Severe Acne Scars Research Articles

COMPARISON OF EFFICACY OF TOPICAL TAZAROTENE 0.1% CREAM VS ADEPALENE 0.3% AND BENZOYL PEROXIDE 2.5% IN TREATING ATROPHIC ACNE SCARS

Atrophic acne scars are a common dermatological concern that significantly impacts patients' self-esteem and quality of life. Topical treatments such as Tazarotene and combinations of Adapalene and Benzoyl Peroxide are often used to improve the appearance of these scars. However, their comparative effectiveness requires further evaluation. Objective: To evaluate the effectiveness of Tazarotene 0.1% cream versus a combination of Adapalene 0.3% and Benzoyl Peroxide 2.5% in treating atrophic acne scars. Methods: This study was conducted in the Dermatology Department of PIMS, Islamabad, from January to June 2024, following approval from the hospital’s ethical committee. A total of 140 participants with atrophic acne scars were enrolled and divided into two groups. Group A received Tazarotene 0.1% cream, while Group B was treated with a combination of Adapalene 0.3% and Benzoyl Peroxide 2.5%, both applied once daily at night. The treatment duration was 12 weeks. The severity of acne scars was assessed using the Global Atrophic Acne Scar Scale (GAASS), and the impact on quality of life was measured using the Quality-of-Life Score. Statistical analysis was performed using SPSS Version 26, with significance set at p < 0.05. Results: The mean age of participants was 40.40 ± 11.24 years. Before treatment, GAASS scores were comparable between Group A (3.70 ± 0.64) and Group B (3.80 ± 0.65, p = 0.36). After 12 weeks, Group A showed significantly greater improvement, with a mean GAASS score of 1.72 ± 0.63 compared to 2.17 ± 0.77 in Group B (p = 0.00). Patient satisfaction was also higher in Group A (7.4 ± 1.5) compared to Group B (6.8 ± 1.7, p = 0.00). The Quality-of-Life Score was slightly higher in Group A (85.3 ± 5.2) than in Group B (82.7 ± 6.1), although this difference was not statistically significant (p = 0.14). Side effects were reported in 17.1% of Group A and 27.1% of Group B (p = 0.15). Conclusion: Tazarotene 0.1% cream was more effective than the combination of Adapalene 0.3% and Benzoyl Peroxide 2.5% in treating atrophic acne scars. Despite no significant difference in quality-of-life improvements between the two treatments, tazarotene patients experienced more significant scar reduction, higher satisfaction, and fewer side effects.

Investigation of the effect of adapalene 0.3%/benzoyl peroxide 2.5% gel in Korean patients with acne: a randomized, double-blind clinical trial, with a histopathological and immunohistochemical study.

Acne vulgaris poses significant physical and psychological challenges worldwide. Data of adapalene 0.3%/benzoyl peroxide 2.5% gel (A0.3/BPO2.5) for acne treatment in Asian patients is limited. In this randomized double-blind clinical trial, 49 Korean patients with moderate-to-severe acne and scars were assigned to the A0.3/BPO2.5 (N.=37) or vehicle (N.=12) group. Acne and acne scar severity scores were assessed at baseline and 4, 8, 12, and 24 weeks. The primary outcomes were treatment success rate (reduction of ≥2 Investigator's Global Assessment grade and reaching a grade of 0 or 1) and proportional acne lesion and scar count reduction against the baseline. To assess histological changes, 2-mm punch biopsies were performed at baseline and week 24 on the respective inflammatory lesions or scars. At week 24, the A0.3/BPO2.5 group had a significantly higher treatment success rate than the vehicle group. The total acne count, inflammatory lesion count, and non-inflammatory lesion count percentages (against baselines) with A0.3/BPO2.5 and the vehicle were 12.1% vs. 96.7%, 8.0% vs. 101.2%, and 13.3% vs. 98.9%, respectively (all P<0.001). Scar count percentages (against baselines) with A0.3/BPO2.5 and the vehicle were 27.3% and 96.5%, respectively (P<0.001). Significant elevations in collagen 1 and 3, elastin, CK15, and p63 levels, with increases of 172.7%, 230.6%, 176.5%, 286.2%, and 105.9%, respectively, in comparison to baseline (all P<0.05). No major adverse events leading to discontinuation were observed. A0.3/BPO2.5 was an effective and safe treatment for acne and acne scars in Asian patients supported by robust histopathological and immunohistochemical evidence.

Prevalence of Anxiety, Depression, and Body Dysmorphic Disorders Among Dermatology Outpatients With Acne Vulgaris at a Public Hospital in Saudi Arabia.

Acne vulgaris is a chronic inflammatory skin condition that primarily affects the face, affecting a person's physical appearance. Anxiety, depression, and body dysmorphic disorder (BDD) are the three primary psychological conditions seen in dermatological patients. This study aimed to assess how prevalent anxiety, depression, and BDD in acne patients and the negative effect of acne on quality of life and self-esteem in dermatology patients. This cross-sectional study was done at the dermatology clinic in East Jeddah Hospital, Jeddah, Saudi Arabia. Data was collected using two pre-designed questionnaires. Part 1 contained demographic information and part 2 included four sets of questionnaires including the dermatology life quality index (DLQI), Rosenberg Self-Esteem Scale (RSES), Hospital Anxiety and Depression Scale (HADS), and Body Dysmorphic Disorder Questionnaire (BDDQ). Post-acne hyperpigmentation index (PAHPI), globalscale for acne scar severity (SCAR-S), and LEEDS were used by the dermatologist to assess the patients' acne severity, post-acne scars, and pigmentation conditions. Data were analyzed using the IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). The majority of the participants were females (76%), Saudi Arabians (95%), students (58%), single (82%), and attended university (66%). The mean acne duration was 5.75 ± 4.58 years and 44% of the participants used social media for more than five hours per day. The participants scored high on the RSES (27.54 ± 3.05), indicating normal self-esteem. The HADS-A score was 11.14 ± 2.74, whereas the HADS-D score was 11.46 ± 1.78, indicating anxiety and depression symptoms. Their mean SCAR-S score is 4.38 ± 2.89. DLQI scores (6.04 ± 6.05) indicate that acne had a moderate effect on patients' quality of life. The percentage of positive BDD patients is significantly higher than those with negative BDD (p = 0.022). Furthermore, a significant association between PAHPI total score and SCAR-S (r = 0.48, p ≤ 0.001) and HADS-D (r = 0.39, p = 0.005) total scores. The study focuses on how acne vulgaris affects patients' quality of life. The findings suggest that acne-related quality of life is positively associated with anxiety and depressive symptoms. This study provides clinicians with practical advice for implementing a more thorough management strategy for acne vulgaris.

Subcision with and without suction for acne scars: a split-faced, rater-blinded randomized control trial.

Therapeutic options for acne scars include subcision and suction with microdermabrasion, but these treatment modalities have not been studied in conjunction. To compare effectiveness of subcision alone versus subcision with suction for the treatment of facial acne scars. Randomized, split-faced, evaluator-blinded control trial. Participants underwent one subcision treatment on both sides of the face followed by 10 sessions of suction to one side. Photographs at baseline, 1-month, and 4-months were assessed. Primary outcome measures were the validated Acne Scar Severity Scale (ASSS) (0 = no acne scarring, 4 = severe), Acne Scar Improvement Grading Scale (ASIGS) (-100to100%), and modified Quantitative Global Scarring Grades (QGSG) (point-based questionnaire instrument), as well as subject preference. Twenty-eight treatment areas and 154 treatments were analyzed. Dermatologist raters found no differences between subcision alone and subcision-suction at 1-month or 4-months. Mean subject-assessed percent improvement for subcision-suction was higher than that for subcision alone at 1-month (37% versus 24%, p = 0.04) but not at 4-months (p = 0.37). Subjects preferred combination therapy to monotherapy at 1-month (50% vs. 21%) and 4-months (43%vs.21%). While blinded raters did not detect significant differences, subjects perceived combination treatment as working more quickly than monotherapy, and preferred combination treatment at all time points.Clinical trial registration NCT01696513 on Clinicaltrials.gov.

Risk factors for acne scarring in Ecuador.

Acne is a common disease that is associated with scarring and substantial psychosocial burden. The Global Burden of Skin Disease reported that the burden from acne as measured by disability-adjusted life years (DALYs) from 188 countries and specifically that it is greatest in Western Europe, high-income North America and Southern Latin America. This paper aimed to identify risk factors for acne scarring specific to the Ecuadorian population in order to adapt the 4-ASRAT tool accordingly. This was an observational prospective study. Participants were recruited to complete a survey that was developed based on the potential risk factors for acne scarring and had facial photographs taken. To determine risk factors and their respective weighting, a logistic regression was performed. The study included 404 participants. Results from univariate analyses indicated that being male (OR = 2.76 95%CI [1.72; 4.43]), having severe or very severe acne scarring (OR = 4.28 95%CI [1.24; 14.79]), acne duration over 1 year (OR = 1.71 95%CI [1.12; 2.60]), oily skin (OR = 2.02 95%CI [1.27; 3.22]) and the presence of acne on the neck (OR = 2.26 95%CI [1.30; 3.92]), were all significantly associated with the presence of acne scarring. Male sex (2.56 95%CI [1.58;4.17]), oily skin (1.96 95%CI [1.20;3.20]) and severe or very severe acne (3.75 95%CI [1.05;13.37]) remained significant risk factors for acne scarring in the multivariate analysis. By identifying acne scarring risk factors and applying the tool in everyday dermatology visits, we can reduce the physical and psychological burden that acne scarring causes in the adolescent and adult populations. Further research should be conducted to reassess potential risk factors and complete the adaptation of the tool for the Ecuadorian population, with a larger and more representative study population.

Shedding Light on Acne Scars: A Comprehensive Review of CO2 vs. Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser Therapy.

Acne scars pose a significant cosmetic concern and can have a profound impact on individuals' self-esteem and quality of life. Laser therapy has emerged as a promising treatment modality for improving the appearance of acne scars by promoting collagen remodeling and tissue regeneration. This comprehensive review compares two commonly used laser modalities, CO2 and erbium-doped yttrium aluminum garnet (Er:YAG), focusing on their mechanisms of action, efficacy, safety profiles, and patient outcomes. While CO2 lasers offer deeper tissue penetration and the potential for more significant improvement in severe acne scars, Er:YAG lasers provide a gentler approach with a lower risk of post-inflammatory hyperpigmentation. Recommendations for clinical practice include tailoring treatment approaches to individual patient characteristics, educating patients about treatment expectations and post-treatment care, considering combination therapies for enhanced outcomes, and implementing regular follow-up care. Areas for further research include long-term outcome studies, investigation of laser therapy in ethnically diverse populations, exploration of combination therapies, and evaluation of emerging laser technologies. This review aims to provide clinicians and patients with valuable insights to inform treatment decisions and optimize outcomes in managing acne scars.

Clinical factors influencing the effectiveness of microplasma fractional radiofrequency treatment for atrophic acne scars: Aretrospective analysis.

Microplasma fractional radiofrequency (MP FRF) technology has been increasingly used for acne scars. Nevertheless, little evidence has analyzed the factors influencing its effectiveness before and during treatment. To evaluate the clinical factors affecting the effectiveness of MP FRF therapy for atrophic acne scars. We analyzed retrospectively the clinical data of 79 acne scar patients treated with MP FRF technology. The outcome of interest included the effectiveness and adverse events after MP FRF treatment. Multivariable logistic regression was utilized to evaluate clinical factors associated with effectiveness after the initial session. All patients received 115 sessions of MP FRF therapy (average: 1.5 sessions). Twenty-eight (35.4%) patients improved moderately to excellently after one session. We found that the severe grade before treatment was negatively correlated with the effectiveness according to Goodman-Baron qualitative scores (OR = 0.02, 95% CI [0.001, 0.37], p = 0.009). The presence of icepick scars was also a negative correlation factor for the effectiveness (OR = 0.06, 95% CI [0.004, 1.00], p = 0.049). Furthermore, after excluding the effects of icepick scars and Goodman-Baron scores before treatment, ECCA scores were also correlated with effectiveness (OR = 1.04, 95% CI [1.01, 1.06], p = 0.009). MP FRF therapy was effective in treating atrophic acne scars with no permanent adverse events. The severity of Goodman-Baron qualitative scores and icepick scars were independent clinical factors affecting effectiveness, suggesting the possible requirement for additional treatments other than MP FRF for severe acne scars and icepick scars.

Psychosocial impact of acne scarring: correlational study at Euderma Clinic Bali

Purpose: Acne scars are abnormalities in the contour and color of the skin that occur due to acne vulgaris, caused by increased tissue formation or local tissue damage and loss, which often causes disability, especially on the face. Acne scars often cause aesthetic, psychological, social, and emotional problems. This is a challenge for doctors to carry out comprehensive treatment strategies including primary, secondary, and tertiary prevention efforts. This research aims to determine the correlation between psychosocial impact and acne scars at the Euderma Clinic.&#x0D; Methods: The research method used was descriptive cross-sectional. The sampling technique used consecutive sampling, namely collecting participants who underwent acne scar management at the Euderma Clinic in the period May-July 2023. In this study, data collection was carried out using a questionnaire that included patient characteristics, acne history, and description of acne scars. The data was analyzed descriptively and correlatively for further data interpretation. &#x0D; Results: Descriptive test results on 121 samples, mostly female (77.7%), mature (72.7%), had a history of untreated acne for &gt; 12 months, (46.3%), and had a habit of squeezing. acne (53.7%), and the severity of acne pustules &gt; 20 (51.9%). The appearance of acne scars is mostly mild (40.5%) and moderate (39.7%). The correlation test results show a close relationship between acne scars and psychosocial impacts. &#x0D; Conclusion: The severity of acne scars in adults is mostly at the mild to moderate stage. Prevention efforts that can be taken are to carry out appropriate acne treatment so that inflammation does not prolong. Management of mild moderate acne scars can be done with laser procedures and subcision to increase patient confidence.

Factors influencing the severity of acne scars

Factors influencing the severity of acne scars

Ablative Fractional CO2 Laser with or without Low Dose Isotretinoin in Treatment of Acne Scars: A Comparative Study

Abstract Background Acne scarring is one of the most common sequelae of acne vulgaris. The severity of acne scars correlates with acne duration, severity and delay in treatment of acne as well as positive family history. Patients who have acne scars frequently seek treatment options to improve appearance and quality of life. Aim of the Study The aim of this study was to assess the safety of combining low-dose isotretinoin with ablative fractional CO2 laser in patients with acne scars. Patients and Methods This study included 40 patients with different types of acne scars. There were 27 females and 13 males. The patients have divided into two groups; Group A received low-dose isotretinoin with full face AF Co2 laser session, while Group B was treated with full face AF Co2 laser session. The age of patients ranged from 18 to 45 years old, with the mean age was 27.2± 6.9 yrs in group A and was 27.5± 6.06 yrs in group B. Results Duration of wound healing, PIH and pain were parallel in both groups with no significant difference between them. No other complications were reported as keloid formation, secondary infection, edema, milia or acneform eruption in study groups. Satisfactory results were reported in most of the patients. Conclusion Our study concluded that using low-dose isotretinoin with AF Co2 laser session safe procedure with normal wound healing and no keloid or hypertrophic scars formation.

Study on Acne Scarring and Its Relationship between Severity and Treatment of Active Acne: An Observational Study

Background: Incorrectly selected treatment or the presence of severe acne vulgaris can lead to the formation of atrophic scars. Objective: The purpose of the present study was to evaluate the acne scarring and its relationship between severity and treatment of active acne. Methodology: This was cross-sectional observation study was performed in the EW VM Health Bangladesh Ltd., Dhaka for a period of 6 months. Evaluation of the types, sites, and severity of acne scars was done, and details of the severity and treatment of acne were recorded. Patients of all age-groups presenting for treatment of acne scars were included in the study. Results: This study shows maximum (40%) were age group 31-40 years. Face was involved in all the patients with acne vulgaris, which included the cheeks (91%), forehead (43%), jaw (51%), chin (27.0%), and nose (16.0%). The most common type of lesion predominantly observed was comedones (54.0%) followed by papules (53.0%), pustules (43.0%), nodules (29.0%), and cysts (3.0%). It was observed that 21.0% were mild acne, 27.0% were moderate acne and 52.0% severe acne. In grading system of acne scaring, 19.0% were macular acne scar, 14.0% were mild acne scar, 28.0% were moderate acne scar and 39.0% were severe acne scar. Conclusion: This study found majority of patients with active acne delay treatment, which leads to increased acne scarring. Journal of Current and Advance Medical Research, July 2022;9(2):69-73

Clinical evaluation of needle-free electronic pneumatic hyaluronic acid injection treatment for facial atrophic acne scars: A prospective, randomized comparative trial.

Acne scars are common but difficult to treat, and an effective new treatment strategy is desired. This prospective, split-face randomized controlled trial was designed to compare the safety and efficacy of needle-free electronic pneumatic hyaluronic acid injection (EPI-HA) treatment for acne scars. Thirty Japanese subjects with moderate to severe facial atrophic acne scars underwent EPI-HA treatment on a randomized side of their face. Three treatment sessions were carried out at 1-month intervals, and the subjects were followed-up for 3 months after the final treatment. Three months after the final treatment, 48.3% of treated sides met the criteria for success, compared with 0% for the control sides (P < 0.0001). Rolling type scars were much improved compared with boxcar types and icepick types. Satisfaction (or better) was reported by 55.2% of subjects at the 3-month follow-up after the final treatment, which was similar to the physicians' assessment. Three-dimensional in vivo imaging analysis detected significant difference in scar reductions between the treated and control sides in the mean scar area, scar depth, and maximum depth of the biggest scar at 1 and 3 months after the final treatment (all P < 0.05). In conclusion, EPI-HA treatment significantly improved rolling facial atrophic acne scars in our Japanese subjects, with minimal side effects.

Sequential Treatment With Topical Trifarotene and Injectable NASHA Gel in Acne Scars: A Case Series.

Topical retinoids are a mainstay in acne management and have been shown to improve skin texture. Injectable non-animal stabilized hyaluronic acid (NASHATM) gel as skin booster is largely used in aesthetic treatments to improve skin quality including the appearance of atrophic acne scars. To evaluate a new sequential treatment with topical trifarotene and injectable skin booster NASHA gel in acne scars. 10 patients between 19 and 25 years (3 males and 7 females) with previous moderate to severe acne vulgaris on the face with the outcome of atrophic and post-inflammatory slightly hyperpigmented scars were prescribed home short contact therapy (SCT) with topical trifarotene 50 &mu;g/g at the evening for 3 months. A proper skincare routine for sensitive skin was also recommended. The 3-month retinoid therapy was followed by an injectable medical procedure with NASHA gel 20 mg/ml as skin booster. A minimum of 3 sessions to 10 sessions were carried out according to the severity of acne scars and the skin response observed. Adherence to the treatment was complete and the results evaluated by digital photography showed very effective results with high clinical improvement or almost complete resolution of atrophic acne scars. The results observed in this case series show that the sequential treatment with topical trifarotene and injectable NASHA gel as skin booster can be effective in the progressive reduction of acne scarring, potentially related to a synergic effect of skin remodeling and collagen stimulation. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7630.

A Split Face Comparative Interventional Study to Evaluate the Efficacy of Fractional Carbon Dioxide Laser against Combined use of Fractional Carbon Dioxide Laser and Platelet-Rich Plasma in the Treatment of Acne Scars.

Fractional carbon dioxide laser (FCL) is an established treatment option for acne scars, but use of platelet-rich plasma (PRP) as an adjuvant still requires elaborate studies. To compare the efficacy and safety of FCL alone and combined use of FCL with PRP in the treatment of acne scars. This was a split-face (right-left) comparative study including 32 patients with moderate to severe acne scars. The patients underwent three sessions of FCL along with PRP and FCL alone on right and left sides of the face, respectively, at an interval of 6 weeks. Goodman and Baron qualitative and quantitative scores were used for the evaluation of results along with visual analog scale (VAS) for patient satisfaction and physician assessment of scars. Adverse effects following the procedure were also evaluated and compared. There was significant improvement of scars over both sides of the face, but the difference between right and left sides was not statistically significant according to Goodman and Baron qualitative (p 0.9115) and quantitative score (p 0.6957). On assessing VAS score, patients were more satisfied with the right side, but the values were not statistically significant (p 0.8571). Physician assessment grading showed comparable results over both the sides (p 1). There was no difference in adverse effects between both sides of the face. Inclusion of intradermal PRP to FCL did not produce any statistically significant synergistic effects in the treatment of acne scars.

Fractional CO2 Laser resurfacing treatment of acne scar comparing high and low energy levels

Background : Fractional CO2 laser resurfacing in the treatment of acne scars, attempts to reduce the adverse effect of laser resurfacing by creating microscopic injury zones to the dermis with skipped interval areas. Aim of the study : The purpose of this study is to compare the safety and efficacy of high pulse energy (70 mJ) and low pulse energy (45 mJ) of fractional CO2 laser resurfacing in the treatment of facial acne scars. Patients and Methods : Twenty patients with moderate to severe atrophic acne scars were treated with three sessions of fractional CO2 laser resurfacing at four-week intervals with high and low energy levels applied to each side of the face separately. The severity of acne scars at baseline and after treatment was assessed using Goodman and Baron’s qualitative scar grading system. Patient satisfaction score was obtained using a quartile grading scale. Results : The severity of acne scars on both sides was comparable to each other before the treatment (p = 0.643). At the final assessment, both sides with high and low energy levels demonstrated an excellent response (p = 0.000). However, the difference between the mean final scores of both sides was not significant (p = 0.731). The most frequently reported side effects were crustation and erythema. Crustation lasted longer on the right side (mean = 6.75 days) whereas for the left side (mean = 5.45 days). Erythema was transient and only in four cases persisted beyond a week (right side mean = 10.5 days while left side mean = 8.75 days) Conclusions : Both high energy (70 mJ/pulse) and low energy (45 mJ/pulse) CO2 fractional laser resurfacing of acne scar results in satisfactory outcomes with no statistically significant differences. While the duration of side effects (crustation and erythema) was increased slightly with higher fluence.

Ablative fractional carbon dioxide laser combined with autologous platelet-rich plasma in the treatment of atrophic acne scars: A systematic review and meta-analysis.

Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80%-90% of all acne scars. Ablative fractional carbon dioxide (FCO2 ) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars. Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review sought to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD). Eleven RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR=2.56, 95% CI 1.37-4.78 and OR=3.38, 95% CI 1.80-6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD=-0.40, 95% CI -0.65 to -0.14). The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars.

A prospective study on the efficacy and safety of fractional carbon dioxide laser in the treatment of post-acne scars

Introduction Acne scars can play havoc with the social functioning of the patient leading to severe depression with reduced quality of life. Fractional CO2 laser provides a fine balance between the undesirable side effects of ablative lasers and the limited efficacy of nonablative lasers. Objective The present study was conducted to evaluate the efficacy and safety of fractional CO2 laser in the treatment of acne scars. Patients and methods Fractional CO2 laser treatment performed on 30 patients with atrophic acne scar by different protocols depending on the type and its depth. Results were assessed based on serial photographs, clinical improvement, and physician’s global assessment scale. Results Of the 30 participants, 27 completed all three sessions. Out of the 27 patients in the final follow-up, three (10%) had excellent improvement of which two had mild acne scar and one had moderate scar before treatment; 16 (59.2%) had good response of which 13 had moderate acne scar and three had mild scar and eight (29.7%) had fair response of which six had moderate scars and two had mild scars. Conclusion Fractional CO2 laser as monotherapy in the treatment of mild-to-moderate post-acne scars seems to be effective with good patient satisfaction and reduced side effect profile. In case of severe acne scars, fractional CO2 laser can be used as a combined procedure along with other therapeutic modalities like subcision, platelet-rich plasma, and TCA CROSS (chemical reconstruction of skin scars using trichloroacetic acid) techniques.

Triple steps acne scar revision technique: A new combination therapeutic modality for atrophic acne scars.

Atrophic acne scarring is an unfortunate, permanent complication of acne vulgaris, associated with significant psychological distress. A new complementary treatment of atrophic acne scars using subcision and injection of hybrid cooperative complexes of high and low molecular weight hyaluronan (hybrid H-HA/L-HA). This study included eighty-two patients divided into two groups with predominantly atrophic acne scarring. Group 1 received subcision with saline injection, while group 2 received triple steps acne scar revision technique (TSASRT). After topical anesthesia, the procedure of combining subcision and hybrid H-HA/L-HA technique was done in which the first step started using subcision technique done to release fibrous cordsat the dermal or deep dermal, subcutaneous plane using Nokor needles-18g. The second step is to inject the scar's atrophic dermal component with a 29g needle, applying an average amount of hybrid H-HA/L-HA (0.02-0.1mL) to the dermal component. The third step was to fill the subcisied space with hybrid H-HA/L-HA (0.02-0.1mL) using a 25g cannula. Clinical improvement was achieved in both groups. There were statistically significant improvements in the TSASRT versus subcision (p≤0.05) in acne scar severity index and qualitative scarring grading system. The triple step acne scar revision technique appears to be a safe and effective way to treat atrophic acne scars on the face.

Evaluation of serum hepcidin level in acne vulgaris patients

Background: Acne vulgaris is a pilosebaceous unit inflammatory condition. Although acne is not life-threatening, it can cause psychological issues such as low self-esteem and anxiety in people who suffer from it. Acne scarring is a common and unpleasant consequence of acne vulgaris. Predicting scarring liability can modify treatment protocol and aid in the prevention of such disfigurement. Methods: This study included 82 participants divided into 3 groups: 26 patients with acne vulgaris without scars, 36 patients with acne vulgaris with scars and 20 control. Serum hepcidin level was assessed by a commercially available double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) kit. Results: Serum hepcidin is significantly higher in patients suffering from acne without acne scars than patients suffering from acne with acne scars (p &lt; 0.05). serum hepcidin is significantly higher in the control group than patients with active acne with scars (p &lt; 0.05). There was a statistically significant difference between serum hepcidin level in control versus severe acne scars (p &lt; 0.05). Serum hepcidin level acts as a predictor of occurrence of acne scars and occurrence of severe acne scars. Serum hepcidin level can be used as an indication for beginning aggressive and specific acne treatment as systemic retinoid.

Single session of combined microfat and subcision in the treatment of Grade 4 atrophic acne scars.

Severe atrophic acne scars (AAS) remain the "Achilles's heel" of AAS treatment. The combination of microfat and subcision treatment is a potential solution for severe AAS. This study aimed to evaluate the efficacy and safety of combined microfat and subcision treatment for severe (Grade 4) AAS. Data of patients with Grade 4 AAS who underwent combined microfat and subcision treatment between September 2016 and December 2020 were reviewed. Post-treatment evaluation was performed at least 3months postoperatively. The severity of AAS was graded based on Goodman's qualitative classification. The volume of concavities was measured using an Antera 3D camera. Complications were documented. A total of 42 patients received a single treatment session. Excellent response was observed in 5 (11.9%) patients, very good in 13 (31.0%), good in 22 (52.4%), and poor response in 2 (4.7%). The average reduction of the total volume of concavities was 28.0%. The most common minor side effects were mild swelling and bruising. No major complications were observed. Combined microfat and subcision treatment is a safe and effective treatment for severe AAS. The approach will be a significant treatment for severe AAS.