Laser de CO2 potencializado com técnica de CROLL modificada otimizando resultados no rejuvenescimento da região perioral / CO2 laser enhanced with modified CROLL technique optimizing results in the perioral region rejuvenation

Introdução: O rejuvenescimento da região perioral é considerado um grande desafio. Inúmeras modalidades terapêuticas são utilizadas, porém não há um procedimento específico ideal, sendo consenso da literatura a associação de técnicas, considerada a melhor opção. Os lasers fracionados proporcionam excelentes resultados sendo o de CO2 descrito como bastante eficaz. Objetivo: Aumentar a eficácia do laser fracionado de CO2 para o tratamento de rejuvenescimento da região perioral, utilizando a técnica de CROLL modificada. Métodos: Selecionaram-se 12 pacientes do sexo feminino, com idades entre 50 e 68 anos, com aplicação do laser de CO2 em dois momentos. Inicialmente, foi aplicada a técnica de CROLL modificada sobre as rítides periorais e, posteriormente, o laser foi aplicado, com menor potência, em toda a face, incluindo a área perioral. Foram realizadas três sessões com intervalo de 45-60 dias. Resultados: Houve melhora na elasticidade tecidual e superficialização das rítides, e o grau de satisfação de todas as pacientes esteve em consonância com a avaliação clínica e os registros fotográficos. Conclusões: O laser de CO2 oferece excelentes resultados para o tratamento do rejuvenescimento da região perioral, sobretudo quando potencializado com a técnica de CROLL modificada.

Introduction: The rejuvenation of the perioral region is considered a significant challenge. Numerous therapeutic modalities are used; however, there is no specific single gold standard, and the literature agrees that the best option is to associate techniques. Fractional lasers provide excellent results, and the CO2 laser is described as quite effective. Objective: To increase the efficiency of fractional CO2 laser for the perioral region rejuvenation, using the modified CROLL technique. Methods: We selected 12 female patients, between 50 and 68 years, who underwent application of the CO2 laser in two moments. Initially, the modified CROLL technique was applied to the perioral rhytids, and later the laser was used, with less power, on the entire face, including the perioral area. Three sessions were conducted with an interval of 45-60 days. Results: There was an improvement in tissue elasticity and rhytids superficialization, and the degree of satisfaction of all patients was in line with the clinical evaluation and photographic records. Conclusions: The CO2 laser offers excellent results for the perioral region rejuvenation, especially when enhanced with the modified Croll technique.

Evaluation of vitamin D plasma levels after mild exposure to the sun with photoprotection

Abstract: Background: Most of the organism's vitamin D (VD) is obtained through the cutaneous synthesis after exposure to the sun's UVB radiation. Sunscreens are indicated for the prevention of actinic damage to the skin, however, there are few clinical trials assessing the synthesis of cutaneous VD in real-life situations of sun exposure with ordinary clothing and usual photoprotection. Objectives: To evaluate the synthesis of VD with suberythemal sun exposure in healthy adults using topical photoprotection (SPF 30). Methods: Quasi-experimental study, conducted at Rio de Janeiro (Brazil), during winter, with 95 healthy adults who had 25-OH-VD checked twice, 24 hours apart, and were exposed to the sun (UVB=20 mJ/cm2), according to a randomized grouping: SC - use of SPF 30 on the face, neck and chest (n=64), NO - no sunscreens (n=10), CO - confined from sun exposure for 24h (n=21). The groups were matched according to the propensity score related to gender, age, phototype, body mass index, glycosylated hemoglobin and baseline levels of VD. The outcome evaluated was the variation (ΔVD) in serum level of 25-OH-VD (ng/ml) between the groups. Results: A statistically significant difference was identified between CO and SC groups [median (p25-p75)]: ΔVD =1.4 (-0.3-3.6) vs. 5.5 (4.8-6.6); p<0.01. There was no difference between SC and NO groups: 5.4 (3.1-6.1) vs. 4.1 (2.5-6.0); p=0.17. Study limitations: Laboratory analysis technique (chemiluminescence) with great variability, loss of food intake standardatization, unbalanced groups. Conclusions: Suberythemal sun exposure with sunscreen (SPF 30) provides similar vitamin D serum variation than without photoprotection in healthy adults.

Syringocystadenoma papilliferum in an unusual location

Abstract: Syringocystadenoma papilliferum is a rare benign hamartomatous adnexal tumor of the apocrine or eccrine sweat glands. Most patients present a solitary lesion in the head and neck region. Presentation outside the head and neck region is even more uncommon. We present a case of Syringocystadenoma papilliferum with papulonodular lesion located on the vulva of an infant girl. This case illustrates the atypical location of this rare disease and adds to the differential diagnosis of lesions on the vulva.

A case of generalized ostraceous psoriasis mimicking dermatitis neglecta

Lithium has been implicated in the exacerbation of pre-existing psoriasis, in the induction of psoriasis on previously uninvolved skin of psoriasis patients, and in the triggering of psoriasis for the first time in patients without a personal or family history. Lithium-induced psoriasis (and its resistance to treatment) is one of the major reasons for noncompliance in patients treated with lithium. We describe a male patient who developed generalized ostraceous psoriasis whose clinical appearance mimicked dermatitis neglecta, 10 months after starting therapy with lithium.

Tumor triquilemal proliferante: relato de caso / Proliferating trichilemmal tumor: case report

Tumor triquilemal proliferante é uma neoplasia incomum que surge do istmo folicular, cuja característica histológica é a presença de ceratinização triquilemal. Apresenta-se usualmente como nódulo solitário no couro cabeludo de mulheres idosas. Descreve-se um caso de tumor triquilemal proliferante que se apresenta como lesão tumoral nodular na região glútea de uma jovem de 16 anos de idade.

Proliferating trichilemmal tumor (PTT) is an uncommon neoplasm arising from the follicular isthmus. Its histological characteristic is the presence of trichilemmal keratinization. PTT usually presents as a solitary nodule on the scalp of elderly women. We describe a case of a PTT on the gluteal region (buttocks) of a 16-year-old female, presenting as a solitary nodule.