Periocular Area Research Articles

Investigating basal cell carcinoma recurrence and outcomes following surgical excision at Broomfield hospital ophthalmology department, United Kingdom

AbstractPurposeOur current practice involves 2 years follow up after periocular BCC excision. This audit aims to investigate outcomes of: BCC recurrence rate while under follow up after histologically proven complete excision. Histological findings in cases of biopsy of suspected recurrent BCCMethodsRetrospective identification of samples sent to histopathology by a single Oculoplastic consultant with suspected or confirmed BCC between 01/01/16–30/04/19. Clinic letters identified the duration from surgical excision to latest follow up and any suspicion of recurrence. Where initial surgery was incomplete, or recurrence suspected clinically, secondary surgery results were checked to determine whether residual BCC was reported. Initial diagnostic incising biopsy results were excluded.ResultsOf 115 samples, 51 were excluded as per criteria. Of the remaining 64 patients, 56 patients were reviewed post‐operatively with no suspicion of recurrence in timeframe seen (1–>24 months). Of 64 patients, 8 (12.5%) warranted secondary surgery within 2 years: 5 indicated by reported margin involvement (7.8%); 3 indicated by clinical suspicion (4.7%). This audit did not identify any cases of BCC recurrence. Residual BCC was identified on one deeper resection indicated by histopathology. Patients may continue to be risk assessed, and follow‐up preserved for: persistent marginal involvement; aggressive BCC sub‐type; pre‐disposition for BCC; immunosuppression; higher risk initial BCC site (e.g. medial canthus or orbital invasion).ConclusionsNo cases of BCC recurrence were identified within this cohort. Re‐excision of involved margin tends not to a show positive result. Minimal residual BCC may have been destroyed during the initial surgical cauterisation or by the immune system. We propose to discharge patients following complete excision of low risk BCCs from the periocular area with advice to seek referral with any new lesions following self‐examination.

Cutaneous squamous cell carcinomas on special locations: perioral, periocular and genital area.

If tumours arise in special locations such as around the eyes, mouth or in the genital area, patients and physicians are challenged by the need for complete removal of the tumour with safety margins and high demands on function and aesthetic aspects. Treatment should be performed by specialized physicians including ophthalmologists, head and neck surgeons, surgical, medical and radiation oncologists. The first-line treatment for most cutaneous malignancies is surgical excision; however, in several situations, such as well-differentiated cutaneous squamous cell carcinomas (cSCC) in the periocular or anal region, radiotherapy is a very reasonable and sometimes treatment of first choice, especially in patients with advanced age. In periocular SCC, radiotherapy with superficial x-ray combined with eye shielding, while in anal SCC, radiotherapy combined with chemotherapy is recommended. However, after failure of local treatment options including surgery and radiotherapy, systemic medications are indicated in order to achieve tumour control or cure. Systemic therapies include immunotherapy, targeted therapy or chemotherapy. Preventive strategies are based on UV protection in facial, and vaccination in HPV associated anogenital SCCs.

Noninvasive evaluation of vascular endothelial growth factor-A (VEGF-A) protein concentrations in the stratum corneum and serum of healthy and atopic dogs.

Vascular endothelial growth factor (VEGF) is a cytokine involved primarily in angiogenesis. In human atopic dermatitis (AD), VEGF has been detected in the stratum corneum and blood. To evaluate VEGF-A expression in the serum and stratum corneum of healthy and atopic dogs, and its possible correlation with disease severity in atopic dogs. Fifteen atopic and 15 healthy, privately owned dogs. The severity of clinical signs associated with AD was evaluated with the Canine Atopic Dermatitis Extent and Severity Index (CADESI-04). For all dogs, a single blood sample was performed and serum collected. Tape stripping (15 times) was performed on the left periocular area (lesional skin). A commercially available canine-specific VEGF-A enzyme-linked immunosorbent assay was performed with all samples. Vascular endothelial growth factor-A was undetectable in the serum. In the stratum corneum, there was no significant difference in VEGF-A concentrations between healthy (mean 89.4 ± 59.5 pg/ml) and atopic dogs (mean 100.3 ± 77.1pg/ml) (P=0.71). There was no correlation between stratum corneum VEGF-A concentrations and CADESI-04 scores. The role of VEGF in canine AD is unclear. Because of many variants, VEGF-C and VEGF-D or VEGF-A isotopes should be explored in the skin to better evaluate the role of VEGF in canine atopy. Full-thickness skin biopsy, molecular biology and histopathological investigation may be necessary to further assess cutaneous VEGF expression.

Nonsurgical blepharoplasty

The eyes are an important component of facial aesthetics. They are in the center of an anatomical area of the face very important for rejuvenation procedures, the so-called "periorbital region." The appearance of the eyes therefore decisively influences the perception of the aesthetics and aging of the entire face. In juvenile age, the skin of the periocular area is elastic and tonic, without sun damage; the eyebrow is full, well defined, and not descending; there is a clear and visible fold of the upper eyelid, with minimal dermatochalasis; the lower eyelid is tense and well positioned. The aim of this preliminary study is to define a protocol for the use of plasma technology in the treatment of aging signs of the periorbital region. The protocol is aimed to provide predictable, constant, and safe results.

Postmarket Experience of Polymethylmethacrylate-Collagen Gel Dermal Filler.

This report synthesizes 12 years of postmarket surveillance data (PMSD) for polymethylmethacrylate (PMMA)-collagen gel dermal filler. To present PMMA-collagen gel PMSD findings on real-world safety. Postmarket surveillance data were collected from January 2007 to December 2018 and evaluated to determine the overall adverse event (AE) complaint rate, the nature of reported AEs, and whether the complaint included on-label, off-label, both, or unknown areas. In the 12 years examined, 754,229 PMMA-collagen gel syringes were distributed worldwide, and 839 product-related complaints (including those classified as unknown) resulted in an overall complaint rate of 0.11%. The 3 most frequent primary complaints in AE reports were lump/bump (309/839, 37%), nodule (152/839, 18%), and swelling (138/839, 16%). Histologically confirmed granuloma accounted for 17/839 complaints (2.0%; overall complaint rate of 0.002%), and histologically unconfirmed granuloma accounted for 66/839 complaints (8%; overall rate of 0.009%). There were 666 complaints representing AEs related to off-label injection in which the periocular area was most frequently represented. Although a limiting factor across all PMSD is voluntary reporting and resultant underrepresentation of AEs, the PMSD reported here are consistent with safety findings from US clinical studies in more than 1,500 patients with up to 5 years of follow-up.

A New Perspective to the Periorbital Aesthetics: Bella Eyes.

The term beautiful eyes can be defined as youthful, brilliant, vivid, and attractive eyes. The anthropometric findings about beautiful eyes may differ according to gender or race. In order to form such a beautiful eye, a variety of surgical, nonsurgical, or combination methods for periorbital region rejuvenation have been proposed. The surgical methods include coronal/peritrichial, endoscopic, upper and lower eyelid, or transconjunctival incisional procedures. Neuromodulators, fillers, and laser treatments are some of the nonsurgical approaches. Regardless of the method, while treating this particular area, the aesthetic unit concept should always be taken into consideration. We attempted to combine an endoscopic dynamic canthopexy procedure with endoscopic temporal and brow lift, which we call "bella eyes" to achieve a more attractive look, especially in young people who desire a slanted eyelid. We aim to share our clinical experience from 35 patients and the technical details of the bella eyes procedure. Patient satisfaction was high, and the endoscopic technique eliminated all of the minor deformities and provided excellent harmony through each subunit of the periocular area with minimal discomfort and well-hidden scars. We believe that this procedure is a good way to achieve a beautiful eye in young women. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Dermoscopy of dermatitis neglecta in the periocular area in skin of color

Dermoscopy of dermatitis neglecta in the periocular area in skin of color

Periocular hyaluronic acid fillers: applications, implications, complications.

The use of dermal filler in the periocular area is increasing - both for functional and aesthetic indications. Hyaluronic acid fillers dominate the market; these treatments offer an alternative to some surgical procedures with the advantage of instant results, minimal healing time and low complication rates. However, success depends on judicious selection of patients, products and procedures to achieve favourable outcomes. This article reviews current understanding of the principal complications in the periocular area and their management. Hyaluronic acid is a ubiquitous, biodegradable, nonspecies-specific molecular substrate with limited potential for immunogenic reactions. However, in the periocular area, such products can migrate and last significantly longer than the expected filler lifespan. Contamination or subsequent immune stimulation can trigger delayed-onset inflammatory reactions. Though minor vascular occlusions are not uncommon, cases of blindness secondary to facial filler injections are thought to be rare. Timely enzymatic degradation with injectable hyaluronidase can be effective in the treatment of some such complications. But recent studies demonstrate lack of penetration through arterial walls and optic nerve sheath, casting doubt on the role of retrobulbar hyaluronidase in the management of vision loss because of embolism with hyaluronic acid filler. Hyaluronic acid fillers represent an emerging and important addition to the armamentarium of the oculofacial plastic surgeon with their use in the aesthetic field also expected continue to rise. The oculoplastic facial surgeon, armed with a thorough knowledge of facial anatomy, safe injection planes and the means of minimizing and treating complications is in the best position to lead clinically in the use of this well tolerated and effective treatment modality.

P3.60: Native spleen preservation attenuate graft versus host disease in an experimental model of modified multivisceral transplantation.

Introduction: Native spleen used to be removed in patients undergoing modified multivisceral transplantation (MMVT) increasing the risk of sepsis and graft-versus-host disease (GVHD). The mechanistic basis of these effects including mixed chimerism level is poorly understood. Based on a novel experimental procedure of MMVT that triggers GVHD, we aimed to evaluate the effects of native spleen preservation in this model in order to gain insight into the mechanisms that may mediate this phenomenon. Material and Methods: Heterotopic MMVT from Lewis to Brown Norway rats was performed. MMVT graft consisted of stomach, duodenum, pancreas, spleen and the small bowel of the donor. The native spleen was removed (MMVT-S) in half of the MMVT recipients (N=5), while the remaining preserved their own spleen (MMVT+NSP) (N=5). After MMVT mixed hematopoietic chimerism was determined in native spleen and peripheral blood samples by flow cytometry using strain-specific HLA antibodies. Also, histopathological (using Pintar score) and clinical signs of GVHD such as skin rash were evaluated. Results: all animals in the group MMVT-S presented clinical signs of GVHD such as skin rash, weight loss, and diarrhea, among others, between 7–10 days after transplantation. Skin rash was particularly remarkable in the ears and periocular area. Clinical signs of GVHD were less frequent in MMVT+NSP recipients (40%; p<0.05). Also, significant differences between groups were observed in the histopathological study and mixed chimerism in peripheral blood 3 days after MMVT (36.6 and 23.62 % in MMVT-S and MMVT+NSP respectively) (Figure 1). Also, native spleen showed an 18±5 % of chimerism (CD3+ donor cells) 1 week after transplantation. After day 10 post-MMVT, when the signs of transient GVHD disappeared, both groups presented graft rejection. Conclusions: Native spleen preservation in MMVT recipients attenuated the occurrence of GVHD and reduced the level of chimerism compared to recipients that underwent spleen removal during MMVT. Despite more studies are necessary, our preliminary results suggest that native spleen preservation increase the efficacy in removal of anti-recipient reactive clones that would explain the protective effect of native spleen preservation against GVHD.

569 Development of an advanced retinol oil composition with superior bioactivity and anti-aging clinical efficacy

Vitamin A or retinol is a proven cosmetic ingredient for the treatment of photoaged skin. It has been incorporated in various product forms which are used in daily skin care regimens. Retinol as an oil form can offer unique aesthetics and physicochemical characteristics. The relative polarity between skin, retinol, and emollient ratios allows for controlled biodelivery of retinol. Retinol induced-bioactivity could be enhanced, and its irritation potential could be mitigated by controlling its delivery rate to skin. Thus, an optimized retinol oil formulation enabling a controlled release of retinol drives better efficacy and lower irritation. An advanced retinol oil was developed through evaluation of the relationship between its composition versus its bioactivity and irritation potential by using clinically correlated standardized biomarker gene expression analysis. This retinol oil composition delivered superior bioactivity with a low irritation potential profile in comparison with other marketed retinol oil-based products. When used as part of a retinol-based skin care regimen, this retinol oil composition delivered twice the bioactivity of retinol in vitro. Moreover, a single center, open-label, clinical trial was conducted to evaluate its overall effectiveness as a daily treatment for photoaged skin. 35 healthy female subjects were enrolled with moderate photodamage of the face and moderate to severe facial fine wrinkles in the periocular area. This advanced retinol oil composition was well tolerated and resulted in significant and sustained improvements versus baseline in the appearance of fine lines and wrinkles and other antiaging parameters evaluated. Thus, this anti-aging retinol oil, supported with scientific testing and clinical assessments, constitutes a novel, unique, and superior retinol form that delivers improvements in facial wrinkles as early as 1 week, as well as sustained improvements in cutaneous skin parameters that address the needs of subjects with signs of skin aging and photodamage.

Topical effects of SCA® (Cryptomphalus aspersa secretion) associated with regenerative and antioxidant ingredients on aged skin: evaluation by confocal and clinical microscopy.

PurposeThis was an open-label, single-center clinical study to evaluate a topical association of SCA® (Cryptomphalus aspersa secretion) with regenerative and antioxidant ingredients, according to the type and area of the face, on the improvement of signs of skin aging.Patients and methodsOne hundred and twenty female participants aged between 40 and 65 years, with facial aging complaints (presence of static, dynamics wrinkles, loss of elasticity, and skin firmness) were randomized into two groups according to the type of skin: normal–oily and normal–dry, and 40 participants were randomized for evaluation of the periocular area (with the presence of wrinkles, expression lines, and dark circles) with both types of skin. The groups received serum for normal–oily skin, a cream for normal–dry skin, and a cream for periocular and eyelid skin (eye area). All the participants were evaluated by a dermatologist and submitted to hydration evaluation by corneometry, elasticity and firmness measures complementarily, and images were collected in confocal reflectance microscopy.ResultsTopical skin treatment with the association of SCA with antioxidant ingredients (green coffee oil, olive oil, ectoine, hyaluronic acid, and peptides) was able to promote significant clinical and subjective improvement of all signs of skin aging. This improvement was presented at the epidermal level, with improved hydration levels measured by corneometry and epidermal thickness, and at the dermal level, with improvement of the firmness and elasticity parameters, measured by cutometry, from 45 days of use.ConclusionAll the evaluated topical formulations seemed to be an effective alternative for the progressive treatment of signs of skin aging, since they demonstrate a real improvement of dermal–epidermal structure and function with high safety margin for long-term use.

Nonsurgical management of periocular scars along with review of literature

Introduction: Facial scars in the periocular region may cause cosmetic blemish as well as functional deficits. There are several treatment options available for scar management, but many of these are unsuitable for periocular region because of their potential to cause damage to the ocular structures. This article aims to present an ophthalmic plastic surgeon's perspective of managing these scars safely and effectively. Methods: An extensive literature search was done using PubMed (Medline), Cochrane, and Google Scholar with multiple combinations of search terms such as scar, facial scar, contracture, and keloid. Articles in English language published describing the existing and emerging modalities of treatment for periocular facial scars were reviewed. Results: The scarring pattern in the face and periocular area is different as wound healing in these areas differs from that of the rest of the body. Various techniques ranging from simple scar massage to laser and intralesional steroids and antimetabolites have been described with good results for managing scars in various parts of the body. However, safety of some of these modalities in periocular region has not been established unequivocally as yet. Conclusion: Effective scar management requires a multipronged therapeutic approach. Facial and periocular scars deserve special care due to their close proximity to the eyes. Hence, it is paramount that safety of any approach be ascertained prior to the procedure, especially in periocular areas.

A Predictive Model for Primary Closure Lengths in Mohs Surgery Based on Skin Cancer Type, Dimensions, and Location

Surgical scar length is a common concern among patients undergoing Mohs micrographic surgery (MMS). This study evaluates 3 metrics of preoperative lesion size to determine which correlates best with primary linear closure lengths for nonmelanoma skin cancers (NMSCs) treated with MMS. This metric is then used to develop predictive models for linear closure lengths in 10 different anatomical regions. A retrospective study of 4,049 NMSCs treated with MMS and repaired with primary linear closure was conducted. Primary closure lengths were plotted against preoperative lesion circumference, area, and short axis length. Linear regression analysis was performed. Preoperative NMSC circumference correlated best with closure length. Twenty-one of the 28 regression models had coefficients of determination (R) above 0.5. Closure lengths increased by 0.52 to 1.1 mm, depending on location, for every millimeter increase in preoperative NMSC circumference. Preoperative lesion circumference is directly proportional to primary closure length and is a better indicator of closure length than preoperative area and short axis for MMS of NMSCs. Closure lengths located on the nasal tip, supratip, or periocular areas are most sensitive to differences in NMSC size. These data might aid Mohs surgeons with preoperative planning for wound reconstruction and patient counseling.

Squamous Cell Carcinoma Involving Periocular Area

Squamous Cell Carcinoma Involving Periocular Area

Use of ultrasonography to identify a periocular plant foreign body in a dog

A one-year-old female spayed miniature schnauzer was referred to the Kansas State University Veterinary Health Center Ophthalmology Service for evaluation of chronic purulent discharge and conjunctival hyperaemia of the right...

Clinical-pathological characteristics of patients treated for cancers of the eyelid skin and periocular areas.

Malignant cancers of the eyelid skin and the periocular area comprise 5-10% of facial skin malignant cancers. Basal cell carcinomas (BCCs) dominate, comprising approx. 80-90% of cancers of this area of the face. Considerably less often, in 9-14% of cases, squamous cell carcinomas (SCCs) are observed. The aim of this study is to provide an epidemiological-clinical assessment of patients treated over the period 2006-2015 for primary malignant cancers of the eyelid skin considering histological diagnosis and clinical staging. This study was based on an analysis of the medical records of 262 patients. Demographic data, age, sex, size and location of lesions, histological types, and clinical staging were assessed. In the analyzed group of 262 patients, most were over the age of 60 years. Primary cancers were most frequently located in the area of the medial canthus of the eye and in the lower eyelid skin. They were mainly lesions of 6-10 mm and 16-20 mm with histologically diagnosed basal cell carcinoma of nodular and cystic types. The most represented group was that of patients aged 60-70 years with primary cancers located in the medial canthus of the eye (47.3%) and in the lower eyelid. Basal cell carcinoma was diagnosed, mainly nodular and cystic types.

Pediatric Periocular Dermoid Cysts: Incidence, Clinical Characteristics, and Surgical Outcomes

ABSTRACTPurpose: To report the incidence, clinical findings, and surgical outcomes of periocular dermoid cysts diagnosed among children over a 20-year period.Methods: All patients ≤5 years of age, who were diagnosed with a periocular dermoid cyst in Olmsted County, Minnesota from 1986 to 2005 were reviewed to determine the population incidence, clinical presentation, and management outcomes.Results: A total of 54 children were diagnosed with a periocular dermoid cyst during the 20-year period, yielding a birth incidence of 1 in 638 live births. The mean age at diagnosis was 12 months (range, 1 month–60 months) and 29 (53.7%) were female. A total of 44 cysts (81.5%) occurred in the superotemporal orbital rim, 6 (11.1%) in the superonasal orbital rim, 3 (5.6%) in other periocular areas, and one (1.9%) within the orbit. A total of 34 (63%) children had an ophthalmic exam, all without amblyopia or other ocular sequelae. A total of 48 (88.9%) patients underwent surgical excision with 5 (10.4%) having documented intra-operative cyst rupture, none of whom had post-operative complications. Two (4.2%) other patients were, however, noted to have lesion recurrence following surgical intervention.Conclusions: Periocular dermoid cysts occur in approximately 1 in 650 live births and most commonly occur in the superotemporal region of children aged 1 year or less. Ocular sequelae are rare and surgical excision often yields excellent results.

Controversies in periocular reconstruction for facial nerve palsy.

Periocular rehabilitation of the patient with a facial nerve palsy has evolved over time. Although protection of the ocular surface is paramount, application of disfiguring tarsorrhaphies should be utilized only in special situations. The purpose of this review is to discuss current surgical and medical strategies in treatment of the periocular area in patients with facial nerve palsy to give maximal functional and cosmetic results. Upper lid lagophthalmos is preferentially treated with upper eyelid weights. Platinum has distinct advantages over gold. A supratarsal position of the upper lid weight is preferred over a pretarsal location. Lower lid malposition should be treated as a retraction, rather than an ectropion. Recalcitrant ocular surface disease can be effectively managed with a scleral lens. Tearing in the patient with a facial nerve palsy is often multifactorial; small lumen Jones tubes and botulinum toxin injection to the lacrimal gland should be considered to treat epiphora in these patients. A facial nerve palsy can be devastating for patients from both a functional and cosmetic perspective. Although seismic shifts in treatment of the periocular subunit have not occurred, there are a number of small, yet significant, changes in treatment that should be adopted in taking care of these patients.

Antimicrobial Activity of a New Aloe Vera Formulation for the Hygiene of the Periocular Area.

The aim of this study was to evaluate the antimicrobial activity of a novel preservative-free lid wipe formulation containing Aloe vera gel and hyaluronic acid that is commercialized for the hygiene of the periocular area. In vitro susceptibility testing of the solution contained in wipes against bacteria and fungi commonly colonizing the periocular area, both reference strains and multidrug-resistant (MDR) clinical isolates, was assessed following the CLSI M07-A9 and M27-A3 broth methods, respectively. The solution was 2-fold serially diluted in broth from 25 μL (25% v/v) to 0.012 μL (0.012% v/v) in microtiter plates. Plates were incubated and minimal inhibitory concentrations (MICs) were read visually. The antimicrobial effectiveness test was performed by inoculating the wipe solution with microbial suspensions at the initial concentration of 105-106 CFU/mL, as recommended by the international Pharmacopoeias. At different time intervals, samples were tested for microbial count. The MIC value of the solution ranged from 25% to 12.5% for bacteria and was 6.25% for Candida albicans. The MIC for MDR isolates was 12.5%. By assessing antimicrobial effectiveness, we found that the solution meets the criteria reported by the European Pharmacopoeia and United States Pharmacopeia for its preservative effect. This study demonstrates that the novel wipes herein tested possess antimicrobial activity against bacteria and yeast commonly found in the periocular area, and against MDR clinical isolates. The microbial death curves obtained following deliberate contamination of the wipe solution revealed potent bactericidal and fungicidal activity of the formulation.

Miltefosine Administration in Cats with Refractory Sporotrichosis

Background: Sporotrichosis is a zoonosis caused by fungi of the Sporothrix schenckii complex. Cats have important zoonotic potential due to the high parasite load found in the cutaneous lesions. Refractory cases to antifungal therapy are increasing, becoming a public health problem. Miltefosine is a drug with high in vitro activity against Sporothrix brasiliensis. However, this efficacy has not been confirmed in vivo yet and administration has not been studied in the feline species. This study aimed to evaluate the effectiveness and safety of miltefosine administration in cats with resistant sporotrichosis.Materials, Methods &amp; Results: Ten cats with refractory sporotrichosis were included in this study. Inclusion criteria were previous diagnosis for sporotrichosis associated with therapy with oral antifungals (itraconazole and/or potassium iodide) for more than one year, followed by one of these conditions: incomplete clinical remission, worsening of disease during treatment or recurrence after conventional treatment. Cats underwent clinical and dermatological examinations. Data on lifestyle and previous treatments were provided by the owners. Fungal culture and histochemical techniques were performed in all cats before miltefosine treatment. Blood samples were collected before and during the study for laboratory tests, such as blood count, blood urea nitrogen (BUN), serum creatinine, alanine aminotransferase (ALT) and alkaline phosphatase, as well as serology for Feline Immunodeficiency (FIV) and Feline Leukemia (FeLV). Miltefosine was prescribed at a dosage of 2 mg/kg orally every 24 h. The animals were monitored by phone during the whole process and reassessed on days 0, 15, 30 and 45 of the treatment. Out of 10 cats, lesions were present on the nose in nine, ears in four, periocular areas in one and limbs in four. One cat received treatment for 45 days, six for 30 days, one for 21 days, one for 15 days and one for 3 days. One cat showed no response to the treatment and nine showed disease progression. Hyporexia and weight loss were the most frequent clinical signs related to miltefosine treatment, followed by sialorrhea, vomiting and diarrhea. Few adverse effects on hematology and biochemistry (mainly renal and hepatic parameters) were observed during the study. Hematocrit decrease was observed in four animals. However, only one cat had hematocrit decrease below normal values (anemia), which was already present before miltefosine administration. Other cats had a decrease of five points. Three cats showed elevation in leucometria and four in plasma protein. In relation to renal and hepatic biochemistry, one animal showed a BUN increase and another one showed a transient increase in ALT. Two animals started the treatment with increased ALT but had no problems during the study and values decreased even during the miltefosine administration.Discussion: Although two cats showed sialorrhea, most owners did not report difficulty in administering the drug orally, representing an advantage of this medication. Weight loss, secondary to gastrointestinal changes, was the most clinically relevant alteration. The most frequent hematological alteration was hematocrit decrease and only the animal that started the study with 20% hematocrit ended the study with anemia. Renal and hepatic parameters were not significant in the cats of this study. Miltefosine did not lead to sporotrichosis remission in this small population of cats, which reveals that, despite its in vitro efficacy against Sporothrix spp., the drug is not effective in vivo in the feline species. Further studies are needed to investigate the efficacy of this drug in a larger number of cats, and possible reasons for its in vivo ineffectiveness.