorias o permanentes. El conocimiento, abordaje, tratamiento y prevención de las distintas complicaciones son esenciales para los dermatólogos y cirujanos plásticos. Los procedimientos más utilizados son: administración de rellenos, peeling químicos, láser, luz pulsada intensa y ultrasonido de alta frecuencia. La siguiente revisión tiene como objetivo reconocer las principales complicaciones de estos procedimientos y su manejo.

In recent decades, new techniques and indications of minimally invasive aesthetic procedures have been developed, presenting increasingly better results with a high level of safety, however these are not exempt from complications, which may be transient or permanent. The knowledge, approach, treatment and prevention of the different complications are essential for the dermatologist and plastic surgeons. The most used procedures are the administration of fillers, chemical peels, lasers, intense pulsed light and high frequency ultrasound. The following review aims to recognize the main complications of these procedures and their management.

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.

Efficacy and safety of superficial chemical peeling in treatment of active acne vulgaris

Abstract: Acne vulgaris is an extremely common condition affecting the pilosebaceous unit of the skin and characterized by presence of comedones, papules, pustules, nodules, cysts, which might result in permanent scars. Acne vulgaris commonly involve adolescents and young age groups. Active acne vulgaris is usually associated with several complications like hyper or hypopigmentation, scar formation and skin disfigurement. Previous studies have targeted the efficiency and safety of local and systemic agents in the treatment of active acne vulgaris. Superficial chemical peeling is a skin-wounding procedure which might cause some potentially undesirable adverse events. This study was conducted to review the efficacy and safety of superficial chemical peeling in the treatment of active acne vulgaris. It is a structured review of an earlier seven articles meeting the inclusion and exclusion criteria. The clinical assessments were based on pretreatment and post-treatment comparisons and the role of superficial chemical peeling in reduction of papules, pustules and comedones in active acne vulgaris. This study showed that almost all patients tolerated well the chemical peeling procedures despite a mild discomfort, burning, irritation and erythema have been reported; also the incidence of major adverse events was very low and easily manageable. In conclusion, chemical peeling with glycolic acid is a well-tolerated and safe treatment modality in active acne vulgaris while salicylic acid peels is a more convenient for treatment of darker skin patients and it showed significant and earlier improvement than glycolic acid

Efeito da largura temporal de pulso do Laser de Er: YAG em zircônia pré-sinterizada / Effect of Er: YAG laser pulse widths on pre-sintered zirconia

Este estudo se propôs a analisar os efeitos das diferentes larguras temporais de pulso do laser de Er:YAG na rugosidade superficial, na perda de volume do material e na altura do degrau formado em uma Y-TZP (Yttrium-stabilized Tetragonal Zirconia Polycrystal) pré-sinterizada. Foram utilizados 5 blocos de Y-TZP pré-sinterizados destinados ao uso CAD/CAM que foram seccionados, obtendo-se 63 espécimes padronizados. Em seguida, esses espécimes foram lixados com uma sequência decrescente de lixas para padronização da superfície. Os grupos experimentais foram compostos a partir de 1 fator de variação - o tratamento de superfície. Os espécimes foram irradiados com o laser de Er:YAG (Fidelis III Fotona, Eslovênia) - 2,94 µm, 100 mJ, 15,87J/cm2, 10 Hz, 1W, 7 mm, 60% água/40% ar. Assim formaram-se 7 grupos experimentais (n=9): G1 (50 ?s); G2 (100 µs); G3 (300 ?s); G4 (600 ?s); G5 (1000 µs); G6 (Abrasão triboquímica com partículas de 30 µm); G7 (Sem tratamento). Após os tratamentos de superfície, os espécimes foram sinterizados em forno específico, de acordo com as recomendações do fabricante. Foram capturadas imagens em Microscópio Confocal a Laser 3D de cada espécime e avaliadas por meio de um software. A análise dos grupos irradiados revelou um aumento da rugosidade nos grupos G1, G2, G3 e G4 quando comparados aos grupos G6 e G7. O grupo G5 apresentou superfície totalmente plana e desfavorável para retenção. No que se refere à perda de volume e formação de degrau, os grupos G1, G2 e G3 demonstraram grande perda de volume e grande altura de degrau formado, o que pode levar a uma desadaptação da peça protética. No grupo G4 foram observados valores de rugosidade satisfatórios com pouca perda de volume e pequena altura de degrau formado, semelhante ao que foi notado para a abrasão trioboquímica (G6), podendo ser indicada para tratamento de superfície de Y-TZP pré-sinterizada

A irradiação com o laser de Er:YAG promoveu um padrão morfológico com muitas irregularidades, característico de ablação para os grupos G1, G2, G3 e G4 e, para todos os protocolos utilizados, não foi observada a presença de trincas ou carbonização. Sugere-se que a largura temporal de 600 ?s (G4) seja a mais indicada como alternativa para tratamento de superfície, objetivando a criação de micro-retenções superficiais, com pouca perda de volume de material e que, ao mesmo tempo, não provoque danos à estrutura da cerâmica policristalina .

This study evaluated the effects of different Er:YAG laser pulse width protocols on surface roughness, loss of volume of the material and the step height formed of pre-sintered Yttrium-stabilized tetragonal Zirconia Polycrystal (Y-TZP) by three-dimensional profilometric assessment. Blocks of pre-sintered Y-TZP were cut providing 63 standard 5mm thick samples which were divided by surface treatment, as follows (n=9): G1 (50?s); G2 (100?s); G3 (300?s); G4 (600?s); G5 (1000?s); G6 (tribochemical silica coating); G7 (Untreated). Laser settings: The Er:YAG laser (Fidelis III; Fotona, Ljubljana, Slovenia) 100mJ, 15,87J/cm2, 10Hz, 1W, (60%) and air (40%) cooling. After treated or not, samples were sintered according to the manufacturer's recommendations. Roughness, volume loss and step and were analyzed by 3D profilometric assessment with confocal laser microscopy. Irradiated groups showed an increased roughness in the groups G1, G2, G3 and G4 when compared to G6 and G7 groups. The G5 group showed a completely flat and unfavorable surface for retention. The groups G1, G2 and G3 shown great loss of volume and the step height formed, which can lead to a gap on the crowns. In G4 were observed satisfactory roughness with little loss of volume and the step height formed similar to G6. Irrespective of laser protocol, any of the specimens showed presence of cracks and carbonization. It is suggested that the pulse width 600?s (G4) is the most suitable pulse width protocol as an alternative surface treatment, promoting micro-retention, with little loss of volume of material, comparable to gold standard treatment

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.

Randomized clinical efficacy of superficial peeling with 85% lactic acid versus 70% glycolic acid / Estudo randomizado da eficacia clinica dos peelings superficiais de acido lactico 85% versus acido glicolico 70%

BACKGROUND: Peeling is a procedure which aims to accelerate the process of skin exfoliation. OBJECTIVES: Development of formulations containing lactic acid at 85% or glycolic acid at 70% and the evaluation of these formulations on clinical efficacy in reduction of fine wrinkles. METHODS: Preliminary stability tests were carried out and an in vivo study was performed with three groups with 9 representatives each. One was the control group, which used only sunscreen; another one used lactic acid+sunscreen, and the last group used acid glycolic+sunscreen. Clinical efficacy was assessed with a CCD color microscope, through the digitization of images before and after treatment. The applications were carried out by a dermatologist, once a mont h every 30 days, during 3 months. The area with wrinkles was calculated by planimetry point counting, in accordance with Mandarin-de-Lacerda. RESULTS: The formulations were stable in the visual and Ph evaluation. There was no improvement in the control group; for lactic acid, there was significant improvement after the second peeling application on the outer lateral area of the right eye and after the third application on the outer lateral area of the left eye. For the glycolic acid group, there was significant improvement in the outer lateral area of the left eye after the first application, and of the right eye region, after three applications. The formulations used must be kept under refrigeration and should be manipulated every 30 days. CONCLUSIONS: Both peelings were effective in reducing fine wrinkles of the outer lateral eye area after three applications (p≤0.05%). It was observed that peeling efficacy in the external-lateral region of one eye might be different compared with that in skin of the external-lateral region of the other eye, relative to the speed of skin improvement. .

FUNDAMENTOS: Peeling visa a acelerar o processo de esfoliação da pele. OBJETIVOS: Desenvolver formulações contendo ácido láctico a 85% ou ácido glicólico a 70% e avaliar sua eficácia clínica na redução de rugas finas. MÉTODOS: Testes preliminares foram efetuados e estudo in vivo foi realizado em três grupos com nove representantes cada, separados de forma randomizada. Um grupo foi controle, utilizando apenas fotoprotetor; outro utilizou ácido láctico e fotoprotetor; o último usou ácido glicólico e fotoprotetor. Para eficácia clínica, empregou-se microscópio CCD color, digitalizando-se as imagens do pré e do pós-tratamento. As aplicações foram realizadas por médica dermatologista uma vez por mês, a cada 30 dias, durante três meses. A área com traços de ruga foi calculada pela planimetria por contagem de pontos. RESULTADOS: As formulações foram estáveis na avaliação visual e de pH. Não houve melhora no grupo controle; para o grupo do ácido láctico, houve melhora significativa após a segunda aplicação do peeling na região lateral externa do olho direito e após a terceira aplicação na região lateral externa olho esquerdo. Para o grupo do ácido glicólico, houve melhora significativa na região lateral externa olho esquerdo após a primeira aplicação e, depois de três aplicações, na região lateral externa do olho direito. As formulações magistrais empregadas no estudo devem ser mantidas sob refrigeração e manipuladas a cada 30 dias. CONCLUSÕES: Tanto o peeling de ácido láctico quanto o de ácido glicólico foram eficazes na diminuição de rugas finas da região lateral externa dos olhos após ...

Observations on estrus as monitored by receptivity to mating activity and pattern of vaginal exfoliates in trypanosoma brucei ­ infected WAD goat does synchronized with Estrumate® / Observaciones sobre el estro monitorizado por la receptividad a la actividad de apareamiento y el patrón de exfoliación vaginal en cabras WAD infectadas por trypanosoma brucei sincronizadas con Estrumate®

The effects of experimental Trypanosoma brucei infection on receptivity to mating activity and pattern of vaginal exfoliates were monitored using twenty-one adult WAD goats which were synchronized with double injection, seven days apart of Estrumate®. The twenty-one goats consisted of 3 bucks and 18 does. The does were randomly divided into control group 'A' having 10 does and test group 'B' with 8 does. The goats were fed with Elephant grass in the morning and commercial feed containing 15.23 percent CP at the rate of 0.25kg/head in the afternoons. Freshwater was provided ad libitum. Results showed that while all the control does were observed to stand to be mounted and mated, none of the infected does did. Also, the pattern of the mean percentage vaginal exfoliated cell types encountered between the control and infected doe groups were converse. While parasabal cells changed from 2.90±0.03 percent during proestrus through 3.05 +/- 0.46 percent during estrus to 2.42 +/-0.08 percent at diestrus in the control does, it changed from 22.07 +/- 0.56 percent during expected proestrus through 8.48 +/- 0.05 percent during expected estrus to 28.05 +/-1.09 percent respectively in the infected does. In like manner, intermediate cell changed from 11.10 +/- 0.03 percent during proestrus through 11.10 +/- 0.31 percent during estrus to 1.21 +/- 1.00 percent during diestrus in control does while it changed from 27.27 +/- 0.08 percent during expected proestrus through 42.37 +/- 2.39 percent during expected estrus to 40.24 +/- 1.06 percent during expected diestrus in infected does. Similarly, superficial cells changed from 56.25 +/- 0.75 percent during proestrus through 63.70 +/- 1.05 percent during estrus to 7.37 +/- 0.01 percent during diestrus while it changed from 0.00 percent during expected proestrus through 3.39 +/- 0.02 percent during expected estrus to 63.70 +/- 1.05 percent during estrus to 6.10 +/- 0.01 percent during expected diestrus. In the control does, the ...

Los efectos de la infección experimental por Trypanosoma brucei sobre la receptividad a la actividad de apareamiento y el patrón de exfoliación vaginal fueron monitoreados utilizando 21 cabras WAD adultas sincronizadas con doble inyección, a los siete días de diferencia de Estrumate®. De las 21 cabras utilizadas eran 3 machos y 18 hembras. Las hembras se dividieron al azar en grupo control "A" con 10 sujetos y un grupo de prueba "B" con 8. Las cabras fueron alimentadas con pasto y alimento comercial que contenía 15,23 por ciento de CP en tasa de 0,25kg/por cabeza en las tardes. Agua fresca fue proporcionada ad libitum. Los resultados mostraron que mientras todos las cabras del grupo control pudieron ser montadas y acopladas, ninguna de las infectadas pudo. Además, fue contradictorio el patrón de la media porcentual de los tipos de células vaginales exfoliadas encontradas entre los grupo control e infectadas. Mientras que las células parabasales cambiaron desde un 2,90 +/- 0,03 por ciento durante el proestro, al 3,05 +/- 0,46 por ciento durante el estro y 2,42 +/- 0,08 por ciento al diestro en el grupo control, el grupo infectado cambió desde un 22,07 +/- 0,56 por ciento durante el proestro, al 8,48 +/- 0,05 por ciento durante el estro y 28,05 +/- 1,09 por ciento al diestro. De la misma forma, las célula intermedias cambiaron de un 11,10 +/- 0,03 por ciento durante el proestro, al 11,10 +/- 0,31 por ciento durante el estro y al 1,21 +/- 1,00 por ciento durante el diestro en el grupo control, mientras que en el grupo infectado pasó del 27,27 +/- 0,08 por ciento durante el proestro, al 42,37 +/- 2,39 por ciento durante el estro y al 40,24 +/- 1,06 por ciento durante el diestro. Las células superficiales pasaron desde un 56,25 +/- 0,75 por ciento durante el proestro, 63,70 +/- 1,05 por ciento durante el estro, hasta un 7,37 +/- 0,01 por ciento durante el diestro, mientras en el grupo infectado pasaron de un 0.00 por ciento durante el proestro, al 3,9 +/- 0,02 p...

Histopathological aspects of cutaneous photoaging and phenol peeling

The skin is regarded as the largest organ in our system and has the general purposes of physical, mechanical and immunological protection, sealing against the elements and thermoregulation and tactile perception of environmental stimuli. Skin aging is a complex biological event that affects all skin layers. The dermis, however, is particularly affected due to its histophysiologies' characteristics. With the expansion of life expectancy, the dermatological questions among the older population has had an increasingly bigger importance, propelling the development and perfecting of rejuvenation techniques. The phenol peeling is a deep, chemical one, which offers intense clinical results. The application on small areas of the body, for example, around the eyes, is safe and does not lead to cardiovascular complications. This review aims to update the knowledge of skin histology, the alterations related to photoaging and phenol peeling.

Innovative non-invasive techniques in skin pharmaceutics as valid complements in cosmetic dermatology practice

Non-invasive tools for measuring various skin parameters are widely used as research tools in the area of skin pharmaceutics to evaluate the cutaneous effects of topically applied skin care products. They provide objective and quantitative data of various skin attributes as compared with subjective clinical grading and allow detection of differences that are not apparent to the eye. On the other hand, typical dermatological practice is based on the skills and trained eyes of dermatologists to evaluate the skin conditions of patients and their response to various treatments. This study aims at showing the feasibility of using three non-invasive instruments as complementary tools in dermatology practice to evaluate and monitor quantitatively relevant cutaneous treatment effects. Mexameter[registered sign], Corneometer[registered sign], and Tewameter [registered sign] were used to evaluate quantitatively the degree of pigmentation, hydration, and barrier integrity, respectively, at baseline and 1, 7, 14, and 30 days after one session of superficial TCA peel treatment of melasma on the face of a female patient. The results show the ability of these devices to aid the dermatologist in quantifying and comparing the changes in skin attributes over time

Rejuvenecimiento no ablativo / Non ablative rejuvenation

La estética facial y el rejuvenecimiento se han desarrollado rápidamente debido a cambios en los productos, procedimientos y datos demográficos de los pacientes. Los clínicos pueden beneficiarse guiando en el uso de los productos, adaptando tratamientos a pacientes individuales, tratando múltiples áreas faciales, usando las combinaciones de productos para optimizar resultados. Cuando estas técnicas son combinadas, los resultados son superiores al empleo de terapias individuales. Las terapias posibles de combinar son: toxina botulínica, agentes de rellenos, peelings químicos, luz pulsada intensa láser ablativo y no ablativo. Recientemente, una variedad de sistemas de láser está disponible, que permiten un remodelamiento dérmico selectivo sin la disrupción de la superficie epidérmica. Más recientemente, el expertisse de los médicos con los sensibilizantes tópicos y las fuentes luminosas empleadas en la terapia fotodinámica ha conducido a mayores usos, incluyendo su empleo para la mejoría de los signos visibles del fotoenvejecimiento.

Facial aesthetics and rejuvenation are evolving rapidly due to changes in products, procedures and patients demographics. Clinicians can benefit from ongoing guidance on products, tailoring treatments to individual patients, treating multiple facial areas, using combinations of products to optimize outcomes. When these techniques are combined, the results are superior to the use of individual therapies alone. The possible combination therapies are: botulium toxin, fillers agents, chemicals peels, intense pulsed light, nonablative and ablative lasers. A variety of laser systems have recently become available that allow for selective dermal remodeling without disruption of the epidermal surface. More recently, increasing physician expertise with the topical sensitizers and light sources employed in photodynamic therapy has led to expanded applications, including its use for improvement of the visible signs of photoaging.

Melasma: patogénesis y tratamiento / Melasma: pathogenesis and treatment

El melasma es un desorden pigmentario simétrico que afecta áreas fotoexpuestas de mujeres, y que también ha sido descrito en hombres. Esto hiperpigmentación es inducido, principalmente por lo radiación ultravioleta y por factores hormonales, entre otros. Su patogénesis no es del todo conocido y su tratamiento a la fecha es difícil. La mayoría de los agentes despigmentontes actúan o diferentes niveles de la biosíntesis de lo melanina y de su transferencia al queratinocito. Éstos agentes pueden asociarse entre sí, o utilizarse por si solo. Las terapias físicas como el tratamiento químico abrasivo, la dermabrasión y el láser también han sido descritas.

Melasma is an acquired symmetrical pigmentary disorder that affects sun-exposed skin in females, but is also present in men. The hyperpigmentation is mostly induced by ultraviolet radiation and hormones among others. The pathogenesis remains largely unknown and treatment is still nowadays difficult. Most of the lightening agents acts at different levels of the biosynthesis of melanin and its transfer to keratinocytes. These agents may be used alone or in combination between them. Physical therapy, such as peeling. dermabrasion and laser, have also been described.

Estudo comparativo: analgesia tópica pós-peeling facial médio com ácido tricloroacético (ATA) a 30 utilizando água destilada e heparina sódica tópica em spray (Alimax®) / Comparative study: topical analgesia after facial peeling with trichloroacetic acid (TCA) 30(per cent) utilizing distilled water and topical sodic heparin in spray(Alimax®)

A dor pós-peeling é um fator limitante ao seu uso universal. Alguns pacientes com indicação para tal tratamento estético acabam se abstendo desta terapia devido ao temor da dor imediatamente após este procedimento. O que poderia tornar um procedimento seguro, simples, barato e de fácil reprodução, mais difundido entre pacientes e profissionais, seria o controle efetivo desta dor, de preferência se fosse por meio de uma terapia tópica. A avaliação da dor após o uso de heparina sódica tópica em spray (ALIMAX®), utilizada para tratamento tópico em queimaduras, e sua comparação à água destilada, utilizada pela mesma via, foi estudada em 12 pacientes após o peeling médio com ácido tricloroacético (ATA) a 30(per cent) em face.

The pain after peeling limits the universalization of this aesthetic procedure. Many patients with indication for such treatment deny the use of this therapy, fearing the pain immediatelyafter the peeling. The effective control of the pain could became the a procedure safe, simple, cheap and easily reproductable more diffused among patients and professionals, especiallyby a topical therapy. The evaluation of the pain after the use of sodium aqueous heparin solution in spray (ALIMAX®), utilized for topical treatment in burns, and its comparison to the distilled water, utilized by the same way, was studied in 12 patients after the medium-depthpeeling with trichloroacetic acid (TCA) 30% on face.

Standard guidelines of care for chemical peels.

Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. PHYSICIANS' QUALIFICATIONS: The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. FACILITY: Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. PREOPERATIVE COUNSELING AND INFORMED CONSENT: A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient's skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. ENDPOINTS IN PEELS: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner's solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. Postoperative care includes sunscreens and moisturizers Peels may be repeated weekly, fortnightly or monthly, depending on the type and depth of the peel.

Efficacy of trichloroacetic acid peel in the treatment of facial melasma

Modern medical exfoliation with trichloroacetic acid [TCA] formulas began in 1926, today TCA peels are used to treat a multitude of cutaneous disorders. Melasma is a common pigmentary disorder characterized by the development of slowly enlarging tan-brown macules and patches. Thirty female patients with moderate to severe facial epidermal melasma were included in the present study. Patients' melasma was treated by application of 35% trichloroacetic acid peel once which may be repeated for the second time after 3 months depending on the clinical results after peeling. All patients were followed up once weekly during the first month, then monthly for a total of 6 months. Improvement ranged between excellent to fair, 20% of patients required second [TCA] application after 3 months from the first

Ceratoacantoma após peeling profundo com fenol / Keratoacanthoma development after deep phenol peeling

O peeling químico profundo com fenol é uma técnica utilizada para intensa esfoliação cutânea para posterior renovação celular. Está indicado nos tratamentos de rugas faciais e para homogeneização da pigmentação da pele. Relata-se um caso em que a paciente, em tratamento com fenol, desenvolveu ceratoacantoma de face.

The deep phenol peeling consists in a technique used to cause an intense facial exfoliation and further cellular regeneration. It is indicated to treat of facial wrinkles and to make homogeneous the skin pigmentation. A case in which a patient submitted to fenol treatment developed a facial keratoacanthoma is decribed.