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Reports written by Dr. Lilia Guadanhim (Dermatologist, Brazil) and Dr. Marcela Cirigliano (Dermatologist, Argentina)
Related topics
RADLA is the Annual meeting of dermatologists from Latin America that took place in the end of May, in Curitiba, Brazil. It is with deepest pride and greatest pleasure that I welcome you to join us in the highlights of this great meeting!
Speakers: Johanna Peceros, Maria Cecília da Matta Rivitti Machado, Maria del Carmen Boente, Ana Maria Mósca de Cerqueira, Margarita Larralde, Felipe Velásquez Valderrama, Vania Oliveira de Carvalho, Rosalía Ballona, Kerstin Taniguchi Abagge, Rosa Inés Castro Rodríguez and Reynaldo Alberto Pomar Morante
Report written by Dr. Lilia Guadanhim
Speakers: Nuria Ferrera, Bollea Garlatti, Luis Agustin, Lídice Dufrechou, Alejandra Larre, Borges Renato, Marchiori Bakos, Maria Sofia, Nicoletti Carolina, Spinelli Lídice, Dufrechou Blanca, Carlos Ortega and Giselle Claros
Report written by Dr. Lilia Guadanhim
- If red flags (rapid growth, big anatomy change, extensive periungual dissemination and pigment progression, bleeding or pain): biopsy of nail matrix.
- If not, re-evaluate in six months
The second day of RADLA was cloudier and colder but the science keeps on! Let’s dive in the subjects of the day!.
Speaker: Antonio Massa (Portugal)
Reports written by Dr. Lilia Guadanhim
Speakers: Marco Rocha (Brazil), Patricia Troiellli (Argentina), Leonel Fierro Arias (Mexico)
Report written by Dr. Lilia Guadanhim
Report written by Dr. Lilia Guadanhim
- Ulceration
- Functional compromise
- Hypothyroidism
- Cosmetic sequelae
Off we go to the third day of RADLA – Annual meeting of the dermatologists from Latin America, with focus sessions on important topic! Come on aboard!
Speaker: Jose Luis López Estebaranz (Spain)
Report written by Dr. Lilia Guadanhim
- 29% of patients have depression.
- Vitiligo patients are almost 5x more likely to be depressed than healthy controls
- 91% of patients report stigmatization.
- 1/3 of patients are at risk for suicide.
- Face and extremities: self-consciousness
- Genital, chest and back: sexual dysfunction.
- Melanocyte stress – Antioxidants?
- Autoimmune destruction:
- Melanocyte regeneration:
- NB-UVB + Er:YAG laser+ topical 5% 5-FUI
- NB-UVB + needling/microneedling
- Tacrolimus ointment + NB-UVB
- Fractional laser + UVB/MEL
- Afamelanotide:
- Bimatroprost and Latanoprost
- 51 and MIA:
- Janus kinase inhibitor
Speaker: Jose Luis López Estebaranz (Spain)
Report written by Dr. Lilia Guadanhim
Today was the last day of RADLA but there was still time for some pearls! Hope you’ve enjoyed this journey!
Report written by Dr. Lilia Guadanhim
Hypersensitivity to mosquito bites as the primary clinical manifestation of a juvenile type of Epstein-Barr virus associated natural killer cell leukemia/ lymphoma.
Erythema Multiforme minor around nevi associated to herpes simples and COVID. There’s also description of Nevocentric erythema multiforme after SARS- Cov2 vaccine:
Speaker: Dr. Gil Yosipovicth – USA
Report written by Dr. Marcela Cirigliano
Dr. Yosipovitch's conference covered various topics related to itch and its management and new treatment options. Here is a summary of some topics considered of relevance along his conference.
The pruritogens (cytokines, non-histaminergic pruritogens and histamine) bind to their respective receptors in nerve fibers (peripheral nerves) and generate and action potential via activating TRP channels: TRPA1, TRPV1, Nav 1,7.
Cytokines→ receptors→ JAK activation→ STAT phosphorylation→ Gene transcription
Itch is a behavioral extension of type 2 inflammation.
Type 2 cytokines directly stimulate sensory neurons in sites of inflammation.
Th2 immunity is a major driver of chronic pruritus.
IL31 is an “itchy cytokine: cellular origin: Th2 cells, macrophages, eos, basophils, keratinocytes, fibroblasts, mast cells.
Receptor components: IL-31 RA and OSMR:
JAK/STAT pathway plays a key role in generating an action potential by cytokines.
Ion channels are receptors for both pain and itch.
Prurigo nodularis (PN) is highly linked with neural sensitization disorders of pain like fibromyalgia, chronic interstitial cystitis and irritable bowel syndrome and type 2 inflammation plays a role in the inflammation seen in PN
Dupilumab and Nemolizumab significantly improves itch and lesions of prurigo nodularis
JAK inhibitors show a broad anti-pruritic effect possibly trough inhibition of TRPV1 and TRPA1
Antioxidants: systemic administration of N-acetyl-Cysteine (NAC) and N-tert-butyl-α-phenylnitrone (PBN) and Quercetin has shown to attenuate histamine dependent and independent itch
Speakers: Dr. Ivonne Arellano, Dr. Paula Torres, Dr. Fátima Agüero de Zaputovich, Dr. Ricardo Galván García and Dr. César González
Report written by Dr. Marcela Cirigliano
Dr. Ivonne Arellano – Mexico
Dr Arellano began her talk by explaining that when it comes to the therapeutic approach for melasma, it’s important to take into account the following pathogenic factors:
As for the objectives of therapy:
Melasma therapy is based on the following pillars:
Effective, avoiding sunlight and using broad-spectrum sunscreen against UVR and visible light
Topical and oral
Topical and oral
Chemical exfoliation (series), microneedling, laser, OTC products/cosmetics
Diminishing pigment
Monotherapy
Double or triple combination
Dr Arellano presented a very interesting algorithm for the treatment and monitoring of patients with melasma, in which she defined three phases:
Maintenance phase (16 weeks), tapering plan: same topical treatments as in phase 1, plus review the therapy: consider alternatives (occasional adjustments or change of therapy).
Procedures should be used in combination, never as a monotherapy.
Dr. Paula Torres – Mexico
Dr Torres reported that the use of antioxidants has increased thanks to a better understanding of melanogenesis and its alterations (oxidative stress), as well as the effects of UV and infrared radiation and visible light: photoageing and photodamage, inflammation, and hyperpigmentation.
The use of antioxidants can be complex due to variables such as stability, dosage, penetration, solubility, and absorption.
Dr. Fátima Agüero de Zaputovich – Paraguay
Dr Agüero highlighted the mechanism of action of tranexamic acid for the pathogenic targets of melasma:
She presented, among other studies, an interesting meta-analysis that indicated an optimum dose of 250 mg three times a day for 12 weeks, with the option of 250 mg twice a day. The preferred duration is 12 weeks, versus 8 weeks.
Dr Agüero stressed the adverse effects that can occur when using tranexamic acid to treat melasma, including nausea, diarrhoea, nasal congestion, muscle aches, oligomenorrhoea, abdominal pain, and eye problems such as blurred vision. She mentioned that there are other, more severe adverse effects, such as acute cortical necrosis, heart attack, and pulmonary embolism, that wouldn’t be described at the doses used for melasma. She recommended that, in addition to taking an exhaustive clinical history, you should request for the patient:
Dr. Ricardo Galván García – Mexico
Dr Galván García gave a very interesting presentation concerning his vast experience with equipment and techniques that are effective for treating melasma. Some key points include:
Laser treatment of the pigmentary component: Q-switched Nd:YAG 1064 nm ns laser. Monthly sessions, with 4 to 6 in total.
He underscored that the ms pulse width (duration) should maintain a relation with the calibre of the vessel or structure to photocoagulate for the technique to be effective and safe.
Laser treatment of the vascular component:
+ IPL 555 nm, 3 to 7 J/cm2, 0.5-1.5 ms, SWT or SMT
+ Nd:YAG long-pulse 1064 nm, spot 5-6 mm, 10 to 18 J/cm2, 0.3 to 0.6 ms, 10 Hz
Dr. César González – Colombia
To begin, Dr González shared a few key points regarding the pathogenesis and histopathology of melasma:
The basement membrane is synthesised by fibroblasts and keratinocytes. Structural damage to the basement membrane facilitates the passage of dermal cytokines to melanocytes, which thus encourages the protrusion of melanocytes into the dermis.
The gene expression profile of fibroblasts in melasma includes proinflammatory and promelanogenic factors, as well as factors related to the tissue repair deficit. These factors can cause damage in the upper dermis and support the focal pigmentary phenotype.
Dr González highlighted the fact that using PLLA (poly-L-lactic acid) can improve not only colour, but also skin quality.
Sebocytes can encourage the development of melasma by exerting a paracrine effect, inducing an inflammatory process that contributes to proliferation, differentiation, and melanogenesis, since sebocytes can increase propigmentary factors, lipid mediators, and proinflammatory cytokines. Given these facts, the doctor highlighted the usage of low-dose isotretinoin for the treatment of melasma as a component of the process of ageing and photoageing.
With regard to another of the pathogenic factors, oxidative stress, Dr González noted that there appears to be a strong negative correlation between the levels of plasma glutathione and the severity of melasma; meanwhile, oxidative stress leads to depletion of plasma glutathione. Additionally, UVB radiation stimulates the expression of iNOS in keratinocytes, which leads to the activation of tyrosinase. In connection with that point, he underscored the action of melatonin as a potent eliminator of free radicals that acts indirectly by stimulating antioxidant enzymes such as SOD, glutathione peroxidase, and glutathione reductase. That stabilises the cell membranes and makes the cells more resistant to oxidative damage.
Speakers: Dr. Juan Carlos Diez de Medina, Dr. Ianina Massimo, Dr. Jaime Piquero Casals, Dr. Josaine Sanjinés Acuña and Dr. César González
Report written by Dr. Marcela Cirigliano
Dr. Juan Carlos Diez de Medina – Bolivia
Dr Diez de Medina shared a series of general concepts relating to the link between rosacea and comorbidities:
Following those points, Dr Diez de Medina shared the results of various studies pertaining to possible comorbidities in patients with rosacea. Based on the evidence presented, the possible associations described can be summarised as follows:
Dr. Ianina Massimo – Argentina
Dr Massimo presented the topographical and pathogenic characteristics of childhood rosacea.
Inflammatory component: erythema, papules, and pustules
Vascular component: erythema and flushing, telangiectasias, and oedema
Sebaceous component: fibrosis and phymas
In reference to a study carried out by Dr Massimo and her team, she reported that in the population studied, 84% of patients had the erythematotelangiectatic form of rosacea. In that clinical form, we find persistent erythema and telangiectasias, generally on the malar area, nose, chin, and glabella. On a histological level, we observe an inflammatory infiltrate that surrounds pilosebaceous units.
Other forms in childhood and adolescence:
OCULAR: In the study presented, 45% of cases had ocular compromise.
The ocular pathologies that appeared in the group studied included:
78% presented demodex mites and 30% had a family history of rosacea.
With regard to therapeutics, Dr Massimo underscored the fact that the therapy must cover multiple factors, focussing on treating a combination of immune-mediated and neovascular responses, while taking into account environmental factors.
Dr. Jaime Piquero Casals – Venezuela
Dr Piquero Casals spoke about the laser treatment options for rosacea:
Dr. Josaine Sanjinés Acuña – Bolivia
Dr Sanjinés Acuña highlighted the role of BT in rosacea and flushing, pointing to the various targets:
Dr Sanjinés Acuña noted that there is an increasing volume of evidence showing that botulinum neurotoxins have a biological effect on various types of cells, and as such, they can be used for the treatment of numerous non-cosmetic dermatological conditions.
The main angiogenic factor that produces the non-transitory erythema is VEGF, and BT suppresses VEGF through the inhibition of IL-8. It also inhibits TRPV1, which is the receptor that is activated by heat, spicy food, and alcohol. TRPV1 activation increases the release of substance P and CGRP, which are the mediators of the characteristic neurogenic inflammation we see in rosacea. Additionally, it has the ability to inhibit the degranulation of mast cells, reducing erythema.
Dr. César González – Colombia
Dr César González shared a series of case studies on erythematotelangiectatic rosacea with ocular compromise, treated with IPL + BT.
He commented on the ophthalmic treatment of dry eye with IPL and, specifically, the changes that occur with meibomian gland dysfunction (MGD), in which the destruction of fine telangiectasias along the eyelid inhibits the passage of inflammatory factors to the meibomian glands, reducing chronic inflammation. Focal heating enables better flow of the secretion, which favours the unblocking of the gland and reduces bacterial and parasite growth.
Speakers: Dr. Jorge Moreno, Dr. Jaime Piquero Casals and Dr. Maria Eugenia Capetta
Report written by Dr. Marcela Cirigliano
Dr. Jorge Moreno – Mexico
Dr Moreno highlighted the value of daily skin care with rosacea. That skin care regimen fundamentally relies on avoiding triggers, using gentle cleansers with an acidic pH, avoiding excessive and exfoliant cleansing, using emollients and moisturisers, selecting products that promote a healthy skin barrier, and, above all, strong photoprotection against UVR and visible light. He mentioned a few active ingredients found in OTC “cosmeceuticals” that are anti-irritant, anti-erythema, and antioxidant, such as licochalcones, ambophenol, neurosensine, caffeine, liquorice, and niacinamide, among others.
He presented evidence regarding the use of roflumilast to treat papulopustular rosacea. Roflumilast is a PDE-4 inhibitor that reduces the release of inflammatory mediators.
Dr. Jaime Piquero Casals – Venezuela
“Cosmeceuticals” are considered a complementary therapy to medical treatment. They include cleansers, moisturisers, and sunscreens. Dr Piquero Casals explained that the usage of cosmeceuticals specifically formulated for acne may:
Dr Piquero Casals presented a few cosmeceuticals of interest for acne:
Regarding adjuvant procedures to acne treatment (peels, lasers, PDT), Dr Piquero Casals noted that they accelerate results and improve upon medical treatments.
Dr. Maria Eugenia Capetta – Argentina
Damage to the hair fibre initially manifests as dry, dull, and brittle hair.
Dr Capetta explained that hair requires three levels of care:
She stated that the frequency of washing may vary and she presented evidence that showed that greater frequency of washing is beneficial and preferable to a lesser frequency. The frequency of washing and the selection of the shampoo will depend on the conditions of the hair and scalp.
Speakers: Dr. Patricia Troielli, Dr. Carlos Eduardo Montealegre Gómez, Dr. Esperanza Meléndez and Dr. Marco Alexandre Dias da Rocha
Report written by Dr. Marcela Cirigliano
Dr. Patricia Troielli – Argentina
In her talk, Dr Troielli presented unresolved questions and controversies relating to two key themes:
acne and hormonal alterations.
Acne has a peak incidence rate at 15 years old, declining in late adolescence; however, its prevalence continues into people’s twenties. This incidence curve is associated with the slow decline of insulin and IGF-1 from its peak in late puberty.
Sebaceous glands have various hormone receptors (for growth hormone, melanocortin-5, CRH, and α-MSH, as well as for neuropeptides such as P substance). External stressors act on this hormonal level by stimulating the production of sebum and producing inflammatory cytokines. As such, we can say that the skin is a neuroendocrine organ, much like the HPA axis, and there is bidirectional interaction between stress and acne.
With regard to evaluating the hormones of patients with acne, Dr Troielli commented that there are several options. She also mentioned a few concepts to consider:
According to the International PCOS Network (2018-2021), the tests requested when PCOS is suspected are:
Dr Troielli also presented evidence concerning biochemical anomalies in acne in adult women: in an observational study, 53% of subjects had persistent acne and 50% experienced premenstrual flare-ups. In the study population, 25% had a fasting glycaemia of ≥100 mg/dl, 10% had insulin levels >25 μIU/ml, and 55% had a HOMA-IR score >2.41. Additionally, 91% presented alterations in blood lipid levels.
Average dose: 100 mg. Dosage range: 25 to 200 mg. Initial: 50 to 100 mg. Higher doses are not recommended. Taking it with food rich in fat or fish oil increases its bioavailability.
For patients 18 to 45 years old, rates of hyperkalaemia are very low, but the risk increases in women over 45 (physiological decline of kidney function in women >40 years old).
It may not be necessary to monitor potassium levels in patients with normal cardiac and renal function, independent of their age.
To summarise:
Combined oral contraceptives (COC)
Oestrogens/Progestins
Approved (2012) by the U.S. FDA for the treatment of moderate inflammatory acne in women.
It can take six months to observe clinical improvement. After six months, they are as effective as oral antibiotics.
It is recommended that you push back the start of COC therapy to two years post-menarche to ensure adequate bone development, unless the treatment is clinically indicated.
Dr. Carlos Eduardo Montealegre Gómez – Colombia
Dr Montealegre began his presentation by explaining in which cases we should use isotretinoin:
The recommendations mentioned and explained by Dr Montealegre are:
When selecting the therapy, adequately educate patients: this means that they should understand the instructions for usage and possible side effects. Whenever possible, provide information in writing.
Educate patients about troubling symptoms and always order prior testing.
Potential risks: Monitor alcohol consumption and take special care when treating women of childbearing age and high-level athletes.
Review potential drug interactions.
Recommend the use of cosmeceuticals: lip balm, eye drops, and photoprotection.
Bidirectional communication: use teledermatology
Always ask about neuro-psychiatric symptoms, alcohol consumption, and contraception.
Employ a multidisciplinary focus: paediatrics, psychiatry, and other specialities.
Stay up to date with required tests and updates from academia (publications, consensus).
With regard to lab work:
Pay special attention to problematic values: triglycerides ≥500 and AST/ALT up to double the maximum.
In case of elevated transaminase levels: decrease the dosage, monitor alcohol consumption, and check in every month.
In case of elevated lipids: use statins or gemfibrozil.
Dr. Esperanza Meléndez – Colombia
Dr Meléndez began her talk by explaining that this type of acne appears suddenly and is connected to a history of taking medicine; it then improves after the medicine is stopped.
Among the possible acne-inducing drugs, she mentioned:
Below is a summary of some of the medicines discussed in Dr Meléndez’s presentation.
Anaerobic metabolism by C. acnes relies on vitamin B12. When a culture of C. acnes receives a vitamin B12 supplement, it increases the synthesis of porphyrins and produces inflammation. Additionally, excretion of vitamin B12 can irritate the follicular epithelium, resulting in inflammation.
This is seen with the usage of high levels of topical, inhaled, or systemic steroids. Anabolic steroids produce an increase in lipids on the skin’s surface (free fatty acids and cholesterol). This stimulates the proliferation of C. acnes and produces hypertrophy of the sebaceous glands. The clinical presentation can range from a papulopustular form to acne conglobata or fulminans. Steroids can also exacerbate existing acne and may be accompanied by hirsutism and androgenic alopecia.
Iodine can exacerbate existing acne or cause an acneiform eruption. It results in compromise of the face and upper trunk. In iodine patch tests, you may observe inflamed follicular pustules.
This is frequently used as a supplement by patients who visit the gym often. It increases levels of IGF-1, thus stimulating sebogenesis.
These are used to improve libido, muscular strength, cognition, and cardiovascular function, as well as avoid the effects of ageing. The most commonly reported adverse effects associated with their use are acne and hirsutism.
In biopsies of acne lesions, researchers have observed overexpression of JAK1 and JAK3 compared to skin free of lesions. As such, more studies are required to understand the mechanism by which acne is induced with JAK inhibitors.
This occurs in 45% to 100% of patients receiving EGFRi therapy and it always develops in the first four weeks. It is more severe with monoclonal antibodies than with kinase inhibitors. The severity of the eruption is generally mild to moderate, but it can be severe. The lesions include comedones, papules, and pustules on the face and thorax, with sensations of burning, itching, and xerosis. It is the most common manifestation with targeted therapy. With regard to treatment, Dr Meléndez mentioned topical doxycycline foam, clindamycin, metronidazole, or mupirocin. The use of BPO is not recommended as it may cause xerosis. She also mentioned that administering vitamin K prevents this rash and decreases the intensity of the acneiform eruption.
Dr. Marco Alexandre Dias da Rocha – Brazil
Dr Dias da Rocha talked about the three acne phenotypes that tend to appear in women.
Dr Dias da Rocha explained several key points:
Speakers: Dr. José María Azeñas, Dr. Héctor Cáceres, Dr. Natalia Velásquez, Dr. Andrés Luque, Dr. Susana Misticone, Dr. Carlos Echevarría Escribens and Dr. María Victoria Suarez
Report written by Dr. Marcela Cirigliano
Dr. José María Azeñas – Bolivia
Dr Azeñas presented cases of acne treated with high doses of isotretinoin, a sign that these were cases that were more difficult to treat, whether due to their clinical severity, or due to poor previous treatment of the patient’s pathology, or due to a lack of response to previous topical and/or systemic treatments. The doctor presented three cases of severe acne in male patients who were treated with isotretinoin at 1.5 mg/kg per day, for a cumulative total dose of 130 mg/kg. Dr Azeñas reported that these were patients who had a slower response, as shown by the fact that they started seeing improvement after about four months. These were patients who came to see the doctor with significant emotional distress due to the quantity and severity of lesions and resulting scars. After completing medical treatment with high-dose isotretinoin, for patients that need it, the doctor may proceed with treating the scars.
Dr. Héctor Cáceres – Peru
Dr Cáceres shared with the audience his experience with combined medical and laser treatments. He reported that today, a high percentage of women around the age of 70 years old have some degree of dyschromia or melasma, conditions in which there is dysregulation of the mechanisms that control pigmentation, resulting in greater production of melanin by melanocytes, greater transfer of melanosomes to keratinocytes, and ultimately, a very important fact, disruption of the basement membrane, with the appearance of “pendulous melanocytes,” which protrude into the dermis and are difficult to treat due to their depth. In addition to a genetic predisposition, light exposure is a critical factor in pathogenesis, and not just UVA, UVB, and infrared radiation, but also, particularly, blue light. Other factors involved in the pathogenesis are hormonal: oestrogens and progestogens, inflammatory mechanisms, and an increase in dermal mast cells, which produce angiogenic factors that increase vascularisation. As such, Dr Cáceres noted that, in his opinion, all cases of melasma have some grade of vascular alteration, whether visible or not, such that if you perform dermatoscopies on these patients, they all show some grade of vascular alteration.
When developing therapies for these patients, it is essential to bear all of these factors in mind. Firstly, Dr Cáceres noted the crucial importance of broad-spectrum photoprotection with pigments to protect against blue light. Additionally, he suggested melanin synthesis inhibitors: Hydroquinone (with the doctor emphasising its use as a first-line treatment, not for maintenance treatment), kojic acid, azelaic acid, arbutin, and ascorbic acid; you can also aim to inhibit the transfer of melanosomes to keratinocytes, for which niacinamide 10% is very effective. To remove pigment, if it’s in the epidermis, you can increase turnover, which can be done using glycolic acid, lactic acid, or retinoic acid. To treat inflammation and secondary vascularisation, the doctor recommends tranexamic acid.
With regard to equipment that can be used for treatment, he mentioned pulsed light and laser equipment. These devices remove melanic pigment, but they do not prevent its production; as such, Dr Cáceres proposed and underscored the value of mixed or combined therapy. He noted that when using lasers, it’s important to minimise excessive heat in the area around the treatment area. This can be done by using newer equipment that allows for short pulses (in picoseconds) that produce a photoacoustic effect rather than a photothermal effect, with selective destruction that prevents damage to surrounding tissue. These devices produce greater fragmentation of the pigment via pulverisation: thus, the pressure of the laser energy breaks up the melanin without generating heat that would inflame the healthy tissue around the treatment area. You must always choose the right wavelength, using very short pulses, which is what produces the effect of an acoustic shock wave. Additionally, Dr Cáceres mentioned that these procedures using equipment producing picosecond pulses are better tolerated by patients. The doctor presented several of his own clinical cases in which he combined treatments using equipment producing picosecond pulses: in these cases, not only was pigment removed, but also the treatment created microchannels in the tissue to allow for the application of medicine (laser-assisted drug delivery), in this case, tranexamic acid in a gel under occlusion. He also mentioned a new 9-mm fractional laser device specifically for the treatment of melasma, with larger spots and lower fluency, which produces a great distribution of energy and can be used with various wavelengths. These combined treatments prove to be particularly effective with mixed melasmas, achieving a very noticeable response after four or five sessions. Dr Cáceres also highlighted the importance of accompanying these procedures with maintenance treatment, applying SPF 50+ sunscreen with pigment every two hours, a vitamin C serum in the morning, and a niacinamide 10% plus tranexamic acid 5% cream at night.
Dr. Natalia Velásquez – Colombia
Dr Velásquez presented her experience with care and treatment for infantile haemangiomas, which are the most common tumours found in infancy, are of endothelial origin, and have an incidence rate of 4%. Among the risk factors, she mentioned pre-term birth, low birth weight, being female, being white-skinned, multiple gestation, and a family history of haemangiomas, among others. She noted that they are typically visible within the first few weeks of life and they follow a trajectory of proliferation followed by involution. Most (50-60%) are superficial and consist of bright red papules, plaques, or tumours with a smooth or lobulated surface; 15% are deep and appear as bluish or skin-coloured tumours with telangiectasias on the surface; and 25-35% are mixed. Dr Velásquez presented two of her own clinical cases treated with timolol 0.5% drops (starting with one application per day and later two per day) with great results in terms of progressive reduction and complete elimination. She also presented a case of an ulcerated surface haemangioma treated with an intralesional injection of triamcinolone 50%, resulting in progressive reduction.
Dr. Andrés Luque – Colombia
Dr Luque shared his experience with surgical treatment for keloid scars, with techniques combined with injections of bleomycin, as well as intralesional cryosurgery. Dr Luque highlighted the importance of maintenance treatment with pressotherapy for up to one year after surgery to prevent recurrence. With regard to the injections, he underscored the importance of seeing immediate whitening of the lesion as a sign that the injection was done properly, at the right level, which also avoids potential atrophy of the tissue. He also talked about the technique he uses for cryotherapy on keloids, using hydrodissection between the healthy tissue and the keloid tissue, which can be done with a saline solution or anaesthetic. He also shared his experience with the laser-assisted drug delivery technique for the application of topical corticosteroids. Additionally, Dr Luque presented the treatment of multiple keloids with CO2 laser in ultrapulsed mode, resulting in near-complete resection of the lesion, followed by contact cryotherapy. This technique, which combines the use of fractional laser with cryotherapy using a contact probe, in addition to offering great results, enables better recovery after treatment.
Dr. Susana Misticone – Venezuela
Around 70% of scars caused by second- or third-degree burns show abnormal healing, with alterations in thickness, texture, and pigmentation, as well as erythema. Dr Misticone explained that the earlier you detect pathological scarring, the easier it will be to treat. She noted that when any rigidity or hardness is detected at one to three months, the bandaging with silicone gel sheets should be exchanged for steroid tape, or you should start steroid injections. If the scarring doesn’t improve, you should treat it with enzymes, 5-FU, or laser.
Laser treatments are effective, with low risk of adverse effects and fast recovery time. They can’t replace surgery, but they can reduce its extent. Given that burn scars present alterations in thickness, pigmentation, and texture, the combination of several lasers enables more comprehensive treatment, especially using PDL or IPL combined with a CO2 laser. CO2 and erbium fractional lasers are the most common non-surgical option for improving the functional results of serious recalcitrant hypertrophic scars. Dr Misticone also mentioned the laser-assisted drug delivery technique, in which fractional lasers create lines in the epidermis in which the drug is delivered for better release and action.
With regard to the treatment of itching in keloids, she noted the action of collagenase, which reduces fibrosis, and injectable bleomycin, which inhibits collagen synthesis via suppression of TGF-β1. Finally, she mentioned radiotherapy for its anti-fibroblastic and anti-angiogenic action as an adjuvant treatment 24-48 hours post-surgery.
Dr. Carlos Echevarría Escribens – Peru
Dr Echevarría Escribens presented a case of a patient with hypertrophic and deforming scars on the face and neck, for which he combined treatments: first with enzymes and intralesional corticosteroids, then with surgery on certain hypertrophic scars—only those oriented in the same direction as the skin’s tension lines—and later with sessions using a CO2 fractional laser, followed by treatment with clobetasol cream. The results were highly satisfactory after four sessions.
Dr. María Victoria Suarez – Brazil
Through the presentation of a case of severe psoriasis in a patient who also suffered from a psychiatric disorder, drug abuse, and alcoholism, Dr Suarez reviewed the evidence for the prevalence of addictions in patients with psoriasis. She also highlighted the fact that cocaine produces an inflammatory state, with activation of microglia and an increase in inflammatory cytokines, as well as an increase in the IL-6 to IL-10 ratio, which further boosts the inflammatory state. Through a strict and precise discussion of the case presented, Dr Suarez underscored the importance of a multidisciplinary approach for these patients, particularly involving collaboration between psychologists and dermatologists. She views this as crucial for this type of high-risk patient.
