Mônica Manela-Azulay

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.

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.

Immunohistochemical expression of matrix metalloproteinases in photodamaged skin by photodynamic therapy

Background  Photodynamic therapy (PDT) has been described for photoageing treatment, but its mechanism of action is not clarified. Although PDT‐induced matrix metalloproteinase (MMP) expression and collagen production have been studied in normal skin and in inflammatory disease, there is no report about the effect of PDT on the extracellular matrix in photodamaged skin.

Oral isotretinoin in photoaging: clinical and histopathological evidence of efficacy of an off-label indication

Background  Despite evidences of the beneficial clinical effects of oral isotretinoin in the treatment of cutaneous photoaging, scientific evidences are still scarce, mainly supported by histopathological and morphometric studies.

Métodos objetivos para análise de estudos em dermatologia cosmética

Cosmetic dermatology is a field of medicine that is in constant development; therefore, the use of objective methods for validating the findings of scientific studies is crucial. The most commonly used techniques in the majority of these studies include histopathology, immunohistochemistry, morphometry, stereology, digital photography, biometry, optical profilometry and confocal microscopy. The objective of this review was to provide an update on the principal methods used as tools for analyzing outcomes and also to provide the dermatologist with means of sharpening his/her critical judgement with respect to the publications and presentations that use subjective evaluation methods.

High Patient Satisfaction of a Hyaluronic Acid Filler Producing Enduring Full-Facial Volume Restoration: An 18-Month Open Multicenter Study.

BACKGROUND Volume restoration is an essential part of facial rejuvenation. OBJECTIVE To assess long-term full-facial volume restoration using HAEL Volume Lidocaine hyaluronic acid filler. METHODS An 18-month open study in 60 subjects with at least Grade 2 on the 4-point volume loss scale (VLS) for full face and at least 2 indications affected among chin, temporal areas, jawline, cheeks, cheekbones, and nasolabial folds (NLF). Performance was assessed by VLS, Lemperle rating scale (LRS), investigator Global Aesthetic Improvement Scale (GAIS), and 3-dimensional (3D) imaging. RESULTS Most subjects (71.6%) had 3 or 4 indications injected, most commonly cheekbones (96.7%) and NLF (93.3%). At 18 months, at least a 1-grade improvement in VLS was observed for full face (68.3% of subjects), chin (77.8%), temporal areas (73.7%), cheeks (66.6%), cheekbones (58.6%), jawline (43.1%), and NLF (71.4%; LRS). For all indications, more than 60% of the volume gained at 3 weeks was sustained at 18 months based on 3D digital imaging. At 18 months, 95.0% of subjects had improved full-face GAIS and all subjects were satisfied with their aesthetic outcome. One subject (1.6%) had treatment-related adverse events. CONCLUSION Full-facial volume restoration was well sustained over 18 months with high patient satisfaction and good tolerability.

Photoaging and the clinical utility of fractional laser.

The description of atomic structure by Niels Bohr set the basis for the emergence of quantum physics. Based on these fundamentals, Einstein published in 1917 a paper on the amplification of energy by Stimulated Emission of Radiation as part of his quantum theories. In 1955, Townes and Gordon turned Einstein’s theories into practice, creating a coherent and amplified microwave device using ammonia gas in an optical medium. But it was at the beginning of the 1980s, that Anderson and Parrish published an article about the selective photothermolysis model which revolutionized clinical practice. The use of laser in photoaging began with CO2 (10,600 nm). In 1989, it was first used for resurfacing of a face with prominent photoaging. Ablative lasers have therefore had great popularity in the 1980s and 1990s, but prolonged postoperative time and significant risk of side effects have lowered the acceptance by patients. In 2004, the description of the fractionated radiation for the treatment of photoaging, by Mainstein, represented a great event. The stimulation of collagen occurred through fractional laser beams, which would reach the selected area while saving islands of sound skin. These islands accelerated the process of cicatrization of the treated tissue and shortened the postprocedure time. Furthermore, the fractionated radiation presented a smaller range of side effects, increasing the safety of the procedure. As mentioned earlier, as fractional lasers incise on the skin, they leave islands of healthy skin that accelerate recovery, while generating necrosis columns. Such necrosis columns remove damaged extracellular matrix material, allowing resettlement of fibroblasts. Such resettled fibroblasts, under the influence of a new tensile strength, restart to produce structures for extracellular matrix, such as collagen, elastin, and proteoglycans, in a more physiological way. Fractional lasers are considered by many dermatologists as the best choice in laser therapy for the treatment of photoaging.

Oleoma treated with oral colchicine: Report of two cases and review of the literature

Oleoma is a non-allergic, foreign body type granulomatous reaction. It appears as response to oily exogenous substances injected to the dermis or subcutis for aesthetical purposes. Treatment for localized lesions is surgical. When they are multiple, steroids may show some result. Newer therapeutic possibilities are being introduced and colchicine constitutes an alternative that is financially accessible and safe in moderate doses for certain dermatological illnesses. We present two women with oleoma on the legs treated with oral colchicine. This option was due to the extension of the clinical picture, which would not have a good surgical outcome. There was significant improvement in one patient, while we had to interrupt the medication in the other because of side effects.