Treatment of keloids and hypertrophic scars. Position statement of the Brazilian expert group GREMCIQ.

Keloids (K) and hypertrophic scars (HS) are abnormal responses to wound healing that occur as the result of dermal inflammation. Despite the advances on their treatment, many patients still suffer from the negative effects of excessive scarring; its approach is impaired by the lack of objective data on different treatments and the large genetic variability among patients and the difficulties in producing multicentre studies. Their incidence among the Brazilian population is high, as the result of an admixture of Amerindians, Europeans and Africans ancestral roots. With the aim of producing multicentre studies on K and HS, a panel of senior Brazilian dermatologists focused on their treatment was invited to contribute with the K and HS Treatment Brazilian Guidelines. In the first part of this study, different treatment modalities for keloids and HS are fully reviewed by the panel. The second part of the study presents a consensus recommendation of treatment for different types of lesions. More than a literature review, this article aims to show the pitfalls and pearls of each therapeutic option, as well as a therapeutic approach by the Panel of Experts on keloids and Scars on a highly mixed population, providing simple guidelines.

A validated photonumeric cellulite severity scale.

BACKGROUND: With recent advances in the treatment of cellulite and localized fat, a comprehensive objective method of measuring cellulite can be potentially useful, especially since important morphological aspects of cellulite are not part of the current classification. Objective To develop and to validate a new photonumeric cellulite severity. METHODS: Based on standardized photographs of 55 patients with cellulite, five key morphological aspects of cellulite were identified. A new photonumeric severity scale was developed and validated. RESULTS: The five key morphological features of cellulite were identified and included the number of depressions, depth of depressions, clinical appearance of evident raised lesions, and presence of flaccidity and the grade of cellulite. Each item was graded from 0 to 3, allowing final classification of cellulite as mild, moderate, and severe. Results for validation of the scale are statistically significant (P < 0.05) and are as follows: intraclass correlation coefficient > 0.7; correlation item-total > 0.7, with the exception of the right buttock; intraclass correlation coefficients 0.881-0.922; Cronbach's alpha 0.851-0.989 and factor analysis 68-76%. CONCLUSION: The proposed photonumeric scale is a consistent, comprehensive, reliable, and reproducible tool for the standardized and objective assessment of the severity of cellulite. Conflicts of interest The authors hereby affirm that neither the manuscript nor any part of it has been published or is being considered for publication elsewhere.

Subcision: a treatment for cellulite.

BACKGROUND: Cellulite is a common clinical condition, with few proven effective therapeutic options. Subcision is a surgical technique that is useful in treating advanced degree cellulite. This study was designed to determine the usefulness of the treatment of cellulite by subcision. METHODS: From January 1995 to January 1998, 232 female patients, aged 18-52 years, with cellulite on the thighs and buttocks were treated on an outpatient basis by the subcision technique. RESULTS: In the postoperative period, all the patients had pain, bruises, and hemosiderosis. An improvement in the surface depressions was observed and the patients reported a high degree of satisfaction. CONCLUSIONS: This outpatient procedure is effective in the correction of surface depressions on the thighs and buttocks, clinically classified as cellulite.

Clinical comparative study between cryotherapy and local dermabrasion for the treatment of solar lentigo on the back of the hands.

BACKGROUND: Solar lentigo is a common and unsightly dermatosis that has a variety of proposed treatments. OBJECTIVE: This study was done to assess the efficacy and the effectiveness of localized dermabrasion compared with cryotherapy with liquid nitrogen on solar lentigo on the back of the hands. METHODS: Ten female patients aged 64-96 years with solar lentigo on the back of the hands were treated with dermabrasion or cryotherapy and observed over a 6-month period. RESULTS: The postsurgery signs and symptoms were less intense and better tolerated with localized dermabrasion. More than 50% of the patients treated with cryotherapy still had hypochromia in the treated areas 6 months after treatment, compared with 11% of the patients treated with dermabrasion. The percentage of recurrence was the same with the both treatments (55.55%). CONCLUSION: Localized dermabrasion is an efficacious and effective technique comparable to cryotherapy for the treatment of solar lentigo on the back of the hands.