Flávia Alvim Sant’Anna Addor

Barreira cutânea na dermatite atópica

Research about the skin barrier and its properties has increased significantly since the 60s, with studies that indicated its resistance when isolated, as well as its particularities in relation to skin permeability. At the same time, description of Odland bodies helped to understand how stratum corneum stability is maintained. The âbrick and mortarâ model is the most accepted so far. In this analogy, the corneocytes are the bricks and the intercellular lipids are the mortar. Currently, there is concrete evidence that the stratum corneum is an active metabolic structure that holds adaptive functions, interacting dynamically with the underlying epidermal layers. The skin barrier also plays a role in the inflammatory response through melanocyte activation, angiogenesis, and fibroplasia. The intensity of this response will essentially depend on the severity of the injury. Skin barrier abnormalities in atopic dermatitis are clinically observed by the presence of dry skin, a common and significant symptom which constitutes a diagnostic and monitoring parameter. The stratum corneum hydration level and transepidermal water loss are associated with the level of damage to the barrier, representing biophysical parameters. These parameters help doctors monitor patients in a less invasive and more sensitive manner.

Atopic dermatitis: correlation between non‐damaged skin barrier function and disease activity

Background  Atopic dermatitis (AD) is a chronic dermatosis, predominant in childhood, characterized by pruritus and eczematous‐type lesions with xerosis as the prominent clinical sign.

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.

Acne da mulher adulta: aspectos epidemiológicos, diagnósticos e terapêuticos

BACKGROUND Adult female acne (AFA) is a dermatosis of increasing incidence; hyperandrogenism is present in many cases, but there are patients without hormonal abnormalities. OBJECTIVE To analyze the prevalent characteristics in adult women with acne without hyperandrogenism. MATERIAL AND METHODS A survey of 226 medical records with AFA complaints was conducted; of these, 116 (51.3%) had a normal hormonal profile and were, therefore, included in the study. We investigated age, ethnicity, clinical profile of acne, complementary exams, previous treatment, prescribed treatment and evolution. RESULTS The mean age was 33.9 years and the predominant clinical grade of acne was moderate inflammatory (grade 2). The face was the most affected area. Topical retinoids were the most prescribed drugs, and systemic medication was prescribed to 53.4% of the patients. Total regression was observed in 31 patients (26.7%) within 12 weeks of treatment. Adverse reactions to topical treatment occurred in 21.5% of the patients. CONCLUSION The clinical manifestations of AFA in patients without hyperandrogenism are moderate, with predominance of inflammatory lesions. Treatment is similar to that of acne vulgaris; however, special attention should be taken with more irritating medication since this group appears to be more predisposed to skin irritations.

Use of silicon for skin and hair care: an approach of chemical forms available and efficacy

Silicon is the second most abundant element on Earth, and the third most abundant trace element in human body. It is present in water, plant and animal sources. On the skin, it is suggested that silicon is important for optimal collagen synthesis and activation of hydroxylating enzymes, improving skin strength and elasticity. Regarding hair benefits, it was suggested that a higher silicon content in the hair results in a lower rate of hair loss and increased brightness. For these beneficial effects, there is growing interest in scientific studies evaluating the efficacy and safety of using dietary supplements containing silicon. Its use aims at increasing blood levels of this element and improving the skin and its annexes appearance. There are different forms of silicon supplements available and the most important consideration to be made in order to select the best option is related to safety and bioavailability. Silicon supplements are widely used, though there is wide variation in silicon bioavailability, ranging from values below 1% up to values close to 50%, depending on the chemical form. Therefore, the aim of this study was to evaluate the scientific literature related to the different chemical forms of silicon supplements available and the limitations and recent progress in this field. According to reported studies, among the different chemical forms available, the orthosilicic acid (OSA) presents the higher bioavailability, whereas the others forms have absorption inversely proportional to the degree of polymerization. However, clinical studies evaluating safety and efficacy are still lacking.

Skin barrier in rosacea

Recent studies about the cutaneous barrier demonstrated consistent evidence that the stratum corneum is a metabolically active structure and also has adaptive functions, may play a regulatory role in the inflammatory response with activation of keratinocytes, angiogenesis and fibroplasia, whose intensity depends primarily on the intensity the stimulus. There are few studies investigating the abnormalities of the skin barrier in rosacea, but the existing data already show that there are changes resulting from inflammation, which can generate a vicious circle caused a prolongation of flare-ups and worsening of symptoms. This article aims to gather the most relevant literature data about the characteristics and effects of the state of the skin barrier in rosacea.

Antioxidants in dermatology

The skin cells continuously produce, through cellular respiration, metabolic processes or under external aggressions, highly reactive molecules oxidation products, generally called free radicals. These molecules are immediately neutralized by enzymatic and non-enzymatic systems in a physiological and dynamic balance. In situations where this balance is broken, various cellular structures, such as the cell membrane, nuclear or mitochondrial DNA may suffer structural modifications, triggering or worsening skin diseases. several substances with alleged antioxidant effects has been offered for topical or oral use, but little is known about their safety, possible associations and especially their mechanism of action. The management of topical and oral antioxidants can help dermatologist to intervene in the oxidative processes safely and effectively, since they know the mechanisms, limitations and potential risks of using these molecules as well as the potential benefits of available associations.

Beyond photoaging: additional factors involved in the process of skin aging

Studies assessing the impact of extrinsic factors on skin aging have increased during the last with the increase in life expectancy. Although most of the studies are about the sun radiation impact, many factors should be considered in elderly people, beyond environmental conditions. Lifestyle factors, like diet, sleeping, smoking, should be analyzed carefully, as common age-related conditions (menopause, diabetes, pulmonary diseases, etc.). All these factors could accelerate the natural decline of skin structure and functions, possibly affecting the responses to treatments and drugs. This review demonstrates that growing evidence regarding environmental factors that are associated with lifestyle and comorbidities deserve greater attention from researchers and dermatologists and may require new approaches in the management of skin aging.

Comparative evaluation between two nutritional supplements in the improvement of telogen effluvium

Purpose Telogen effluvium (TE) is defined as a diffuse hair loss characterized by shortening of the anagen phase and precipitation of the telogen phase, with a consequent reduction of total hair volume. Nutritional supplementation is indicated under conditions in which TE is related to dietary disorders. The aim of this clinical study was to compare the efficacy of two different supplements in monotherapy for TE. Patients and methods Female adult patients were randomized to receive two oral nutritional supplements (group 1: a supplement composed of zinc, biotin, iron, vitamins A, C, E, and B complex, folic acid, magnesium, and amino acids of keratin and collagen and group 2: calcium pantothenate cystine, thiamine nitrate, medicinal yeast, keratin, and aminobenzoic acid) to treat hair loss for 180 days. They were evaluated clinically and by digital trichoscopy. Results Clinical evaluation showed significant clinical improvement (P<0.05) for the evaluated parameters: hair loss, hair volume, density of hair (scalp cover), hair shine, hair strength, in 180 days. At 90 days evaluation, group 1 showed significant improvement for all parameters, while group 2 did not show any significant improvement for hair shine and hair strength. In the digital trichoscopy, there was a significant improvement only in group 1 (11.09%×7.76%) after 180 days. Conclusion In idiopathic TE, the nutritional component should be suspected; the supplementation of an association of nutrients in recommended daily intake can lead to significant improvement of the condition from the first trimester of use. The use of an association with proven efficacy and a safety profile and posologic convenience facilitate its indication and patient adherence.

Improvement of dermal parameters in aged skin after oral use of a nutrient supplement

Purpose Skin aging is a progressive and degenerative process caused by a decrease in the physiological functions of the skin tissue. In addition, environmental factors as well as concomitant diseases and lifestyle (nutrition, sedentary lifestyle, smoking, etc) negatively impact the aging process. An association between oral administration of collagen peptides combined with vitamin C and extracts of Hibiscus sabdariffa and Aristotelia chilensis (Delphynol®) (Eximia Firmalize Age complex®) on dermal thickness was studied and the improvement in aging signs was evaluated. Patients and methods Female adult patients received an oral nutritional supplement containing collagen peptides, vitamin C, H. sabdariffa, and A. chilensis (Delphynol) in a sachet and were instructed to consume 1 sachet diluted in 200 mL of water once daily for 12 weeks. They were evaluated clinically, by high frequency ultrasound and cutometry. Results There was a significant improvement of firmness and elasticity and an increase in dermal thickness by ultrasound after 3 months of use. Conclusion The association of collagen peptides, vitamin C, H. sabdariffa and A. chilensis (Delphynol) could improve the signs of dermal skin aging.