Estimulación facial con factores de crecimiento plaquetario en consulta de Dermatología / Facial stimulation with platelet growth factors in Dermatology consultation

RESUMEN El envejecimiento es un proceso complejo que trae consigo cambios celulares, histológicos y cutáneos. Estos últimos son una de sus manifestaciones más evidentes. El plasma rico en plaquetas es una fuente fiable de obtención de células para regenerar tejidos; por su fácil disponibilidad es un material inocuo. La bioestimulación con el mismo, por su parte, es un conjunto de procedimientos para activar las funciones anabólicas de los fibroblastos, producción de colágeno, elastina y ácido hialurónico. La tendencia al empleo de este en tratamientos antiedad es cada vez mayor. El objetivo de este trabajo fue realizar una actualización del tema, para exponer aspectos importantes sobre formas de aplicación, indicaciones, complicaciones y contraindicaciones. Existen varios métodos para la bioestimulación facial, tales como la realización de pápulas, napagge y retroinyección. Se han empleado en alopecia androgénica, areata, envejecimiento cutáneo, etc. Las complicaciones más observadas son dolor, eritema, ardor y sangrado local. Entre las contraindicaciones más comunes se observan el herpes simple recidivante, coagulopatías, tratamiento con anticoagulantes, colagenopatías y neoplasias (AU).

ABSTRACT Aging is a complex process that brings with it cellular, histological and cutaneous changes, the latter being one of its most obvious manifestations. Platelet-rich plasma is a reliable source of cells to regenerate tissues; due to its easy availability, it is a harmless material. Bio-stimulation with it is a set of procedures to activate the fibroblasts anabolic functions and the production of collagen, elastin and hyaluronic acid. The tendency to use it in anti-aging treatments increases faster and faster. The objective of this work was updating the topic to expose important aspects about application methods, indications, complications and contraindications. There are several methods of applying facial bio-stimulation such as performing papules, napagge, and retroinjection. It has been used in androgenic alopecia, alopecia areata, cutaneous ageing, etc. The most commonly found complications are pain, erythema, burning and local bleeding. The most common contraindications include recidivist herpes simplex, coagulopaties, anticoagulant treatment, collagen-related diseases and neoplasms (AU).

Efectos terapéuticos de la crioterapia con nitrógeno líquido en lesiones por fotodaño, en la consulta dermatológica / Therapeutic effects of cryotherapy with liquid nitrogen in lesions by photo damage in dermatologic consultation

RESUMEN La crioterapia es el conjunto de procedimientos que utilizan el frío en la terapéutica médica. Emplea diversos sistemas y tiene como resultado la disminución de la temperatura de la piel; produce una destrucción local de tejido de forma eficaz y controlada. El objetivo de este trabajo fue realizar una actualización para exponer los aspectos esenciales sobre formas de empleos, indicaciones, complicaciones y contraindicaciones. Existen varios métodos de aplicación de la crioterapia, que incluyen las técnicas de congelación de spray o aerosol y con aplicadores, el método criosonda, y el uso de termoacoplador. Está indicada en varias entidades, entre las que se encuentran la queratosis seborreica y actínica, lentigos solares, carcinoma basocelular y espinocelular in situ. Las complicaciones más observadas son vesicoampollas, hiperpigmentación e hipopigmentación, y las contraindicaciones comunes son intolerancia al frío, tumores con bordes no delimitados o con pigmentación muy oscura, en localizaciones cerca de los márgenes de los ojos, párpados, mucosas, alas nasales y el conducto auditivo. El dominio de los métodos de aplicación e indicaciones es indispensable para elegir la conducta adecuada; de esta forma se evitan complicaciones y efectos colaterales (AU).

ABSTRACT Cryotherapy is the whole of procedures that use cold in medical therapy. It uses various systems and results in a decrease in skin temperature, leading to a local destruction of tissue in an effective and controlled way. The objective of this work is to make an update to expose the essential aspects on the ways of use, indications, complications and contraindications. There are several cryotherapy application methods that include spray or spray freezing techniques and applicators, the cryoprobe method, and the thermocoupler use. It is indicated in several entities, and among the most frequent are seborrheic and actinic keratosis, solar lentigo, basal cell and squamous cell carcinomas in situ. The most observed complications are vesical blisters, hyperpigmentation and hypopigmentation, and the most common complications are: cold intolerance, tumors with non-delimited borders or very dark pigmentation, located near the margins of the eyes, on eyelids, mucous membranes, nasal wings, and on the ear canal. The mastery of the signs and application methods are essential to choose the appropriate behavior against the disease: side effects and complications are avoided that way (AU).

Tratamento a laser para estrias de distensão: revisão bibliográfica / Laser treatment for stretch marks: a literature review

Estrias de distensão são cicatrizes na derme que constrangem os pacientes e oferecem desafios ao tratamento clínico. Resultam do rápido estiramento da pele, frequentemente presente em adolescentes, gestantes, obesos e indivíduos com rápida mudança de peso. Apresentam-se inicialmente como placas eritematosas e edemaciadas (estrias rubras) e, conforme amadurecem, tornam-se esbranquiçadas e atróficas (estrias albas), devido à degradação e reorganização de fibras de elastina e de colágeno. Atualmente, lasers representam modalidade terapêutica não invasiva emergente, que já demonstrou sucesso na redução da vascularização excessiva das estrias rubras, e no estímulo à produção de colágeno e elastina nas albas. Foi realizada revisão da literatura no PubMed referente ao tratamento de estrias atróficas com laser de janeiro de 2000 até dezembro de 2016. Os autores encontraram 28 artigos que se enquadraram nos critérios de inclusão. Existem poucos estudos clínicos randomizados avaliando a eficácia ao longo prazo e a segurança de aparelhos à base de energia. Baseado em casos clínicos e revisões sistemáticas, ambos os lasers - ablativo e não ablativo - fracionados demonstraram melhora modesta do aspecto das estrias distensas. Há tendência a sugestão do laser não ablativo fracionado de 1.540 nanômetro como sendo opção de primeira escolha para tratamento das estrias distensas. Porém, estudos futuros devem focar em desenhos de pesquisa com duração mais longa, medidas objetivas e padronizadas da avaliação dos resultados como biópsias e estudos moleculares, que demonstrem aumento nas fibras elásticas e fibras de colágeno, que correlacionem com a melhora do aspecto clínico das estrias após aplicação de lasers com parâmetros sistematizados.

Stretch marks are scars on the dermis that cause patients to be self-conscious and that pose challenges in clinical treatment. They result from rapid stretching of the skin and often observed in adolescents, pregnant women, obese individuals, and people experiencing rapid change in weight. They initially appear as erythematous and edematous plaques (red striae), and as they mature, they become whitish and atrophic (striae alba) due to the degradation and reorganization of elastin and collagen fibers. Currently, laser treatment is an emerging noninvasive therapeutic modality that is successful in reducing the excessive vascularization of red striae and in stimulating the production of collagen and elastin in the alba. In the present literature review, PubMed was searched for articles on the treatment of atrophic striations with laser that were published from January 2000 to December 2016. The authors have found 28 articles that met the inclusion criteria. Only few randomized clinical trials have evaluated the long-term efficacy and safety of energybased treatments. Based on clinical cases and systematic reviews, both ablative and non-ablative fractional lasers caused moderate improvement in the appearance of distending striae. The 1540-nm non-ablative fractional laser is more likely to be considered the first-line treatment for stretch marks. However, future studies should focus on research with longer duration, studies with objective and standardized measures for the evaluation of results, such as biopsy results, and molecular studies showing an increase in elastic and collagen fibers that correlate to the improvement in the clinical appearance of the striae after using lasers with systematized parameters.

Afecciones de hemangiomas cutáneos en la infancia registrados en Villa Clara desde 2012 hasta 2015 / Cutaneous hemangiomas in children, registered in Villa Clara from 2012 to 2015

Introducción: los hemangiomas son el tumor cutáneo más común en la infancia. Se clasifican dentro de las anomalías vasculares congénitas. Objetivo: identificar el comportamiento clínico-epidemiológico y resultados terapéuticos de los hemangiomas en pacientes atendidos en el Hospital Infantil "José Luis Miranda" de Santa Clara, Villa Clara en el período 2012-2015. Materiales y Métodos: se empleó el método bibliométrico y técnicas de visualización y representación de información. El estudio clasifica como descriptivo de tipo longitudinal retrospectivo. El universo lo constituyó todos los niños con hemangiomas cutáneos atendidos en el Hospital Infantil "José Luis Miranda", de Villa Clara. Las variables que se analizaron fueron: edad, tipo de lesión, localización, complicaciones, afecciones por sexo, raza, antecedentes familiares del padecimiento, así como el tratamiento prescripto y su evaluación. Resultados: se determinaron las afecciones por raza, edad, sexo y antecedentes familiares de los infantes. Se estudiaron las lesiones por tipos y complicaciones. El comportamiento de las afecciones de hemangiomas cutáneos en la infancia registrada en Villa Clara, entre los años 2012 y 2015, coincide con criterios descritos por varios especialistas e investigadores de esta afección. Conclusiones: se corroboró que el sexo femenino, niños menores de 1 año y de piel blanca, fueron los pacientes afectados con mayor regularidad. Se identificó que las lesiones se localizaron con mayor frecuencia en cara, cuero cabelludo y tronco. Los tratamientos más efectivos fueron la cirugía, electrodesecación y los esteroides locales y sistémicos (AU).

Introduction: hemangiomas are the most common cutaneous tumor in the childhood. They are classified among the congenital vascular anomalies. Objective: to identify the clinic-epidemiological behavior and therapeutic outcomes of the hemangiomas attended in the Infantile Hospital "Jose Luis Miranda", of Santa Clara, Villa Clara, in the period 2012-2015. Materials and Methods: the bibliographic method and techniques of information visualization and representation were used. The study classifies as retrospective, descriptive of longitudinal type. The universe was composed by all the children with cutaneous hemangiomas attended at the Infantile Hospital "José Luis Miranda", of Villa Clara. The analyzed variables were: age, kind of lesion, location, complications, conditions by sex, race, and family antecedents and also the prescribed treatment and evolution. Results: the conditions were determined by the children´s race, age, sex and family antecedents. Lesions were studied according to their kind and complications. The behavior of the cutaneous hemangiomas in childhood registered in Villa Clara between 2012 and 2015 agree with the criteria described by several specialists and researchers of this condition. Conclusions: it was corroborated that the patients more regularly affected were the female, white ones, aged less than a year. Lesions were located more frequently on the face, the scalp and the trunk. The most effective treatments were surgery, electro-desiccation and local and systemic steroids (AU).

Epidermólisis bullosa: piel de mariposa. A propósito de un caso / Epidermolysis bullosa: butterfly skin. Apropos of a case

La epidermólisis bullosa comprende un grupo heterogéneo de enfermedades ampollosas de la piel y las mucosas, son de origen congénito y hereditario. Hacer el diagnóstico no es difícil si se tiene experiencia dermatológica, pero su clasificación es compleja y para ello se necesita considerar la clínica, la genética, la microscopia y la evaluación de laboratorio. El tratamiento de esta enfermedad es también dificultoso y son necesarias ciertas medidas, para proteger al paciente, evitar la aparición de lesiones y las complicaciones derivadas de ellas. Se describe el tratamiento de estas lesiones en un recién nacido, al que se administraron antibióticos profilácticos y se colocaron vendajes en las lesiones. Se describieron todos los cuidados y recomendaciones para evitar, especialmente los roces y las presiones en estas lesiones, así como las temperaturas altas. Para la confección del presente trabajo se consultaron 18 materiales entre revistas y libros de Pediatría. El caso reportado fue un recién nacido con epidermólisis bullosa atendido en el Hospital Universitario "Dr. Mario Muñoz Monroy" de Colón, Matanzas. Se demostró lo poco frecuente y raro de esta patología para los especialistas del tema (AU).

The epidermolysis bullosa includes a heterogeneous group of bullous skin and mucous diseases of congenital and hereditary origin. Diagnosing them is not difficult if the specialist has dermatologic experience, but their classification is complex and it is necessary to take into account the clinical, genetic and microscopic factors, and the laboratory assessment. The treatment of this disease is also difficult and it is necessary to take certain measures to protect the patient, avoid the onset of lesions and the complications derived from them. The treatment of these lesions in a newborn is described. Prophylactic antibiotics were administered and bandages were put on the lesions. All the cares and recommendations to avoid rubbings and pressures on these lesions, and also the high temperatures, are described. To develop the current term, 18 materials (journals and pediatric books) were consulted. The reported case was the case of a newborn with epidermolysis bullosa attended in the University Hospital "Dr. Mario Muñoz Monroy" of Colon, Matanzas. It was demonstrated the low frequency and rarity of this pathology for the specialists of the theme (AU).

Stability-indicating RP-LC method for quantification of fusidic acid in cream

ABSTRACT Fusidic acid is an antibiotic steroid indicated for the treatment of infections caused by the genus Staphylococcus, including methicillin resistant Staphylococcus aureus strains, and other Gram-positive bacteria. In the present study, a stability-indicating reversed-phase liquid chromatography (RP-LC) method was developed and validated for the determination of fusidic acid in dermatological cream as an alternative to existing methods. Analyses were performed using a C18 column and guard column at room temperature, eluting with an isocratic mobile phase of acetonitrile and water (72:28, v/v), adjusted to pH 3.5 with acetic acid, pumped at a flow rate of 1.0 mL min-1, detection at 210 nm and 20 µL of injection volume. The forced degradation study was conducted under acidic, alkaline, neutral, photolytic, and oxidative stress conditions. The method was validated according to ICH and FDA guidelines; it was linear, precise, accurate, selective, and robust over concentrations of 5-95 µg mL-1, with detection and quantification limits of 0.43 and 1.31 μg mL-1, respectively. Therefore, we conclude that this method is suitable for quantifying fusidic acid in pharmaceutical dermatological creams and determining its stability, representing a more economical and practical alternative for routine analysis in quality control.

High frequency ultrasound with color Doppler in dermatology

Abstract: Ultrasonography is a method of imaging that classically is used in dermatology to study changes in the hypoderma, as nodules and infectious and inflammatory processes. The introduction of high frequency and resolution equipments enabled the observation of superficial structures, allowing differentiation between skin layers and providing details for the analysis of the skin and its appendages. This paper aims to review the basic principles of high frequency ultrasound and its applications in different areas of dermatology.

Nocebo effect in dermatology.

Nocebo effect, originally denoting the negative counterpart of the placebo phenomenon, is now better defined as the occurrence of adverse effects to a therapeutic intervention because the patient expects them to develop. More commonly encountered in patients with a past negative experience, this effect stems from highly active processes in the central nervous system, mediated by specifi c neurotransmitters and modulated by psychological mechanisms such as expectation and conditioning. The magnitude of nocebo effect in clinical medicine is being increasingly appreciated and its relevance encompasses clinical trials as well as clinical practice. Although there is hardly any reference to the term nocebo in dermatology articles, the phenomenon is encountered routinely by dermatologists. Dermatology patients are more susceptible to nocebo responses owing to the psychological concern from visibility of skin lesions and the chronicity, unpredictable course, lack of ‘permanent cure’ and frequent relapses of skin disorders. While fi nasteride remains the prototypical drug that displays a prominent nocebo effect in dermatologic therapeutics, other drugs such as isotretinoin are also likely inducers. This peculiar phenomenon has recently been appreciated in the modulation of itch perception and in controlled drug provocation tests in patients with a history of adverse drug reactions. Considering the confl ict between patients’ right to information about treatment related adverse effects and the likelihood of nocebo effect stemming from information disclosure, the prospect of ethically minimizing nocebo effect remains daunting. In this article, we review the concept of nocebo effect, its postulated mechanism, relevance in clinical dermatology and techniques to prevent it from becoming a barrier to effective patient management.

Teledermatology protocol for screening of Skin Cancer

BACKGROUND: Telemedicine refers to the use of technology as improvement of healthcare delivery to places where distance becomes an obstacle. Its use represents a great potential for dermatology, a specialty whose visual analysis phase is essential in diagnosis. OBJECTIVES: To analyze the compatibility index of skin cancer diagnoses between primary care and teledermatology, and to validate a protocol for standardization of digital imaging to obtain the reports in teledermatology. METHODS: An observational cross-sectional study developed through the census of 333 examination requests, received between January/2012 and July/2012, in the Center for Telemedicine and Telehealth of SES-SC. We used a protocol for photographic lesion standardization, consisting of three steps (panoramic photo, close-up with ruler and dermoscopy). After collection, the data were sent to a virtual site on the Internet, and recorded with the use of an electronic health record containing the images, the skin phototype and demographic characteristics. RESULTS: The level of compatibility between the diagnosis of skin cancer in Santa Catarina's primary care and the diagnosis proposed by teledermatology was 19.02%. Proportionally, it was 21.21% for BCC, 44.44% for SCC and 6.98% for MM. The protocol was statistically significant (p <0.05), with an OR of 38.77. CONCLUSION: The rate of diagnostic compatibility of skin cancer was low and the use of the protocol optimized the chance of validating requests for examination. .

Teledermatología: experiencia en un centro de salud familiar urbano chileno / Teledermatology: experience in a chilean urban Family Health Center

INTRODUCCIÓN: Los problemas dermatológicos son un importante motivo de consulta en Atención Primaria de Salud (APS). Existe una extensa lista de espera para la evaluación especializada. La teledermatología (TD) se implementó para soslayar esta situación. OBJETIVOS: Describir atenciones de TD y determinar concordancia diagnóstica inter observador entre médico general de APS y dermatólogo. MATERIALES Y MÉTODO: Estudio descriptivo, transversal, de concordancia inter observador. Los criterios de inclusión fueron: pertenencia del usuario al registro del Centro de Salud Familiar (CESFAM) "Jean y Marie Thierry" de Valparaíso y registro en el programa de TD. Se excluyeron atenciones de control. La población considerada corresponde a todas las atenciones realizadas entre marzo de 2014 a julio de 2015. Las variables cuantitativas fueron descritas con media y desviación estándar; las variables cualitativas con frecuencia y porcentajes. Se determinó concordancia con el test Kappa. Se consideró estadísticamente significativo un valor p menor a 0,05. RESULTADOS: Se incluyeron 147 atenciones: 84 (57%) se realizaron a usuarios de sexo femenino. Los usuarios presentaron una media de edad de 46 años (desviación estándar de 25 años). En 112 atenciones (76%) no fue necesaria la evaluación presencial por especialista. Los diagnósticos más frecuentes en APS fueron acné, psoriasis y rosácea; a través de TD fueron psoriasis y acné. Se obtuvo un coeficiente Kappa de 0,65 (IC 95% 0,6-0,67) con valor p<0,05. DISCUSIÓN: Existen pocos trabajos similares en Chile. Los resultados son similares a otros trabajos. En el contexto descrito resulta conveniente la baja proporción de usuarios que requirieron evaluación especializada

Alterações dermatológicas na gravidez: revisão da literatura / Skin changes in pregnancy: literature review

Durante o período gestacional ocorrem profundas alterações imunológicas, metabólicas, endócrinas e vasculares, que são responsáveis por alterações cutâneas, fisiológicas e patológicas. O objetivo deste artigo foi verificar as alterações dermatológicas que ocorrem durante a gravidez. Para isso, foi realizada uma revisão da literatura, de artigos publicados entre 1982 e 2013, indexados no PubMed e SciELO. Em relação a pele, os achados indicam que as alterações gestacionais são divididas em: alterações fisiológicas gestacionais, dermatoses específicas e dermatoses alteradas na gestação. Este apanhado engloba as características clínicas e o prognóstico das alterações fisiológicas da pele durante a gravidez, as dermatoses influenciadas pela gravidez e as dermatoses específicas da gravidez.(AU)

During pregnancy, deep immunological, metabolic, endocrine and vascular changes responsible for physiological and pathological skin changes occur. The objective of this paper was to check the skin changes that occur during pregnancy. For this, a literature review of articles published between 1982 and 2013, indexed in PubMed and SciELO was performed. Regarding the skin, the findings indicate that gestational changes are divided into gestational physiologic changes, specific skin diseases and skin conditions changed during pregnancy. This overview covers the clinical features and prognosis of physiological skin changes during pregnancy, dermatoses affected by pregnancy specific dermatoses of pregnancy.(AU)

Patient-assisted teledermatology practice: What is it: When, where, and how it is applied.

Recent teledermatology practice has been focused on different models made possible by robust advances in information technology leading to consistent interaction between the patient and health care professionals. Patient-assisted teledermatology practice also called patient-enabled teledermatology or home based teledermatology is one such novel model. There is a lack of scientifi c literature and substantive reviews on patient-assisted teledermatology practice. The present article reviews several studies and surveys on patientassisted teledermatology practice and outlines its advantages and barriers to clinical utility and analyses the potentiality of this concept. Incorporating patient-assisted teledermatology practice as a novel model in the revised classifi cation of teledermatology practice is proposed. In patient-assisted teledermatology, the patient can upload his/her clinical images as a fi rst contact with the dermatologist or an initial face-to-face examination can be followed by teledermatology consultations. The latter method is well suited to chronic diseases such as psoriasis, vitiligo, and leg ulcers, which may need frequent follow-up entailing signifi cant costs and time, particularly in the elderly. Teledermatology may also be used by the treating dermatologist to seek expert opinion for diffi cult cases. Studies have demonstrated the importance and usability of the concept of patient-assisted teledermatology practice. Various teledermatology care models are available and the appropriate model should be chosen depending on whether the clinical situation is that of easily diagnosed cases (“spotters”), chronic cases or doubtful cases and difficult-to-manage cases.

A case of stings in humans caused by Sclerodermus sp. in Italy

In the last years, stings of Sclerodermus species in humans have been sporadically reported in Italy. In order to draw attention to these bethylid wasps of medical importance, we report the case of documented Sclerodermus sp. stings on the dorsum, abdomen, arms, and thighs of a 40-year-old man and his wife. The sting sites developed raised red itchy rash. The source of environmental contamination was identified in a worm-eaten sofa purchased from a used furniture dealer and placed in the living room about a month and half earlier. The lesions on the man and his wife rapidly healed within 3 to 4 days once they left the house and treatment for the lesions was instituted. Physicians, dermatologists, medical and public health entomologists, as well as specific categories of workers should be aware of the risk of exposure to Sclerodermus stings.

A case of stings in humans caused by Sclerodermus sp. in Italy

In the last years, stings of Sclerodermus species in humans have been sporadically reported in Italy. In order to draw attention to these bethylid wasps of medical importance, we report the case of documented Sclerodermus sp. stings on the dorsum, abdomen, arms, and thighs of a 40-year-old man and his wife. The sting sites developed raised red itchy rash. The source of environmental contamination was identified in a worm-eaten sofa purchased from a used furniture dealer and placed in the living room about a month and half earlier. The lesions on the man and his wife rapidly healed within 3 to 4 days once they left the house and treatment for the lesions was instituted. Physicians, dermatologists, medical and public health entomologists, as well as specific categories of workers should be aware of the risk of exposure to Sclerodermus stings.

Análise do tratamento do carcinoma basocelular / Analysis of basal cell carcinoma treatment

Introdução: O câncer de pele na população brasileira é a neoplasia mais comum. Localiza-se com mais frequência na face, causando morbidade tanto funcional quanto estética aos pacientes. O tratamento consiste na ressecção oncológica da lesão, preservando a função com a menor deformidade possível. O câncer de pele mais comum é o carcinoma basocelular (CBC), correspondendo entre 70-80% dos casos. Método: Avaliamos retrospectivamente 73 pacientes com 95 carcinomas basocelulares no período de março de 2010 a maio de 2012. Foram analisados os seguintes critérios: idade, sexo, cor, comorbidades, exposição solar, presença de consulta prévia com dermatologia, localização da lesão, tamanho da lesão, tipo clínico, tipo histológico, tipo de reconstrução, complicações cirúrgicas, margem cirúrgicas, conduta na margem cirúrgica comprometida, anatomopatológico após reintervenção, presença de recidiva e aparecimento de outra lesão primária no mesmo paciente. Resultados: A idade média foi de 60,73 anos. O sexo feminino correspondeu a 56,16%. A Exposição solar foi referida em 73,97% dos casos. O tamanho médio da lesão foi 0,91 cm. O local mais frequente foi a face (71,58%). O retalho local foi utilizado em 54,74% dos casos. O CBC sólido circunscrito foi o mais frequente. As margens comprometidas ocorreram em 8,42% dos casos, demonstrando relação com lesões maiores de 2cm e com o nariz sem significância estatística. Conclusão: No tratamento do carcinoma basocelular é importante a participação do cirurgião plástico, objetivando a ressecção sob princípios oncológicos, realizando a reparação da área afetada, a manutenção funcional e a menor alteração estética possível.

Introduction: Skin cancer is the most common neoplasm in the Brazilian population. It most frequently presents on the face, causing functional and aesthetic morbidity in patients. Its treatment consists in resection of the lesion while preserving the skin's function with the least possible deformity. The most common skin cancer is basal cell carcinoma (BCC), representing 70­80% of all cases. Methods: We retrospectively evaluated 73 patients with 95 BCCs from March 2010 to May 2012. The following characteristics were analyzed: age, sex, skin color, comorbidities, sun exposure, prior dermatological consultation, lesion site, lesion size, clinical type, histological type, reconstruction type, surgical complications, surgical margins, management of compromised surgical margins, anatomical pathology after reintervention, recurrence, and appearance of another primary lesion in the same patient. Results: The mean age of the patients was 60.73 years. Female patients accounted for 56.16%. Sun exposure was reported in 73.97% of patients. The mean lesion size was 0.91 cm, and the most common lesion site was the face (71.58%). A local flap was used in 54.74% of cases. Circumscribed solid BCC was the most common type. Compromised margins occurred in 8.42% of cases, demonstrating a relation between lesions >2 cm and the nose but without statistical significance. Conclusion: The plastic surgeon plays an important role in the treatment of BCC, aiming to perform resection following oncological principles, repair the affected area, and maintain the skin's functionality with the least possible cosmetic alterations.

Acitretin in dermatology.

Acitretin, a synthetic retinoid has gradually replaced etretinate in today’s dermatologic practice because of its more favorable pharmacokinetics. Acitretin over the past 20 years has proven useful in a number of diffi cult-to-treat hyperkeratotic and infl ammatory dermatoses and nonmelanoma skin cancers. It is effective both as monotherapy and in combination with other drugs for hyperkeratotic disorders. It is considered to be an established second line treatment for psoriasis and exerts its effect mainly due to its antikeratinizing, antiinfl ammatory, and antiproliferative effect. Its antineoplastic properties make it a useful agent for cancer prophylaxis. Evidence-based effi cacy, side-effect profi le, and approach to the use of acitretin would be discussed in this review. In addition to its approved uses, the various off label uses will also be highlighted in this section. Since its use is limited by its teratogenic potential and other adverse effects, including mucocutaneous effects and hepatotoxicity, this review would summarize the contraindications and precautions to be exercised before prescribing acitretin.