Hair-to-Hair Trichoscopy: An Objective Method to Assess Effectiveness of Botulinum Toxin in a Clinical Trial for Androgenetic Alopecia.

Introduction: Androgenetic alopecia (AGA) is the most common alopecia affecting both genders leading to a potential decrease in quality of life and self-esteem. A current concern in trichology is how to accurately measure clinical response in both daily medical practice and academic research. Hair-to-hair (H2H)-matching technology™ has recently emerged as a technique to evaluate variations in follicular units, hair shaft number, and thickness. This study aimed to describe the methodology employed in a clinical trial using this technology to test the efficacy of botulinum toxin (BT) for male AGA. Methods: This pilot study is a triple-blind, randomized, split scalp, placebo-controlled clinical trial. Patients enrolled were submitted to injections half of the scalp with 50 IU of BT and the other half with 1 mL of normal saline as a control. The trial involved three visits (weeks 0, 12, and 24) and 8 global clinical photographs followed by H2H-matching trichoscopy were captured before the injections at each visit. Paired t test analysis was employed for matched pairs of the following parameters: total hair count, the total number of terminal hair strands, average shaft thickness, and the number of hairs lost or gained during each visit. Then, the software compared the differences between the two sides (BT vs. placebo) per scalp zone and a long time. Conclusion: The combination of manually corrected image processing, follicular map, and H2H-matching technology™ appears to be the most precise way to evaluate changes in hair count and thickness over time. The design is reproducible and can help other researchers and dermatologists in their clinical practice to obtain reliable results in similar scientific research.

Comedonic lupus, a rare variant of chronic cutaneous lupus erythematosus (CCLE): case series and literature review.

BACKGROUND: Cutaneous lupus erythematosus (CLE) is an autoimmune disease with several clinical presentations. The chronic form predominantly presents as discoid rashes but may present with less common morphological findings that can sometimes make diagnosis difficult. Comedonic lupus is a rare and underdiagnosed variant, with unknown etiology and still poorly defined treatment. METHODS: The report illustrates a series of five cases of patients diagnosed with comedonic lupus, and it reviews 18 cases previously published in the literature. RESULTS: The clinical presentation is of comedonal lesions, mostly located on the face, making a differential diagnosis with other benign conditions such as acne vulgaris, Favre-Racouchot syndrome, and syringoma, emphasizing the importance of clinical practice and histopathology for diagnostic confirmation. CONCLUSIONS: There is scarcity in the literature regarding the condition and therapeutic possibilities for these cases of comedonic lupus.

Treatment and Maintenance of Cutaneous Rosacea in Latino Skin Types With Prescription Medications and Non-Prescription Cleansers and Moisturizers as Adjuncts: A Review.

BACKGROUND: Rosacea is an inflammatory dermatosis with at least a ten percent prevalence reported among white adults. Rosacea occurs in nonwhite populations, but prevalence data is limited. METHODS: Five dermatologists from Latin America (the panel) met virtually after completing a survey of their prescription and adjunctive therapy practices when managing Latin American patients with rosacea. Panel members were chosen based on their dermatology expertise in treating a range of skin phototypes. Survey results were reviewed and discussed, along with a review of published guidelines for rosacea treatment. RESULTS: The panel addressed diagnostic challenges in richly pigmented skin individuals. Pathophysiology and treatment of rosacea were reviewed, with a primary focus on how to treat the skin barrier dysfunction in those affected, using prescription and over-the-counter measures. CONCLUSIONS: Appropriate skincare is crucial for effective rosacea management. Cleansers and moisturizers with ingredients such as ceramides, hyaluronic acid, and niacinamide promote a healthy skin barrier, improving rosacea control. J Drugs Dermatol. 2022;21(10):1111-1118.  doi:10.36849/JDD.7010.

Impact on the Quality of Life Following Minimally Invasive Cosmetic Procedures: Assessment Through the Skin Rejuvenation Outcome Evaluation Questionnaire.

BACKGROUND: Aesthetic procedures are widely performed by dermatologists and plastic surgeons, often with subjective results. In cosmetic dermatology, there is a lack of studies that use accurate instruments to assess result outcomes. Quality of life (QoL) questionnaires can objectively assess results. OBJECTIVE: To assess the impact of nonsurgical facial cosmetic procedures on QoL. MATERIALS AND METHODS: This was a longitudinal observational study performed with 81 patients who underwent facial cosmetic procedures at a University Hospital in Rio de Janeiro, Brazil. The Skin Rejuvenation Outcome Evaluation questionnaire, previously adapted and translated to the Portuguese language spoken in Brazil, was selected, and the results were compared with the Dermatology Life Quality Index. The impact on QoL was statistically evaluated after the interventions. RESULTS: The Skin Rejuvenation Outcome Evaluation scores after the procedures were significantly higher than before ( p < .001), independent of sociodemographic characteristics. Patients treated with botulinum toxin and dermal fillers showed greater satisfaction than those treated with laser, chemical peels or microneedling. CONCLUSION: Minimally invasive cosmetic procedures result in improvements in QoL. The use of translated, adapted, and validated questionnaires favors the comparison of results among different populations and reinforces the confidence on the results of established cosmetic treatments.

Tradução e validação transcultural de um questionário de qualidade de vida para avaliar procedimentos cosmiátricos faciais: versão para a língua portuguesa falada no Brasil / Translation and transcultural validation of a quality of life questionnaire to assess facial cosmetics procedures: a Brazilian Portuguese version

Introdução: o aumento da demanda por tratamentos cosméticos faciais é uma realidade universal, sendo o Brasil o segundo país no mundo que mais os realiza. Questionários de qualidade de vida podem ajudar a avaliar os resultados de forma mais objetiva e revelar dados ainda não explorados na literatura científica. O processo de tradução, adaptação e validação de questionários é necessário para a universalização dos dados. Objetivo: traduzir, adaptar e validar um questionário específico de avaliação de procedimentos cosmiátricos faciais para a língua portuguesa falada no Brasil. Métodos: iniciou-se o processo de tradução do questionário SROE (Skin Rejuvenation Outcome Evaluation). Foi realizada a tradução literal, com posterior síntese das versões, seguindo-se a tradução reversa e a validação final por equipe de especialistas. Os dados obtidos foram analisados estatisticamente para validação. Resultados: a versão final foi denominada "Avaliação dos Resultados de Rejuvenescimento da Pele" (ARRP). O Alfa de Cronbach obteve valores acima de 0,70, evidenciando boa consistência interna. O Coeficiente de Correlação Intraclasse foi de 0,995 (p<0,001). Conclusões: Os valores obtidos validam o questionário ARRP, traduzido para língua e cultura brasileiras, que tem como objetivo avaliar os resultados e o impacto na qualidade de vida dos procedimentos faciais em cosmiatria

Background: The increased demand for cosmetic facial treatments is a universal reality, with Brazil being the second country in the world that performs them the most. Quality of life questionnaires can help assess results more objectively and reveal data not yet explored in the scientific literature. For this, the process of translation, adaptation and validation of questionnaires is necessary for the universalization of data. Objective: To translate, adapt and validate a specific questionnaire for the assessment of facial cosmetics procedures into the Portuguese language spoken in Brazil. Methods: After choosing the SROE (Skin Rejuvenation Outcome Evaluation) questionnaire, the translation process started. A literal translation was performed, with subsequent synthesis of the versions. After, reverse translation and final validation by a team of experts were carried out. The data obtained were statistically analyzed for validation. Results: The final version was called "Avaliação dos Resultados de Rejuvenescimento da Pele" (ARRP). The Cronbachs a resulted in values above 0.70, showing good internal consistency. The Intraclass Correlation Coefficient was 0.995 (p<0.001). Conclusions: The values obtained validate the ARRP questionnaire, translated into Brazilian language and culture, which aims to evaluate the results and impact on the quality of life of facial cosmetics procedures.

Uso da toxina botulínica para rosácea: estudopiloto / Use of botulinum toxin for rosacea: a pilot study

Introdução: rosácea é uma doença inflamatória crônica da pele, e a aplicação intradérmica de toxina botulínica (TB) tem sido estudada como uma opção terapêutica aos pacientes de difícil manejo do flushing e/ou eritema facial persistente. Ainda não há protocolo-padrão para aplicação da TB na rosácea. Objetivo: avaliar o efeito da aplicação de toxina botulínica na rosácea eritêmato-telangiectásica. Métodos: estudo-piloto com série de casos. Foi realizada a aplicação intradérmica da TB em 10 pacientes com diagnóstico de rosácea e sintomas de eritema persistente e/ou flushing facial. Os pacientes foram submetidos a 10 a 15 injeções por hemiface (1 unidade de TB onabotulínica por injeção) e 0 a 5 injeções na região nasal, totalizando 25 a 35 unidades por paciente. Resultados: apresentaram redução na intensidade do flush e do eritema 75% dos pacientes. O tempo de acompanhamento foi de três meses e nenhum evento adverso grave foi observado. Conclusões: a aplicação intradérmica de TB tipo A deve ser considerada no arsenal terapêutico para controle do eritema e flushing facial da rosácea, especialmente em casos refratários ao tratamento habitual

Introduction: Rosacea is a chronic inflammatory skin disease. The intradermal application of botulinum toxin (BT) has been studied as a therapeutic option for patients who struggle to manage flushing and/or persistent facial erythema. There is no standard protocol for TB application in rosacea. Objective: To evaluate the effectiveness of botulinum toxin application on erythematotelangiectatic rosacea. Methods: Pilot study with case series. We applied intradermal TB in 10 patients with a diagnosis of rosacea and symptoms of persistent erythema and/or facial flushing. Patients received 10 to 15 injections per hemiface (1 unit of onabotulinum TB per injection) and 0 to 5 injections in the nasal region, totaling 25 to 35 units per patient. Results: Seventy-five percent of the patients presented a reduction in flush and erythema intensity. The follow-up time was three months, and no serious adverse events were observed. Conclusions: The therapeutic arsenal to control erythema and facial flushing of rosacea, especially refractory to the usual treatment, should consider the intradermal application of TB type A.

Consensus on the treatment of vitiligo - Brazilian Society of Dermatology

Abstract Background: Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives: The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods: Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion: The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.

Consensus on the treatment of vitiligo - Brazilian Society of Dermatology.

BACKGROUND: Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. OBJECTIVES: The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. METHODS: Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. RESULTS/CONCLUSION: The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.

Tratamento das cicatrizes atróficas com insulina subcutânea / Atrophic scars treatment with subcutaneous insulin

As cicatrizes atróficas de acne, sequelas persistentes, são indesejáveis e causam impacto negativo cosmético e psicossocial nos pacientes. A questão torna-se mais delicada quando tais cicatrizes localizam-se na região pré-esternal, pelo risco do surgimento de cicatrizes hipertróficas com a realização de procedimentos na região. O papel da insulina na promoção da síntese de proteínas e gorduras é, há muito tempo, reconhecido. A utilização de suas propriedades como fator de crescimento para tratar estas sequelas parece lógica e provou ser gratificante cosmeticamente, com melhora na qualidade de vida

Atrophic acne scars are persistent and undesirable sequelae that have a negative cosmetic and psychosocial impact on patients. This issue becomes more delicate when such scars are located in the presternal region due to the risk of hypertrophic scars appearing when performing these procedures in the area. The literature has long recognized the role of insulin in promoting protein and fat synthesis. Insulin properties as a growth factor to treat these sequelae seems logical and has proved cosmetically satisfying, with quality of life improvement

O lado negro dos clareadores cutâneos / The dark side of skin lightening

Esta carta traz uma reflexão surgida a partir da palestra da professora Fatimata Ly, da University Cheikh Diop de Dakar (África), no último Congresso da Academia Europeia de Dermatologia, em Paris. A professora F. Ly proferiu a palestra Depigmentation: when, where and how. O tom de pele uniforme é um dos critérios de beleza. Esta carta não diz respeito aos pacientes que chegam ao consultório médico e que são cuidadosamente acompanhados e monitorados por dermatologistas criteriosos. Ela quer chamar a atenção para os indivíduos que não chegam aos consultórios, que repetem prescrições de conhecidos ou que mantêm por tempo indefinido uma prescrição realizada por dermatologista numa consulta pontual. Recentemente, participei, de forma anônima, de fóruns de "discussão" na internet de pessoas leigas sobre melasma. A intensidade e a velocidade do compartilhamento em relação àquilo que eles aconselham são expressivas. A criatividade é enorme ao sugerirem usar produtos que podem causar algum dano. Entre os clareadores mais utilizados estão esteroides, hidroquinona, mercúrio e ácidos. Há que se realizar uma campanha de conscientização da população em relação aos perigos de se utilizarem despigmentantes cutâneos sem indicação precisa do médico dermatologista.

This letter is a reflection that arose from the lecture given by Professor Fatimata Ly, from University Cheikh Diop in Dakar (Africa) in the latest Congress of the European Academy of Dermatology and Venereology in Paris. Professor F. Ly gave the lecture "Depigmentation: when, where and how". An even skin tone is one of the criteria for beauty. This letter does not concern those patients that come to our practices and are carefully followed and monitored by discerning dermatologists. She wants to raise attention to those that do not come to our practices, that use prescriptions given to acquaintances, or that use a dermatologist prescription indefinitely, after a single consultation. I was recently part of "discussion" forums over the internet, anonymously, of lay people on melasma. The intensity and speed of sharing of what they recommend using are impressive. They are very creative suggesting the use of products that could cause harm. Among the most used lightening products are steroids, hydroquinone, mercury and acids. There must be an awareness campaign to warn the population regarding the dangers of using skin depigmenting agents without a specific indication by the dermatologist.

Reduction of skin-homing cytotoxic T cells (CD8+ -CLA+) in patients with vitiligo.

BACKGROUND: Vitiligo is a frequently acquired, hereditary disease, characterized by achromic macules due to the absence of melanocytes. In contrast with earlier studies, in which the main pathogenic role was attributed to anti-melanocyte antibodies, recent papers have emphasized a role for CD8(+) cytotoxic T lymphocytes in melanocyte destruction. Fifteen percent of peripheral T cell express cutaneous lymphocyte-associated antigen (CLA), responsible for skin-homing T cell. Phototherapy is used to treat patients with generalized vitiligo and it has been shown to interfere with CLA(+) T cells in other skin diseases. OBJECTIVE: To describe peripheral blood T cell subpopulations' frequency and ability to express the skin-homing molecule (CLA) in patients with non-segmental vitiligo, before and after photochemotherapy (PUVA). PATIENTS AND METHODS: Twenty-two patients with generalized and active spreading vitiligo were submitted to 30 PUVA-8MOP sessions. Lymphocyte immunophenotyping was performed by flow cytometry using anti-CD3, anti-CD8 and anti-CLA monoclonal antibodies. Fifteen healthy volunteers, sex- and age-matched, were included as a control group. RESULTS: CD8(+) -CLA(+) T cells were significantly reduced in number in untreated vitiligo patients (P=0.008) when compared with control individuals, albeit with a more intense CLA expression (P=0.028). These findings were not altered after PUVA. No significant difference was noticed in CD4/CD8 ratios nor in CD4-CLA(+) T cell numbers between vitiligo patients and controls, both before and after PUVA. CONCLUSIONS: CD8-CLA(+) T cells are reduced in peripheral blood of patients with non-segmental vitiligo. This finding may be related to the previously reported increase of CD8(+) cells in both lesions and perilesional skin of these patients.

Redução dos linfócitos T-CD8+ citotóxicos observada com a terapia Puva em paciente com vitiligo / Reduction of cytotoxic T-CD8+ lymphocytes observed during PUVA therapy in a patient with vitiligo

Na patogênese do vitiligo tem-se enfatizado o papel das células T citotóxicas. Identificadas pelo antígeno linfocitário cutâneo (CLA), essas células já foram descritas no sangue de pacientes com outras dermatoses e podem ser depletadas pela fototerapia concomitantemente à melhora clínica. Descreve-se caso de vitiligo generalizado com melhora clínica expressiva após Puva, no qual houve redução de 25% dos linfócitos T CD8+-CLA+ circulantes.

The role of cytotoxic T cells (CD8+) has been emphasized in the pathogenesis of vitiligo. This cell population, identified by a skin homing molecule (cutaneous lymphocyte associated antigen Â- CLA), has been described in patients with other dermatoses and can be reduced with phototherapy. The authors present the case of a patient with generalized vitiligo and clinical recovery after PUVA parallel to a 25% reduction in CD8+-CLA+ T cells in the peripheral blood.