Long-term maintenance treatment of rosacea: experts' opinion.

BACKGROUND: Rosacea is a chronic inflammatory dermatosis characterized by remissions and flares. Although the rosacea active treatment phase is well established, the long-term maintenance phase is still challenging. OBJECTIVE: To discuss and make recommendations on how to treat patients during the long-term maintenance phase for the main rosacea phenotypes. METHODS: A panel of six board-certified Brazilian dermatologists and one American dermatologist gathered to compose a consensus based upon an initial statement on how to treat rosacea during the long-term maintenance phase based on the methodology Nominal Group Technique. The experts discussed each factor based upon an initial statement on how to treat rosacea patients in the long-term maintenance phase. A sequence of comprehensive narrative reviews was performed; a questionnaire preparation about the definition of the maintenance phase and its management was presented; an interpersonal discussion and ranking of the ideas were conducted. Recommendations were made if the specialists had 75% agreement. RESULTS: The maintenance treatment phase, which starts by achieving IGA 0 or 1 grades at the active phase, should be considered at least during the 9-month period after remission. The recommendations of all treatments target this period. Daily skincare regimen and sunscreen are crucial. Active treatment phase should be recommended if signs or symptoms reappear or worsen. CONCLUSION: Maintenance phase success depends on patient's adherence to daily skin care, appropriate treatments, continued follow-up with dermatologist, and self-assessment to identify new signs and symptoms indicating disease relapse.

Epidemiological profile of rosacea in dermatology outpatient clinics in Brazil: an observational report from the Brazilian study group on rosacea.

BACKGROUND: Rosacea prevalence varies worldwide and there is a lack of information in Brazil. OBJECTIVES: To describe the epidemiological profile of rosacea in subjects who consulted in dermatological outpatient clinics in Brazil. MATERIALS & METHODS: A cross-sectional study was conducted in 13 dermatological outpatient clinics across the country. Patients with rosacea diagnosis were eligible for the study according to the investigator's clinical assessment. Clinical, social and demographic data were collected. The overall and regional rosacea prevalence was calculated, and association with baseline characteristics was analysed. RESULTS: A total of 3,184 subjects were enrolled, and rosacea prevalence was 12.7%. The southern region of Brazil presented a higher prevalence, followed by the southeast. The subjects in the rosacea group were older than those without rosacea (52.5 ±14.9 vs. 47.5 ±17.5; p<0.001). Moreover, the rosacea group was associated with Fitzpatrick's phototypes I and II, Caucasian ethnicity, a family history of rosacea, and facial erythema, however, no association with gender was found. The most prevalent clinical sign and clinical subtype in rosacea patients were erythema and erythematotelangiectatic, respectively. CONCLUSION: Rosacea is highly prevalent in Brazil, mostly in the southern region, associated with phototypes I and II and a family history.

Buttocks' Skin Laxity Severity Scale.

BACKGROUND: Clinical scales are useful to assess skin laxity in different areas of the body. OBJECTIVE: To elaborate and validate a photonumeric scale to assess buttocks skin laxity. MATERIALS AND METHODS: The Buttocks' Skin Laxity Severity Scale (SLSS) was developed based on a sample of 120 patients. The SLSS validity and reliability were assessed in 2 validation cycles, performed by 8 dermatologists assessing 50 clinical cases. Both criteria and construct validity were tested. RESULTS: The Buttocks' SLSS is composed by 5 clinical aspects of skin laxity graded from absent (0) to severe (3): buttocks ptosis, skin scalloped appearance, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. Final skin laxity classification results from the sum of each item grade multiplied by its weight and varies from 0 to 24. Overall, Kendall, weighted kappa, and intraclass correlation coefficients indicated very good reliability and consistent interrater and intrarater agreement (p < .001). Cronbach alpha of 0.82 indicates high scale reliability. The scale validity was confirmed by criteria validity tests (rs: 0.72, p < .05). CONCLUSION: Buttocks' SLSS is a reliable and valid scale to identify skin laxity severity and its different features, and it is an accurate tool for clinical research.

Dermoscopic Aspects of Traumatized Nevi After Dermabrasion.

BACKGROUND: Melanocytic nevi submitted to trauma can undergo clinical, dermoscopic, and even histological changes, making it difficult to differentiate them from a melanoma. OBJECTIVE: The aim of this study is to evaluate the dermoscopic changes of traumatized nevi after dermabrasion. METHODS: Dermoscopic images of acquired melanocytic nevi were compared before and 4 weeks after half of their area had undergone dermabrasion. RESULTS: The sample consisted of 50 lesions from 15 patients. The homogeneous pattern was the most frequent, followed by the reticular, cobblestone, and globular patterns. After dermabrasion, nearly half of the lesions (46%) became dermatoscopically asymmetric. Among all lesions, structureless areas, dotted vessels and erythema were the most frequent new dermoscopic structures. CONCLUSION: Trauma after dermabrasion may induce significant dermoscopic changes in melanocytic nevi. Although the global pattern did not change, most of the lesions became asymmetric, with the appearance or fading of dermoscopic structures and colors. A history of recent trauma should be investigated when evaluating pigmented lesions.

Effects of different doses of abobotulinumtoxinA for the treatment of anterior gingival smile.

Botulinum toxin type A (BoNT-A) is an easy and fast treatment for gingival smile (GS). The objective of the study was to compare the reduction of gingival exposure using three different doses of abobotulinumtoxinA (ABO) in patients with different severities of anterior GS, and to assess treatment safety and patients' satisfaction. A prospective, single-center, randomized, double-blind study was conducted. Mild GS (2 to < 3 mm) was treated with 2.5 U of abobotulinumtoxinA (ABO) per side, moderate GS (3 to < 4 mm) with 5 U of ABO per side, and severe GS (4 mm or more) with either 2.5 U, or 5 U or 7.5 U of ABO per side. All the 41 enrolled patients completed the study. The mean gingival exposure reduced significantly 4 and 12 weeks after treatment. The average reduction of gingival exposure with 5 U was significantly larger than that obtained with 2.5 U, (3.46 ± 1.39 vs. 2.05 ± 1.29 mm; p = 0.004). All groups of GS severity presented statistically significant reduction in the gingival exposure 4 and 12 weeks after ABO injections. Twelve weeks after treatment, more than 80% of the patients were satisfied or very satisfied. There were no treatment-related adverse events reported by the patients or noticed by the investigators. Gingival smile can be safely and effectively managed with BoNT-A injections and specifically with ABO injections to target the LLSAN muscle. Further and larger studies may determine the exact influence of each factor on BoNT-A treatments of GS.

Pesquisa de opinião sobre eficácia, custos e cicatrização de procedimentos de resurfacing para rugas estáticas faciais / Expert survey on the efficacy, costs and healing of resurfacing procedures for facial static wrinkles

Foi realizada uma pesquisa de opinião entre especialistas em "resurfacing" cutâneo com a finalidade de compararem-se custos e benefícios entre as técnicas de laser de CO2 totalmente ablativo, lasers fracionados ablativos, lasers fracionados não ablativos, radiofrequência fracionada ablativa, microagulhamento, dermabrasão, peelings médios e peelings de fenol- -óleo de cróton. A opção mais eficaz para tratamento de rugas estáticas faciais foi peeling de fenol-óleo de cróton, ranqueado em primeiro lugar por 71,4% dos experts, seguido de laser de CO2 totalmente ablativo, por 28,6%. Sobre "downtime", os procedimentos elencados com recuperação mais rápida foram microagulhamento e laser fracionado não ablativo, com 42,9% cada um, seguidos por radiofrequência fracionada ablativa, com 14,3%. O período para recuperação completa dos efeitos colaterais e adversos foi percebido como mais curto no microagulhamento por 50% dos experts. Sobre os custos operacionais, o procedimento menos custoso foram peelings médios, de acordo com a opinião de 71,4% dos especialistas. Tais resultados apontam para melhor custo/benefício de procedimentos como peelings químicos e microagulhamento, de acordo com a opinião dos 14 especialistas brasileiros que responderam ao questionário.

A survey on the opinion of specialists regarding skin resurfacing was performed, with the objective of comparing costs and benefits between the techniques: totally ablative CO2 laser, fractional ablative lasers, fractional non-ablative lasers, ablative fractional radiofrequency, microneedling, dermabrasion, medium peels, phenol-croton oil peels. The most effective option for the treatment of static wrinkles was the phenol-croton oil peel, in first place by 71.4% of the experts, followed by totally ablative CO2 laser, by 28.6%. Regarding downtime, procedures ranked as fastest recovery were microneedling and fractional non-ablative lasers, with 42.9% each, followed by ablative fractional radiofrequency, with 14.3%. Complete recovery period for side and adverse effects was perceived as shorter with microneedling by 50% of the experts. Regarding operating costs. The less costly procedure was medium peels, according to the opinion of 71.4% of the experts. Such results point towards a better cost/benefit of procedures such as chemical peels and micro-needling, according to the opinion of 14 Brazilian specialists who answered the questionnaire.

Standardized methods for photography in procedural dermatology using simple equipment.

Photography is an important tool in dermatology. Reproducing the settings of before photos after interventions allows more accurate evaluation of treatment outcomes. In this article, we describe standardized methods and tips to obtain photographs, both for clinical practice and research procedural dermatology, using common equipment. Standards for the studio, cameras, photographer, patients, and framing are presented in this article.

Superficial dermabrasion versus topical tretinoin on early striae distensae: a randomized, pilot study.

BACKGROUND: Striae distensae (SD) is a common skin condition, with a prevalence ranging from 40% to 90%, depending on the population studied. OBJECTIVES: To evaluate the efficacy of superficial dermabrasion and compare it with that of topical tretinoin cream in the treatment of narrow and early SD. MATERIALS AND METHODS: Prospective, single-center, randomized, open-label study. Thirty-two women presenting with early, untreated SD (striae rubra) were included in this study. One group received 16 weekly sessions of superficial and localized dermabrasion, and the other used 0.05% tretinoin cream daily. Striae width and length were measured and compared between groups and over time. Global Aesthetic Improvement Scale scores and subject satisfaction were also assessed. Biopsies were performed for subjects who agreed to undergo this procedure, followed by histologic analyses of the skin samples. RESULTS: Both treatments were efficacious, with significant improvement in early SD from baseline, but there was no significant difference between the two treatments. Histologic assessment showed improvement in epidermal and dermal layers for the dermabrasion treatment group. CONCLUSION: Both treatments had similar efficacy, but superficial dermabrasion had a lower frequency of side effects and better adherence of the patients.

Evaluation of self-esteem and depression symptoms in depressed and nondepressed subjects treated with onabotulinumtoxinA for glabellar lines.

BACKGROUND: Botulinum toxin type A (BoNT-A) injection has become the most popular cosmetic nonsurgical procedure, and it has been suggested that BoNT-A injections may improve emotional states when frown lines are treated. OBJECTIVES: To evaluate symptoms of depression and self-esteem before and after onabotulinumtoxinA (ONA) injections in the glabella in subjects with and without depression. METHODS: Twenty-five subjects with depression were allocated into one group and 25 subjects without depression were matched to those according to demographic characteristics. The Beck Depression Inventory (BDI) and Rosenberg Self-Esteem Scale (RSES) were used to assess depression symptoms and self-esteem, respectively. Patients were assessed up to 12 weeks after the intervention. RESULTS: Patients with depression had significant improvement in depression symptoms after ONA injections. The maximum effect occurred within the first 8 weeks after treatment. A significant reduction from baseline in BDI score and significant improvement in self-esteem were also observed in patients with depression. CONCLUSION: This research presents new data regarding BoNT-A as a potential treatment to improve depression symptoms in patients with Major Depressive Disorder. Self-esteem scores alone cannot explain the improvement in depression symptoms.

Field effect of two commercial preparations of botulinum toxin type A: a prospective, double-blind, randomized clinical trial.

BACKGROUND: The dose equivalence of commonly used commercial preparations of botulinum toxin type A, Dysport (abotulinumtoxinA [ABO] 500 U, Ipsen Biopharm Limited, Wrexham, United Kingdom) and Botox (onabotulinumtoxinA [ONA] 100 U, Allergan, Irvine, CA), remains unclear. OBJECTIVE: We sought to evaluate the field effect for ABO and ONA at dose equivalences of 2.5:1.0 U and 2.0:1.0 U, in both muscular and sweat gland activity. METHODS: In all, 59 female patients with forehead wrinkles were enrolled. Patients were randomized for dose equivalence between ABO and ONA, group A (2.0:1.0 U, ABO:ONA) or group B (2.5:1.0 U, ABO:ONA) administered in the frontalis muscles. Clinical assessment, Minor test, and electromyography evaluations were performed at baseline, 28 days, and 112 days. RESULTS: In group B, the field of anhidrotic effect of ABO showed a greater area and larger horizontal diameter than ONA at 28 and 112 days. At maximum frontalis muscle activity (day 112) patients receiving ABO demonstrated greater improvement based on the Wrinkle Severity Scale. No differences were found in frontalis muscle activity at rest between groups A and B based on results of Wrinkle Severity Scale, electromyography, and interindividual variability data at 28 and 112 days. LIMITATIONS: Currently, there are no objective measurements other than electromyography to evaluate the field effect of botulinum toxin type A in muscles. CONCLUSION: At a dose equivalence of 2.0:1.0 U (ABO:ONA), similar field effects were found for both muscle and sweat gland activity. At a higher dose equivalence of 2.5:1.0 U (ABO:ONA), injections of ABO showed greater area and larger horizontal diameter in field of anhidrotic effect at 28 and 112 days than ONA.

Celluqol® - instrumento de avaliação de qualidade de vida em pacientes com celulite / CELLUQOL® - a quality of life measurement fot patients with cellulite

Introdução: Após a puberdade, a maioria das mulheres desenvolve algum grau de celulite. O aumento do número de consultas dermatológicas relacionadas ao tratamento da celulite demandou compreensão mais ampla de características, desejos e expectativas desses pacientes com relação à qualidade de vida. Objetivo: Elaborar e validar instrumento de avaliação da qualidade de vida para pacientes com celulite.Métodos: O estudo teve duas etapas: a elaboração e a validação dos instrumentos de avaliação da qualidade de vida. Na segunda etapa, dois questionários foram elaborados e aplicados a 100 voluntárias com idade entre 18 e 45 anos, que apresentavam celulite.Resultados: A confiabilidade dos resultados foi verificada por meio de análise fatorial e Teste a de Cronbach para avaliação estatística. Uma análise fatorial exploratória possibilitou testar ahipótese de que todas as questões do questionário resumido mediam um único domínio ou fator (no caso, celulite) e a hipótese de que cada bloco de questões do questionário completo media um único domínio ou fator entre os parâmetros avaliados (modo de vestir, lazer, atividade física, parceiro, sentimentos e mudança de hábitos cotidianos). Conclusões: A análise de validação mostrou que ambos os questionários podem ser usados, com grau similar de eficácia.

Dermabrasion in acquired melanocytic nevi: a histopathological and immunohistochemical study.

INTRODUCTION: When subjected to trauma, acquired melanocytic nevi may present atypical histological features similar to alterations that occur after exposure to ultraviolet radiation. These persist for up to 3 weeks. To date, no study has evaluated the alterations that occur after dermabrasion in acquired melanocytic nevi. OBJECTIVE: To evaluate the histopathological and immunohistochemical alterations those occur in acquired melanocytic nevi, 4 weeks after dermabrasion. MATERIALS AND METHODS: This study evaluated 50 acquired melanocytic nevi, in which half of each lesion was submitted to dermabrasion, leaving the other half intact, and compared the histopathological and immunohistochemical findings from the 2 sides 4 weeks after the procedure. RESULTS: Five acquired melanocytic nevi were from male and 45 from female patients. The age of the patients varied from 15 to 69 years. On the dermabraded side, there was a greater frequency of atypical melanocytes (P = 0.015), increase in relation to nucleus/cytoplasm of the melanocytes (P = 0.034); inflammatory infiltrate (P = 0.007); and neovascularization (P = 0.004). In the immunohistochemical evaluation, there was a significantly higher percentage of immunoreactive melanocytes on this side for the HMB-45 only in the junctional component (P = 0.001) and for Ki-67, at a low rate, in the dermis (P = 0.03). CONCLUSIONS: Four weeks after the dermabrasion, atypical features, such as melanocytic atypia and pagetoid spread remained. Although these alterations may simulate melanoma in situ, the association with features of histopathological tissue repair (inflammatory infiltrate and neovascularization), together with immunohistochemical findings that are uncharacteristic of malignancy, favors a diagnosis of a benign lesion. These atypical alterations persist longer than those found after ultraviolet radiation.