Polycystic ovary syndrome: a dermatologic approach

Polycystic ovary syndrome (POS) is one of the most common endocrine abnormalities affecting women of reproductive age. It is a cause of significant social embarrassment and emotional distress. The pathogenesis of the disease is not yet fully understood, but it is thought to be a complex multigenic disorder, including abnormalities in the hypothalamic-pituitary axis, steroidogenesis, and insulin resistance. The main diagnostic findings of the syndrome are: hyperandrogenism, chronic anovulation and polycystic ovarian morphology seen on ultrasound. Hyperandrogenism is generally manifested as hirsutism, acne, seborrhea, androgenic alopecia and, in severe cases, signs of virilization. Treatment may improve the clinical manifestations of excess androgen production, normalize menses and ameliorate metabolic syndrome and cardiovascular complications. This article reviews the diagnosis, clinical manifestations, metabolic complications, and treatment of the syndrome. Early diagnosis and the consequent early treatment may prevent metabolic complications and emotional distress that negatively impact the patients' quality of life.A síndrome do ovário policístico (SOP) é uma das endocrinopatias mais freqüentes nas mulheres em idade reprodutiva. Caracteriza-se por morbidade elevada devido aos aspectos estéticos e por repercussões metabólicas importantes. Embora a sua patogênese permaneça incompletamente conhecida, acredita-se numa desordem multigênica complexa, incluindo anormalidades no eixo hipotálamohipofisário, esteroidogênese e resistência insulínica. Os achados principais para o diagnóstico são: hiperandrogenismo, anovulação crônica e ovários policísticos à ultrassonografia. As manifestações dermatológicas do hiperandrogenismo incluem: hirsutismo, acne, seborréia, alopecia e, em casos mais graves, sinais de virilização. Existe considerável heterogeneidade nos achados clínicos e também pode haver variação na mesma paciente com o passar do tempo. O tratamento visa reduzir as manifestações do hiperandrogenismo, restaurar os ciclos ovulatórios regulares e corrigir a síndrome metabólica. Este artigo apresenta revisão da fisiopatologia, diagnóstico e tratamento da síndrome do ovário policístico. Enfatiza-se a importância do diagnóstico e tratamento precoces no intuito de prevenir as complicações metabólicas e a repercussão emocional que afeta a qualidade de vida das pacientes.Universidade Federal do Rio de Janeiro Serviço de DermatologiaUniversidade Federal do Rio de JaneiroUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de DermatologiaUniversidade Federal do Rio de Janeiro Faculdade de MedicinaSanta Casa de Misericórdia do Rio de JaneiroFundação Técnico Educacional Souza MarquesUNIFESP, EPM, Depto. de DermatologiaSciEL

Photoaging and the clinical utility of fractional laser

Tullia Cuzzi Teichner - Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Anatomia Patológica. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.Submitted by Janaína Nascimento ([email protected]) on 2019-04-08T12:26:01Z No. of bitstreams: 1 ve_Borges_Juliano_etal_INI_2016.pdf: 200100 bytes, checksum: 5dfbb53c28e8e303b02bcf362788785b (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-04-08T14:51:27Z (GMT) No. of bitstreams: 1 ve_Borges_Juliano_etal_INI_2016.pdf: 200100 bytes, checksum: 5dfbb53c28e8e303b02bcf362788785b (MD5)Made available in DSpace on 2019-04-08T14:51:27Z (GMT). No. of bitstreams: 1 ve_Borges_Juliano_etal_INI_2016.pdf: 200100 bytes, checksum: 5dfbb53c28e8e303b02bcf362788785b (MD5) Previous issue date: 2016Santa Casa de Misericórdia do Rio de Janeiro. Instituto de Dermatologia Professor Rubem David Azulay. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Serviço de Anatomia Patológica. Rio de Janeiro, RJ, Brasil.Santa Casa de Misericórdia do Rio de Janeiro. Instituto de Dermatologia Professor Rubem David Azulay. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Serviço de Anatomia Patológica. Rio de Janeiro, RJ, Brasil.Santa Casa de Misericórdia do Rio de Janeiro. Instituto de Dermatologia Professor Rubem David Azulay. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Serviço de Anatomia Patológica. Rio de Janeiro, RJ, Brasil.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

Métodos objetivos para análise de estudos em dermatologia cosmética

A Dermatologia Cosmética é uma área em constante crescimento, motivo pelo qual se faz necessária a utilização de métodos objetivos para validar os resultados dos estudos científicos. As técnicas mais empregadas na maioria desses trabalhos são: histopatologia, imunoistoquímica, morfometria, estereologia, fotografia digital, biometria, profilometria óptica e microscopia confocal. Esta revisão tem como objetivo trazer informações sobre os principais métodos utilizados como ferramenta de análise dos resultados obtidos, além de auxiliar o dermatologista a aguçar seu senso crítico em relação às publicações e apresentações que se utilizam de métodos subjetivos de avaliação

Fractional erbium laser in the treatment of photoaging: randomized comparative, clinical and histopathological study of ablative (2940nm) vs. non-ablative (1540nm) methods after 3 months

Submitted by Rodrigo Senorans ([email protected]) on 2015-05-27T15:26:39Z No. of bitstreams: 1 Fractional Erbium laser in the treatment of photoaging.pdf: 336042 bytes, checksum: 2c76120d1edf4ef83cce5e67db575813 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-28T13:40:12Z (GMT) No. of bitstreams: 1 Fractional Erbium laser in the treatment of photoaging.pdf: 336042 bytes, checksum: 2c76120d1edf4ef83cce5e67db575813 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-28T13:40:23Z (GMT) No. of bitstreams: 1 Fractional Erbium laser in the treatment of photoaging.pdf: 336042 bytes, checksum: 2c76120d1edf4ef83cce5e67db575813 (MD5)Made available in DSpace on 2015-05-28T18:01:38Z (GMT). No. of bitstreams: 1 Fractional Erbium laser in the treatment of photoaging.pdf: 336042 bytes, checksum: 2c76120d1edf4ef83cce5e67db575813 (MD5) Previous issue date: 2014Santa Casa de Misericórdia do Rio de Janeiro. Rio de Janeiro, RJ, BrasilUniversidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, BrasilUniversidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, BrasilBACKGROUND: Fractional non-ablative lasers keep the epidermis intact, while fractional ablative lasers remove it, making them theoretically more effective. OBJECTIVES: To evaluate the clinical and histological alterations induced by fractional photothermolysis for treating photoaging, comparing the possible equivalence of multiple sessions of 1540nm Erbium, to one session of 2940nm Erbium. METHODS: Eighteen patients (mean age 55.9) completed the treatment with three sessions of 1540nm fractional Erbium laser on one side of the face (50 mJ/mB, 15ms, 2 passes), and one session of 2940nm on the other side (5mJ/mB, 0.25ms, 2 passes). Biopsies were performed before and 3 months after treatment. Clinical, histological and morphometric evaluations were carried out. RESULTS: All patients presented clinical improvement with no statistically significant difference (p> 0.05) between the treated sides. Histopathology revealed a new organization of collagen and elastic fibers, accompanied by edema, which was more evident with the 2940nm laser. This finding was confirmed by morphometry, which showed a decrease in collagen density for both treatments, with a statistical significance for the 2940nm laser (p > 0.001). CONCLUSIONS: Three 1540nm sessions were clinically equivalent to one 2940nm session. The edema probably contributed to the positive results after three months, togheter with the new collagen and elastic fibers organization. The greater edema after the 2940nm session indicates that dermal remodeling takes longer than with 1540nm. It is possible that this histological superiority relates to a more prolonged effect, but a cohort longer than three months is needed to confirm that supposition

Oral isotretinoin in photoaging: objective histological evidence of efficacy and durability

Tulia Cuzzi. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.Submitted by Repositório Arca ([email protected]) on 2019-04-24T17:38:43Z No. of bitstreams: 1 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-08-12T13:41:53Z (GMT) No. of bitstreams: 2 ve_Bravo_Bruna_etal_INI_2015.pdf: 217387 bytes, checksum: 359a52985b36e09323523fb1a567449c (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-08-12T13:41:53Z (GMT). No. of bitstreams: 2 ve_Bravo_Bruna_etal_INI_2015.pdf: 217387 bytes, checksum: 359a52985b36e09323523fb1a567449c (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2015Santa Casa de Misericórdia do Rio de Janeiro. Instituto de Dermatologia Professor Rubem David Azulay. Rio de Janeiro, RJ, Brasil / Hospital Federal da Lagoa. Rio de Janeiro, RJ, Brasil.Santa Casa de Misericórdia do Rio de Janeiro. Instituto de Dermatologia Professor Rubem David Azulay. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.BACKGROUND: The off-label use of oral isotretinoin in photoaging is a therapeutic tool that has been used by dermatologists. There are few studies to corroborate its effectiveness and durability. OBJECTIVES: To assess, both clinically and histologically, the changes caused by the use of oral isotretinoin in skin photoaging as well as the duration of the effects. METHODS: 20 female patients, aged 45-50 years, with phototypes II-VI, none of whom had experienced menopause, were treated with 20mg oral isotretinoin, 3 days a week, for 12 weeks. They underwent clinical analysis and skin biopsies in the pre-auricular region, while histologic cuts enabled assessment of the solar elastosis level and morphologic analysis. RESULTS: Clinically, patients, as well as the researching and the assessor physicians, noticed improvement in skin quality. One patient presented severe solar elastosis, 11 manifested the moderate form, while 8 presented the discreet type. According to histological analysis, 65% of the patients revealed alteration in the distribution and thickness of the elastic fi bers, which can be interpreted as a histological improvement, while 60% showed an increase in collagen density. We observed an increase in collagen density, from 51.2% to 57.4%, (p=0.004). At the end of the 12-week follow-up period, this density decreased to 54.7% (p=0.050). There was an increase in the density of elastic fibers, from 26.5% to 31.3%, (p=0.02), which had dropped to 27.5% at the end of the 12- week follow-up period. CONCLUSIONS: The study confirmed the role of oral isotretinoin in remodeling the extracellular matrix against photoaging, as well as its durability after 12 weeks, especially when we consider collagen fibers

Vitamina C

Há muito o papel do ácido ascórbico (AA) no metabolismo do tecido conjuntivo tem sido reconhecido, sobretudo a partir do século 16, quando o escorbuto começou a ser prevenido com sumo de frutas cítricas. As primeiras publicações referentes ao uso tópico da vitamina C, inicialmente em cobaio, datam da década de 1960. Entretanto, só mais recentemente tem-se dado valor a essa via de aplicação. Os autores apresentam revisão sobre o assunto, discorrendo sobre o histórico da vitamina C, seus efeitos no metabolismo do tecido conjuntivo, no processo de cicatrização, sobre sua atividade antioxidante e mecanismos de ação

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. Keywords: Oleoma, Colchicine, Granulom