Melasma: Estudio comparativo de una asociación de ácido glicólico con hidroquinona y peelings de ácido glicólico / Melasma: A comparative study of the combination of glycolic acid and hydroquinone in association with glycolic acid peelings

El melasma es una alteración adquirida de la pigmentación, frecuente, predominante en las mujeres y habitualmente localizado en las áreas de mayor exposición solar de la cara. En el tratamiento de las manchas normalmente se emplean despigmentantes, como la hidroquinona, y fotoprotección. Existen controversias sobre el beneficio de los peelings químicos en el tratamiento del melasma. Comparar la eficacia de una crema despigmentante y un fotoprotector usados aisladamente, así como asociados a peelings de ácido glicólico al 70% en el tratamiento del melasma. Ocho pacientes del sexo femenino participaron en un estudio prospectivo que duró siete meses. Durante el primer mes las pacientes usaron solamente crema con ácido glicólico 10% e hidroquinona 4%, además de fotoprotector, en ambos lados de la cara. Se aplicó, entonces, una secuencia de 4 peelings de ácido glicólico al 70% en un lado de la cara y en el otro lado solamente el vehículo del peeling. Después de 30 días, se realizó una nueva aplicación del peeling y del placebo en lados inversos de la cara. Tres dermatólogos realizaron la evaluación independiente de las fotos clínicas La mayoría de los pacientes tuvo mejora del melasma con el uso de la crema con ácido glicólico al l0% e hidroquinona al4% asociado a la fotoprotección adecuada. La aplicación de los peelings de ácido glicólieo al 70% no produjo aclaramiento del melasma en comparación al placebo y la inversión de los lados de la aplicación confirmó este resultado. El uso de la crema con ácido glicólico al 10% e hidroquinona al 4% asociado a la fotoprotección adecuada es efectivo en el tratamiento inicial del melasma. La aplicación de peelings seria dos de ácido glicólico al 70% no produjo mejora adicional en el aclaramiento de la piel

Melasma is a common acquired pigmentation disturbance, found mainly in women and located generally in those areas of the face most subject to sun exposure. Photoprotection and depigmenting agents, such as hydroquinone, are used in order to lighten the marks. There is, however, some controversy regarding the use of chemical peelings in the treatment of melasma. To compare the efficacy of a depigmenting cream plus sunprotector alone to this same approach in combination with 70% glycolic acid peelings in the treatment of melasma. Eight female patients participated in a split-face prospective study that lasted seven months. During the first month they were oriented to only use a cream containing 10% glycolic acid and 4% hydroquinone as well as sun protector, on both sides of the face. A sequence of 4 peelings using 70% glycolic acid were then applied to one side of the face while only the peeling vehicle was applied to the other side. After 30 days, the application of the peelings and placebo was repeated on inverse sides of the face The treatment was evaluated using clinical pictures assessed by 3 independent dermatologists. Most of the patients showed improvement in their melasma with the use of the 10% glycolic acid and 4% hydroquinone cream together with adequate sun protection. The application of 70% glycolic acid peelings did not result in lightening of the melasma, and the inversion of the sides receiving peelings or placebo confirmed this result. The use of 10% glycolic acid and 4% hydroquinone cream together with adequate sun protection is effective in the treatment of melasma. The application of 70% glycolic acid peelings did not produce additional improvement in the lightening of the affected skin

Unusual location of cutaneous leishmaniasis on the hallux in a Brazilian patient.

A 70-year-old white Brazilian woman from a rural area had a 2-year history of a painful lesion on her left toe. The lesion increased progressively in size followed by toenail destruction. She was treated with systemic antibiotics for secondary bacterial infection several times without any clinical response. Physical examination showed an erythematous swelling on the first toe with an irregular 2.5 cm ulcer with a raised edge that was infiltrating and destroying the toenail. The bottom of the ulcer was granular and partially covered with a crust (Fig. 1). Laboratory studies showed a strong positive Montenegro intradermal reaction (2.5 mm). Other intradermal reactions were also performed, such as purified protein derivative (PPD) and sporotrichin, which were negative. On X-ray examination of the left foot, bone destruction of the distal phalanx of the first toe and a soft tissue swelling were observed (Fig. 2). A biopsy was taken and the histologic picture showed a chronic inflammatory change with tuberculoid-type granuloma and necrosis suggesting leishmaniasis, although parasites were not observed. Based on the clinical, histologic, and immunologic aspects, we concluded that this was a case of leishmaniasis. Methylglucamine (Glucantime) was introduced at a total dose of 17 g of the salt (10 mg/kg daily for 40 days). Immediately after the start of treatment, the lesion began to improve, and 4 months later the lesion had healed completely and the dystrophic nail had started to grow (Fig. 3).

Xantelasma: experiência no tratamento de 40 pacientes / Xanthelasma: therapppeutic experience in 40 patients

O xantelasma caracteriza-se por placas amareladas nas pálpebras. Na maioria dos casos não há nenhuma causa sistêmica, mas pode estar associado a uma dislipoproteinemia, mais freqüentemente à hipercolesterolemia familiar com níveis elevados de colesterol e LDL. As razões para seu tratamento são estéticas, e diversas modalidades terapêuticas podem ser empregadas. O objetivo era relatar experiência na avaliação e no tratamento de pacientes com xantelasma, enfatizando os resultados satisfatórios da excisão cirúrgica cuidadosa das lesões, seguida de cicatrização por segunda intenção. No período de 42 meses foram tratados 40 pacientes portadores de Xantelasma, sendo 35 mulheres e cinco homens, com idades variando entre 26 e 72 anos, posteriormente seguidos por 18 meses, em média. Os pacientes, foram divididos em dois grupos: no primeiro, com 10 casos, compararam-se duas formas de tratamento de lesões - exérese cirúrgica e cauterização química; no segundo, com 30 casos, foram acompanhados os resultados da exérese cirúrgica seguida da cicatrização por segunda intenção. Todos os paciente foram avaliados quanto ao perfil lipídico. Dos 40 pacientes tratados, 25 (62,5 por cento) tiveram resultado estético ótimo; 12 (30 por cento), bom; e 3 (7,5 por cento), regular, independentemente da técnica utilizada. A complicação tardia mais comum foi a hipocromia leve, em 12 (30 por cento) casos. Recidivas ocorreram em dois casos (5 por cento), após três e seis meses. Em nove pacientes (22,5 por cento) foram detectados níveis elevados de colesterol e LDL. A retirada cirúrgica cuidadosa da xantelasma oferece resultados satisfatórios, com mínimas probabilidades de recidiva e, às vezes, com hipocromia transitória. Destaca-se a importância da avaliação do perfil lipídico