Fear Research Articles

Feasibility of calcium hydroxyapatite (Radiesse®) for improving the biomechanical properties of facial burn scars: A pilot study.

Feasibility of calcium hydroxyapatite (Radiesse®) for improving the biomechanical properties of facial burn scars: A pilot study.

A Meta-Analytic and Posthumanist Review of Post-Inflammatory Cutaneous Sequelae in Contemporary Dermatopathology

After inflammatory dermatoses like acne, eczema, and psoriasis, most patients develop post-inflammatory cutaneous sequelae (PICS) such as hyperpigmentation, atrophic scarring, and keloid. Individuals with darker skin seem to be more affected by these sequelae, and they have to deal with psychological and cosmetic problems for a long time. While many people face PICS, the details of the problem in these terms are still largely unknown. The aim of this meta-analysis is to summarize findings from 15 studies published in the years 2015 to 2021 to describe PICS and examine the data using a posthumanist approach. Studies concerning PICS prevalence and characteristics were selected using the guidelines from PRISMA and MOOSE. Macroscopic criteria, such as study design, skin type, outcomes evaluated, and bias assessment, were collected from the studies. For combining the estimates, we relied on random-effects models. In posthumanist theory, skin was understood as being influenced by different molecular, human, and technological processes. The overall prevalence of post-inflammatory hyperpigmentation was 38.7%. However, this condition was more prevalent in individuals with Fitzpatrick types IV, V, and VI. Among all the patients, 22.5% had atrophic scars. It was learned from the results that skin diseases affect certain skin types more, have different inflammatory responses, and patients are treated unequally. Among its benefits, a posthumanist approach helps dermatologists give fair, well-rounded skin care by paying attention to the impact of biological, technological, and social factors on patients and their skin.

Comparing the Efficacy of Intralesional Saline Versus 35% Trichloroacetic Acid Peel in the Treatment of Atrophic Acne Scar

Atrophic acne scars are a common sequela of acne vulgaris impact patients’ quality of life. Despite the availability of several treatment modalities, there is a need for simpler and cost-effective approaches. Objective: To compare the efficacy of intradermal normal saline versus trichloroacetic acid (TCA) in treating atrophic acne scars. A randomized controlled trial conducted at the Dermatology Department, Sheikh Zayed Hospital, Rahim Yar Khan, from 1st April 2023 to 31st October 2023. Methods: 126 patients were enrolled. Scar grading was based on Goodman and Baron's Qualitative Scar Classification. The Patients Observer Scar Assessment Scale (POSAS) was used by dermatologists. Efficacy was defined as ≥50% improvement in the POSAS. Results: Among 126 participants, the NS group showed significantly greater improvement in PSAS and OSAS scores post-treatment. While total POSAS score reduction was higher in the NS group, the difference was not significant. A ≥50% POSAS improvement was more frequent in the NS group (88.9%) than in the TCA group (73.0%; p = 0.023).Conclusion: This study found that intradermal normal saline is more effective and satisfactory than trichloroacetic acid for treating atrophic acne scars, with greater improvements in scar severity and patient satisfaction.

Simultaneous versus stepwise treatment of acne and atrophic scars: a prospective split-face controlled trial.

Acne frequently coexists with atrophic scars, yet clinical management typically follows a stepwise approach, with limited evidence on the efficacy of simultaneous treatment strategies for both conditions. To address this gap, we conducted a prospective split-face controlled trial involving 30 patients with symmetrical bilateral facial acne lesions and atrophic scars. The right side of the face was assigned to the stepwise treatment group, receiving 30% supramolecular salicylic acid for acne every two weeks for a total of five sessions. Following the resolution of inflammatory lesions, microneedling and subcision were performed for atrophic scars once a month for three sessions. The left side was designated as the simultaneous treatment group, receiving combined therapy (supramolecular salicylic acid, microneedling, and subcision) for both acne and atrophic scars once a month for three sessions.Efficacy and safety were assessed during follow-up. Results demonstrated that the simultaneous treatment regimen was significantly more effective in reducing acne lesions compared to the stepwise approach (P < 0.05), while both regimens showed comparable efficacy in improving atrophic scars (P > 0.05). No significant adverse reactions were observed in either group. Notably, the simultaneous treatment regimen significantly reduced the overall treatment duration and achieved higher patient satisfaction compared to the stepwise approach.In conclusion, the simultaneous treatment of acne and atrophic scars is not only clinically effective and safe but also offers the advantages of shorter treatment duration and enhanced patient satisfaction, making it a promising therapeutic strategy.

Subdermal Laser-Assisted Scar Subcision (SLASS) Combined With Fractional CO2 Laser for Acne Scars: Efficacy Evaluation.

Rolling atrophic acne scars attach the deeper dermis to the muscular-fascial layer with a fibrous component. Subcision is the most commonly used treatment technique for rolling scars. Our objective is to describe the efficacy and safety profile of a new type of subcision: the "subdermal laser-assisted scar subcision" (SLASS), using a 1470-nm diode fiber laser in combination with ablative fractional CO2 laser. A retrospective study of the combination of subcision with subdermal laser and CO2 fractional laser in one session for 42 patients is presented. For the subcision, 400-μm fibers of a 1470-nm diode laser were used with energies ranging from 100 to 200 J per 2 cm2 area, using 3-4 W of power and pulsed mode with 15-25 ms pulses. After subcision, CO2 fractional laser was performed with different settings depending on the deepness of the scars: 40-50 W power peak, 1-1.5 ms dwell time, and 20%-30% density. Mean reduction of the ECCA grade scale before and after treatment was of 92.6 ± 34.3 points (p < 0.05). Considering SCAR-S scale, ranging from 0 to 5 (0 = clear; 5 = very severe), a mean improvement of 1.67 points was obtained (p < 0.05). Significant differences were found in both ECCA scale and SCAR-S scale before and after treatment. None of the patients had severe adverse effects after the procedure. SLASS subcision can be considered as a promising technique for rolling acne scars. It provides a thermo-mechanical subcision effect to the scarred area compared with traditional subcision techniques. CO2 laser seems effective and safe.

A Comparative Study of Picosecond Fractional 1064-nm Nd:YAG Laser Versus Fractional 10,600-nm Carbon Dioxide Laser in the Treatment of Abdominal Striae Alba: A Randomized, Prospective, Assessor-blinded, Split-abdomen Trial

ABSTRACT Background Striae distensae are common disfiguring atrophic dermal scars. Fractional lasers have been utilized to improve the appearance of this condition. Objectives To compare the efficacy and safety of picosecond fractional 1064-nm Nd:YAG (PS Nd:YAG) laser versus fractional 10,600-nm Carbon Dioxide (CO2) laser in treating abdominal striae alba (SA). Methods Thirty-two women with Fitzpatrick skin types III-V and abdominal SA participated in a split-abdomen study, receiving four sessions of fractional PS Nd:YAG and CO2 laser treatments on each side at four-week intervals. Striae texture, atrophy, clinical improvement, and satisfaction were assessed for each side at one and three months, with striae length and width compared pre- and post-treatment. Adverse reactions were noted at each visit. Results Abdomen treated with both lasers had significantly improved skin texture, atrophy and clinical improvements (assessed by physicians and patients) at both follow-ups (p < 0.05), with no difference between the two. Striae length and width did not change significantly (p = 0.203 and p = 0.558). Patients reported greater improvement on the CO2-treated side at 1 month, but not at the final follow-up. High satisfaction was noted for both lasers. Adverse reactions noted after both lasers include erythema, edema, crusting/scaling, pruritus, pain and post-inflammatory hyperpigmentation. The PS Nd:YAG laser was associated with greater pain (p < 0.05), but shorter healing time of 10.26 days. Conclusion Both fractional PS Nd:YAG and CO2 lasers were effective, well-tolerated and safe treatment options for SA.

Efficacy and safety of microneedling with topical insulin compared with placebo in the treatment of atrophic scars: a prospective study and literature review

Abstract Background Atrophic scars, which affect many individuals and arise from various causes, currently lack a standardized treatment protocol. Recent studies suggest that combining microneedling with topical insulin (TI) may offer a promising new approach to improving the appearance of these scars. Objectives To evaluate the efficacy and safety of microneedling combined with TI for treating atrophic scars caused by acne, cutaneous leishmaniasis, striae alba and postoperative wounds. Additionally, we aimed to assess the impact of treatment on improving quality of life. Methods A total of 158 patients with various types of atrophic scars were divided into two groups: one received microneedling with TI and the other received microneedling with a placebo. Each participant underwent 12 monthly sessions, followed by a 1-year follow-up to assess long-term outcomes. Primary outcomes were measured via the Goodman and Baron qualitative grading system and acne scarring grading system, along with patient satisfaction and Dermatology Life Quality Index scores. Results A statistically significant improvement was observed in the TI group, as reported by patients and clinicians, especially regarding postacne and postleishmaniasis scars (P = 0.001). The improvement in quality of life was most pronounced in the postacne group (P = 0.002). Conclusions This study suggests that microneedling, when combined with TI, is a safe and effective standalone treatment for atrophic scars resulting from various causes. Additionally, this approach may enhance the quality of life for patients with this condition. However, further research with larger sample sizes is needed to validate these findings.

How We Do It: Dermal Graft for Atrophic Scarring on Sebaceous Skin.

How We Do It: Dermal Graft for Atrophic Scarring on Sebaceous Skin.

Lactobacillus-Derived Exosome Therapy for Active Acne Vulgaris, Post-Inflammatory Hyperpigmentation, and Atrophic Scarring.

Acne vulgaris often leads to post-inflammatory hyperpigmentation (PIH) and atrophic scarring, affecting patients' quality of life. Traditional treatments may have side effects and inconsistent efficacy. An imbalance in the skin microbiome, particularly a deficiency in Lactobacillus species, has been implicated in acne pathogenesis. Lactobacillus-derived exosomes (LDE) offer a novel, cell-free therapeutic approach with anti-inflammatory and regenerative properties. This case series evaluates the efficacy and safety of LDE therapy combined with microneedling in patients with active acne, PIH, and atrophic scarring. Three patients with moderate to severe acne [Investigator's Global Assessment (IGA) scores 2-4], visible PIH, and atrophic scarring underwent biweekly microneedling treatments followed by topical application of LDE (BLESKIN EXXO, Daeyang Medical) over 2 months. Assessments were conducted at baseline and 2-month post-treatment, utilizing the IGA scale for acne severity, the Postinflammatory Hyperpigmentation Area and Severity Index (PIHASI) for PIH, and the Goodman and Baron Scarring Grading System for atrophic scarring. Two independent, blinded dermatologists evaluated clinical photographs and scored all outcomes. Patient satisfaction was recorded on a 10-point Likert scale. All patients exhibited significant improvements in acne severity, PIH, and atrophic scarring. IGA scores decreased from baseline values of 3 to 4 to 1 to 2 post-treatment. PIHASI scores were reduced by 4 to 6 points, and Goodman and Baron scores improved by one grade level. Patient satisfaction scores ranged from 8 to 9 out of 10. Minimal adverse events were noted, with only one instance of transient erythema observed during the study. LDE therapy combined with microneedling seems to be a promising treatment modality for active acne, PIH, and atrophic scarring, demonstrating significant clinical improvements with high patient satisfaction and minimal adverse effects. Further research with larger cohorts and controlled studies is warranted to validate these findings.

Combined subcision with polydioxanone monofilament (PDO) threads versus polydioxanone monofilament (PDO) threads alone in treatment of atrophic post-acne scars.

Acne scaring negatively impacts life quality. Treatment options vary in clinical effectiveness, side effects, and downtime. Polydioxanone threads (PDO) stimulate neo-collagenesis and create mechanical lift through artificial ligaments, while subcision is an office surgical method for managing atrophic scars. Both methods have their advantages and disadvantages. To assess the clinical efficiency and safety of PDO threads alone against combined subcision in the management of atrophic following-acne scars. Twenty patients with facial atrophic following acne scars were involved. The right side of the face was managed with PDO threads, while the left side was managed with subcision and PDO threads. Patients were assessed after three months using the Goodman and Baron qualitative and quantitative acne scarring grading systems. On the right side, improvement was excellent in two patients (10%), good in fourteen patients (70%), and poor in four patients (20%). On the left side, the improvement was excellent in six patients (30%), good in twelve patients (60%), and poor in two patients (10%). There was a statistically insignificant variance between both sides with a p-value of 0.308. There were no reported serious side effects, and the pain was tolerable. PDO thread insertion, either alone or combined with subcision, is safe and efficient in managing atrophic post-acne scars.

Evaluation of 1565-nm nonabrasive fractional laser efficacy on atrophic facial acne scars in Chinese population using 22-MHz digital ultrasonography

ABSTRACT Objective The purpose of this study was to evaluate the effectiveness of 1565 nm NAFL treatment for atrophic acne scars using 22-MHz digital ultrasonography. Methods A total of 29 patients with acne atrophic scars were sequentially enrolled in this study. Digital clinical images of each patient’s face were collected. The Quantitative Global Acne Scarring Grading System developed was employed to assess the outcomes of acne atrophic scars treated by 1565 nm NAFL. Two independent dermatologists performed an ultrasound examination of the acne atrophic scars using 22-MHz ultrasonography. Results Of all the patients received 1565 nm NAFL treatment, no adverse side effect was detected. The mean scores of Assessments Quantitative Global Acne Scarring Grading System in all the patients were no significant difference between the baseline and after 1-, 2-, and 3-month treatment. The means of epidermal thickness, dermal thickness, and epidermal echo intensity at the baseline and 1-, 2-, and 3-months were of no significant difference (P>0.05). The differences in the means of dermal echo intensity between the baseline and 1-, 2-, and 3- months were statistically significant (P<0.05). Conclusion 1565 nm NAFL was effective in improving the acne atrophic scars due to increased collagen fiber synthesis detected by 22 MHz frequency ultrasound system.

An Assessment of the Efficacy of Erbium Glass Laser Therapy in Acne Scar Treatment Using Image Analysis and Processing Methods

Background: Acne scars significantly impact skin texture and esthetics, necessitating effective treatment modalities. This study evaluates the efficacy of erbium glass laser therapy in improving atrophic acne scars using advanced image analysis techniques. Materials and methods: Twenty patients with mild to moderate atrophic scars underwent two sessions of 1550 nm erbium glass laser treatment. The clinical photographs were analyzed using a Gray-Level Co-occurrence Matrix (GLCM) to assess changes in contrast and homogeneity across the grayscale and RGB channels. The analysis revealed statistically significant improvements post-therapy, including reduced contrast and increased homogeneity, indicating a smoother and more uniform skin texture. The blue and green channels demonstrated the greatest sensitivity to surface-level textural changes, while the red channel exhibited the smallest differences, reflecting its deeper penetration and reduced sensitivity to surface alterations. Conclusions: These findings underscore the value of quantitative imaging techniques in dermatology for objectively evaluating therapeutic outcomes and optimizing treatment strategies. Erbium glass laser therapy emerges as a non-invasive and effective solution for acne scar management.

Fractional CO2 laser with topical insulin versus PRP for atrophic acne scars: a randomized split-face study.

Atrophic acne scarring is a prevalent problem that has been treated with a variety of procedures, each with various degrees of success. For better results, combined regimens of treatment are recommended. Our aim was to compare the efficacy of topical insulin against topical platelet-rich plasma (PRP) as an adjunct treatment to fractional CO2 laser for atrophic acne scars. The study comprised 30 patients with atrophic acne scars. All patients underwent four sessions of fractional CO2 laser on both sides of the face at one-month intervals, followed by topical PRP treatment on one side of the face and topical insulin on the other. Two non-treating dermatologists used the Acne Scar Assessment Scale (ASAS) to assess the outcome. At their last follow-up appointment, patients were asked to assess their improvement on each side of the face in a percentage from 0 to 100%. Prior to treatment, there was no difference in the ASAS scores between the two sides of the face. One month after the last treatment session, ASAS scores improved significantly on both sides of the face. No significant difference (p = 0.794) between both sides were detected. Both techniques helped to improve atrophic acne scars and may have a synergistic outcome regarding efficacy and safety.

Acne scarring: protocol for development of a core outcome set for clinical trials.

Acne scarring is one of the primary sequelae that affect patients with acne, with facial scarring occurring to some extent in 95% of patients with active acne. Subtypes include atrophic, hypertrophic and keloid scarring. Treatment options include topical and surgical approaches. Despite numerous clinical trials focusing on acne scarring treatments, the absence of standardised outcome reporting across these trials raises concerns in evaluating treatment methods. To address this issue, this project aims to develop a core set of outcomes which should be uniformly assessed in all clinical trials involving acne scarring. Outcomes will be extracted from four sources: a systematic literature review, patient interviews, printed and electronic sources and stakeholder involvement. The steering committee will assess the potential outcomes, adding or removing outcomes if needed. The Delphi process will be performed to understand the importance of outcomes. Two rounds of Delphi surveys will be completed by physicians, researchers and patients. Following this, a consensus meeting involving stakeholders will be held to refine the outcomes based on participant scores. The meeting will end in a voting process to determine a final recommended core outcome set (COS). This study will be conducted in collaboration with the Core Outcome Measures in Effectiveness Trials (COMET) initiative and the CHORD COUSIN Collaboration (C3). This study aims to develop a global COS to standardise assessment approaches in clinical trials of acne scarring. The final goal is to enhance uniformity of outcome reporting. Ethical approval and consent to participate for the study have been granted by Northwestern University Institutional Review Board protocol ID: STU00097285. On completion of the COS, we plan to publish our results in peer-reviewed journals and send participants the finalised COS. This study is registered with PROSPERO (CRD42023460964), COMET (754) and C3 (https://www.c3outcomes.org/improved-acne-scarring).

Clinical and genetic rationale for the use of collagen preparation in the prevention and correction of atrophic scars

Introduction. A scar is a newly formed connective tissue that develops at the site of deep skin defects accompanied with the destruction of the dermis due to ulcerations, burns, cracking, and inflammatory processes. Each stage of cicatricial deformation is characterized by specific morphological changes such as alteration and inflammation, fibroblast proliferation and formation of the granulation tissue, epithelialization of the defect, scar tissue maturation and remodelling.Aim. To identify the genetic predisposition to the formation of cicatricial deformities in patients showing signs of undifferentiated connective tissue dysplasia (UCTD) and to develop an optimal algorithm for the prevention and correction of striae distensae using Linerase collagen replacement therapy.Materials and methods. The study was conducted at the laboratory of Melsytech LLC (Nizhny Novgorod). A total of 52 patients (men and women, average age of 21.9 ± 4.4 years) were enrolled in the study. These patients sought advice from the Melsytech clinics (Moscow) in the period from 2022 to 2024. An UCTD screening questionnaire and genetic marker testing was used to diagnose signs of UCTD. A clinical examination of patients, identification of cicatricial changes in the skin and wound healing pattern were carried out separately.Results. The study showed that the risk of predisposition to atrophic scars correlates with the degree of predisposition to UCTD. Incidence rates of a special type of skin healing with the formation of characteristic “cigarette paper” scars, and predisposition to atrophic striae not associated with pregnancy or weight change are higher in patients with UCTD.Conclusions. The risk of predisposition to atrophic scars correlates with the degree of predisposition to UCTD. Replenishment of the building material deficiency and stimulation of collagen I and III gene expression are a pathogenetic therapy option for the correction of atrophic scars and striae.

Isolated Transpupillary Photodynamic Therapy in Local Treatment of Choroidal Melanoma

Objective: To evaluate the long-term results of local application of transpupillary photodynamic therapy (PDT) with chlorine photosensitizer in isolated organ-preserving treatment of uveal melanoma (UM) and to determine predictors of its effectiveness.Patients and methods. Retrospective analysis of transpupillary PDT efficacy in 38 patients (38 eyes) diagnosed with choroidal melanoma (CM) treated between 2016 and 2024. The median follow-up time was 24 months. The mean age was 62.77 ± 10.89 years. Distribution according to TNM: I (n = 12), IIA (n = 20), IIB (n = 6). According to ultrasound Doppler, the initial tumor thickness before treatment ranged from 1 mm to 5.2 mm, with a median value of 2.95 (2.2; 4.0). Distribution by degree of vascularization: avascular СM (n = 4), hypovascular CM (n = 12), hypervascular CM (n = 22); by degree of pigmentation: weak (n = 22), moderate (n = 11), severe (n = 5). In a multivariate statistical analysis of predictors of transpupillary PDT efficacy, the following features were taken into account: tumor thickness, the degree of pigmentation, and the degree of UM vascularization.Results. Complete regression was achieved in 32 of 38 patients (84 %). After treatment, the tumor thickness ranged from 0 to 4 mm, the median value was 0.5 (0.3; 1.0). Mean best corrected visual acuity before treatment was 0.70 ± 0.34 and 0/38 ± 0.37 after treatment. Multivariate analysis of predictors of treatment efficacy reveal that the most significant criterion was the degree of CM vascularization (AUC = 0.906 (0.802; 1.000), p = 0.002). Complete regression was achieved in 100 % of cases with hypervascular UM, 75 % with hypovascular, and 25% with avascular (p = 0.001). Complete regression was significantly more often observed in small CM (AUC = 0.922 (0.795; 1.000), p = 0.001). The optimal threshold values of the CM thickness for transpupillary PDT in an isolated treatment were obtained: 3.9–4.5 mm. It has been proved that the degree of CM pigmentation is a significant predictor of the absence of complete regression (AUC = 0.805 (0.595; 1.000), p = 0.019), so in the weakly pigmented variant, the formation of an atrophic scar was determined in 21 of 22 patients (95.5 %), in the moderate variant — in 9 of 11 cases (81.8 %), in the case of severe pigmentation in 2 of 5 (40 %) patients (p = 0.012).Conclusions. Transpupillary PDT efficacy in the isolated treatment of small and medium CM is determined by the possibility of achieving complete regression in 2/3 of patients. The identified predictors should be taken into account when conducting this type of treatment.

The Efficacy and Safety of a Single Treatment of High-Intensity, High-Frequency, Non-Focused Ultrasound Parallel Beams for Facial Acne Scars in Asian Patients: A Preliminary Study.

Acne vulgaris is a common inflammatory disease that often leads to changes in skin texture. While cosmetic improvement of acne scars is achievable, complete restoration remains challenging. One promising treatment is synchronous ultrasound (US) parallel beam technology, a noninvasive device that targets the mid-dermis while preserving the epidermis. This technology induces controlled thermal injury, stimulating neo-collagenesis and neo-elastinogenesis, which contribute to the improvement of atrophic acne scars. To assess the efficacy and safety of high-intensity, high-frequency, non-focused US parallel beams for the treatment of facial acne scars in Asian patients. Fourteen subjects, aged 24-55 years, underwent a single US treatment and were evaluated for improvement in facial acne scars in a retrospective study. The follow-up period extended up to 8 months after treatment. Pre- and post-treatment photographs were assessed by a blinded dermatologist using the physician global aesthetic improvement scale (PGAIS) and the acne scar severity (ASS) scale. Scar volume was measured using the Antera 3D software. Pain perception was assessed immediately after treatment using an 11-point scale. Any safety concerns were recorded and examined. Fourteen Thai subjects, with a mean age of 43 years, showed significant improvement in depression volumes (small, medium, and large) at follow-up visits compared to baseline. From PGAIS results, all treated areas showed improvement. The mean pain score was 3.94. No adverse events were reported. Synchronous US parallel beam technology appears to be a promising and safe option for treating acne scars in Asian patients.

Comparative study between the combination of nano fat grafting with fractional carbon dioxide laser, versus nano fat grafting alone in treatment of facial atrophic acne scars.

comparative study between the combination of nano fat grafting with fractional carbon dioxide laser, versus nano fat grafting alone in treatment of facial atrophic acne scars.

Scar Management in Pediatric Patients.

Background and Objectives: Pediatric patients can acquire scars from both accidental injury and surgical procedures. While scars cannot be avoided if a full-thickness injury occurs, scar visibility may be minimized through a variety of approaches. In this narrative review, we evaluate the current evidence and propose an algorithm for scar management in pediatric patients. Materials and Methods: A review of the literature was performed for scar management techniques for pediatric patients. Management modalities based on the type of scar and dosing, treatment regimen, and safety profiles are described in this article and used to create a scar management algorithm. Results: The initial step to scar management in the pediatric population involves ensuring minimal wound tension, which can be achieved through making the incision along relaxed skin tension lines, and early, minimal tension wound closure. Subsequent treatments to optimize scar care should begin 2-3 weeks following wound closure and involve the application of silicone gel or sheets and scar massaging. When topical products are insufficient, laser therapy can be utilized for the management of immature erythematous or thick scars. When mature, pathological scars form such as atrophic scars, hyperpigmentation, hypertrophic scars, or keloids, a combination of modalities is recommended. These modalities vary by scar type and include retinoids and dermabrasion for atrophic scars; retinoids, hydroquinone, and laser therapy for hyperpigmentation; and pressure therapy, corticosteroids, and laser therapy for hypertrophic scars and keloids. When mature, pathological scars persist following 12 months of non-invasive therapies, surgical excision should be considered. Conclusions: Several treatment options are available to manage scars in the pediatric population depending on scar type.

New Proposed Classification for Psychodermatosis Based on the Complex Interaction Between the Brain and Skin

The literature describes several dermatological conditions that are not caused by external agents but result from the complex interaction between the brain and the skin. This interaction gives rise to a variety of dermatological lesions, which can be broadly classified into two major categories: psychogenic dermatoses and psychosomatic dermatoses. In this article, we present three cases of Psychodermatosis to illustrate a proposed detailed classification based on the underlying mechanisms and clinical manifestations of these conditions. The cases include: (1) crusty, greasy, brownish facial lesions; (2) excoriated lesions with post-inflammatory hypopigmentation, alopecia, and fractured hairs—characteristic of trichotillomania; and (3) lichenified plaques on the dorsum of the feet, leaving hyperpigmented and atrophic hypopigmented scars, typical of factitious dermatitis. We propose a refined dermatological classification of Psychodermatosis, encompassing two primary categories: (1) cutaneous diseases associated with psychiatric disorders and (2) psychiatric conditions linked to specific cutaneous disorders known to be influenced by psychosomatic factors.