Bioethical Conflicts in Current Dermatology: A Narrative Review. / Conflictos bioéticos en la dermatología actual: una revisión narrativa.

Both the functions and equipment of dermatologists have increased over the past few years, some examples being cosmetic dermatology, artificial intelligence, tele-dermatology, and social media, which added to the pharmaceutical industry and cosmetic selling has become a source of bioethical conflicts. The objective of this narrative review is to identify the bioethical conflicts of everyday dermatology practice and highlight the proposed solutions. Therefore, we conducted searches across PubMed, Web of Science and Scopus databases. Also, the main Spanish and American deontological codes of physicians and dermatologists have been revised. The authors recommend declaring all conflicts of interest while respecting the patients' autonomy, confidentiality, and privacy. Cosmetic dermatology, cosmetic selling, artificial intelligence, tele-dermatology, and social media are feasible as long as the same standards of conventional dermatology are applied. Nonetheless, the deontological codes associated with these innovations need to be refurbished.

Consenso MAPA (Male Aesthetic Patient Approach) de belleza masculina. Consenso español sobre el manejo del paciente estético masculino / MAPA (Male Aesthetic Patient Approach) consensus of male beauty. Spanish consensus on the male aesthetic patient approach

Introducción y objetivo: La demanda masculina de tratamiento estético es cada vez más relevante. Sin embargo, todavía son pocas las evidencias sobre Medicina Estética en el hombre y aunque algunos estudios incluyen recomendaciones sobre las pautas de tratamiento con toxina y con rellenos para el varón, no todas son válidas en nuestro entorno mediterráneo. Por ello se ha elaborado el consenso MAPA (Male Aesthetic Patient Approach) a modo de guía de orientación práctica para ayudar al médico estético que se inicia en el tratamiento del paciente masculino. Material y Método: Un panel de 9 expertos en Medicina Estética de diferentes zonas de España con amplia experiencia en el uso de la toxina Abobotulinum y rellenos de ácido hialurónico se reunieron para poner en común sus conocimientos y prácticas clínicas habituales y desarrollar recomendaciones fundamentales en el campo de la Medicina Estética masculina. Resultados: Los temas discutidos incluyeron cuestiones relativas a la práctica clínica, perfil de pacientes tratados, planificación del tratamiento en función del objetivo deseado y principales técnicas de Medicina Estética recomendadas para los hombres. Finalmente, también se debatieron recomendaciones sobre los tratamientos a aplicar en cada área de tratamiento facial. Conclusiones: Este consenso recoge las opiniones, consejos y experiencia de médicos estéticos españoles con amplia experiencia en el uso de la toxina Abobotulinum y rellenos de ácido hialurónico para ayudar a los profesionales a conseguir los mejores resultados posibles en términos de eficacia y satisfacción del paciente masculino. (AU)

Background and objective: The male demand for aesthetic treatment is increasingly relevant. However, there is still little evidence on Aesthetic Medicine in men and although some studies include recommendations on treatment guidelines with toxins and fillers for male patients, not all are valid in our Mediterranean setting. For this reason, the MAPA (Male Aesthetic Patient Approach) consensus has been drawn up, a practical orientation guide to help the aesthetic doctor who is beginning to treat male patients. Methods: A panel of 9 experts in Aesthetic Medicine from different areas of Spain with extensive experience in the use of Abobotulinum toxin and hyaluronic acid fillers met to share their knowledge and usual clinical practices, and develop a series of fundamental recommendations in the field of male Aesthetic Medicine. Results: The topics discussed included questions related to clinical practice, profile of patients treated, treatment planning based on the desired end goal, and main Aesthetic Medicine techniques recommended for men. Finally, a series of recommendations on treatments to be applied in each area of facial treatment were also discussed. Conclusions: This consensus has collected the opinions, advice and experience of aesthetic doctors with extensive experience in the use of Abobotulinum toxin and hyaluronic acid fillers to help professionals achieve the best possible results in terms of efficacy and satisfaction in male patients. (AU)

Consenso ibérico de buenas prácticas clínicas en tratamientos estéticos con toxina botulínica tipo A / Iberian consensus of good clinical practices in aesthetic treatments with Abobotulinum toxin A

Introducción y objetivo: Con la evolución de la experiencia en el uso de la toxina botulínica tipo A para tratamientos estéticos se necesitan guías actualizadas de buenas prácticas clínicas. El objetivo de este trabajo fue desarrollar recomendaciones actualizadas para buenas prácticas en el uso clínico diario, con el fin de optimizar el manejo del paciente estético y los resultados obtenidos con la toxina botulínica tipo A. Material y método: Un panel de 44 participantes con amplia experiencia en el uso de la toxina Abobotulinum se reunió para revisar y discutir la evidencia disponible y la práctica clínica en la aplicación estética de la toxina Abobotulinum A. Resultados: Los temas discutidos para la creación de este consenso incluyeron cuestiones directamente relacionadas con el uso y las propiedades de la toxina botulínica tipo A (Azzalure®) y temas generales relativos a la práctica clínica: precisión y campo de efecto de la toxina botulínica tipo A, duración del efecto, rapidez en el inicio de acción, protocolos de tratamiento, tratamientos combinados de toxina botulínica tipo A y ácido hialurónico para mayor satisfacción del paciente y armonía facial, recomendaciones post-tratamiento, diagnóstico y valoración previa del paciente para un efecto óptimo, edad en la que los pacientes comienzan a ser tratados con la toxina y su recomendación como tratamiento preventivo según las escalas de envejecimiento Glogau I o II, manejo de las expectativas del paciente y valoración de la satisfacción del mismo. Conclusiones: Este consenso ha recogido las opiniones, consejos y experiencia de médicos estéticos con amplia experiencia en el uso de la toxina botulínica tipo A para ayudar a los profesionales a conseguir los mejores resultados posibles en términos de eficacia y satisfacción del paciente. (AU)

Background and objective: With the evolution of the experience in the use of botulinum toxin type A for aesthetic treatments, updated guidelines of good clinical practices are needed. The objective of this work was to develop updated recommendations for good practices in daily clinical use, in order to optimize the mana- gement of the aesthetic patient and the results obtained with botulinum toxin type A. Methods: A panel of 44 participants with extensive experience in the use of Abobotulinum toxin met to review and discuss the available evidence and clinical practice in the aesthetic application of Abobotulinum toxin A. Results: The topics discussed for the creation of this consensus included questions directly related to the use and properties of botulinum toxin type A (Azzalure®) and general topics related to clinical practice: precision and field of effect of botulinum toxin type A, duration of effect, speed of onset of action, treatment protocols, combined treatments of botulinum toxin type A and hyaluronic acid for greater patient satisfaction and facial harmony, post-treatment recommendations, diagnosis and prior assessment of the patient for optimal effect, age at which patients begin to be treated with the toxin and its recommendation as a preventive treatment according to the Glogau I or II aging scales, management of patient expectations and assessment of patient satisfaction. Conclusions: This consensus has collected the opinions, advice and experience of aesthetic doctors with extensive experience in the use of botulinum toxin type A to help professionals achieve the best possible results in terms of efficacy and patient satisfaction. (AU)

Recommendations for the sale and promotion of dermocosmetic treatments at the office.

A novel chapter in current medical settings is the promotion and attention of esthetic aspects rather than health issues by health professionals. The human aspiration related to the search for personal beauty has generated new scenarios in medical practice. The Committee on Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine of Mexico has analyzed this phenomenon and has issued recommendations directed both to medical professionals and to producers and potential consumers of esthetic procedures.

Un capítulo novedoso es la atención y promoción por parte de médicos especialistas de aspectos relacionados con procedimientos estéticos, más que con la salud. La aspiración humana de la búsqueda de la belleza personal ha generado nuevos escenarios en la labor médica. El Comité de Ética y Transparencia en la Relación Médico Industria (CETREMI) de la Academia Nacional de México ha revisado esta circunstancia y emite recomendaciones tanto a los médicos como a los productores y potenciales consumidores de procedimientos estéticos.

Recomendaciones para la venta y promoción en el consultorio de tratamientos dermocosméticos / Recommendations for the sale and promotion of dermocosmetic treatments at the office

Resumen Un capítulo novedoso es la atención y promoción por parte de médicos especialistas de aspectos relacionados con procedimientos estéticos, más que con la salud. La aspiración humana de la búsqueda de la belleza personal ha generado nuevos escenarios en la labor médica. El Comité de Ética y Transparencia en la Relación Médico Industria (CETREMI) de la Academia Nacional de México ha revisado esta circunstancia y emite recomendaciones tanto a los médicos como a los productores y potenciales consumidores de procedimientos estéticos.

Abstract A novel chapter in current medical settings is the promotion and attention of esthetic aspects rather than health issues by health professionals. The human aspiration related to the search for personal beauty has generated new scenarios in medical practice. The Committee on Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine of Mexico has analyzed this phenomenon and has issued recommendations directed both to medical professionals and to producers and potential consumers of esthetic procedures.

Effects of multi-directional oscillatory vibration in the treatment of cellulite and body remodeling / Efeitos da terapia vibro-oscilatória multidirecional no tratamento da celulite e remodelamento corporal

Abstract Introduction: Several technologies have been developed and optimized for the treatment of unaesthetic disorders. Among them is the oscillatory vibration therapy, a novel form of treatment based on the mechanical and physiological fundamentals of the vibration platform. Objective: The present study evaluated the efficacy of the oscillatory vibration therapy in the improvement of body contour remodeling and in the aspect of cellulite in women. Methods: This is a prospective longitudinal comparative study, in which the following evaluation tools are used: anthropometry, perimetry, adipometry, evaluation of skin viscoelasticity with Cutometer®, evaluation of the thickness of the hypodermis with diagnostic ultrasound and analysis of severity of cellulite (CSS). The evaluations occurred at the start and 1 week after the end of ten oscillatory vibration therapy. The results were analyzing using a paired student's t-test with interval confidence of 95% (PValue <0.05). Results: Thirty women took part in the research, with age of 33 ± 9 years, weight of 62 ± 11 kg, height of 1.66 ± 0.06 m, BMI of 22 ± 2 kg/m2. The measurements of perimetry, adipometry, analysis of subcutaneous tissue thickness by means of diagnostic ultrasound and analysis of skin viscoelasticity did not present significant alterations. However, the CSS variable of the right gluteus (7.3 ± 1.8 to 5.8 ± 1.6 ≤ 0.0001), left gluteus (7.2 ± 1.9 to 5.8 ± 1.6= 0.0001), right thigh (6.9 ± 1.9 to 5.6 ± 1.4 = 0.0004), left thigh (6.9 ± 1.9 to 5.6 ± 1.3 = 0.0004) and Celluqol® (59 ± 16 to 49 ± 16 = 0.022) presented significant difference. Conclusion: The multi-directional oscillatory vibration therapy is an effective and efficient therapy for the treatment of cellulite; however, for the treatment of body remodeling, it must be further evaluated and studied. (AU)

Introdução: Várias tecnologias vêm sendo desenvolvidas e otimizadas para o tratamento das afecções inestéticas. Dentre elas está a terapia vibro-oscilatória, uma nova forma de tratamento baseada na fundamentação mecânica e fisiológica da plataforma vibratória Objetivo: O presente estudo avaliou a eficácia da terapia vibro-oscilatória para melhora do remodelamento corporal e aspecto de celulite em mulheres. Métodos: Trata-se de um estudo clínico longitudinal prospectivo e comparativo, no qual se utilizaram as seguintes ferramentas de avaliação: antropometria, perímetria, adipometria, avaliação da viscoelasticidade da pele com Cutometer®, avaliação da espessura da hipoderme com ultrassom diagnóstico e análise da escala de severidade da celulite (CSS). As avaliações ocorreram no início e após 1 semana de término das dez sessões da terapia vibro-oscilatória. As análises estatísticas foram realizadas com o software Bioestat 5.0, utilizando o teste de normalidade de Lilliefor (P-valor > 0,05), teste paramétrico e teste T-Student da amostra pareada. Resultados: Trinta mulheres participaram da pesquisa, com média de idade de 33 ± 9 anos, peso médio de 62 ± 11 kg, altura média de 1,66 ± 0,06 metros, IMC médio de 22 ± 2 kg/m2 . As medidas de perímetria, adipometria, análise da espessura do tecido subcutâneo por meio de ultrassom diagnóstico e análise da viscoelasticidade da pele não apresentaram alterações significativas. Entretanto as variáveis de CSS glúteo direito (7,3 ± 1,8 para 5,8 ± 1,6 ≤ 0,0001), glúteo esquerdo (7, 2 ± 1,9 para 5,8 ± 1,6 = 0,0001), coxa direita (6,9 ± 1,9 para 5,6 ± 1,4 = 0,0004), coxa esquerda (6.9 ± 1,9 para 5,6 ± 1,3 = 0,0004) e Celluqol® (59 ± 16 para 49 ± 16 = 0,022), apresentaram diferença significativa. Conclusão: A terapia vibro-oscilatória multidirecional é uma terapia efetiva e eficaz para o tratamento da celulite, porém para o tratamento de remodelamento corporal ela deve ser mais bem avaliada e estudada. (AU)

¿Qué tan importante es la estética en la salud? Análisis del tratamiento con láser en los cuidados de la piel / How important is aesthetics in health? Analysis of laser treatment in skin care

Contexto: la importancia de la medicina estética en salud y opciones más solicitadas por los pacientes. Objetivo: determinar los tipos de tratamientos láser utilizados con mayor frecuencia en la Clínica Estética Redux, características de los pacientes y parámetros utilizados con el equipo láser Synus Novadiode 810T, en el período agosto 2010 a julio 2011. Sujetos y métodos: se atendieron 238 pacientes en los cuales se practicaron 432 intervenciones con un rango de 2 a 7 atenciones por paciente. Por ser predominante el fototipo de piel IV (96% de casos) se usaron los parámetros mínimos recomendados por el fabricante del equipo subiendo a un máximo de fluencias de acuerdo al tipo y tono de piel y a la sensibilidad individual de cada paciente. Resultados: predominaron atenciones en mujeres (rango de 3:1), notándose la creciente preocupación del sexo masculino respecto al cuidado de su piel. En cuanto a la edad, el promedio fue de 37 años con un rango de 25 años a 50 años, lo que indica que interés en el cuidado de la piel, especialmente facial cuando transcurre la tercera década de la vida. Destacan los tratamientos combinados (18,9%), discromías (18%), eliminación de lunares (14,3%) y rejuvenecimiento (13%). Conclusión: existe una creciente preocupación en las mujeres, respecto al cuidado de su piel, especialmente facial cuando transcurre la tercera década de la vida, donde es más frecuente el tratamiento combinado de discromías junto a cicatrices, telangiectasias o líneas de expresión. Además hay que considerar la importante demanda de tratamientos láser siendo el mes de agosto el de mayor atención atribuyéndose al periodo de vacaciones en la región sierra. (AU)

Context: importance of aesthetic medicine in health and options most requested by patients. Objective: to determine the types of laser treatments used most frequently in the Redux Aesthetic Clinic, patient characteristics and parameters used with the Synus Novadiode 810T laser equipment, from August 2010 to July 2011. Subjects and methods: 238 patients were attended, in which 432 operations were performed with a range of 2 to 7 attentions per patient. Because skin phototype IV was predominant (96% of cases), the minimumparameters recommended by the equipment manufacturer were used, increasing to a maximum of fluences according to the type and skin tone and the individual sensitivity of each patient. Results: attention in women prevailed (range of 3: 1), noting the growing concern of the male sex regarding the care of their skin. Regarding age, the average was 37 years with a range of 25 years to 50 years, which indicates that interest in skin care, especially facial when the third decade of life elapses. They emphasize the combined treatments (18.9%), dyschromias (18%), elimination of moles (14.3%) and rejuvenation (13%). Conclusion: there is a growing concern in women, regarding the care of their skin, especially facial when the third decade of life, where the combined treatment of dyschromias with scarring, telangiectasia or expression lines is more frequent. In addition, the important demand for laser treatments must be considered, with the month of August receiving the most attention being attributed to the holiday period in the sierra region. (AU)

Algumas considerações acerca da medicina estética / Some considerations about aesthetic medicine

Neste artigo, abordaremos alguns aspectos da construção de sentidos acerca do corpo a partir do discurso científico que se moldou com o pensamento moderno e se transformou no pensamento hegemônico de alguns setores da área médica. Ressaltaremos que os sentidos atribuídos ao corpo incorporam questões oriundas de outras áreas da vida social e vão moldar os parâmetros estéticos que influenciam a construção da identidade, a relação com o próprio corpo, a subjetividade e os cuidados com a saúde. Descreveremos alguns momentos dessa construção do pensamento científico moderno, a forma como este pensamento se torna hegemônico, influencia o senso comum, naturaliza a construção da identidade e a forma de lidar com o corpo, interfere nos cuidados com a saúde, expõe uma divisão entre alguns setores da biomedicina, reforça um tipo específico de racionalidade médica e serve de base epistêmica e fundamentação (teórica e discursiva) para alguns setores ligados à medicina estética e às cirurgias estéticas.

In this article, we will discuss some aspects of the construction of the meanings concerning the body from the scientific speech which was modeled based on modern thinking and became the hegemonic thinking of some sectors of the medical field. Meanings attributed to the body bring questions that come from other areas of the social life and those questions will build the aesthetic parameters which will be part of the identity construction, in the relation with the body itself, subjectivity and healthcare. We will describe some moments of the construction of the modern scientific thought and how this thought became hegemonic, influences the common sense, naturalizes identity construction and how dealing with the body, interferes in the healthcare, show a division among some sectors of the biomedicine, reinforce an specific type of medical rationality and makes an epistemic base and principle (theoretical and discursive) to some sectors connected to aesthetic medicine and aesthetic surgeries.