Maria Claudia Almeida Issa

Terapia fotodinâmica: revisão da literatura e documentação iconográfica

Photodynamic therapy (PDT) consists of a chemical reaction activated by light energy that is used to selectively destroy tissue. The reaction requires a photosensitizer in the target tissue, a light source and oxygen. The most extensively studied photosensitizing agents for PDT are 5-aminolevulinic acid for the treatment of actinic keratosis and methyl-aminolevulinate, which has been approved for the treatment of actinic keratosis, basal cell carcinoma and Bowens disease. The light sources used in photodynamic therapy should emit light at wavelengths within the absorption spectrum of the photosensitizer used in PDT treatment. Light emitting diode (LED) lamps are indicated for the photodynamic treatment of nonmelanoma skin cancer. PDT should be considered as a therapeutic option, particularly in the case of patients with superficial, multiple or disseminated lesions and for immunosuppressed patients. More recently, PDT has been indicated for a wide range of dermatological conditions such as photo-damaged skin, acne, hidradenitis, scleroderma, psoriasis, warts and leishmaniosis, among others. This article provides an extensive review of photodynamic therapy, its mechanisms, indications and results.

Topical delivery of triamcinolone via skin pretreated with ablative radiofrequency: a new method in hypertrophic scar treatment

Epidermal permeability alterations induced by ablative fractional resurfacing and low‐frequency ultrasound technology may offer drug delivery for the treatment of hypertrophic scars through transepidermal drug delivery (TED). This technology can improve treatment efficacy and minimize side effects.

Photorejuvenation with Topical Methyl Aminolevulinate and Red Light: A Randomized, Prospective, Clinical, Histopathologic, and Morphometric Study

BACKGROUND Photodynamic therapy (PDT) is an option for skin rejuvenation. Although many studies report clinical improvement with PDT in photodamaged skin, histologic and morphometric evidence is not documented in most cases. OBJECTIVE To evaluate clinical and histopathologic changes induced by methyl aminolevulinate (MAL)‐PDT and to morphometrically quantify collagen and elastic fibers in skin remodeling induced by MAL‐PDT in photodamaged skin. METHODS AND MATERIALS Fourteen patients were treated with two sessions of MAL‐PDT. The light source was a light‐emitting diode: 635 nm, 37 J/cm2. Skin biopsies were performed before and 3 and 4 months after treatment. All fragments were stained using the hematoxylin‐eosin, orcein, and picrosirius techniques. Morphometric studies were done of three samples from each patient. RESULTS Global clinical improvement was observed in 10 of 14 patients. The histopathologic study showed increased collagen fibers 3 and 6 months after treatment. The decrease in the amount of elastic fiber was statistically significant 3 (p=.016) and 6 (p=.008) months after treatment. The increase in the amount of collagen fiber was statistically significant 6 months after treatment (p=.048). CONCLUSION Clinical improvement with regard to texture, firmness, wrinkle depth, skin coloration, and clearance of actinic keratoses was observed. Histopathologic and morphometric studies were consistent with the clinical findings. Dr. M. Issa is a consultant to Galderma (Brazil). Galderma Industries provided the Metvix used in this study.

Transepidermal Retinoic Acid Delivery Using Ablative Fractional Radiofrequency Associated With Acoustic Pressure Ultrasound for Stretch Marks Treatment

Striae distensae (SD) treatment still remains a therapeutic challenge to dermatologists. Ablative fractional laser and radiofrequency (RF) enhance skin‐drug permeability for SD treatment.

A double‐blind randomized study comparing the association of Retinol and LR2412 with tretinoin 0.025% in photoaged skin

Topical tretinoin is considered the gold standard to treat photoaged skin, but it is associated with side effects and only available upon prescription.

Early investigations in drug delivery of onabotulinum toxin A using combined fractional ablative laser with impact ultrasound vs. injections of onabotulinum toxin A for palmar hyperhidrosis: a right-left comparison trial

SIR, we evaluated whether laser-assisted drug delivery (LADD) of onabotulinumtoxinA using combined fractional ablative laser with impact ultrasound was capable of reducing palmar sweat production. Palmar hyperhidrosis is a common disorder with substantial negative impact on quality of life. Palliative non-surgical treatments include antiperspirants, iontophoresis, oral anticholinergic drugs, and intradermal injection of botulinum toxin (BTX). Antiperspirants, although convenient, require repeated applications and cause skin irritations. Iontophoresis is effective in some cases, but it requires lengthy treatments. This article is protected by copyright. All rights reserved.

Nevus lipomatosus cutaneous superficialis

Nevus lipomatosus cutaneous superficialis is a rare benign hamartomatous skin tumor characterized by dermal deposition of mature adipose tissue. Two clinical forms have been described (classical and solitary types). We describe a case of nevus lipomatosus cutaneous superficialis with a 13-year history of growth in a young woman who had a solitary skin-colored tumoral mass on the right buttock. Histopathological findings were typical and confirmed the diagnosis. In this case, the lesion was a skin-colored isolated mass, as described in the solitary type, but its localization and age of appearance were compatible with the classical type. The combination of simultaneous clinical findings of both types had not been published before.

Merkel cell carcinoma in an immunosuppressed patient

Merkel cell carcinoma is an uncommon neuroendocrine carcinoma with a rising incidence and an aggressive behavior. It predominantly occurs in older patients, with onset occurring at a mean age of 75-80 years. Recognized risk factors are ultraviolet sunlight exposure, immunosuppression, and, more recently, Merkel cell polyomavirus. We report a case of Merkel cell carcinoma in a young HIV positive patient with Merkel Cell polyomavirus detected in the tumor.

Herpes zoster ophthalmicus after onabotulinumtoxin for cosmetic treatment: a case report

Herpes zoster outbreaks following minor procedures have been documented recently in literature. Since the use of botulinum toxin is nowadays spread in several medical areas for different purposes, it is crucial to study its side effects and complications. Literature review revealed 65 cases of zoster reactivation following minor procedures, and three cases related to BTA injections (two for facial lines treatment and one for chronic migraine). In our case, a 43 year old healthy woman had herpes zoster on the face and scalp after receiving BTA injections for cosmetic purpose, with complete recovery after anti-viral treatment.