Estudo comparativo do uso de pigmentação exógena como adjuvante à luz intensa pulsada no tratamento de melanoses solares do dorso das mãos / Comparative study of the use of exogenous pigmentation as an adjuvant therapy to Intense Pulsed Light in the treatment of melanoses on the dorsum of the hands

RESUMO

Introdução: O fotodano intenso e crônico geralmente produz inúmeras queratoses actínicas, sendo importante o tratamento precoce e global da pele acometida. Objetivo: Avaliar a efetividade de dois tratamentos distintos para ceratoses actínicas múltiplas. Métodos: Foram selecionados 5 pacientes com ceratoses actinicas difusas no dorso de mãos e antebraços foram submetidos ao seguinte protocolo lado A (direito) peeling químico superficial quinzenal com ácido glicólico 70% em gel seguido de solução de 5-fluoracil 5%; lado B (esquerdo) criopeeling mensal. O número de sessões variou de quatro a seis no lado A e de duas a três no lado B, de acordo com o grau de fotodano. Resultados: Todos os pacientes apresentaram resposta clínica satisfatória, com melhora das ceratoses actínicas e de toda área de dano actínico, com boa tolerância dos pacientes ao tratamento, apenas com a ressalva de que ao criopeeling segue-se eritema mais intensoe persistente. Conclusões: As duas terapêuticas utilizadas constituem-se em alternativas válidas e eficazes para tratamento do "campo de cancerização".

ABSTRACT

Introduction: The use of exogenous pigmentation as an adjuvant therapy to Intense Pulsed Light in the treatment of melanoses is routine, nevertheless there is an absence of published comparative studies. Objective: To compare Intense Pulsed Light therapy in isolation, or combined with exogenous pigmentation in the treatment of solar lentigines on the dorsum of the hands. Methods: Twenty women (mean age = 56.5 years) with skin types from I to III, underwent three sessions of Intense Pulsed Light, with a brown makeup pencil pigment reinforcement being applied to the lesions on the right hand. The patients were queried about the degree of discomfort, swelling, crusting, and improvement experienced, their treatment of preference and which they felt provided greater effectiveness, and the incidence of side effects. Results: When assessing all three of the treatment sessions together, the median discomfort score, as well as the degree of inflammation and crusting (p < 0.01), were higher on the right hand. Regarding the subjective impression of the final result, 15 in 20 patients preferred the technique applied on the right hand, considering it more effective (p < 0.01). Eleven in 20 patients reported fewer side effects in the un-pigmented side (p = 0.12). The degree of discomfort did not correlate significantly with the preferred technique (p = 0.67). Conclusions: In this sample, there was a preference for the method with the adjuvant use of exogenous pigmentation, however the incidence of pain and side effects was higher in this group.