Marcia Ramos-e-Silva

New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group.

The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.

Cryosurgery in oral lesions

Background Cryosurgery is a therapeutical method successfully used for many cutaneous conditions. Its use is increasing for several conditions in the oral cavity.

Dermoscopy: basic concepts

Dermoscopy is a very useful technique for the analysis of pigmented skin lesions. It represents a link between clinical and histological views, permitting an earlier diagnosis of skin melanoma. It also helps in the diagnosis of many other pigmented skin lesions, such as seborrheic keratosis, pigmented basal cell carcinoma, hemangioma, blue nevus, atypical nevus, and mole, which can often clinically simulate melanoma. In this article, dermoscopy is reviewed from its history to the basic concepts of the interpretation of dermoscopic images. The goal is to introduce this subject to those not yet familiar with it, in order to instigate and encourage the training and practice of this technique of growing importance for everyday usage.

Hypertrophic versus non hypertrophic scars compared by immunohistochemistry and laser confocal microscopy: type I and III collagens†

Oliveira GV, Hawkins HK, Chinkes D, Burke A, Pasqua Tavares AL, Ramos‐e‐Silva M, Albrecht TB, Kitten GT, Herndon DN. Hypertrophic versus non hypertrophic scars compared by immunohistochemistry and laser confocal microscopy: type I and III collagens.

Elderly skin and its rejuvenation: products and procedures for the aging skin

In the last few decades, there has been a substantial increase in the population of people over 60 years of age. Most of them maintain a good general health and physical activity and fitness. For these individuals there is a good number of dermatologic procedures, medications, and cosmetics that can be prescribed to improve the aspect of skin aging, providing an improvement in their self‐esteem and quality of life as a result of their better look. We will discuss the mechanisms of skin aging, and the procedures and substances used to minimize its deleterious effects, such as sunscreens, estrogens, chemical peels, toxin botulinum, fillers and surgical procedures, among others. The use of makeup and the adverse reactions to cosmetics will also be mentioned.

Superficial mycoses in immunodepressed patients (AIDS)

HIV infection has the capacity to distort the epidemiology and clinical course of infectious diseases, producing atypical manifestations and changing diagnoses. Superficial fungal infections are frequent in HIV-positive/AIDS patients and are no exception. These infections are frequently different in immunodepressed patients (AIDS), with a modified course or exacerbations. This chapter discusses the diagnosis and treatment of superficial mycoses in HIV patients, including cutaneous alterations caused by Candida, dematiaceous fungi agents of phaeohyphomycosis, Malassezia spp, dermatophyte, and filamentous nondermatophyte fungi.

New dressings, including tissue-engineered living skin

In humans, skin corresponds to one-tenth of the body mass, and damage of a part of this organ has critical consequences. Trauma, disease, burn or surgery can result in a great difficulty to heal the affected area. Any significant loss of dermis tends to contract and distort the skin producing a scar. Unfortunately, skin cannot just be transplanted like others organs and requires other methods, such as reconstructive surgery, or grafting procedure. Healing by second intention is a common technique of managing wound, but it has an unpredictable cosmetic result and often prolongs healing time by several weeks. Growing replacement tissues to repair skin was science fiction in the past. The first experience took place in 1907 when Harrison demonstrated that individual cells were capable to live outside the body in which they were grown. In our time, clonage is a reality. Different materials or devices, capable of specific interactions with biologic tissues, were developed to restore the barrier function while permitting epidermal regrowth. Some are entirely synthetic; some are combination of materials, while others are built from biologic products. Many different wound dressings and tissue-engineered skin are now available. Tissue-engineered skin was defined in 1987 by the National Science Foundation Bioengineering Panel Meeting, in Washington, DC, as “the application of the principles and methods of engineering and life sciences toward the development of biologic substitutes to restore, maintain, or improve function.” At present, there are no strict distinction between wound dressing and skin substitutes. Generally, synthetic polymer materials and synthetics associated to some biologic component are termed wound dressings, and materials that combine matrix proteins and synthetics polymers and matrix proteins with cells are consider skin substitutes. The exact definition is very hard in biologic dressings, such as Biobrane, which are in between wound dressings and skin substitutes. The skin is divided in epidermis, dermis, and hypodermis. The first is totally cellular and, although thin, has a sufficient thickness to provide the vital barrier function. The dermis right below constitutes the bulk of the skin. The upper layer of the dermis is based on an extracellular matrix of predominantly of collagen, with some elastin and glycosaminoglycans; fibroblasts are distributed through it, adhering to the collagen fibers and also to blood and lymph vessel, nerve endings, and others structures. Fibroblasts are capable of producing enzymes, such as collagenases and others proteases that “re-model” the deposited collagen; this is a very important process in the latter stages of the wound-healing process. The hypodermis is the layer located beneath the dermis, containing a considerable amount of adipose tissue, which provides mechanical and thermal insulating properties to the skin. Tissue-engineered skin combines novel materials with living cells to yield functional tissue equivalents, such as skin substitutes. They provide a matrix, which is required for the healing process. Culturing fibroblast in collagen gels or “lattices” produces structures known as dermal equivalent, which forms the basis for constructing skin equivalent. A dermal equivalent is constructed by seeding dermal fibroblasts into a reformed, three-dimensional collagen matrix. Layering keratinocytes on the upper surface of such a structure produces a skin equivalent. It is a simplified model, but they represent the first step in skin reconstruction.

Systemic mycoses in immunodepressed patients (AIDS)

Infectious and noninfectious skin diseases are observed in about 90% of HIV patients, and their incidence increases and is more severe as the immune system weakens. Cutaneous manifestations are considered good clinical predictors for the immunological condition of the patient with AIDS and the introduction of highly effective antiretroviral therapy totally changed the prognosis of the mycoses, among other diseases associated with AIDS, permitting longer survival and acceptable level of quality of life for these patients. This contribution describes the systemic mycoses that are more frequent in the seropositive population, that is, patients with HIV/AIDS, which are cryptococcosis, histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, sporotrichosis, penicilliosis, and aspergillosis. Their causative agents, mode of transmission, clinics, laboratorial diagnosis and therapy, in the aspects related to immunodepressed patients, are reviewed.

Prurigo nodularis of Hyde: an update

Prurigo nodularis of Hyde is an unusual disorder of unknown aetiology characterized by extremely pruritic nodules with well defined clinical and histopathological aspects. The literature on this disease is reviewed, focusing on the historical background, aetiology, pathogenesis, histopathology and ultrastructure, clinical aspects, differential diagnosis and therapeutic alternatives.

Isomorphic phenomenon of Koebner: Facts and controversies

Heinrich Koebner (1838-1904) presented in a meeting in 1872 and reported in 1877 the emergence of psoriatic lesions following trauma to healthy skin areas of patients with psoriasis. Since then, the Koebner phenomenon has been the subject of research, as it offers a unique opportunity in the investigation of the disease, especially in experimental studies, when this dermatosis may be observed in all its phases. Establishing the differences between Koebner, Wolf, Renbök, reverse Koebner, pseudo-Koebner phenomena, and pathergy is sometimes unclear. We review the various aspects of the Koebner phenomenons clinical description and presentation, pathophysiology, histopathology, reverse phenomenon, therapeutic treatments, and prevention.