Atrophic Post-acne Scars Research Articles

Treatment of Atrophic Post-Acne Scars

Treatment of Atrophic Post-Acne Scars

Microneedling With Topical Insulin Versus Microneedling With Placebo in the Treatment of Postacne Atrophic Scars: A Randomized Control Trial.

Among the treatment modalities for post-acne scars, microneedling is considered a safe and effective method. To compare the efficacy and safety of combined microneedling with topical insulin versus microneedling with placebo (topical saline) in treating atrophic acne scars. Twenty-one patients with atrophic post-acne scars were randomized and treated in a split face manner with 4 sessions at 3-week intervals of microneedling using dermapen, followed by application of insulin on one side of the face and saline (placebo) on the other side. Evaluation of response was done before the sessions and after 1 month of the last session using the Global Scarring Grading System of Goodman & Baron and Lipper & Perez scores, Patient reported acne scar improvement using a 4-point scale, patient satisfaction, and the facial acne scar quality of life tools. Both therapeutic modalities yielded a statistically significant improvement of atrophic acne scars. By comparing both modalities, there was no statistical significance regarding clinical improvement and side effects. Using topical insulin combined with microneedling may have a value in improving atrophic acne scars, suggesting further evaluation using different delivery systems, insulin formulations, and assessment modalities.

The effectiveness of microneedling in the treatment of Atrophic post-acne scars:A systematic Review

The effectiveness of microneedling in the treatment of Atrophic post-acne scars:A systematic Review

Microneedling with Topical Insulin Versus Microneedling with Non-Cross-Linked Hyaluronic Acid for Atrophic Post-Acne Scars: A Split-Face Study.

Post-acne scars are a prevalent cosmetic complaint that usually require multi-modality treatment to achieve accepted results. The target of this research was to evaluate and compare the efficacy and safety of microneedling with topical insulin versus microneedling with non-cross-linked hyaluronic acid in atrophic post-acne scar treatment. The current comparative split-face research included 30 patients with atrophic facial acne scars. Each patient received six sessions of microneedling with topical insulin on one side of the face and microneedling with non-cross-linked hyaluronic acid on the other side. Sessions were done three weeks apart, and digital photographs were taken before and three months after the last treatment session. Goodman and Baron qualitative and quantitative grading system was used to evaluate the improvement across both sides of the face, along with patient satisfaction. Three months after the last session, a statistically significant improvement in qualitative acne scar grading on both sides of the face (P < 0.001) was reported, with non-significant difference between the two sides (P = 0.864). Moreover, the mean percentage of improvement in quantitative acne scar grading was 49.18 ± 13.22 on the insulin side and 47.72 ± 15.08 on the hyaluronic acid side, with non-significant difference between the two sides after treatment (P = 0.235). Both microneedling with topical insulin and with non-cross-linked hyaluronic acid achieved comparable significant improvement of atrophic post-acne scars.

Simultaneous versus sequential fractional CO2 laser and subcision combination for management of post-acne atrophic scars: A split-face comparative study.

A combination of fractional CO2 laser and subcision is usually employed for the treatment of post-acne atrophic scars. However, the efficacy and safety of both simultaneous and sequential combination therapies should be explored. To compare the efficacy and safety of simultaneous and sequential fractional CO2 laser and subcision combination therapies for post-acne atrophic scars. This single-blind, split-face clinical trial included 34 patients with post-acne atrophic scars at our institution. Each patient underwent three sessions of subcision combined with fractional CO2 laser, with a 1-month interval between each session. The left side of the face was treated with simultaneous combination therapy, whereas the right side was treated with sequential combination therapy. Treatment efficacy was assessed at 4, 8, and 12 weeks; and 3 and 6 months after the last session. Simultaneous and sequential treatments demonstrated comparable efficacy. Regarding the adverse events, the side of the face undergoing simultaneous treatment experienced longer swelling duration, higher pain levels during laser treatment, and shorter downtime. Despite the longer swelling time and higher pain levels during laser treatment in the simultaneous treatment side, the effectiveness and satisfaction level of the CO2 fractional laser and subcision for treatment of the acne scars were comparable between the two combinations, with a shorter downtime for the simultaneous than for the sequential combination therapy.

Efficacy of autologous platelet rich plasma with subcision vs platelet rich plasma with microneedling in atrophic acne scars: A single-center, prospective, intra-individual split-face comparative study.

Severe post-acne scarring has been implicated as a cause of considerable psychological distress, mainly among adolescents. Subcision and microneedling are cutting-edge treatment options available nowadays. In this study, we aimed to compare the efficacy of microneedling with platelet-rich plasma (PRP) against subcision with PRP in treating atrophic post-acne scars in a split-face study design. Fifty patients with atrophic post-acne facial scars were included in this prospective interventional study. Group A included the left side of the face managed by microneedling with PRP and group B included the right side of the face that was subjected to subcision with PRP. Results were assessed based on Goodman and Baron qualitative and quantitative grading. In our study, at the end of the treatment, on the left side, 5 (10%) had 1 grade of improvement showing good response, 35 (70%) had 2 grades of improvement showing very good response, and 10 (20%) had 3 grades of improvement showing excellent response. On the right side, 1 (2%) patient had no improvement in acne grade showing poor response, 9 (18%) had 1 grade of improvement showing good response, 25 (50%) had 2 grades of improvement showing very good response, whereas 15 (30%) had 3 grades of improvement showing excellent response. Till date, apart from ours no other study has compared the two modalities head-to-head with adjuvant PRP in both groups. Although both modalities showed statistically significant results individually, there was no significant difference in qualitative improvement of acne scars between the two groups.

Atrophic Postacne Scar Treatment: Narrative Review.

Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well-being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aimed to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefit compared to the implementation of a single method.

Fractional CO2 laser as monotherapy or combined with platelet-rich plasma in the treatment of atrophic postacne scars: A narrative review

Abstract Acne scars are the unfortunate outcome of acne vulgaris. It is a common problem that faces many young adults and can cause severe distress and impair their quality of life. Different therapeutic modalities have been tried for atrophic acne scars; however, no standard treatment has been identified yet. In this review, we are focusing on fractional CO2 laser (FCL), whether used as monotherapy or combined with platelet-rich plasma (PRP), trying to highlight the efficacy and safety of such modalities in the treatment of atrophic acne scarring. PubMed, Embase, and Cochrane Library databases were used to search for relevant studies that were published in the period from January 2017 to December 2022. We used a combination of the following keywords: “acne scar,” “acne scars,” “modalities for acne scars” in addition to the names of additional therapies studied in this review, such as “laser and acne scars,” “plateletrich plasma,” “platelet-rich plasma,” “PRP,” and “platelet-rich plasma therapy and acne scars”. Twelve studies were found utilizing the use of FCL whether used as monotherapy or combined with PRP in the treatment of atrophic acne scarring. Most of the studies showed that acne scars improved with both treatment modalities, but the combination approach yielded better results with less incidence of side effects.

Evaluation of microneedling depth of penetration in management of atrophic acne scars: a split-face comparative study.

Microneedling is a technique of repeated puncturing or drilling of the skin to induce repair and collagen induction. There are many reported important factors determining the efficacy of microneedling treatment. The extent of injury needed to produce the desired effect in each condition is one of these important factors. We designed the present split-face comparative study to evaluate the use and effectiveness of two different depths of penetration of Dermapen needles in the management of atrophic postacne scars. The present study involved 14 subjects with atrophic postacne scars. In each patient, both sides of the face were treated with six sessions of microneedling, using Dermapen at 2-week intervals. A split-face study design was performed. The right (Rt) side of the face was treated with Dermapen using 2.5 mm needle length, while the left (Lt) side was treated using 1.5 mm needle length. There was a significantly better percentage of improvement of acne scars on the Rt side of the face compared to the Lt side (P = 0.02) after six sessions. Both sides of the face showed improvement of collagen bundles and elastic fibers characteristics after six sessions. The use of 2.5 mm depth proved to be more effective both clinically and histologically in the management of atrophic postacne scars.

Fractional CO2 Laser with Platelet-Rich Plasma Versus Fractional CO2 Laser with Topical Insulin in The Treatment of Postacne Atrophic Scars

Background: Postacne atrophic scars (PAS) are a common acne consequence. When paired with a fractional CO2 laser, topical insulin and PRP may both help. Objective: To compare the effectiveness of a fractional CO2 laser plus PRP versus a fractional CO2 laser with TI in the management of PAS. Methods: This research was conducted on 20 patients suffering from PA atrophic scars. Enrolled patients received four sessions of FCL plus topical PRP in addition to FCL+ topical insulin on left as well as right sides of the face, respectively, at monthly intervals. One month following the fourth session, the last assessment was completed. Side effects were recorded. Patients were encouraged to use photoprotective precautions. Results: There was a statistically significant difference of acne scar grade post treatment between right and left side. Higher improvement is detected among right side treatment than left side. There was a statistically considerable difference between studied groups regarding improvement degree between both sides. For right side 10% excellent improvement, 65% good and 25% fair improvement versus 75% fair improvement and 25% good improvement for left side (P=0.001*). Conclusions: In PAS of skin-of-color populations, TI and PRP coupled with Fractional CO2 laser may both provide improvement with an excellent safety profile. However, the ease of access, low cost, and noninvasive characteristics of TI make it preferable to PRP. The degree of improvement was statistically considerably greater with TI than with PRP (P=0.001*).

Efficacy of transdermal microneedling redermalization with high-molecular-weight hyaluronic acid and sodium succinate in the correction of postacne scars

BACKGROUND: Acne is a chronic inflammatory skin disease of multifactorial nature that affects more than 80% of adolescents and is one of the top 10 most common diseases in the world. Currently, dermatologists have various techniques for the correction of postacne scars: from minimally invasive hydroxy acid peels to surgical excision of scar tissue. One of the most effective, affordable, and at the same time minimally invasive and safe treatment methods is microneedling ― micro-damage of the skin with thin needles in the lesion area, stimulating the production of collagen and elastin.&#x0D; AIM: to study the efficacy and safety of transdermal redermalization with microneedling using high-molecular-weight hyaluronic acid and sodium succinate in patients with atrophic postacne scars of varying severity.&#x0D; MATERIALS AND METHODS: A prospective study was carried out at the Clinic of Skin and Venereal Diseases of the Sechenov University. A. Rakhmanov, Sechenov University, with the participation of 80 patients with postacne scars of varying severity. The Hyalual Perfoskin Complex device was used for microneedling in combination with a sodium succinate preparation based on hyaluronic acid. The apparatus was used in a linear technique along the Langer tension lines and in mutually perpendicular direction, 1015 passes in each area (lower jaw, cheek-curve area, forehead area). Each subject underwent 4 treatments at 21-day intervals. Clinical assessment of the treatment dynamics before and after treatment was performed using the Miravex 3D multispectral imaging device. Before and after treatment, patients were evaluated for the severity of postacne scars according to the International Qualitative Scale for the classification of postacne scars, as well as a dermatological index of quality of life. Subjective evaluation of the effectiveness of therapy by the physician and the patient was performed using the International Global Aesthetic Improvement Scale one month after each treatment and 3 months after the last treatment.&#x0D; RESULTS: Among the 80 patients, 47 women and 33 men aged 18 to 46 years had atrophic postacne scars of varying severity: I in 9, II in 26, III in 40, and IV in 5 patients; the rashes were most often localized to the cheek-cusp (55; 69%) and forehead (15; 19%) and were represented by U-shaped (35; 44%), V-shaped (17; 21%), M-shaped (19; 24%) and macular (9; 11%) patterns. The duration of the disease averaged 5.33.2 years. Improvement of the clinical picture was observed in 92.5% of cases after treatment. For example, 8 patients with I degree of scarring managed to achieve complete clearing of the skin; out of 26 patients with II degree of scarring, 15 patients achieved I degree of severity and 10 patients experienced clinical remission at the end of treatment; in the group of patients with III degree of scarring (n=40), 18 patients had I degree of severity, 20 patients had II degree of severity; in the group of patients with IV degree of severity after 4 treatments, 2 patients had III degree of severity and 1 patient had II degree of severity. The dermatological quality of life index decreased by 77% on the average: from 18.632.28 to 4.253.16. The final result was considered "optimal aesthetic result" by doctors and patients in 86% and 82% of cases, respectively, "significant improvement" in 4% and 12% of cases, respectively, "improvement" in 2.5% and 4% of cases, respectively, and "no change" in 7.5% and 2%, respectively. All patients noted good tolerability of treatment. Thus, side effects in the form of skin redness and painful sensations were insignificant and passed on their own within 23 days after the procedure.&#x0D; CONCLUSION: Microneedling with high-molecular-weight hyaluronic acid and sodium succinate has demonstrated high efficacy and safety in the treatment of postacne scars of varying severity. The minimal invasiveness and affordability of the procedure result in high patient adherence to therapy.

Comparative Study of Polydioxanone Monofilament (PDO) Threads Combined with Scar Subcision versus Fractional CO2 Laser Combined with Scar Subcision in Management of Atrophic Post Acne Scars

Abstract Background Acne is an inflammatory disorder of the pilosebaceous unit characterized by comedones, inflammatory papules, pustules, and nodules of the face, chest, and back. The inflammatory response in some acne patients results in permanent, disfiguring scars from either increased tissue formation or due to loss or damage of tissue. Many treatments have been attempted in order to improve acne scarring such as: chemical peels, surgical excision, subcision, punch grafting, dermabrasion, fillers and laser have been used to ameliorate atrophic acne scars with varying degrees of success Objectives The aim of this work was to study the efficacy of polydioxanone (PDO) monofilament threads combined with scar subcision versus fractional Co2 laser combined with scar subcision in management of atrophic acne scars. Patients and Methods This is a split-face pilot study included 10 patients with atrophic acne scars. The patients recruited from the Outpatient Dermatology Clinic at Ain Shams University Hospitals. Fractional CO2 laser sessions were done for the right side of the face (2 sessions - one month apart), and Polydioxanone (PDO) threads were inserted to the left side of the face (2 sessions - one month apart), each treatment modality was preceded by scar subcision. The patients were followed up for 3 months. The response of treatment was evaluated by Antera 3D camera. Results Our study revealed that treatment of the right side of the face with fractional CO2 Laser led to statistically significant improvement more than what was achieved by PDO threads on the left side. It was also found that both PDO monofilament threads and Fractional Co2 laser improved the skin texture. Conclusion .The current study confirmed the superiority of fractional CO2 laser for the management of atrophic post acne scars. Polydioxanone threads had an effect in improving the skin texture but their overall effect is not comparable to the effect of fractional CO2 laser. To the best of our knowledge, we were the first to compare between Fractional Co2 laser and poydioxanone threads regarding there efficacy in management of atrophic acne scars and to evaluate the response using Antera 3D camera.

Comparative study between therapeutic effects of microneedling versus CO2 laser in acne scars

Objectives: To study the clinical aspect of acne scars while grading them on the basis of severity as well as to study and compare the therapeutic effects of CO2 laser and microneedling in their management. Methods: This study used prospective comparison as its method of study. Over the course of two years, from June 2021 to June 2023, 100 patients above 18 years of age having post-acne atrophic scars will be enrolled. Patients will be split into two groups and each group will be selected for fractional CO2 laser (non-ablative) and microneedling respectively. Four treatments will be administered to each group of patients with a four-week gap between each session. All clinical findings will be recorded for data analysis and comparision. “Goodman and Baron’s Qualitative and Quantitative grading system for scars” will be used after each session in order to compare the therapeutic effects for each group. Results: At the end of each session, acne scar grading will be done in each group and data will be compiled to assess and compare the therapeutic effects between CO2 laser and microneedling. Conclusions: The findings of the protocol research will be used to form the conclusions. Trial Registration: Submitted for registration to Clinical Trial Registry of India (CTRI).

Topical timolol maleate 0.5% after fractional carbon dioxide laser versus fractional carbon dioxide laser alone in treatment of acne scars: split face comparative study

Acne is a common inflammatory condition that mostly involves the face, chest and back. A number of different modalities had been employed for treating scars of which laser remains to be a pivotal choice. We aimed to compare the efficacy of topical timolol maleate 0.5% after fractional CO2 (AFCO2) laser versus fractional CO2 Laser alone for treatment of atrophic acne scars. A split-face comparative clinical experiment on 30 cases of atrophic post-acne scars that were treated on one side with ablative fractional CO2 laser followed by timolol application while with only ablative fractional CO2 laser on the other side. Following treatment, both sides demonstrated significant improvement with the laser + timolol treated side showing better improvement; yet not significantly higher than the laser only treated side. In conclusion, both topical timolol maleate 0.5% after fractional CO2 laser and fractional CO2 laser may achieve comparable significant improvement. The good safety profile, easy accessibility, low cost, and non-invasive nature merits the use of timolol in acne scars pending verification by larger sample reproduced and controlled trials.

Effectiveness of combined methods of treatment of atrophic scars of skin

Atrophic post-acne scars are severe manifestations of the post-acne symptom complex, which occur as a result of inflammation due to the loss of collagen fibers and subcutaneous fat during the healing of inflammatory acne elements. The incidence of post-acne scars has been little studied, but according to some authors, about 90 % of patients with severe and moderate acne suffer from them. The aim of the study was to study the effect of the combined use of IPL- and PRP-therapy, fractional microneedle radiofrequency therapy and PRP-therapy, as well as microneedling of autologous plasma with cells on the clinical symptoms of atrophic skin scars, taking into account the duration of the pathological process, based on the dynamics of the indicators of the Manchester Assessment Scale of Scar Deformations. Complex methods showed higher efficiency than the use of hardware techniques in relation to all clinical signs of atrophic scars.

Use of Microneedling with Platelet Rich Plasma for Management of Atrophic Post-Acne Scars: Review Article

Use of Microneedling with Platelet Rich Plasma for Management of Atrophic Post-Acne Scars: Review Article

Combined Micro-Needling with Lyophilized Platelet-Rich Plasma versus Micro-Needling Monotherapy in The Treatment of Atrophic Post-Acne Scars: Split-Face Study

Combined Micro-Needling with Lyophilized Platelet-Rich Plasma versus Micro-Needling Monotherapy in The Treatment of Atrophic Post-Acne Scars: Split-Face Study

A combined subcision approach with either fractional CO2 laser (10,600 nm) or cross-linked hyaluronic acid versus subcision alone in atrophic post-acne scar treatment

Different treatment options for post-acne scars exist, but with varying clinical efficacy, side effects, and prolonged downtime. This study aims to compare the efficacy and safety of combined subcision with either fractional CO2 laser or cross-linked hyaluronic acid filler (HA) versus subcision alone in the treatment of facial atrophic post-acne scars. Forty patients with atrophic post-acne scars were subjected to subcision on both sides of the face, then were randomly divided into three groups. Group I (20 patients): subcision combined with cross-linked HA filler injection at one side of the face; group II (20 patients): subcision followed by fractional CO2 at the other side of the face; and group III (20 patients): with subcision only as a control group. Treatment sessions were every month until clinical improvement or for maximum three sessions. The treatment’s efficacy was assessed by Goodman and Baron’s qualitative and quantitative grading systems. The two blinded investigator scores showed significant improvement in both the filler side versus subcision (p value = 0.015), and the fractional laser side versus subcision (p value < 0.001), with no statistically significant difference between both sides (p value = 0.171). Qualitative grading by Goodman and Baron scores showed that the percentage of patients with excellent improvement was higher in group 1 and group 2 than in group 3 with p value = 0.031; also the mean percentage of reduction in quantitative grading was higher in group 1 and group 2 than in group 3 with p value < 0.00. Either combined subcision with fractional CO2 laser or with cross-linked HA filler achieved superior improvement in facial atrophic post acne scars treatment with no serious side effects in this study. However, subcision only by blunt canula also had modest improvement.

Correction of atrophic post-acne scars with ablative erbium laser, taking into account the predominant type of scar

Background. The choice of an effective method of laser correction of atrophic post-acne scars, suitable for a particular type of scar, remains a difficult task, despite the variety of interventions.&#x0D; Aim. To study the effectiveness of a combination of planar and fractional laser ablation in patients with atrophic post-acne scars, taking into account the predominant type of scar.&#x0D; Material and methods. An open clinical intervention study included 60 patients with IIIV scar severity grade, 36 females and 24 males, with a mean age of 28.874.81 years. The predominance of V-shaped scars was observed in 11 (18.3%) patients, U-shaped in 29 (48.3%), M-shaped in 12 (20.0%), macular in 8 (13.3%) patients. An erbium laser with a wavelength of 2940 nm was used to resurface the edge of the scars, followed by fractional ablation of the affected area. The change in the severity and quantitative index of the severity of post-acne scars after treatment, as well as the results on the international scale of aesthetic improvement, were evaluated. The safety of the method was assessed during a clinical examination on the 7th day after each procedure and 3 months after the last one, any adverse events and complications were recorded. The significance of differences was calculated using the Wilcoxon, MannWhitney, KruskalWallis and the 2 tests. Differences were considered statistically significant at p 0.05.&#x0D; Results. Reduction of scar severity was registered, the quantitative index after treatment decreased from 11.43.25 to 6.23.1 points (p=0.000, Wilcoxon criterion). Regression of quantitative indices was established in patients with U-shaped and macular scars compared with patients with a predominance of M- and V-shaped scars (p 0.05, MannWhitney test). The average effectiveness of treatment on a scale of aesthetic improvement was 2.420.72 points, in 33 (55.0%) people the result corresponded to a significant improvement, in 19 (31.7%) moderately pronounced improvement, a noticeable improvement in appearance compared to baseline was noted in 8 (13.3%) patients (2=23.55, p 0.000). Complications of procedures were not registered.&#x0D; Conclusion. Correction of atrophic scars with an erbium laser, which combines planar and fractional ablation, is effective and safe for various types of atrophic scars; the optimal result is achieved in patients with U-shaped and macular scars.

Microneedling opportunities in acne and postacne treatment

Postacne is one of the leading problems in aesthetic medicine. Often, the presence of postacne elements is combined with ongoing acne, which together creates conditions for social maladaptation, a decrease in self-esteem, and the patient’s desire for social isolation. Currently, the issue of postacne correction remains open and not fully resolved. The difficulties of correction, in particular atrophic postacne scars, lie in the depletion of the skin after a long inflammatory process and a decrease in skin resources that ensure full regeneration. The thickness of the dermis of the skin of the face and the depth of the postacne scars create a pronounced optical defect, which often demonstrates resistance to correction by fractional laser radiation, chemical and laser peels. In this article, microneedling is considered as one of the options for correcting atrophic scars post-acne, by stimulating the synthesis of collagen in the atrophic scar, hanging the regenerative abilities of the skin, the formation of organotypic healing, and so accelerating the resorption of postinflammatory stagnant spots. Also, the use of microneedling contributes to the resolution of inflammatory elements and the prolongation of acne remission.