Depressed Acne Scars Research Articles

A systematic review and meta-analysis on the effects of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scars.

Acne is a chronic inflammatory disease that occurs in the sebaceous glands of the hair follicles. Depressed acne scars, also known as depressed scars, remain after recovery. Clinical treatments of depressed scars include chemical peels, surgical treatments, radio frequency treatments, and laser treatments. Ultra-pulse carbon dioxide (CO2) fractional laser treatment has become the main method for treating depressed scars in recent years, but there are no systematic reports on the effectiveness and safety of this treatment. English databases, including PubMed, Embase, and Ovid-Medline, were searched to retrieve relevant articles. The search period ran from the establishment of the databases to April 2021. The search terms included CO2 lattice laser, depressed acne scars, depressed scars, and effectiveness. A total of 6 articles comprising 467 patients with depressed acne scars were included in the meta-analysis. The results showed that patients treated with ultra-pulsed CO2 fractionated laser scored higher in skin smoothness compared to other methods [standard mean difference (SMD) =0.49, 95% confidence interval (CI): 0.13-0.84; P=0.008], and significantly higher total skin lesion scores (SMD =0.35, 95% CI: -0.00 to 0.70; P=0.05). A total of 6 articles were included in this study on the clinical efficacy of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scars. The study found that compared to other treatments, this laser had a better curative effect in terms of the effective rate and patient skin smoothness score.

28492 Doxycycline pigmentation in a patient with vandetanib-induced acne

We present a case of doxycycline-induced hyperpigmentation in a 49-year-old male with a history of Hodgkins lymphoma, melanoma, and radiation-induced medullary thyroid cancer (MTC). The MTC was treated with the oral kinase inhibitor, vandetanib. Shortly thereafter he developed pustular acne. This was treated with oral doxycycline and after 6 weeks he developed blue-gray discoloration within depressed acne scars on the face and scalp. This case highlights that shorter courses of doxycycline can induce cutaneous hyperpigmentation that may be irreversible.

Topographic computer analysis for acne scar treatment on face accompanying biopsy study after dermal injection of hydrotoxin mixture.

BackgroundAcne during youth can leave permanent facial scarring. The depressed acne scars can be treated by injection of stabilized hyaluronic acid (S‐HA) into the dermis. Due to the large number of acne scars, manual injection methods are technically difficult and bear high risk of lump formation in the dermis. Therefore, the author designed a specific injection method to solve the two abovementioned problems.AimsThis research aims to assess the effect of the intradermal injection of S‐HA and aboborulinumtoxinA mixture in the treatment of all types of acne scars.Materials/MethodsA total of 102 patients who suffered from acne scars were treated with a mixture of S‐HA (Restylane Vital®) and abobotulinumtoxinA (Dysport®). Using an automatic injector, micro‐droplets of the mixture (0.001 cc of S‐HA and 0.125 U abobotulinumtoxinA) were delivered into 1000 intradermal sites on whole face except eyelids. This instrument radically reduced injection amounts per site (0.001 cc), lessened manual operator efforts, and ensured consistent injection depth (from 0.8 to 1.2 mm depending on individual dermal thickness) into the facial dermis. The changes in each depression site of acne scars were evaluated by topographic computer analysis (point roughness), based on the 40 magnification microscopic photographs generated. Depth measurements of each small acne scar point were taken one by one at the exact same point before and after the treatments. Global Aesthetic Improvement Scale (GAIS) was measured for improvement of acne scars at 1‐ and 6‐month posttreatment. Additionally, serial histologic examinations of the biopsy specimens evaluated neocollagenesis, neoelastinogenesis, and longevity state of the S‐HA.ResultsA total of 78 patients showed improvements of depressed acne scars in physical examinations, medical photographs, and dermascopic photographs.Using topographic computer analysis, the average point roughness decreased 27.48% (at 1 month) from 29.042 ± 6.85 (baseline) to 21.05 ± 6.30 µm (P < .0001), corresponding with scar improvements observed in physical examinations, and 3.02 ± 0.66 of GAIS at 1‐month posttreatment. Using an injector allowed the hydrotoxin mixture into the deep dermal layer. Biopsy study proved that the injection depth was exactly in the dermis, and showed evidence of neocollagenesis and neoelastinogenesis. Also, the S‐HA particles remained after 1 year, which proved its longevity of at least 1 year.ConclusionThe topographic computer analysis using point roughness showed improvement of all subtype acne scars at 1‐month posttreatment. The improvement may have resulted from dermal expansion due to the neocollagenesis and neoelastinogenesis. S‐HA lasted more than 1 year in human dermis.

Comparing cannula-based subcision with the common needle method: A clinical trial.

Treatment of depressed acne scars requires multiple modalities. Although needle subcision is a valuable method, it exhibits mild to moderate efficacy in treatment of deep acne scars owing to the high recurrence rate and other side effects. A total of 100 patients with rolling acne scars were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision in two parallel groups, and the effect of cannula subcision instead of needle subcision was evaluated in the treatment of rolling acne scars. A total of 100 patients were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision. The outcomes of these procedures were assessed by three blinded dermatologists and by patients' satisfaction. Subcision using the cannula showed good and very good improvement in about 83% of patients (n=50, P<.05) based on dermatologists investigation and almost no side effects were observed in compared with needle subcision. The response rate was significantly different while using cannula subcision. Cannula subcision appears to be a safe and practical technique that can enhance the efficacy of subcision without considerable complications.

Histological Study on the Effect of Hyaluronic Acid Injection (Dermal Filler) on the Skin of the Adult and Aged Albino Rat

Background: Injectable dermal fillers became more popular for improving skin contour defects such as wrinkles, lines, and depressed acne scars. Aim of the work: This work aimed to study different skin changes induced by dermal filler injection in adult and aged albino rat. Material and Methods: Forty five female albino rats were used. The animals were divided into three groups: Group I (Control): Included twenty adult rats. Group ІІ: Included fifteen adult rats, they received an injection of 0.1 ml of hyaluronic acid (HA). The animals were subdivided into three subgroups according to time of sacrification , five rats each: Subgroup IIa: after 7 days. Subgroup IIb: after 60 days. Subgroup IIc: after 90 days. Group ІІІ: Included ten aged rats, they were subdivided into two subgroups, five rats each: Subgroup IIIa: (Control aged group). Subgroup IIIb: the rats were given an injection of HA and were sacrificed after 30 days.Results:Thin skin of HA injected animals revealed significant (< 0.05) increase in the thickness of subcutaneous tissue (SC) and significant increase in collagen and elastic fibers, and significant increase in the CD34 positive endothelial cells as compared to control and aged rats. Active fibroblasts at the site of injection showing euchromatic nuclei. Their cytoplasm contained well developed rER, numerous mitochondria, many vesicles, and centrioles.Conclusion: Hyaluronic acid filler injection stimulated vascularization and enhanced fibroblasts to synthesize collgen and elastic fibers in SC. This protected the skin from aging features in adults,and play a role in improvement of skin defects in aged rats.

Percutaneous induction of collagen with needles (IPCA®) associated with Pulsed radiofrequency with multineedles (RFPM®) in the management of depressed acne scars: treatment protocol

Percutaneous induction of collagen with needles (IPCA®) associated with Pulsed radiofrequency with multineedles (RFPM®) in the management of depressed acne scars: treatment protocol

Clinical efficacy of fractionated ultrapulse carbon dioxide laser combined with microneedle for the treatment of acne scars

Objective To investigate the clinical efficacy of fractionated ultrapulse carbon dioxide laser combined with microneedle for depressed acne scars. Methods Totally 86 patients with depressed acne scar were randomly divided into 2 groups: the treatment group received fractionated ultrapulse carbon dioxide laser combined with microneedle technology and the control group only received fractionated ultrapulse carbon dioxide laser. The treatment interval was 1 to 3 months, and the whole course was 2-8 times. The total effective rate and the adverse reaction were analyzed in the facial acne scar. Results The surface of depressed acne scars was significantly improved. ECCA score of all patients declined obviously after treatment, the score of the treatment group declined from 61±11 to 45±15, and the control group declined from 57±14 to 40±16. There were significantly statistical differences in the results of each group (P<0.05). More treatment times resulted in better surface improvement. The total effective rate were 81.8% (18/22) and 100% (24/24) in the treatment group, and 80.0% (16/20) and 100% (20/22) in the control group. The course was 6.8±1.6 months in the treatment group and 20.8±4.6 months in the control group (P<0.05) to get a similar satisfied result. There were no obvious adverse reactions except two cases of erythema and pigmentation in the treatment group and 5 cases in the control group. The former was with less adverse reactions. Conclusions Ultrapulse carbon dioxide laser combined with microneedle technique is effective for facial acne scars, with less complications and shorten treatment course. Key words: Fractional laser; Micro needle; Acne scars

Subcision in the Treatment of Acne Scar in Iraqi Patients

Background: Acne vulgaris is a very common skin disease among young people which might be associated with scarring that has a great impact on the emotional, psychological and social life of the patients as it will go with them for life. Subcision is a new technique for the treatment of acne scars. Objective: To assess objectively and subjectively the efficacy and safety of subcision in the treatment of depressed acne scars. Patients and Methods: This is an open-label therapeutic trial. A total of 16 patients were enrolled in this study. Twelve were males and 4 were females. Their ages ranged from 19 - 39 with a mean of 26.64 ± 5.64. The duration of scar varied between 6 months and 10 years with a mean of 4.14 ± 2.54 years. subcision was done by introducing a sterile, hypodermic, 18-gauge needle. The needle was held by a three ml syringe for better orientation of the sharp tip of the needle. It was kept horizontal to the skin surface with the bevel up, and was introduced in a high sub dermal plane. The needle was slowly advanced parallel to the skin surface. Initially, rapid, repetitive linear back-and-forth motion of the needle makes the skin free of the underlying scar. This procedure was repeated in all directions in a fan-like manner. Results: According to Modified Sharquie’s scoring system for grading acne scars, 4 (25%) patients had severe grade, 11 (68.8%) patients had moderate grade and only 1 (6.2%) patient had mild grade. Evaluation at 6 months after treatment revealed that 8 (50%) patients had mild acne scar, 7 (43.8%) had moderate acne scar and only 1 (6.2%) patient still had severe grade. This change in the grades was statistically significant (p-value = 0.01713441). The average score before treatment was 13.13 ± 2.363; it became 9.50 ± 2.944 after 6 months. By paired t-test comparison, the difference in the score was statistically highly significant (p = 0.000044). Regarding the photographic assessment, the difference in the visual analogue scale before and after treatment was statistically significant (p-value = 0.043823). All patients were satisfied regarding subcision as treatment for their acne scars with variable degrees. In general the reported side effects were transient and vanished within 3 - 7 days apart from firm bumps which resolved within 12 weeks in all patients. Conclusion: Subcision appears to be simple, safe, minimally invasive, well-tolerated, and effective surgical procedure that provides significant long-term betterment for depressed acne scars especially for the rolling type.

Depressed Acne Scars—Effective, Minimal Downtime Treatment with a Novel Smooth Motion Non-Insulated Microneedle Radiofrequency Technology

Background: The microneedle fractional RF handpiece used in our study (Intensif Handpiece, EndyMed Medical, Caesarea, Israel) is a novel handpiece that uses a tip with 25 non-insulated, gold plated microneedle electrodes. The needles are inserted into the skin by a specially designed electronically controlled, smooth motion motor minimizing patient discomfort. RF emission delivered over the whole dermal portion of the needle allows effective coagulation resulting in minimal or no bleeding, together with bulk volumetric heating. Study Design/Materials and Methods: The study included 20 patients, treated for depressed acne scars using the IntensifTM Microneedles handpiece (EndyMed PRO Platform System, EndyMed Medical, Caesarea, Israel). The degree of clinical improvement was assessed by the global aesthetic improvement scale (GAIS) and subjects satisfaction by post treatment questionnaires. Results: The number of treatments per patient varied between 1 and 6 (average 3.3 treatments per patient). Eleven patients (55%) reported none to minimal pain, six (30%) moderate discomfort and only three (15%) reported significant pain. Objective evaluation of the improvement by a board certified dermatologist showed improvement in 95% of patients. 25% showed excellent improvement, 50% experienced good improvement, and the 20% showed minimal improvement. One patient showed no improvement. Conclusions: The presented results show that the tested electronically controlled motorized insertion, non-insulated microneedle treatment technology provides a minimal discomfort, minimal downtime, effective and safe treatment for depressed acne scars.

Evaluation of Fractional CO2 Laser Efficacy in Acne Scar

Introduction: Acne scar is formed after severe episodes of acne in teen and early adult years. Several treatment options have been used for depressed acne scars such as punch grafting, punch excision carbon dioxide (CO2 ) laser etc. Moreover, Studies show that laser skin resurfacing such as CO2 fractional can effectively treat depressed acne scars. We investigated the efficacy of fractional CO2 laser in acne scar. Methods: In this clinical trial; we used CO 2 fractional laser (Unit: eCO 2 Lutronic Korea; FDA approved) in 15 female cases with an age range of 20-40 years old. They underwent 3 sessions of laser resurfacing at one month intervals. In the first session we used laser with a density of 150 and fluency of 70 with a 4mm diameter circular spot in static mode on depressed acne scars, and we exerted laser with density of 100 and fluency 70 with 12 mm diameter square spot in static mode on all involved skin in the other sessions. Photographs were taken before every process. The patients and another dermatologist filled the questionnaire concerning the percent of improvement. Finally, we compared photographs and evaluated the efficacy of CO 2 fractional laser in acne scars. Results: Objective and subjective improvement was estimated about 20-70% and 30-70%, respectively, without any erythema, permanent hyperpigmentation and other adverse effects. The important point is that, participants returned back to work after 4-7 days. Conclusion: The Fractional CO 2 laser resurfacing can be used as a safe and efficacious method to treat depressed acne scar.

Facial soft tissue augmentation with Artecoll®: A review of eight years of clinical experience in 153 patients

Artecoll (Canderm Pharma Inc, Canada) is a semipermanent, injectable, soft tissue filler composed of uniform polymethylmethacrylate microspheres in a bovine collagen gel, which has been used in Europe over the past decade. The authors review their experience using Artecoll as an injectable material for the correction of deep static folds of the face, improvement of nasal asymmetries following rhinoplasty, depressed acne scars and augmentation of the lip. A retrospective chart review, subjective patient satisfaction feedback and objective findings noted by the senior author were performed over an eight-year period. A total of 153 patients were treated with Artecoll injections; 74 underwent lip augmentation, 21 underwent deep nasolabial fold augmentation, eight underwent glabellar fold augmentation, 26 were treated for minor nasal dorsal irregularities and 24 were treated for depressed acne scars. No early or delayed allergic responses were reported. Complications occurred most commonly with lip augmentation, in which 13.5% of patients noted significant noticeable bruising postinjection that resolved completely within one week, 51.3% had detectable implant on palpation, and 13.1% required further intervention with massage, steroid injection and/or local excision to correct for lumpiness. Sixty per cent of patients requiring further intervention responded successfully, while local excision was performed on the two patients who failed to respond after six months of massage and steroid therapy. Overall, a total of 11 patients (14.9%) had minor asymmetries or less than optimal results within the lip augmentation study group. Among other sites, the most common complaint was undercorrection of the fold or wrinkle. Based on the authors' experience, Artecoll is a safe, viable option for long-term treatment of deep facial wrinkles, nasal asymmetry, hypoplastic or atrophic lips, and depressed acne scars, and the results have been accompanied by a high degree of patient satisfaction. Although the implant is often palpable, rarely does it cause significant visible lumps. Its use and applications as a semipermanent injectable agent certainly warrant further investigation.

In vivo animal histology and clinical evaluation of multisource fractional radiofrequency skin resurfacing (FSR) applicator

Objective. Acne scars are one of the most difficult disorders to treat in dermatology. The optimal treatment system will provide minimal downtime resurfacing for the epidermis and non-ablative deep volumetric heating for collagen remodeling in the dermis. A novel therapy system (EndyMed Ltd., Cesarea, Israel) uses phase-controlled multi-source radiofrequency (RF) to provide simultaneous one pulse microfractional resurfacing with simultaneous volumetric skin tightening. Methods. The study included 26 subjects (Fitzpatrick's skin type 2–5) with moderate to severe wrinkles and 4 subjects with depressed acne scars. Treatment was repeated each month up to a total of three treatment sessions. Patients’ photographs were graded according to accepted scales by two uninvolved blinded evaluators. Results. Significant reduction in the depth of wrinkles and acne scars was noted 4 weeks after therapy with further improvement at the 3-month follow-up. Conclusion. Our data show the histological impact and clinical beneficial effects of simultaneous RF fractional microablation and volumetric deep dermal heating for the treatment of wrinkles and acne scars.

The Efficacy of Stereoimage Optical Topometry to Evaluate Depressed Acne Scar Treatment Using Cultured Autologous Fibroblast Injection

Despite the use of several evaluation methods, the lack of a true consensus scale hinders standardization of evaluation and treatment of depressed acne scars. To investigate the usefulness of a stereoimage optical topometer (SOT) system in evaluating the efficacy of autologous cultured fibroblast injection for depressed acne scars and to compare the results with those obtained using a visual grading system. Twenty-two patients with depressed acne scars were included. Three doses of cultured autologous fibroblast (2 × 10(7) cell/mL) injections were given at 2-week intervals. Efficacy was evaluated at 2, 4, 12, and 16 weeks using a visual grading system and a SOT. After autologous fibroblast injection, the lesions evaluated using the visual grading and SOT systems steadily improved. Visual grading and SOT variables obtained showed a similar tendency, although an interrater reliability test of the visual grading system correlated poorly. A three-dimensional morphologic study can be a useful and reliable method of evaluating the severity of acne scars. We were able to more objectively and quantitatively evaluate acne scar severity through combined analysis using visual grading and SOT systems.

Treatment of Depressed Acne Scars with High-Concentration Trichloroacetic Acid

Treatment of Depressed Acne Scars with High-Concentration Trichloroacetic Acid

Acne scar subcision

Subcision is a simple and safe office surgery procedure for treatment of depressed acne scars. It can easily be combined with other treatments such as laser, dermaroller and scar revisions for maximum efficacy.

Histologic Study of Depressed Acne Scars Treated with Serial High-Concentration (95%) Trichloroacetic Acid

Acne scarring is a common manifestation that remains a therapeutic challenge to dermatologists, dermatologic surgeons, and plastic surgeons. Although multiple therapeutic modalities exist, treatment often remains inadequate. The use of high-concentration (95%) trichloroacetic acid (TCA) applied focally to atrophic acne scars has been described. The current study confirms the utility of focal application of 95% TCA to acne scars in addition to a histologic examination of this technique. Acne scars in three patients were treated with focal 95% TCA by serial application. Wooden applicators were used to apply TCA focally and repeated at 6-week intervals for a total of six treatments. Punch biopsies were performed at baseline and at 1 year postoperatively. Histologic examination was performed with routine hematoxylin/eosin, Masson trichrome, and Verhoeff-van Gieson staining. Clinical examination revealed apparent cosmetic improvement in both depth and appearance of acne scars. Patient satisfaction was high. Histologic examination demonstrated a decrease in the depth of acne scars. In addition, increased collagen fibers and fragmentation of elastic fibers were noted. There were no complications from the procedure. Focal application of high-concentration TCA to atrophic and "ice-pick" acne scars appears to produce clinical improvement. Histologic changes of this technique are described.

Histologic Study of Depressed Acne Scars Treated with Serial High-Concentration (95%) Trichloroacetic Acid

BACKGROUND Acne scarring is a common manifestation that remains a therapeutic challenge to dermatologists, dermatologic surgeons, and plastic surgeons. Although multiple therapeutic modalities exist, treatment often remains inadequate. The use of high-concentration (95%) trichloroacetic acid (TCA) applied focally to atrophic acne scars has been described. OBJECTIVE The current study confirms the utility of focal application of 95% TCA to acne scars in addition to a histologic examination of this technique. METHODS Acne scars in three patients were treated with focal 95% TCA by serial application. Wooden applicators were used to apply TCA focally and repeated at 6-week intervals for a total of six treatments. Punch biopsies were performed at baseline and at 1 year postoperatively. Histologic examination was performed with routine hematoxylin/eosin, Masson trichrome, and Verhoeff-van Gieson staining. RESULTS Clinical examination revealed apparent cosmetic improvement in both depth and appearance of acne scars. Patient satisfaction was high. Histologic examination demonstrated a decrease in the depth of acne scars. In addition, increased collagen fibers and fragmentation of elastic fibers were noted. There were no complications from the procedure. CONCLUSION Focal application of high-concentration TCA to atrophic and “ice-pick” acne scars appears to produce clinical improvement. Histologic changes of this technique are described.

Tetracycline/doxycycline-induced cutaneous depressed pigmentation

Pigmentary disorders are recognized adverse effects of tetracyclines. Unlike minocycline, which occasionally causes black pigmentation of a variety of tissues, tetracycline itself or doxycycline is rarely attributed to the pigmentation of skin. Herein, we report the first case report of blue-black discoloration developed within depressed acne scars following tetracycline/doxycycline therapy for acne.

Treatment of Acne Scars with Liquid Silicone Injections

This article addresses the use of liquid injectable silicone as both an immediate and long-lasting treatment for broad-based, depressed acne scars. The only filler substance that maintains precision and permanence in improving and/or correcting these types of acne scar defects is medical-grade liquid silicone. We describe five patients with a history of acne scarring who showed improvements from injections of liquid silicone at the initial treatment session and lasting over a 10-, 15-, and 30-year follow-up period. Monthly liquid silicone injections using a technique known as the microdroplet, multiple-injection approach. This article documents the safety, effectiveness, and precision of silicone in addition to highlighting the fact that its permanence is what distinguishes it from other filler materials. As a precise and permanent filling substance used for soft tissue augmentation, liquid injectable silicone can improve and/or eliminate depressed, broad-based acne scars through a technique known as the microdroplet, multiple-injection

Nonablative resurfacing.

In expert hands, ablative laser resurfacing has a long history of excellent results in the treatment of photodamage-induced rhytids, depressed acne scars, and other signs of cutaneous aging. Over the last decade there have been a growing number of reports in the emerging area of nonablative resurfacing. Nonablative modalities provide less impressive clinical results for rhytid reduction but have shown particular promise for the treatment of scars and superficial dyschromias. It is also ideally suited for those patients seeking a minimally invasive, greatly reduced downtime procedure.