Denise Steiner

Brazilian Consensus on Photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

Rejuvenescimento da pele por peeling químico: enfoque no peeling de fenol

The natural aging of facial skin is a source of preoccupation for many, who seek out the aid of a specialized physician to minimize its signs. The skins youthfulness can be obtained using chemical peeling made from various active substances such as glycolic, retinoic, and trichloroacetic acids and phenol. These substances proportion cutaneous exfoliation with subsequent cellular renovation. Depending on the formula concentration and pH value, peelings may be superficial, medium or deep. Phenol has been used in deep peeling. It is the main component of the Baker/Gordon formula, as well as other formula substances acting as penetration and permeation promoters. The use of these active substances results in an intensive process of cellular renovation. It decreases wrinkles, softens the presence of dark spots and gives the skin a youthful appearance. Due to its toxicity and side effects, phenol should be used carefully. Technical steps must be followed. The patient should be monitored in order to obtain maximum effectiveness from the peeling, thereby minimizing effects on the systemic functions.

Acne vulgaris: prevalence and clinical forms in adolescents from São Paulo, Brazil

BACKGROUND Acne is a common disease in adolescents, but there are no epidemiological data for acne in Brazil. OBJECTIVES To estimate the prevalence and degree of acne in adolescents from Sao Paulo and study socio-demographic factors, family history and lifestyle, associated with the disease. METHODS Cross-sectional study with 452 adolescents aged between 10 and 17 (mean=13.3 years), students from elementary and high school, examined by 3 independent evaluators. RESULTS 62.4% were female, 85.8% white and 6.4% were aged 14. The prevalence was 96.0% and increased with age - all students over 14 had acne. The most prevalent form of acne was comedonal (61.1%), followed by mild (30.6%) and moderate (7.6%) papular-pustular, which affected mostly the face (97.5%). About half of the adolescents reported family history for acne in mother or father, and 20.6% reported previous treatment for acne. There was a higher chance of presenting non-comedonal acne with increased age (p<0.001). DISCUSSION The prevalence of acne in adolescents varies widely due to the clinical features and diagnostic methods used. Adolescents whose brothers/sisters had acne (OR=1.7-p=0.027) and those over 13 (OR=8.3-p<0.001), were more likely to have non-comedonal acne. CONCLUSION This study showed high prevalence of acne in adolescents from Sao Paulo, predominantly the comedonal form on the face, with a higher chance of presenting non-comedonal acne with increased age.

Remarkable Improvement of Nail Changes in Alopecia Areata Universalis with 10 Months of Treatment with Tofacitinib: A Case Report

Alopecia areata (AA) is a chronic, autoimmune disease. The main symptom is massive hair loss, localized or diffuse, in the scalp and the whole body. However, nails may also be involved, and brittleness, fragility and pitting can be signs of nail dystrophy in AA patients. Here, we report the case of a male patient with AA refractory to various treatments, including oral, topical and intralesional corticosteroids, immunosuppressants, cyclosporin and PUVA (oxoralen plus ultraviolet light), all interrupted due to side effects. The patient’s nails had erythematous blotches (striated lunulae) with regular and superficial pitting as well as fragility (trachyonychia), and he could no longer play the guitar because of these symptoms. With patient consent, we introduced tofacitinib (5 mg twice daily), which resulted in remarkable improvements not only regarding hair regrowth but also nail changes, with function recovery within 10 months.

Mal de Meleda: relato de 2 casos de ocorrência familiar

Mal de Meleda e uma ceratodermia palmoplantar transgressiva rara, com prevalencia estimada de 1:100.000 habitantes, descrita em 1826 por Stulli, na Ilha de Meleda. A heranca autossomica recessiva foi descrita em 1938 e a alteracao genica no locus 8qter, documentada em 1998. As principais manifestacoes clinicas decorrem da alteracao da ceratinizacao palmoplantar. Ha intensa hiperceratose transgressiva com eritema tambem no dorso das maos e pes com distribuicao em luvas e botas O aconselhamento genetico faz-se necessario, sobretudo nos casos de consanguinidade. Nosso objetivo e relatar 2 casos de ocorrencia familiar de pais consanguineos

Activation of melanocytes in idiopathic guttate hypomelanosis after 5-fluorouracil infusion using a tattoo machine: Preliminary analysis of a randomized, split-body, single blinded, placebo controlled clinical trial

3. Le Poole IC, van den Wijngaard RM, Westerhof W, Das PK. Presence of T cells and macrophages in inflammatory vitiligo skin parallels melanocyte disappearance. Am J Pathol. 1996; 148:1219-1228. 4. Gupta AK, Ellis CN, Nickoloff BJ, et al. Oral cyclosporine in the treatment of inflammatory and noninflammatory dermatoses. A clinical and immunopathologic analysis. Arch Dermatol. 1990;126:339-350. 5. Radmanesh M, Saedi K. The efficacy of combined PUVA and low-dose azathioprine for early and enhanced repigmentation in vitiligo patients. J Dermatolog Treat. 2006;17:151-153.

Tratamento de psoríase vulgar pela microinfusão de medicamentos na pele (MMP®) usando ciclosporina e metotrexato

Systemic oral medications – such as cyclosporine (CYA) or methotrexate (MTX) – for the treatment of psoriasis have limited bioavailability due to incomplete gastrointestinal absorption and first-pass hepatic metabolism. Moreover, they are associated with adverse effects. The application of CYA or MTX using the microinfusion of drugs into the skin method (MMP®) for the treatment of psoriasis vulgaris yielded a therapeutic response with significant reduction of lesions, and absence of side effects. In the present report, the authors describe 4 cases of psoriasis vulgaris treated using the MMP® method, with the application of CYA or MTXSystemic oral medications – such as cyclosporine (CYA) or methotrexate (MTX) – for the treatment of psoriasis have limited bioavailability due to incomplete gastrointestinal absorption and first-pass hepatic metabolism. Moreover, they are associated with adverse effects. The application of CYA or MTX using the microinfusion of drugs into the skin method (MMP) for the treatment of psoriasis vulgaris yielded a therapeutic response with significant reduction of lesions, and absence of side effects. In the present report, the authors describe 4 cases of psoriasis vulgaris treated using the MMP method, with the application of CYA or MTX.

Diabetes, Non-Enzymatic Glycation, and Aging

First described in the context of diabetes, advanced glycation end products (AGEs) are formed through a type of non-enzymatic reaction called glycation. Protein glycation and formation of advanced glycation end products (AGEs) play an important role in the pathogenesis of diabetic complications like retinopathy, nephropathy, neuropathy, cardiomyopathy along with some other diseases such as rheumatoid arthritis, osteoporosis, and, recently, skin aging. Glycation of proteins interferes with their normal functions by disrupting molecular conformation, altering enzymatic activity, and interfering with receptor functioning. AGEs form intra- and extracellular cross linking not only with proteins, but with some other endogenous key molecules including lipids and nucleic acids to contribute in the development of diabetic complications. Recent studies suggest that AGEs interact with plasma membrane localized receptors for AGEs (RAGE) to alter intracellular signaling, gene expression, release of pro-inflammatory molecules and free radicals. Characteristic findings of aging skin, including decreased resistance to mechanical stress, impaired wound healing, and distorted dermal vasculature, can be in part attributable to glycation. Multiple factors mediate cutaneous senescence, and these factors are generally characterized as endogenous (e.g., telomere shortening) or exogenous (e.g., ultraviolet radiation exposure). Interestingly, AGEs exert their pathophysiological effects from both endogenous and exogenous routes. The former entails the consumption of sugar in the diet, which then covalently binds an electron from a donor molecule to form an AGE. The latter process mostly refers to the formation of AGEs through cooking. Results of several studies in animal models and humans show that the restriction of dietary AGEs has positive effects on wound healing, insulin resistance and cardiovascular diseases. Recently, the effect of restriction in AGEs intake has been reported to increase the lifespan in animal models. Recent studies have revealed that certain methods of food preparation (i.e. grilling, frying, and roasting) produce much higher levels of AGEs than water-based cooking methods such as boiling and steaming. Moreover, several dietary compounds have emerged as promising candidates for the inhibition of glycation-mediated aging. In this chapter, we summarize the evidence supporting the critical role of glycation in skin aging and highlight preliminary studies on dietary strategies that may be able to combat this process.

Diagnostic index of cutaneous neoplasia in a campaign to fight skin cancer at a dermatologic service located in the Brazilian State of São Paulo’s midlands

Introduction: Skin cancer is the most common type of cancer in the world. It is classified into melanoma (corresponding to 4% of cases) and non-melanoma types: basal cell carcinomas (70 to 80% of cases) and squamous cell carcinoma (25% of cases). The Brazilian Society of Dermatology conducts the National Campaign Against Skin Cancer on a yearly basis, aiming at diagnosing and providing early treatment to the neoplasia. Objective: To demonstrate the incidence of lesions suspicious of skin cancer in selected patients originated from the 2016 National Campaign Against Skin Cancer, at the dermatologic clinic of a university hospital located in the Brazilian State of São Paulo’s midlands. Methods: Two hundred and thirty patients were examined, of which 24 were selected with 22 undergoing biopsy of the suspected lesions. Results: Sixteen basal cell carcinoma cases, one squamous cell carcinoma and one melanoma were confirmed through anatomopathology. Conclusions: Notwithstanding the small sample, it was possible to conclude that the results found are compatible with those of the literature reviewed. It is of paramount importance to carry out the campaign as a way to streamline the population’s access to a dermatologist, which results in the early diagnosis and treatment of skin cancers.

Cutaneous Field Cancerization on a Vitiligo Area

Vitiligo is the most commom depigmentary disorder of the world, with probably an autoimmune cause. Studies reveal the presence of genes likely the emergence of Vitiligo, many of them involved in the synthesis of proteins related to the recognition and killing of melanocytes. The interaction of these genes may suggest protection and good prognosis for Vitiligo patients in relation to skin cancer. We describe the case of a patient with field cancerization in areas affected by Vitiligo, counteracting, therefore, the usual.