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IMCAS Americas 2025
Program

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100

Contributing lectures: Clinical dermatology

Room: Room 2
Date: Sunday 13 April 2025 at 15:00 to 16:00
Format: CONTRIBUTED TALKS > session made up of abstract submissions that were carefully reviewed and selected by the Scientific Board

Chairs

Prof Piergiacomo CALZAVARA PINTON

Dermatologist

Italy

Dr Sergio TALARICO

Dermatologist

Brazil

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
15:00	Dr Martha VIERA	Succesful treatment of resistant melasma with intradermal injection of botulinum toxin type A combined with tranexamic acid solution	View	148089
15:15	Dr Andjela PROLIC	Chemical peel acid combinations for effective hyperpigmentation treatment	View	148088
15:30	Dr Mariany REZENDE	Allergic contact dermatitis to lettuce	View	145957
15:45		Discussion and Q&A		148098

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Peelings

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Dr Martha VIERA

Dermatologist

United States

Other author(s) : Martha Viera,MD, FAAD; Jaime Camino, BS

Succesful treatment of resistant melasma with intradermal injection of botulinum toxin type A combined with tranexamic acid solution

Objectives: Assess the effectiveness of intradermal injections of botulinum toxin combined with tranexamic acid in managing melasma, with a focus on the anti-melanogenic role of botulinum toxin and the melanogenesis-inhibiting properties of tranexamic acid (TXA).

Introduction: Melasma is one of the most common dermatological conditions, predominantly affecting women with darker skin types. Numerous causes have been associated with its development, the most extensively studied being sun exposure, hormonal changes, and genetic factors. Some studies have identified a direct role of botulinum-toxin in melanogenesis, though further research is required to comprehensively understand its effects. Tranexamic-acid (TXA) is another well-known agent currently used to treat melasma, demonstrating its efficacy. This study explores the synergistic of both agents together.

Materials / method: An open case series included 10-female patients (40–50-yo, Fitzpatrick IV) diagnosed with melasma resistant to conventional-treatments. Quantificare-imaging system was used to assess pigment and a MASI score was-applied. Two-out of 10 had severe melasma and the other 8-patients were moderate. A single-session was done. A topical-anesthesia was applied 15 minutes prior. Intradermal-injections were administered to each cheek, 100U-Botox vial diluted in 4cc normal-saline. Fifteen units mixed with 0.7 mL of 100mg/mL tranexamic acid total of 3ml were injected per-site. Post-care instructions given

Results: The significant reduction in the MASI score was observed compared to previous treatments used in these patients. The improvement was particularly evident in areas of significant hyperpigmentation treated, suggesting that intradermal injections of botulinum toxin type A combined with TXA effectively reduce visible melanin deposition and improve overall skin tone uniformity.

Conclusion: Melasma continue being challenging to treat. Botulinum-toxin effectively modulates melanogenesis by reducing inflammatory mediator and suppressing tyrosinase activity. TXA inhibits the plasminogen/plasmin system, reducing hyperpigmentation and inflammation. TXA has gained traction in dermatology for melasma treatment. This combination therapy appears promising for melasma management, warranting further investigational-studies. Large-scale, randomized, placebo-controlled-trials are needed to validate the effectiveness of this combined therapy in melasma and determine optimal delivery method.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Andjela PROLIC

Croatia

Other author(s) :

Chemical peel acid combinations for effective hyperpigmentation treatment

Objectives: Chemical peels are gaining popularity due to their effectiveness and affordability. The objective of this case report is to evaluate the effectiveness of a specific combination of acids in the treatment of hyperpigmentation. This combination includes Trichloroacetic Acid (12%), Kojic Acid (5-7%), and Mandelic Acid (5-7%). The aim is to assess the efficacy of this acid blend in reducing hyperpigmented areas while minimizing side effects such as irritation and peeling, thereby providing a balanced approach that prioritizes both treatment efficacy and patient comfort.

Introduction: Hyperpigmentation and melasma are prevalent pigmentation disorders primarily affecting women living in regions with high sun exposure. In this Case report a 38-year-old European female patient, classified as Fitzpatrick skin type III from a Mediterranean country, presented with forehead hyperpigmentation. Clinical examination revealed multiple pigmented brown macules and patches diffusely distributed on the forehead. Intensity confirmed with Lifeviz Quantificare camera. The treatment aimed to provide an effective chemical peel and to keep the patient comfortable without a recovery period.

Materials / method: Three treatment sessions were conducted 14 days apart, utilizing a combination of Trichloroacetic Acid (12%), Kojic Acid (5-7%), and Mandelic Acid (5-7%) at a pH of 0.2-1. After completing the treatment protocol, the patient was followed up from March to May 2024. Following each session, the patient experienced mild erythema that appeared immediately but resolved within the same hour. To ensure optimal results the patient was advised to avoid sun exposure and to apply sunscreen regularly. Any strenuous physical activity wasn't recommended for two days following treatment.

Results: By the conclusion of the treatment plan, the clinical assessment indicated significant improvement, characterized by a visibly noticeable reduction in both the size and color intensity of the hyperpigmented lesions on the forehead. This positive outcome was corroborated by measurements taken with the Lifeviz Quantificare camera, further validating the effectiveness of the treatment while ensuring patient comfort and safety. Results were stable and confirmed after three months follow-up.

Conclusion: The combination of Trichloroacetic Acid (12%), Kojic Acid (5-7%), and Mandelic Acid (5-7%) at a pH of 0.2-1 provides a highly safe and convenient treatment option for patients. This blend significantly addresses hyperpigmentation and melasma without causing pain or excessive exfoliation. The synergistic effects of these acids make this combination an effective and reliable choice for clinicians, enhancing patient satisfaction and outcomes. Thus, it represents a valuable addition to clinical practice for managing pigmentation disorders.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Mariany REZENDE

Dermatologist

Brazil

Other author(s) : Mariany Lima Rezende, Ana Luiza Castro Fernandes Villarinho, Maria das Graças Mota Melo, Clarissa Vita Campos

Allergic contact dermatitis to lettuce

Objectives: To describe a case of Allergic Connate Dermatitis (ACD) triggered by an allergen present in lettuce in a food handler, in whom the test with the fresh vegetable was relevant for diagnostic confirmation.

Introduction: Hand contact dermatitis is considered the most common occupational dermatosis, causing morbidity and functional impairment. The diversity of allergens in the workplace makes it difficult to determine the causative substrate, making the patch test (CT) essential for diagnosis. A 46-year-old man, a general services assistant in a fruit and vegetable store, with no history of previous allergies, reported blisters, exudation and itching on his hands for four months (Fig. 1A). Worsened when handling green vegetables. Treated with moisturizers, corticosteroids and antibiotics, without results.

Materials / method: A patch test was performed with a Latin American battery, which showed positivity for sesquiterpene lactones (SLs). Due to reports of worsening with the handling of leaves, CT was also applied to fresh vegetables (cilantro, chives, parsley, watercress, leaves and stems of American and curly lettuce) prepared with a drop of bidistilled water and applied to the skin under occlusion for 48 hours (Fig. 2A). The results were positive for both types of lettuce tested (Fig. 2B).

Results: The findings corroborated the diagnosis of ACD with an occupational link, with lettuce being the causal agent. The patient was taken off work for thirty days and medicated with emollient and topical corticosteroid, with the lesions resolving. He returned to work, but without direct exposure to vegetables and without recurrence of the condition (Fig. 1B).

Conclusion: ACD caused by lettuce is rarely reported in the literature, considering its high rate of consumption and cultivation. There is a possibility of cross-reactions with other plants of the Compositae family, including hygiene and dermocosmetic products that contain SLs in their formulation. It is important to emphasize that, in addition to the causative substrate, other mechanisms that trigger eczema must be identified in order to improve the functionality of patients affected by this condition.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

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IMCAS Americas 2025 Program

100

Contributing lectures: Clinical dermatology

Chairs

Lectures of the session

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IMCAS Americas 2025
Program