Samira Yarak

Células-tronco derivadas de tecido adiposo humano: desafios atuais e perspectivas clínicas

Adult or somatic stem cells hold great promise for tissue regeneration. Currently, one major scientific interest is focused on the basic biology and clinical application of mesenchymal stem cells. Adipose tissue-derived stem cells share similar characteristics with bone marrow mesenchymal stem cells, but have some advantages including harvesting through a less invasive surgical procedure. Moreover, adipose tissue-derived stem cells have the potential to differentiate into cells of mesodermal origin, such as adipocytes, cartilage, bone, and skeletal muscle, as well as cells of non-mesodermal lineage, such as hepatocytes, pancreatic endocrine cells, neurons, cardiomyocytes, and vascular endothelial cells. There are, however, inconsistencies in the scientific literature regarding methods for harvesting adipose tissue and for isolating, characterizing and handling adipose tissue-derived stem cells. Future clinical applications of adipose tissue-derived stem cells rely on more defined and widespread methods for obtaining cells of clinical grade quality. In this review, current methods in adipose tissue-derived stem cell research are discussed with emphasis on strategies designed for future applications in regenerative medicine and possible challenges along the way.

Dermabrasion for Acne Scars During Treatment with Oral Isotretinoin

BACKGROUND Oral isotretinoin is the criterion standard treatment for severe inflammatory acne associated with scar development. Atypical or exaggerated cicatrization related to oral isotretinoin was reported throughout the 1980s and 1990s. Dermabrasion for atrophic acne scar revision is not recommended 6 to 12 months from the end of oral isotretinoin treatment. OBJECTIVE To evaluate wound healing after localized dermabrasion in patients receiving oral isotretinoin. MATERIALS & METHODS Interventional, prospective study involving seven patients taking oral isotretinoin to treat acne and with atrophic acne scars on the face. Manual dermabrasion was performed on all patients in an area of approximately 1 cm2, and a 6‐month reepithelization follow‐up by clinical evaluation was conducted. RESULTS All patients presented normal cicatrization evolution; hypertrophic scarring or keloid as a result of localized abrasion was not observed, and atrophic acne scar revision result was excellent. CONCLUSION The current recommendation to wait 6 to 12 months after treatment with oral isotretinoin for acne scar revision using dermabrasion should be re‐evaluated. Abrasion of a small test area may be a useful predictor of wound healing, enabling earlier acne scar treatment using this procedure.

Hiperandrogenismo e pele: síndrome do ovário policístico e resistência periférica à insulina

The polycystic ovary syndrome is an extremely common endocrine disorder in women of chilbearing age. It is characterized by menstrual disturbance, hyperandrogenism and/or hyperandrogenemia. The primary pathophysiological defect is unknown, but important characteristics include insulin resistance, androgen excess and impaired gonadotropin dynamics. The most frequent clinical characteristics of polycystic ovary syndrome are associated with the pilosebaceous unit, such as hirsutism, acne, seborrhea and alopecia. Thus, the dermatologist may be responsible for making an early diagnosis of the syndrome, thus preventing delay in establishing preventive and therapeutic measures. The current management recommended for skin manifestations of polycystic ovary syndrome includes combined oral contraceptives, antiandrogens and insulin-sensitizing agents, besides changes in life style. This is a review article on diagnosis, pathophysiology and treatment of polycystic ovary syndrome. The authors emphasize that a clear understanding of pathophysiology of this syndrome, especially by dermatologists, is crucial for its preventive treatment through the different phases in the life of women.

Early chemabrasion for acne scars after treatment with oral isotretinoin.

BACKGROUND Acne is an inflammatory disease of the pilosebaceous follicles. Oral isotretinoin is the treatment of choice for severe acne. Exaggerated cicatrization related to oral isotretinoin was reported in the 1980s and 1990s. Currently, dermabrasion for acne scar revision is only recommended 6 to 12 months after the completion of oral isotretinoin treatment. OBJECTIVE To evaluate the evolution of healing from manual chemabrasion of depressed scars resulting from acne conducted within 1 to 3 months after oral isotretinoin treatment. METHODS AND MATERIALS This was an interventional, prospective study involving 10 patients with depressed facial scars. A medium‐depth chemical peel was applied to the entire face. Manual sandpaper dermabrasion was performed to areas of scarring until the appearance of bloody dew. A 6‐month reepithelization follow‐up was conducted. RESULTS All of the patients presented with normal cicatrization, and neither hypertrophic scars nor keloids were observed. Depressed acne scar revision was satisfactory. CONCLUSION Our observations may contribute to the discussion of the negative influence of oral isotretinoin on wound healing. Other studies are necessary to reevaluate the current recommendation of a 6‐ to 12‐month waiting period after oral isotretinoin treatment before performing dermabrasion or fractional ablative laser for acne scar revision.

“Blepharopeeling” in the Upper Eyelids: A Nonincisional Procedure in Periorbital Rejuvenation—A Pilot Study

Currently, the best results in cosmetic surgery have been obtained through combined surgical and/or nonsurgical procedures. Thus, in the past decade, the search for less invasive or combined procedures aimed at skin rejuvenation enlarged the spectrum of cosmetic surgery. Due to advances in laser therapy, the use of chemical peels by dermatologists for treating facial aging, mainly in the periorbital area, has decreased despite its low cost and effectiveness.

Prevalence of acquired melanocytic naevi in Brazilian schoolchildren

Background.  The prevalence of acquired melanocytic naevi (AMN) is one of the most important known risk factors for malignant melanoma (MM) in homogeneous white populations. However, there are few studies on AMN in heterogeneous populations. Insight into the causes of AMN in heterogeneous populations in a country with intense ultraviolet radiation should lead to successful strategies in the prevention of MM.

Clinical and Histopathological Characteristics of Genital Melanocytic Nevi: A Report of 109 Cases and a Review of the Literature

Melanocytic lesions on the genital area are rare and poorly documented; they occur more frequently on the vulva and less often on the perineum, pubic area, and male genitalia. Genital melanocytic nevi exhibit features similar to nevi occurring on other areas of the body; in addition, they display high clinical and histopathological variability and are mostly classified as common nevi. However, a benign subtype of genital nevi that occurs in young women is known as atypical melanocytic nevi. These nevi exhibit distinct morphological characteristics that sometimes overlap with those of cutaneous melanoma. A retrospective systematic review was performed of 111 biopsy specimens of pigmented lesions on the vulva, perineum, pubic area, penis, and scrotum collected between 1998 and 2009 to assess their clinicopathological characteristics. In this sample, there were 101 cases of common genital melanocytic nevi, two genital melanotic macules, seven atypical melanocytic nevi, and one dysplastic melanocytic nevus; no cases corresponded to cutaneous melanoma. Of the 111 patients, 14.4% were male, and 85.6% were female with a mean age of 34.3 years. The female exhibited a larger number of atypical melanocytic nevi than the males. The nevi displayed melanocytic proliferation, forming irregular and coalescent nests with a loss of cellular cohesion at several sites in the rete ridges. Cytologic atypia was mild to moderate. Difficulties in the histological interpretation of these lesions remain to this day; thus, diagnosis relies significantly upon the experience and subjective judgment of pathologists to distinguish morphologically between atypical genital nevi and melanoma.

What do Cochrane systematic reviews say about interventions for treating psoriasis

CONTEXT AND OBJECTIVE Psoriasis is a common chronic inflammatory skin disease characterized by abnormal and increased growth of the cells that produce keratin and abnormal functioning of the immune system. We aimed to summarize the evidence available regarding interventions for patients with psoriasis. DESIGN AND SETTING Review of systematic reviews, developed in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS A systematic search was conducted to identify Cochrane systematic reviews that fulfilled the eligibility criteria. Two authors screened titles and abstracts that had been retrieved through the search strategy. The results from all the Cochrane systematic reviews that were included were summarized and presented in a narrative synthesis. RESULTS We included six Cochrane systematic reviews assessing interventions for treating psoriasis. The findings from high-quality evidence were that (a) etanercept reduced the psoriasis severity index, compared with placebo and (b) steroids plus vitamin D, compared with vitamin D alone, improved the skin clearance rate, as assessed by investigators, but was associated with a higher proportion of participants who dropped out due to adverse events. For all other comparisons, the quality of the evidence ranged from moderate to very low. CONCLUSION This review included six Cochrane systematic reviews that provided evidence ranging in quality from unknown to high, regarding management of psoriasis. Further randomized controlled trials are imperative to reduce the uncertainties relating to several treatments that are already used in clinical practice.

Effect of botulinum toxin type A on the healing of facial skin biopsies - series of cases

Background: Unsightly scars are complication in the healing process after a tissue injury. Effective prevention and treatment of these scars is a challenge. Botulinum toxin A (BTAX) causes chemoimmobilization, which reduces the tension decreasing the microtrauma in the healing process and subsequently the local inflammatory response, with a lower expression of cytokines and transforming growth factor β1. These effects lead to earlier maturation of the new collagen.

Squamous cell carcinoma arising in a multiple verrucous epidermal nevus

Verrucous epidermal nevi are hamartomatous lesions of the epidermis that, unlike other epidermal nevi (such as sebaceous nevus or nevus comedonicus), are rarely associated with malignant neoplasms. The majority of squamous cell carcinoma develop in linear or multiple epidermal nevus and rarely in solitary epidermal nevus. In general, the prognosis is favorable. We report a case of well-differentiated invasive squamous cell carcinoma arising from a multiple verrucous epidermal nevus. Although there is no consensus on prophylactic removal of epidermal nevus, its removal and biopsy should be considered if changes occur.