Intradermotherapy is a medical procedure introduced by Pistor in 1958 that consists in the application of intradermal injections of diluted pharmacological substances that are given directly into the region to be treated. There are reports of the use of intradermotherapy to treat painful diseases, skin diseases and unaesthetic conditions. Medical clinics have been recently offering the treatment of intradermotherapy, using the more popular name for this practice -mesotherapy. There is only scant scientific information about this subject published in periodicals indexed on MedLine. Only a few states rigorously pursue this method. Most indexed publications about this subject deal with the complications of this technique. Unaesthetic dermatoses have been a common complaint in dermatologic clinics, and it has become necessary to have scientific evidence to give to patients. Therefore, well-researched scientific studies about this technique are necessary to offer data to medical professionals that will clearly explain to patients both the benefits and the risks of these procedures. A bibliographical review was conducted and we verified the need for new studies with adequate methods to confirm the benefits of intradermotherapy as used in dermatologic treatment. Keywords: Injections, intradermal; Review; Skin; Therapeutics Resumo: A intradermoterapia é um procedimento médico introduzido por Pistor, em 1958, e consiste na aplicação, diretamente na região a ser tratada, de injeções intradérmicas de substâncias farmacológicas muito diluídas. Esse método é capaz de estimular o tecido que recebe os medicamentos tanto pela ação da punctura quanto pela ação dos fármacos, e apregoa-se que sua vantagem é evitar o uso de medicação sistê-mica. Há relatos da utilização da intradermoterapia para tratamento de doenças dolorosas, dermatoses e condições consideradas inestéticas. Atualmente, clínicas médicas oferecem esse tratamento, utilizando, porém, o nome mais popular para essa prática, mesoterapia. Há escassa informação científica sobre o tema publicada em periódicos indexados no MedLine e poucos estudos com metodologia mais rigorosa sobre a eficácia e o mecanismo de ação da via intradérmica. A maioria das publicações indexadas sobre esse tema versa sobre as complicações dessa técnica. As dermatoses inestéticas têm se tornado queixas frequentes nos consultórios dermatológicos, sendo necessário um embasamento científico para lidar com tais pacientes, os quais, muitas vezes, estão em busca das novidades mostradas através da mídia. Assim, há necessidade de estudos cientificamente bem conduzidos sobre essa técnica. Estes estudos deverão oferecer aos médicos elementos para esclarecer os pacientes sobre quais benefícios esperar e quais os riscos de tal abordagem. Desse modo, realizou-se uma revisão bibliográfica sobre o assunto e constatou-se a necessidade de novos estudos com metodologia adequada para a confirmação dos benefícios da intradermoterapia como ferramenta útil no tratamento dermatológico.

Recently, a controlled double-blind study in patients with photo-aged facial skin demonstrated the beneficial role of oral intake of silanol for skin, hair and nails. The aim of our pilot study was to investigate histologic alterations in human skin after injection of silanol. Seven healthy female caucasian volunteers with a moderate degree of photoaged skin received ten sessions of weekly injections of 0.1% salicylate silanol in the left ventral lateral forearm. The histologic features of punch biopsies of the treated area and the nontreated contralateral arm were compared and the collagen and elastic fibers quantified. Texture analysis was performed on digitalized microscopic images by analyzing the Sarkar fractal dimension or amplitudes (inertia values) after Fast Fourier transformation. The treated area revealed a statistically significant increase of the density of both collagen and elastic fibers. Texture analysis showed more compact and homogeneously distributed collagen fibers after silicon injection. Our results suggest that the application of silicon may stimulate the production of collagen and elastic fibers leading to remodeling of the dermal fiber architecture, which may explain the improvement of the skin surface observed in clinical studies.

Cryosurgery with liquid nitrogen is an efficient, safe and in most cases aesthetically acceptable alternative method to treat LM.

Ultrasound hydrolipoclasia is a form of mesotherapy in which physiological solution is injected subdermally before ultrasound application; it is an off-label treatment for localized fatty areas. A 28-year-old white woman presented with painful erythematoussecreting nodules in her abdomen for 1 week. The nodules were located where a non-physician performing another service had applied an ultrasound hydrolipoclasia treatment 1 month before ( Figure 1). She reported that four other women who had received this sort of intervention on the same day and in the same aesthetic clinic were presenting with the same symptoms. The patient did not experience systemic symptoms.The diagnostic hypothesis was atypical mycobacteriosis. A biopsy of one lesion was performed, and cultures of the smear and of the biopsy specimen were prepared. The culture of the smear isolated Mycobacterium fortuitum, and a histologic examination revealed dermal chronic inflammation with alcohol-acid-resistant bacilli present at the Ziehl-Nielsen stain.Treatment was performed with 100 mg of doxycycline twice a day for 6 months, resulting in complete remission of the erythema and secretions and involution of the lesions. Because skin palpation demonstrated remaining nodules, a topical betamethasone dipropionate ointment was prescribed during the last month of antibiotic treatment, which resulted in improvement of the skin texture.Six months after the final treatment, the lesions were atrophic, with an appearance resembling stretch marks ( Figure 2A). To improve this condition, we submitted the scars to five weekly sessions of intradermotherapy with 0.5% silanol salicylate. Injections were performed beginning with 1 mL of silanol salicylate, in consecutively decreasing amounts, until filling of the scar was visually evident.After the intradermotherapy treatment, some improvement in skin texture was noted ( Figure 2B), and the patient was satisfied. DiscussionUltrasound hydrolipoclasia is an off-label procedure for treatment of localized fatty areas and cellulite that consists of injections of physiologic solution into the subdermic tissue followed by ultrasound applications. 1 This procedure has little scientific documentation, and unlicensed medical personnel sometimes perform it, as was the case with our patient. Advocates of this procedure state that, because the substance being injected is a 0.9% physiologic solution, it is a safe procedure, and for this reason it is popular in Brazilian esthetic clinics, but this report indicates that this technique can cause undesirable complications and that it should not be performed

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