Antioxidants in dermatology

Abstract The skin cells continuously produce, through cellular respiration, metabolic processes or under external aggressions, highly reactive molecules oxidation products, generally called free radicals. These molecules are immediately neutralized by enzymatic and non-enzymatic systems in a physiological and dynamic balance. In situations where this balance is broken, various cellular structures, such as the cell membrane, nuclear or mitochondrial DNA may suffer structural modifications, triggering or worsening skin diseases. several substances with alleged antioxidant effects has been offered for topical or oral use, but little is known about their safety, possible associations and especially their mechanism of action. The management of topical and oral antioxidants can help dermatologist to intervene in the oxidative processes safely and effectively, since they know the mechanisms, limitations and potential risks of using these molecules as well as the potential benefits of available associations.

The in vivo effect of L-arginine on skin elasticity in mice

ABSTRACT The human skin aging process is a complex mechanism that can be induced both by intrinsic and extrinsic factors. Observations include a decrease in the biosynthetic and proliferative capacity of cells, increased expression of matrix metalloproteinases, reduction in collagen type I expression, and the progressive disappearance of elastic tissue in the papillary dermis. L-arginine, the substrate of nitric oxide synthesis, is involved in angiogenesis and cell proliferation, as well as an indirect precursor of collagen synthesis via the proline pathway. The aim of this study was to examine the tensile strength, histology, and immunohistochemistry of female and male mice skin receiving different concentrations of topically applied L-arginine, in order to evaluate the possibility of using L-arginine as an active cosmetic ingredient in antiaging products. The results suggest that the application of L-arginine improves the mechanical resistance of skin from older female mice (20 weeks old) and promotes the formation of a larger amount of collagen and elastic fibers in the skin when applied at a concentration of 15%.

Use of silicon for skin and hair care: an approach of chemical forms available and efficacy

Abstract Silicon is the second most abundant element on Earth, and the third most abundant trace element in human body. It is present in water, plant and animal sources. On the skin, it is suggested that silicon is important for optimal collagen synthesis and activation of hydroxylating enzymes, improving skin strength and elasticity. Regarding hair benefits, it was suggested that a higher silicon content in the hair results in a lower rate of hair loss and increased brightness. For these beneficial effects, there is growing interest in scientific studies evaluating the efficacy and safety of using dietary supplements containing silicon. Its use aims at increasing blood levels of this element and improving the skin and its annexes appearance. There are different forms of silicon supplements available and the most important consideration to be made in order to select the best option is related to safety and bioavailability. Silicon supplements are widely used, though there is wide variation in silicon bioavailability, ranging from values below 1% up to values close to 50%, depending on the chemical form. Therefore, the aim of this study was to evaluate the scientific literature related to the different chemical forms of silicon supplements available and the limitations and recent progress in this field. According to reported studies, among the different chemical forms available, the orthosilicic acid (OSA) presents the higher bioavailability, whereas the others forms have absorption inversely proportional to the degree of polymerization. However, clinical studies evaluating safety and efficacy are still lacking.

Eyelid aging: pathophysiology and clinical management / Envelhecimento palpebral: fisiopatologia e considerações clínicas

ABSTRACTLife expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging. Dermatochalasis, ptosis, ectropion, and entropion are common disorders in middle-aged and older adults. This review outlines the pathophysiology and clinical management of these involutional eyelid disorders. Recently, a decrease in elastic fibers with ultrastructural abnormalities and an overexpression of elastin-degrading enzymes have been demonstrated in involutional ectropion and entropion. This may be the consequence of local ischemia, inflammation, and/or chronic mechanical stress. Eyelid aging with progressive loss of tone and laxity may affect the ocular surface and adnexal tissues, resulting in different clinical symptoms and signs. Surgical management depends on the appropriate correction of the underlying anatomical defect.

RESUMOA expectativa de vida está aumentando na maioria dos países. Com o envelhecimento, muitos indivíduos desenvolverão doenças oculares crônicas e involucionais, tais como o envelhecimento palpebral. Dermatocálase, ptose, ectrópio e entrópio são doenças frequentes em adultos e idosos. Esta revisão destaca a fisiopatologia e a clínica de doenças palpebrais involucionais. Recentemente, uma diminuição de fibras elásticas com anormalidades ultraestruturais e um aumento de enzimas degradantes de elastina foram demonstrados em ectrópio e entrópio involucionais. Isto pode ser consequência de isquemia local, inflamação e/ou estresse mecânico crônico. O envelhecimento palpebral com perda progressiva de tônus e flacidez pode afetar a superfície ocular e os anexos oculares, resultando em sinais e sintomas clínicos diferentes. O tratamento cirúrgico depende da correção apropriada do defeito anatômico subjacente.

Influência do envelhecimento na qualidade da pele de mulheres brancas: o papel do colágeno, da densidade de material elástico e da vascularização / Influence of aging on the skin quality of white-skinned women: the role of collagen, elastic material density, and vascularization

INTRODUÇÃO: O objetivo deste estudo é avaliar a influência do envelhecimento na qualidade da pele de mulheres brancas, analisando o colágeno, as fibras elásticas e a vascularização. MÉTODO: Foi realizada análise histológica e morfométrica de 218 retalhos pré-auriculares de mulheres brancas, que se submeteram a cirurgia estética facial. Foram utilizados o imunomarcador AntiCD 34, que evidencia os vasos sanguíneos, a coloração de Weigert, para visibilização das fibras elásticas, e a coloração de Picrosirius Ultrared, para analisar e quantificar os colágenos I, III e total. Os dados foram analisados de acordo com a faixa etárias das doadoras: < 40 anos, 40 anos a 49 anos, 50 anos a 59 anos, 60 anos a 69 anos, e > 70 anos. RESULTADOS: Foi observada fragmentação e desorganização das fibras de colágeno, especialmente acima de 60 anos. Não houve diferenças significantes entre a idade e a espessura da derme e da epiderme, porém foi identificada relação com as porcentagens de colágeno I, III e total (P < 0,001). Houve aumento da densidade de fibras elásticas com a progressão da idade (P < 0,001). Comparando-se as peles das pacientes de faixas etárias vizinhas, com diferença de uma década entre elas, não houve diferença significativa na quantidade de material elástico dessas peles; porém, ao se comparar aquelas com diferença de 2 ou mais décadas nas faixas etárias, o aumento foi significante (P < 0,05). A diferença do número de vasos não foi significante (P = 0,112). CONCLUSÕES: O envelhecimento promoveu redução do colágeno, degradação e fragmentação das fibras, e aumento da densidade de material elástico desorganizado, e não influenciou no número de vasos sanguíneos da derme.

BACKGROUND: In the present study, we aimed to evaluate the influence of aging on the skin quality of white-skinned women by assessing collagen levels, elastic material density, and vascularization. METHODS: Histological and morphometric analyses were performed on 218 preauricular skin fragments from white-skinned women who underwent facial cosmetic surgery. Anti-CD34 was used to identify the blood vessels, Weigert's staining was used to visualize elastic fibers, and Picro-sirius Ultra Red staining was employed for analyzing and quantifying the expression of type I, III, and total collagen. Data were analyzed according to the following donor age groups: < 40, 40-49, 50-59, 60-69, and > 70 years. RESULTS: Fragmentation and disorganization of collagen fibers were observed in certain samples, particularly in samples from patients aged > 60 years. Significant differences between age and the thickness of the dermis and epidermis were not detected. However, a relationship was identified between age and the percentages of type I, III, and total collagen, and an increase of elastic fibers density was associated with age progression (P < 0.001). The comparison of the skin of patients with a decade difference in age did not reveal a significant difference in the elastic material quality; however, when the age difference was of 2 decades or more, there was a significant difference in elastic fibers (P < 0.05). The difference in the number of blood vessels between the groups was not significant (P = 0.112). CONCLUSIONS: Aging promoted collagen reduction, fiber degradation and fragmentation, and increased disorganized elastic material density; however, it did not affect the number of dermal blood vessels.

Características de la piel del adulto mayor y condiciones dermatológicas asociadas a la edad: revisión de la literatura / Skin characteristics of the elderly and dermatological conditions associated with age: review

Consideramos adultos mayores a aquellas personas de 65 años o más. En el contexto de la transición demográfica experimentada durante los últimos años, tanto a nivel global como también en nuestro país, una cada vez más importante proporción de la población pertenece a este grupo etario. Al igual que en otros órganos, el proceso de envejecimiento tiene sus repercusiones a nivel cutáneo. Se experimentan cambios importantes en la estructura y en distintas funciones de la piel, como por ejemplo, en la permeabilidad, angiogénesis, la función de barrera, la lipogénesis, función inmune, cicatrización, la capacidad de producir vitamina D y la sudoración. El rol del daño acumulativo por radiación UV y otras noxas ambientales tiene especial relevancia en estas alteraciones. Lo anterior contribuye a que la población geriátrica presente con mayor frecuencia ciertas condiciones cutáneas o afecciones dermatológicas, como xerosis, dermatitis de contacto, úlceras por presión, alteraciones ungueales, alopecia, las reacciones adversas a medicamentos y las enfermedades ampollares. Considerando el aumento en número de estos pacientes, su mayor complejidad en términos globales y la alta prevalencia de patologías dermatológicas de este grupo etario, es relevante mantener actualizados nuestros conocimientos sobre los problemas dermatológicos más relevantes en el adulto mayor y su tratamiento, razón por la cual hemos realizado esta revisión de la literatura.

Geriatric population consider those individuals of 65 years or older. In the context of demographic transition in recent years, both globally and in our country, an increasingly large proportion of the population belong to this age group. As in other organs, the aging process has its effects on the skin. Important changes occur in the structure and various functions of the skin, such as the permeability, angiogenesis, barrier function, lipogenesis, immune function, wound healing, the ability to produce vitamin D, and sweating. The role of cumulative UV damage and other environmental noxas is particularly relevant in these alterations. This contributes to the fact that geriatric population present most frequently certain skin conditions such as xerosis, contact dermatitis, pressure ulcers, nail changes, alopecia, adverse drug reactions and bullous diseases. Considering the increasing number of these patients, the over complexity in global terms and the high prevalence of dermatological diseases in this age group, it is important to keep updated our knowledge about the most important dermatological problems in the elderly and its treatment; that is the reason why we conducted this review.

Influence of aging on the quality of the skin of white women: the role of collagen / Influência do envelhecimento na qualidade da pele de mulheres brancas: o papel do colágeno

PURPOSE: Evaluate the influence of aging on the quality of the skin of white women, analyzing the dermal collagen. METHODS: Pre-auricular flaps were collected for histological and morphometric analysis of 218 white women who underwent spontaneous facial aesthetic plastic surgery. Picrosirius ultrared stain was used for analysis and quantification of collagen in five age groups (<40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years and 70 to 79 years) . RESULTS: Histological analysis showed changes suggestive of skin aging (fragmentation and disorganization of collagen fibers), especially in patients over 60 years. There were no significant changes in the relationship of age with the thickness of the dermis and epidermis, but there was with the percentage of the collagen I, III and total (p<0.001), which decreased with increasing aging. CONCLUSION: There is reduction in collagen with increasing age, and an increase in its degradation, leading to fragmentation of the fibers.

OBJETIVO: Avaliar a influência do envelhecimento na qualidade da pele de mulheres brancas analisando o colágeno dérmico. MÉTODOS: Realizou-se análise histológica e morfométrica de 218 retalhos pré-auriculares de mulheres brancas que se submeteram espontaneamente à cirurgia estética facial. Foi usada a coloração de Picrosirius Ultrared para analisar e quantificar os colágenos I, III e total em cinco grupos etários (<40 anos, 40 a 49 anos, 50 a 59 anos, 60 a 69 anos e 70 a 79 anos). RESULTADOS: A análise histológica mostrou alterações sugestivas de envelhecimento cutâneo (fragmentação e desorganização das fibras de colágeno), especialmente em pacientes acima de 60 anos. Não houve diferenças significantes entre a idade e a espessura da derme e da epiderme, mas houve diferenças significantes entre as percentagens de colágeno I, III e total (p<0,001) com o aumento da idade. CONCLUSÃO: Existe redução do colágeno com o aumento da idade e um aumento na sua degradação, levando à fragmentação das fibras.

Dermatosis frecuentes en pacientes geriátricos de la ciudad de Matanzas / Frequent dermatosis in geriatric patients of Matanzas

Introducción: las enfermedades dermatológicas a pesar de no constituir causa de mortalidad dentro la población cubana, es uno de los factores generadores de morbilidad apreciados con frecuencia en los adultos mayores, con gran repercusión estética y posibilidad de malignización.Objetivo: definir las dermatosis frecuentes en los pacientes geriátricos de la ciudad de Matanzas.Métodos: diseño: estudio observacional, descriptivo, transversal. Universo: conformado por 25 377 adultos mayores, pertenecientes a las siete áreas de salud de la ciudad de Matanzas. Muestra: 380 pacientes geriátricos portadores de afecciones dermatológicas. Variables: sexo, edad, color de la piel, fototipo cutáneo, nivel de escolaridad.Resultados: se detectó como promedio un 7,6 por ciento de afecciones dermatológicas en los casos del estudio; predominó el sexo femenino, y el grupo etario comprendido entre 60 a 64 años de edad. Prevalecieron los pacientes de piel blanca y del fototipo cutáneo II, con un nivel de escolaridad bajo (secundario)

Introduction: although the dermatological diseases are not a cause of mortality among the Cuban population, they are one of the factors generating morbidity that are frequently appreciated in elder people, with a great esthetic repercussion and possibility of getting malignant. Objective: to define the frequent dermatosis in geriatric patients of Matanzas.Methods: design: Cross-sectional, descriptive, observational study.Universe composed by 25 377 elder people of seven health areas of Matanzas. Sample: 380 geriatric patients carrying dermatologic diseases. Variables: genre, age, race, skin phototype, scholarship. Results: we found an average of 7,6 per cent of dermatologic diseases in the cases studied; there it was a predominance of the female genre and of the age group from 60 to 64 years old. There it was also a prevalence of the white skin and the skin phototype II, with a low scholarship (junior high school)

Dermatomicosis en ancianos institucionalizados y estudios de sensibilidad in vitro a los antifúngicos sistémicos / Dermatomycosis in institutionalized elderly patients and in vitro sensitivity study to systemic antifungus

Se determinó la prevalencia de dermatomicosis en ancianos institucionalizados de Ciudad Bilívar, Estado Bolívar, Venezuela, y se evaluó la sensibilidad in vitro de los aislamientos clínicos a los antifúngicos itraconazol, fluconazol y terbinafina mediante el método de microdilución en medio líquido, recomendado por el Comité Internacional de Laboratorios Clínicos (M38-P), con algunas modificicaciones. Los hongos fueron identificados mediante métodos tradicionales. Las levaduras se identificaron mediante pruebas bioquímicas, sistema Api 20 C AUX (Biomérieux SA®, France) y crecimiento en medio de Staib. Se estudiaron 74 ancianos, todos recluidos en el Asilo "San Vicente de Paúl" y el Geriátrico "Carlos Fragachán" quienes dieron consentimiento por escrito para participar en el estudio. La edad de los pacientes estuvo comprendida entre 63 y 98 años (80 ± 8,4 años), la mayoría eran hombres (73%). Todos los pacientes tenían lesiones sugestivas de onicomicosis en los pies. El único dermatofito aislado fue Trichophyton rubrum (n=2) el cual resultó sensible al Itraconazol, terbinafina y sensibilidad variable a flucozazol. Asimismo se logró aislar Aspergillus niger (n=5; 6,7%) demostrándose sensible a terbinafina y fluconazol con sensibilidad variable a itraconazol. Candida albicans (n=3; 4,1%) fue sensible a fluconazol, resistentes a itraconazol y variable a la terbinafina. Aspergillus flavus fue aislado en dos casos (2,7%). Además de Geomyces sp, Fusarium oxysporum y Pseudeurotium ovale. Se concluye que existe una prevalencia baja de dermatomicosis en los ancianos institucionalizados de Ciudad Bolívar y que las lesiones clinicamente observadas son debidas a los cambios degenerativos propios de la edad.

A study determine prevalence of dermatomycosis in 74 institutionalized elderly patients was conductted in Ciudad Bolivar, state of Bolivar, Venezuela. Clinical isolates were assayed for in vitro sensitivity to itraconazole, fluconazole, and terbinafine using a slightly modified version of the microdilution method in liquid medium recommended by the International Committee of Clinical Laboratory (M38-P). Traditional methods were used to identify the fungi. The yeasts were identified by Api 20C AUX biochemical testing (bioMérieux SA®, France) and growth on Staib media. The elders, mostly men (73%), from the "San Vicente de Paúl" Nursing Home and the "Carlos Fragachan" Geriatric Hospital, were aged between 63 and 98 (80 ± 8.4 years). All the patients, whose written consent was secured, had lesions suggestive of onychomycosis. Trichophyton rubrum was the only isolated dermatophyte (n=2), which resulted sensitive to itraconazole and terbinafine, with variable sensitivity to fluconazole. Aspergillus niger (n=5;6.7%) was sensitive to terbinafine and fluconazole with variable itraconazole sensitivity. Candida albicans (n=3; 4.1%) was fluconazole sensitive, resistant to itraconazole, and variable to terbinafine. Aspergillus flavus was isolated in two cases 2.7%). Geomyces sp., Fusarium oxysporum, and Pseudeurotium ovale were also isolated. It is concluded that there is a low prevalence of dermatomycosis among institutionalized elders in Ciudad Bolivar, and that the lesions clinically observed were due to degenerative changes naturally occurring with aging.

Bases biomoleculares do fotoenvelhecimento: [revisão] / Molecular basis of photoaging: [review]

Com o aumento da expectativa de vida, o estudo do processo de envelhecimento orgânico tem sido estimulado. O envelhecimento da pele, órgão que espelha os sinais do tempo, é processo de deterioração progressiva, tempo-dependente, e pode ser intensificado pela exposição solar, então designado fotoenvelhecimento. O dano das radiações sobre diversas estruturas celulares e cutâneas leva a alterações morfológicas nesses componentes, fruto de modificações biomoleculares. Muitas pesquisas são desenvolvidas com o intuito de combater ou minimizar os efeitos do fotoenvelhecimento, porém a principal estratégia nesse sentido continua sendo a prevenção, só conseguida pelo progressivo desvendar dos mecanismos fisiopatogênicos envolvidos nesse processo.

As a result of the increase in life expectancy, the study of the organic process of aging has been stimulated. Skin ageing, which reflects the signs of time, is a time-dependent process of progressive deterioration that can be intensified by sun exposure, which is known as photoaging. The damage of radiation on various cell structures and on the skin results in molecular and morphological changes to these components. Many research studies are performed to try to minimize the effects of photoaging; however, the main strategy to manage it is still prevention, which will only be achieved once we learn about the mechanisms involved in the process.

Piel y climaterio / Skin and climacteric

El envejecimiento está asociado a una disminución de los niveles de estrógenos. Aunque sus efectos en la piel aún no están completamente aclarados, es conocido que la deficiencia estrogénica está asociada a varios cambios cutáneos. Además debido al incremento de la expectativa de vida, las mujeres pasarán más de un tercio de su vida en condición menopáusica. El climaterio sumado a los efectos del envejecimiento cronológico, la exposición solar, factores endógenos y a otros factores ambientales, parece ejercer dramáticas consecuencias sobre la piel. La piel puede verse afectada globalmente, en particular la epidermis, la dermis y el pelo. La deprivación estrogénica está asociada con xerosis, atrofia, formación de arrugas finas, bochornos, laxitud y mala cicatrización. La terapia hormonal en mujeres postmenopáusicas ha demostrado incrementar el contenido de colágeno, el grosor dérmico y la elasticidad de la piel. A la luz de los últimos antecedentes la relación riesgo - beneficio de la terapia de sustitución estrogénica prolongada debe ser evaluado cuidadosamente por los médicos y sus pacientes.

Aging is associated with declining levels of estrogen. Although the effects of estrogen on the skin are still not fully understood, it is known that, in women. Declining estrogen levels are associated with a variety of cutaneous changes. Due to an increased life expectancy, women can now expect to spend more than one-third of their lifetime after menopause. In addiction to the effects of chronological aging, sunlight exposure, and other environmental and endogenous factors, the climacteric appears to exert some dramatic consequences of the skin. The whole skin can be affected, in particular the epidermis, dermis and hair. The estrogen deprivation is associated with dryness, atrophy, fine wrinkling, hot flashes, laxity, and impairing wound healing. Hormonal therapy in post-menopausal women has been shown to increase collagen content, dermal thickness and elasticity. In light of recent data regarding long-term use of estrogen supplementation, the risk to benefit ratio of this therapy needs to be carefully evaluated by physicians and their patients.

Prevalência de dermatoses em idosos residentes em instituição de longa permanência / Prevalence of dermatoses in residents of institutions for the elderly

OBJETIVOS: Determinar a prevalência das afecções dermatológicas em 75 idosos residentes em instituição de longa permanência na cidade de Santos-SP, e confrontar os achados com revisão da literatura. MÉTODOS: Setenta e cinco idosos foram submetidos a exame dermatológico. Com os dados obtidos calculou-se a prevalência, o número médio por paciente e a freqüência de dermatoses. Foi ainda analisado a distribuição nos subgrupos sexo, raça, faixa etária e nos subgrupos principais de dermatoses. RESULTADOS: O número total de dermatoses diagnosticadas foi 280, o número médio por paciente foi 3,73 e o número total de tipos de dermatoses foi 32. A prevalência das principais dermatoses encontradas foi: melanose solar (53,3 por cento), queratose seborréica (46,6 por cento), onicomicose (37,3 por cento), nevo rubi (33,3 por cento), púrpura senil (29,3 por cento), xerose (14,6 por cento), escabiose (12,0 por cento) e neoplasia maligna (1,3 por cento). A distribuição das dermatoses foi 70 por cento (IC95 por cento: 59 por cento a 81 por cento) maior no sexo feminino do que no masculino. CONCLUSÃO: Apesar da pequena casuística, os dados obtidos são compatíveis com os poucos relatos disponíveis na literatura. Este estudo de prevalência definiu a distribuição de dermatoses em uma fração da população de idosos. Entretanto, os dados agregados de casuísticas subseqüentes podem permitir tornar os dados mais precisos, cuja relevância é indiscutível na orientação de medidas de saúde individual e coletiva.

OBJECTIVE: To determine the prevalence of dermatoses in 75 elderly residents in an institution of long permanence in the city of Santos, and to compare findings with those in literature. METHODS: Seventy five healthy elderly persons were submitted to a dermatological exam. The prevalence, the average number per elderly person and the frequency of dermatoses were calculated from the data collected. An analysis was then made of the distribution in the subgroups of, gender, race, age bracket as well as of dermatosis in the main sub-groups. RESULTS: The total number of diagnoses of dermatosis was 280 with an average number of 3. 73/ per elderly person and 32 different types of dermatosis: were found. The prevalence of the dermatosis most often found was respectively: melanosis (53.3 percent), seborrheic keratosis (46.6 percent), onychomycosis (37.3 percent), nevus (33.3 percent), senile purpura (29.3 percent), xerosis (14.6 percent), scabies (12.0 percent) and malignant neoplasm (1.3 percent). The distribution of dermatosis was 70 percent (CI95 percent: 59 percent to 81 percent) higher in the female population than in the male. CONCLUSION: Notwithstanding the small number of cases, these data are compatible with the few reports available in literature. This study of prevalence defined the distribution of dermatosis in a fraction of the elderly population. However the aggregate data of subsequent casuistries may provide the more precise information whose relevance is undeniable in the orientation of individual and collective future health measures.

Restauración frontal miniinvasiva por abordaje mixto / Restoration minimally invasive front by mixed approach

La disminución del volumen de la estructura esquelética de la cara ocasiona flaccidez de todos los elementos que se apoyan sobre ella y su subsecuente caída. A falta de recurso efectivo para lograr la recuperación del volumen óseo, lo indicado es restaurar la relación entre las partes blandas y el volumen óseo vigente. Basados en este principio, hemos desarrollado el procedimiento de restauración facial subperióstico miniinvasivo. En este trabajo describimos la aplicación de este procedimiento para la restauración de la región frontal... Se describen los medios para realizar este procedimiento por las vías frontal y transpalpebral, y combinando ambas vías. Sobre la base de la anatomía quirúrgica, se da orientación para lograr las metas del procedimiento y evitar complicaciones. Se mencionan los procedimientos que se pueden asociar a este procedimiento y se describen los detalles del manejo posoperatorio.

The reduction of the bony structure of the face is the main reason of the flabbiness and fall of the facial soft tissues. Because we do not have already recourses to restore the lost bony volume, a good possibility is to reestablish a good relationship between the soft tissues and the present bony volume. Based on this principle we have developed the procedure of mini-invasive subperiosteal facial restoration. In this paper we described the application of this procedure to restore the frontal region... The maneuvers and instrumentation used to perform this procedure through frontal, aplpebral or combining both approaches are described. Based on the surgical anatomy, orientation and advices to reach the goals of the procedure and to avoid complications are given. The ancillary procedures, which could be associated to this procedure, are described as well as the details of the post-op care.

Alterações cutâneas relacionadas ao fotoenvelhecimento / Alterations related to cutaneous photoaging

A exposição à radiação ultravioleta (UV) é o principal fator ambiental responsável pelo envelhecimento precoce da pele. O fotoenvelhecimento, caracterizado clinicamente por aparecimento de rugas, distúrbios de pigmentação e alterações da textura cutânea, é resultante da ação cumulativa dos raios UV e depende do grau de exposição solar e pigmentação da pele. Os indivíduos de pele clara, que habitam regiões ensolaradas e adotam padrões de vida com exposição intensa à luz solar, apresentam os maiores graus de fotoenvelhecimento. Este artigo descreve as alterações cutâneas mais comuns relacionadas à exposição crônica à luz solar, faz uma breve revisão sobre as vias moleculares em que ocorrem estes danos e apresenta novos dados sobre a freqüência destas alterações entre indivíduos atendidos num centro de referência em Dermatologia.

Exposure to solar UV radiation is the main environmental factor that causes premature aging of the skin. Photoaging is characterized clinically by wrinkles, mottled pigmentation, rough skin, and loss of skin tone. Human skin aging resulting from UV irradiation is a cumulative process that occurs based on the degree of sun exposure and the level of skin pigment. Individuals who have outdoor lifestyles, live in sunny climates, and are lightly pigmented will experience the greatest degree of photoaging. This article reviews our current understanding about the molecular pathways of skin photodamage, describe the most common skin lesions related to chronic sun exposure, and presents new data about the skin changes associated with chronic sun exposure among individuals attended at a dermatology reference centre.

Peeling y dermabrasión / Peeling and dermabrasion

En el último tiempo, los peelings químicos y mecánicos como la microdermabrasión se han convertido en importantes armas terapéuticas para los dermatólogos, permitiendo mejorar el aspecto de la piel, disminuir los efectos del fotoenvejecimiento y utilizarlos en diferentes patologías cutáneas de consulta frecuente. Es responsabilidad del dermatólogo conocer y controlar los diferentes productos y métodos utilizados en estas técnicas, asegurándose su confiabilidad mediante estudios científicos serios que permitan comprender su verdadera efectividad. En este artículo se revisarán aspectos clínicos e histológicos del envejecimiento intrínseco y del fotoenvejecimiento, así como las principales características de los peelings químicos, sus indicaciones, manejo y complicaciones. También se abordarán los elementos más importantes de los peelings mecánicos.

Menopausia y Piel / Skin and menopause

La menopausia ocurre a edades variables entre los 45 y 55 años en el 65 por ciento - 70 por ciento de las mujeres. La deficiencia estrogénica se acompaña de una serie de desórdenes fisiológicos y de alteraciones dermatológicas que incluyen disminución del colágeno y envejecimiento de la piel. Las terapias de reemplazo hormonal producen mejorías significativas en las arrugas finas y un incremento en el contenido de colágeno. Los principales efectos colaterales de los tratamientos sistémicos y cutáneos de la terapia de reemplazo hormonal son revisados. Las terapias tópicas con estradiol, fitoestrógenos, retinoides, ácido glicólico y vitamina C conllevan incrementos de colágeno dérmico.