RESUMO
Durante vários anos o tratamento da acne vulgar tem-se baseado no uso de medicamentos orais ou tópicos, isolados ou usados de forma associada. Embora ainda representem, em sua maioria, excelentes opções terapêuticas, há casos em que essas inúmeras opções não podem ser usadas, seja por seus efeitos colaterais ou falta de resposta ao tratamento observada com a crescente resistência bacteriana aos antibióticos. Na tentativa de buscar novas opções terapêuticas e com base no fato de a luz ser utilizada com sucesso no tratamento de diversas doenças, a acne entre elas, inúmeros dispositivos foram desenvolvidos para esse fim com bons resultados. Este artigo tem por objetivo fazer uma revisão da fisiopatologia da acne, bem como dos princípios fotobiológicos aplicados em seu tratamento e aborda algumas das principais modalidades fototerápicas atuais.
For several years, the treatment of acne vulgaris has been based on the use of oral or topical medication, isolated or in association with other medications. Such options still represent excellent therapeutic alternatives; however, there are cases in which they cannot be used either because of their side effects or the lack of response to treatment due to the growing bacterial resistance to antibiotics. Based on the observation that light has been successfully used to treat many pathologies including acne a number of therapeutic devices have been developed that demonstrate good results.The objective of this article is to present a review of the pathology of acne and of the photobiological principles used in its treatment, considering some of the main current phototherapeutic modalities.
RESUMO
BACKGROUND: Keratoacanthoma (KA) is easily confused with squamous cell carcinoma (SCC) on a clinical or a histopathologic basis. However, KA undergoes spontaneous regression, whereas SCC does not. OBJECTIVE: Our objective was to study the histopathologic features associated with clinical regression in KA-like lesions to support the therapeutic option. METHODS: Forty-three biopsies of KA-like lesions were taken at patient admission. One month later, surgical excision was performed in 18 growing lesions. Regressing lesions were left untreated. Classic histopathologic features and diagnosis were blindly recorded in both biopsies and surgical specimens. RESULTS: On a clinical and a histologic basis, 32 lesions were assessed as KA and 11 as SCC. Features that indicated malignancy were observed in both groups, but the probability of SCC was 31 times higher in tumors with five or more of such features. Several of the histologically atypical lesions were found to regress. CONCLUSION: SCCs and KAs have more pathologic similarities than differences, especially in the proliferative phase. The combination of the most useful features did not allow the nosologic diagnosis in difficult cases but helped. Differential diagnosis was easier to determine after the 1-month follow up. Complete surgical excision should be indicated in nonregressing and growing lesions.
