RESUMO
Gingiva hyperpigmentation resulting from physiological melanosis causes aesthetic discomfort and is usually perceived as a disease by patients because healthy attached gingiva is typically characterized by coral pink coloring with stippling and scalloped contours. When physiological melanosis compromises the aesthetics of smiling, it may induce insecurity in patients, who usually seek out alternatives for reducing or eliminating hyperpigmentation. We present a case report of a surgical procedure combining gingivectomy with gingivoplasty for the management of physiological melanosis. The surgical procedure was performed on a 40-year-old female patient with bilateral pigmentation in both arches. The results of the histological analysis confirm the diagnoses of melanotic macula, with papillary hyperplasia and cytopathic changes being suggestive of HPV infection, which was verified using an immunohistochemistry analysis based on the detection of a major capsid protein of HPV. Acceptable functional and aesthetic results were obtained for the patient without major discomfort during the postoperative period. In cases when HPV infection is present, long-term follow-up becomes necessary.
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Hyperpigmentation is a skin disorder characterized by excessive production of melanin in the skin and includes dyschromias such as post-inflammatory hyperchromias, lentigens, melasma and chloasma. Topical products containing depigmenting agents offer a less aggressive treatment option for hyperpigmentation compared to methods like chemical peels and laser sessions. However, some of these agents can cause side effects such as redness and skin irritation. Encapsulating these actives in nanosystems shows promise in mitigating these effects and improving product safety and efficacy. In addition, nanocarriers have the ability to penetrate the skin, potentially allowing for targeted delivery of actives to the affected areas. The most commonly investigated nanosystems are nanoemulsions, vesicular nanosystems and nanoparticles, in which different materials can be used to generate different compositions in order to improve the properties of these nanocarriers. Nanocarriers have already been widely explored, but it is necessary to understand the evolution of these technologies when applied to the treatment of skin hyperchromias. Therefore, this literature review aims to present the state of the art over the last 15 years on the use of nanosystems as a potential strategy for encapsulating depigmenting actives for potential application in cosmetic products for skin hyperchromia. By providing a comprehensive overview of the latest research findings and technological advances, this article can contribute to improving the care and quality of life of people affected by this skin condition.
Assuntos
Portadores de Fármacos , Humanos , Portadores de Fármacos/química , Nanopartículas/química , Hiperpigmentação/tratamento farmacológico , Preparações Clareadoras de Pele/administração & dosagem , Preparações Clareadoras de Pele/química , Pele/efeitos dos fármacos , Pele/metabolismoAssuntos
Hiperpigmentação , Melanose , Adulto , Humanos , Feminino , Prevalência , Melanose/epidemiologia , FaceRESUMO
BACKGROUND: Clobetasol has demonstrated remarkable results in treating melasma within a short time frame; however, its use is limited because of the risk of local side effects. To date, there is no controlled trial on sequential clobetasol/hydroquinone for melasma. This study aimed to investigate the tolerability and efficacy of 0.05% clobetasol followed by 4% hydroquinone (CLOB-HQ) in comparison to the isolated use of 4% hydroquinone (HQ). METHODS: A double-blinded, randomized clinical trial involving 50 women with facial melasma was performed. They were directed to apply 0.05% clobetasol every night for 14 days, followed by 4% hydroquinone for 46 days (CLOB-HQ group), or the use of hydroquinone for 60 days (HQ group). Evaluations were carried out at inclusion, and after 14 and 60 days of treatment, measuring modified Melasma Area and Severity Index (mMASI), Melasma Quality of Life scale (MELASQoL), and colorimetry. The Global Aesthetic Improvement Scale (GAIS) was assessed by a blinded evaluator. RESULTS: There was no difference in the main outcomes at D14 and D60 (P > 0.1). For CLOB-HQ, the mean (CI 95%) reduction in mMASI was 13.2% (5.1-21.3%) and 43.1% (32.2-54.0%) at D14 and D60, and for HQ, they were 10.6% (5.9-27.5%) and 44.8% (33.2-52.3%). The MELASQoL, colorimetric luminosity, and GAIS showed a progressive improvement for both groups despite no difference between them. No severe side effects were identified. No cases of telangiectasias, atrophy, or perioral dermatitis were associated with the use of CLOB. CONCLUSION: The sequential CLOB-HQ regimen was safe and well tolerated, even though its efficacy was not different from HQ after 14 or 60 days of treatment. Based on these findings, the use of clobetasol 14 days before hydroquinone is not advisable for the treatment of melasma.
Assuntos
Clobetasol , Quimioterapia Combinada , Hidroquinonas , Melanose , Qualidade de Vida , Índice de Gravidade de Doença , Humanos , Hidroquinonas/administração & dosagem , Hidroquinonas/efeitos adversos , Melanose/tratamento farmacológico , Melanose/diagnóstico , Feminino , Método Duplo-Cego , Adulto , Clobetasol/administração & dosagem , Clobetasol/efeitos adversos , Pessoa de Meia-Idade , Dermatoses Faciais/tratamento farmacológico , Esquema de Medicação , Administração Cutânea , Resultado do Tratamento , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversosRESUMO
BACKGROUND: Acne is a chronic inflammatory disorder of the pilosebaceous unit that is associated with a negative impact on quality of life, causing anxiety, depression, and poor self-esteem. The treatment of acne is not simple and presents some new challenges. This article addresses important issues faced by dermatologists on their daily, some of them specific for Latin America. OBJECTIVE: To discuss daily practice recommendations when managing acne patients. METHODS: A literature review was conducted by a group of eight experts with extensive experience in the field of acne. The results of the data review were presented at an initial kick-off meeting to align the consensus topics. Two e-surveys using the Delphi methodology and an interim group webinar meeting were held. RESULTS: The expert panel reached a consensus on all proposed key statements, providing scientific support to help dermatologists and healthcare providers make acne management decisions on topics that can be challenging in the everyday practice of dermatology, such as the characteristics of Generation Z or the importance of the maintenance phase of adult acne treatment. CONCLUSION: This article provides current recommendations for managing acne patients. The high level of agreement achieved based on the latest evidence supports the best acne therapeutic choices in both established topics and new important issues that have emerged in recent years, such as the impact of social media, Generation Z characteristics, and transgender male patient specifics.
Assuntos
Acne Vulgar , Consenso , Acne Vulgar/tratamento farmacológico , Acne Vulgar/terapia , Humanos , América Latina , Técnica Delphi , Fármacos Dermatológicos/uso terapêutico , Qualidade de VidaRESUMO
BACKGROUND: Melasma is a chronic dermatosis that impacts the patient's quality of life and can present considerable challenges in terms of effective treatment. OBJECTIVE: To evaluate the effectiveness, tolerability, and safety of 5% cysteamine combined with 4% nicotinamide in female subjects with melasma. METHODS: This single-center, single-arm, prospective, open-label study evaluated patients with melasma using a combination cream of 5% cysteamine and 4% nicotinamide in a progressive regimen (60 min in the first month, 120 min in the second month, and 180 min in the third month). RESULTS: Overall, 35 treated subjects exhibited reduced modified Melasma Area and Severity Index (mMASI) (p < 0.001) and decreased MelasQoL scores (p < 0.001), accompanied by improved brightness, luminosity, homogeneity, and spot intensity (p < 0.001). Photographic and colorimetric analysis revealed smaller spots and improved homogeneity. LIMITATIONS: Adherence to progressive daily treatment could not be evaluated long-term. CONCLUSION: A combination cream comprising 5% cysteamine and 4% nicotinamide was effective, tolerable, and safe for treating melasma.
Assuntos
Cisteamina , Combinação de Medicamentos , Melanose , Niacinamida , Índice de Gravidade de Doença , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Administração Cutânea , Cisteamina/administração & dosagem , Cisteamina/efeitos adversos , Melanose/tratamento farmacológico , Melanose/diagnóstico , Niacinamida/administração & dosagem , Niacinamida/efeitos adversos , Estudos Prospectivos , Qualidade de Vida , Creme para a Pele/administração & dosagem , Creme para a Pele/efeitos adversos , Resultado do TratamentoRESUMO
RESUMEN El eritema fijo pigmentado es una toxicodermia que puede afectar la piel o las mucosas. Tiende a recurrir en las mismas localizaciones tras la administración repetida del agente desencadenante. Los principales grupos farmacológicos asociados han sidoanalgésicos, antiepilépticos y AINES. Clínicamente, hayaparición de placaseritemato-edematosas redondas u ovaladas, definidas. Existen diferentes variantes;la generalizada es una de las menos frecuentes. Se reporta el caso de un paciente de mediana edad, quien presentó un cuadro deeritema fijo pigmentadogeneralizado, asociado al uso de ARA II. Es el primer caso reportado de esta patología secundaria al uso de dicho grupo farmacológico.
SUMMARY Pigmented fixed erythema is a toxicoderma, it can affect the skin or mucous membranes. It tends to recur in the same locations after repeated administration of the triggering agent.1 The main associated pharmacological groups have been: analgesics, antiepileptics and NSAIDs. Clinically, there is the appearance of defined round or oval erythematous-edematous plaques. There are different variants, the generalized is one of the least frequent. The case of a middle-aged patient is reported, who presented a generalized fixed pigmented erythema, associated with ARBS, it is the first reported case of this pathology secondary to the use of said pharmacological group.
RESUMO
A hiperpigmentação melânica ocorre devido à deposição anormal de melanina na camada basal e suprabasal do epitélio, criando uma aparência escurecida. É fisiológica, por isso não representa dano à saúde, podendo ser apenas uma queixa estética do paciente. O objetivo deste trabalho foi realizar uma revisão de literatura narrativa sobre o uso da técnica cirúrgica com bisturi, da abrasão com instrumento rotatório e da ablação com laser como métodos para realizar a remoção da hiperpigmentação melânica gengival de etiologia fisiológica. Muitas técnicas têm sido utilizadas para fazer a despigmentação, diferentes resultados e fatores, como conforto do paciente, cuidado pós-operatório e recorrência, têm sido apresentados. A técnica cirúrgica com bisturi é considerada o padrão ouro devido aos seus bons resultados, material de fácil acesso e baixo custo. A abrasão com instrumentos rotatórios não requer nenhum equipamento ou material sofisticado, é relativamente simples e segura. E a terapia a laser é uma modalidade de tratamento eficaz, minimamente invasiva, com trans e pós-operatório confortável. Entretanto, são necessários mais estudos sobre o uso da abrasão com instrumento rotatório que acompanhem os pacientes em longo prazo e pesquisas que descrevam o uso e resultados proporcionados pelos diversos tipos de laser de alta potência. Tendo em vista a presente revisão de literatura pode-se concluir que a repigmentação não ocorre por uma média de um a dois anos. Porém, são necessários mais estudos para especificar qual técnica apresenta menor índice de repigmentação.
Melanic hyperpigmentation occurs due to abnormal deposition of melanin in the basal and suprabasal layers of the epithelium, creating a darkened appearance. It is physiological, so it does not represent harm to health, and may be just an aesthetic complaint by the patient. The objective of this work was to carry out a narrative literature review on the use of surgical technique with a scalpel, abrasion with a rotary instrument and laser ablation as methods to remove gingival melanin hyperpigmentation of physiological etiology. Many techniques have been used to perform depigmentation, different results and factors, such as patient comfort, postoperative care and recurrence, have been presented. The surgical technique with a scalpel is considered the gold standard due to its good results, easily accessible material and low cost. Abrasion with rotary instruments does not require any sophisticated equipment or material, is relatively simple and safe. And laser therapy is an effective treatment modality, minimally invasive, with comfortable trans and postoperative. However, more studies are needed on the use of abrasion with a rotary instrument to monitor patients in the long term and research that describe the use and results provided by the different types of high-power lasers. In view of the present literature review, it can be concluded that repigmentation does not occur for an average of one to two years. However, further studies are needed to specify wich technique has the lowest rate of repigmentation.
Assuntos
Hiperpigmentação , Terapia a Laser/métodosRESUMO
PURPOSE: Photobiomodulation therapy (PBM) is a versatile technique for treating skin diseases. Melasma, a chronic hyperpigmentation condition, has recently been associated with vascular features and dermal photoaging and poses significant management challenges. We review the recent literature on melasma etiology and the evidence supporting PBM as a therapeutic modality for melasma treatment. METHODS: We conducted a comprehensive literature search in three different databases from May to August 2023, focusing on studies published in the past 10 years. The inclusion criteria comprised full-text studies investigating low-power lasers and/or light-emitting diodes (LEDs) in in vitro or in vivo models, as well as clinical trials. We excluded studies discussing alternative melasma therapies or lacking experimental data. We identified additional studies by searching the reference lists of the selected articles. RESULTS: We identified nine relevant studies. Clinical studies, in agreement with in vitro experiments and animal models, suggest that PBM effectively reduces melasma-associated hyperpigmentation. Specific wavelengths (red: 630 nm; amber: 585 and 590 nm; infrared: 830 and 850 nm) at radiant exposures between 1 and 20 J/cm2 exert modulatory effects on tyrosinase activity, gene expression, and protein synthesis of melanocytic pathway components, and thus significantly reduce the melanin content. Additionally, PBM is effective in improving the dermal structure and reducing erythema and neovascularization, features recently identified as pathological components of melasma. CONCLUSION: PBM emerges as a promising, contemporary, and non-invasive procedure for treating melasma. Beyond its role in inhibiting melanogenesis, PBM shows potential in reducing erythema and vascularization and improving dermal conditions. However, robust and well-designed clinical trials are needed to determine optimal light parameters and to evaluate the effects of PBM on melasma thoroughly.
Assuntos
Hiperpigmentação , Terapia com Luz de Baixa Intensidade , Melanose , Animais , Terapia com Luz de Baixa Intensidade/efeitos adversos , Melanose/radioterapia , Melanose/complicações , Lasers , Eritema/etiologiaRESUMO
Abstract Background Acne is a chronic inflammatory disorder of the pilosebaceous unit that is associated with a negative impact on quality of life, causing anxiety, depression, and poor self-esteem. The treatment of acne is not simple and presents some new challenges. This article addresses important issues faced by dermatologists on their daily, some of them specific for Latin America. Objective To discuss daily practice recommendations when managing acne patients. Methods A literature review was conducted by a group of eight experts with extensive experience in the field of acne. The results of the data review were presented at an initial kick-off meeting to align the consensus topics. Two e-surveys using the Delphi methodology and an interim group webinar meeting were held. Results The expert panel reached a consensus on all proposed key statements, providing scientific support to help dermatologists and healthcare providers make acne management decisions on topics that can be challenging in the everyday practice of dermatology, such as the characteristics of Generation Z or the importance of the maintenance phase of adult acne treatment. Conclusion This article provides current recommendations for managing acne patients. The high level of agreement achieved based on the latest evidence supports the best acne therapeutic choices in both established topics and new important issues that have emerged in recent years, such as the impact of social media, Generation Z characteristics, and transgender male patient specifics.