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.

Allergic contact dermatitis among construction workers detected in a clinic that did not specialize in occupational dermatitis / Dermatite alérgica de contato entre pedreiros, num serviço não especializado em dermatoses ocupacionais

BACKGROUND: Contact dermatitis is one of the common work-related dermatoses. Among bricklayers, cement can cause both allergic contact dermatitis and primary contact irritative dermatitis. The personal protective equipment (rubber gloves) may favor the development of allergic contact dermatitis. OBJECTIVES: 1) to evaluate the frequency of allergic contact dermatitis among construction workers between January 2005 and December 2009; 2) to determine the major sensitizing agents in the study group; and 3) to compare the data obtained from the construction workers to that of a group of patients who were not construction workers. METHODS: A retrospective analysis of patch tests. Patients were separated into two groups: 1) bricklayers and 2) non-bricklayers. RESULTS: Of the 525 patch tests analyzed, 466 (90%) were from non-bricklayers and 53 (10%) from bricklayers. The hands were affected in 38 (61%) of them. 13 patients (24%) had irritative contact dermatitis and 40 (76%) had allergic contact dermatitis. The group of construction workers had a high frequency of sensitization to cement, and 29 (54.7%) had sensitization to rubber vulcanizing agents. 23 patients (43.4%) had sensitization to both cement and rubber. CONCLUSIONS: Among the bricklayers the presence of allergic contact dermatitis to rubber and cement in the same patient is common and demonstrates the importance of the patch test.

FUNDAMENTOS: A dermatite de contato é uma das dermatoses comumente relacionadas ao trabalho. Entre os pedreiros o cimento pode causar tanto a Dermatite Alérgica de Contato quanto a Dermatite de Contato por Irritação Primária. Os equipamentos de proteção individual (luvas de borracha) podem favorecer o desenvolvimento de Dermatite Alérgica de Contato. OBJETIVOS: 1) avaliar a freqüência de Dermatite Alérgica de Contato entre os pedreiros entre Janeiro de 2005 e Dezembro de 2009; 2) determinar os principais agentes sensibilizantes; e 3) comparar os resultados obtidos entre o grupo de pedreiros com um grupo sem pedreiros. MÉTODOS: análise retrospectiva de testes de contato. Pacientes foram separados em 2 grupos: 1) pedreiros e 2) não pedreiros. RESULTADOS: dentre os 525 testes de contato analisados, 466 (90%) eram de não pedreiros e 53 (10%) de pedreiros. As mãos foram acometidas em 38 (61%). 13 pacientes (24%) tinham Dermatite de Contato por Irritação Primária e 40 (76%) tinham Dermatite Alérgica de Contato. O grupo de pedreiros apresentou alta freqüência de sensibilização ao cimento, e 29 (54,7%) tinham sensibilização a agentes vulcanizadores da borracha. 23 pacientes (43,4%) pedreiros tinham sensibilização tanto ao cimento quanto à borracha. CONCLUSÕES: entre os pedreiros a presença de Dermatite Alérgica de Contato ao cimento e à borracha no mesmo paciente foi comum e demonstrou a importância do teste de contato.