Post-acne Scarring Research Articles

Comparison of the efficacy of Subcision with Fractional Carbon Dioxide Laser versus Subcision with Microneedling Fractional Radiofrequency in the Treatment of Atrophic Post acne Scars

Background: Many interventions have been used to treat post-acne scars, with various degrees of efficacy and adverse reactions. Multimodal approach can achieve better results for improving the physical appearance that even if minor may result in significant distress and reduced quality of life. Objective: To compare the efficacy of subcision with fractional carbon dioxide (CO2) laser and subcision with microneedling fractional radiofrequency (RF) in treating post-acne scars and to study their adverse effects. Methods: In this prospective, interventional clinical study, a total of 64 patients with post-acne scars were enrolled. The patients were randomly allocated into two groups of 32 patients each, in which group A was treated with subcision plus fractional carbon dioxide laser (CO2) and group B was treated with subcision plus microneedling fractional radiofrequency (RF) every 6 weeks for a total of four sittings. An objective score was calculated for each patient using the Goodman and Baron scale to evaluate the outcome every visit during treatment and then 3 months after completion of therapy. Results: In group A, the percentage reduction in the mean objective scores was found to be 64%. In group B, the percentage reduction in mean objective scores was found to be 42%. Most of the changes were seen in the boxcar and rolling types of scars. Conclusions: Subcision and fractional CO2 laser were considered superior over subcision with microneedling fractional (RF) technique for the treatment of post-acne scars. Boxcar and rolling types of scars showed a high response to treatment than icepick scars

Fractional Carbon Dioxide Laser versus Combined Fractional Carbon Dioxide Laser with Platelet-rich Plasma in the Treatment of Atrophic Post-acne Scars: A Split-face Comparative Study.

Context:Though many treatment options are available for treating post-acne scars, optimized treatment still does not exist. Till date, comparative split-face studies, analyzing the efficacy of combined treatment modalities for acne scars with adequate sample size and with statistically significant results, are still lacking.Aim:The aim of this study was to compare the effectiveness of the combined use of platelet-rich plasma (PRP) and fractional ablative CO2 laser (FACL) versus FACL in the management of acne scars and to study the safety of autologous PRP and FACL in the treatment of post-acne scars.Settings and Design:This was a randomized split-face trial study.Materials and Methods:This study was conducted in 30 patients having Goodman and Baron’s grade 3 and 4 acne scars. The efficacy of PRP in combination with FACL was compared to FACL alone in the treatment of post-acne scars. Right half of the patient’s face was taken as the study side where FACL was performed followed by PRP injections. The left half of the same patient’s face was taken as the control side where FACL was performed followed by normal saline injections.Statistical Analysis:Results were analyzed using Statistical Package for the Social Sciences (SPSS, Chicago).Results:At the time of enrollment, mean Goodman and Baron Acne Qualitative Grading Scale on study and control side was 3.80 with standard deviation (SD) of 0.40 at baseline. After completion of four treatment sessions, it was reduced to 2.43 (SD = 0.76) and 2.76 (SD = 0.49) on the study and control side, respectively. Improvement on both sides was statistically significant (P = 0.000).Conclusion:There is no single proven modality for the effective treatment of post-acne scars. Combination of FACL with newer adjuvants such as PRP has definitive role in managing post-acne scars with better safety profile than FACL alone.

Scientometric analysis of evidence-based studies of physical methods of post-acne scar correction

Scientometric analysis of evidence-based studies on the use of therapeutic physical factors in the correction of post-acne scars. The analysis of evidence-based studies in electronic databases (PEDro, PubMed, eLibrary) and in databases of systematic reviews (Cochrane database) for the period from 2015 to 2020 was carried out. The following terms in Russian and English were taken as key words: acne scars (acne scarring), physical therapy (physical therapy). The final assessment of physical methods of correction included mainly data from foreign systematic reviews, meta-analyzes of RCTs, data from individual RCTs in English and/or Russian and tests rated at 4 points or higher on the PEDro scale. The clinical effects and supposed mechanisms of action of the currently proven therapeutic physical factors in the treatment of patients with post-acne scars are considered in detail. The most studied physical methods are technologies of high-intensity laser therapy (44.2%), fractional radiofrequency therapy (17%), combined methods of exposure (high-intensity laser therapy or micro-needling in combination with peels, fillers, PRP injection) (25%), micro-needling as monotherapy (5.8%) and microdermabrasion (4.5%) causing the most significant clinical changes and pronounced remodeling of the extracellular matrix of the skin in the area of scars. There is a need for regular synthesis and analysis of existing evidence-based studies, as well as the implementation of new high-quality randomized controlled clinical trials to study the effect of physical correction methods on post-acne scars which serve as the basis for the development of clinical guidelines.

Fractional CO2laser versus fractional CO2laser with subcision in management of atrophic postacne scar

ObjectiveTo evaluate efficacy and safety of fractional CO2 laser treatment versus fractional CO2 with subcision in the management of atrophic postacne scars.BackgroundAtrophic postacne scarring has always been a challenge to treat. Fractional CO2 resurfacing in combination with subcision is effective and well tolerated.Patients and methodsThis prospective study includes 50 patients with atrophic acne scars from Outpatient Clinic of Dermatology, Andrology and STDs Department. An informed consent was obtained. Patients from both sex at least 18 years with any types and any grade of atrophic postacne scars, and not receiving any treatment in the past 6 months for their scars were included. All patients were subjected to history taking, general examination, and qualitative grading of acne. Patients were divided into two groups: group A included 25 patients who were subjected to fractional CO2 laser, and group B included 25 patients who were subjected to subcision and fractional laser on the second day of subcision.ResultsExcellent satisfaction was 100% with grade 1 scar, and good satisfaction was more common with grade 2 scar (60%) in group A. There were highly statistically significant differences found between grade of scar and patient satisfaction in group A (P = 0.001). Excellent satisfaction was 90.91% with grade 1 scar, and good satisfaction was more common with grade 1 scar (57.14%) in group B. There were statistically significant differences found between grade of scar and patient satisfaction in group B (P = 0.028).ConclusionThe combination of fractional carbon dioxide laser and subcision is safe and effective modality for the treatment of atrophic acne scars. Moreover, there were improvements in patient satisfaction, without considerable complication.

Split-face Comparative Study of Efficacy of Platelet-rich Plasma Combined with Microneedling versus Microneedling alone in Treatment of Post-acne Scars.

Context:Skin conditions contribute substantial burden toward global morbidity and mortality. Acne vulgaris, with its rising prevalence, has become a cause of concern among researchers as well as dermatologists due to scarring.Aims:The aim of this study was to compare the efficacy of microneedling alone versus microneedling combined with platelet-rich plasma (PRP) in post-acne scars using a split-face method.Materials and Methods:Thirty patients with atrophic post-acne facial scars were offered four sittings of treatment monthly once. As a standard protocol, the right side of the face was subjected to microneedling with PRP (Group A) and the left side of the face with microneedling alone (Group B). Objective evaluation of improvement was performed by the physician recording the acne scar assessment score at baseline and thereafter at every visit using Goodman and Baron scale. Alongside patients also graded the improvement in acne scars at the end of the study.Statistical Analysis Used:The collected information was entered in MS Excel (Bellevue, WA, USA) and analyzed using appropriate statistical methods with Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY). The significance of the outcomes of the study was assessed by calculating the P value and the value of P < 0.05 was considered statistically significant.Results:The mean age of patients was 25 years. Thirteen (43%) patients in Group A had an excellent response as compared to 6 (20%) patients in Group B according to physician assessment. Patient’s satisfaction was more in Group A as compared to Group B as 11 (36%) patients had more than 75% improvement in Group A as compared to 1 (3%) patient in Group B.Conclusion:The study showed a decrease in scar severity grade in all the patients enrolled for treatment. However, the combined use of microneedling and PRP was found to be more effective than a single method used for treatment of acne scars.

Treatment of Pathological Scars with Nanofat Lipograft at the Hermanos Ameijeiras Hospital

Introduction: The healing is the result of the natural restoration of the organism before a corporal aggression produced by a surgical wound or trauma. Poor wound and injury healing represents a functional and aesthetic problem, which is why it deserves special attention. Objective: To evaluate the aesthetic results of the treatment of pathological scars with lipotransfer by nanofat. Method: A prospective longitudinal and descriptive study was carried out with 8 patients from Plastic Surgery Hospital ‘‘Hermanos Ameijeiras” with pathological scars, who received lipotransfer treatment by Coleman method and processing of adipose tissue by nanofat from January to June 2020. Results: 8 patients with ages between 25 and 50 years with a mean age of 39 years were included. The female sex predominated with 75%. The predominant skin color was grades 3 and 5 of the Fitzpatrick classification, both with 50%. The most frequent etiologies were post acne, postoperative and injection scars of allogenic substances, all with 25%. The main anatomical locations were the facial region and in the breasts with 3 patients each, followed by 2 cases in the gluteal region. The postoperative aesthetic results at three months were 100% good, observing macroscopic and microscopic positive changes with the nanograft. No patient presented complications. Conclusions: The treatment of pathological scars with lipotransfer by nanofat is an available, simple and reproducible option that offers objective improvement of the scar with rapid recovery.

A comparative study of efficacy of dermaroller versus fractional CO2 laser for management of post acne scars

Background: Acne vulgaris is a chronic skin disease caused due to blockage and/or inflammation of pilosebaceous units in which lesions present as non-inflammatory, inflammatory or mixture of both. The inflammatory type, often results in distressing scars for which dermaroller therapy and fractional CO2 laser have shown to be effective treatment modalities. Material and Methods: This is a prospective, descriptive and hospital based study. Total of 140 cases were enrolled in study carried out for 1 year in the Department of Dermatology at tertiary health centre and medical college with subsequent follow up of up to six months. Patients with acne scars under the groupings of a score > 3 points on Global Acne Scarring Classification Scale were enrolled.Results: Out of 140 patients, (70 - dermaroller group, 70 - CO2 laser group) completed treatment and follow-up. Dermaroller therap results indicated that the baseline was 23.43±6.32 and reduced to 13.23±3.65 after the treatment. This difference was found to be statistically highly significant with p value as

Double-blind, randomized controlled trial comparing the use of microneedling alone versus chemical peeling alone versus a combination of microneedling and chemical peeling in the treatment of atrophic post-acne scars. An assessment of clinical effectiveness and patients' quality-of-life.

IntroductionAcne vulgaris is a common, chronic disease. One of the most commonly encountered complications of acne is permanent atrophic scarring. Treatment of atrophic scars includes fillers, dermabrasion, laser resurfacing, microneedling and peelings and it is often difficult to treat. In our double-blind randomized controlled trial (RCT), we investigated the synergistic effect of microneedling with the application of trichloroacetic acid, kojic acid and hydrogen peroxide in the treatment of atrophic acne scars.AimTo assess the clinical effectiveness and patients’ quality-of-life (HRQoL) after three types of atrophic post-acne scar treatment, namely microneedling alone (MN) vs chemical peeling alone (CP) vs. a combination of microneedling and chemical peeling (MN + CP).Material and methodsA total of 120 patients were enrolled into the study following strict inclusion/exclusion criteria and randomized into the three treatment groups – MN, CP (a combination of trichloroacetic acid, kojic acid and hydrogen peroxide), and MN + CP. According to a preapproved protocol, each patient underwent four treatment sessions, each spread 20 days apart. Both pre- and post-treatment clinical status (using the Goodman-Baron scale; two expert raters blinded to the treatment used) and patients’ HRQoL (using the Dermatology Life Quality Index) were assessed.ResultsDuring the 5-month recruitment period, a total of 120 patients were approached and agreed to take part in the study (94 females – 78.3% and 26 males) (mean age of 30.14 ±3.64 years; range: 18–45 years). Only in the MN + CP group there was a statistically significant improvement according to the G-B scale post-treatment (2.87 ±0.83 vs. 2.03 ±1.16 respectively; p = 0.0005). Patients in all three treatment groups experienced a statistically significant improvement in their HRQoL post-treatment (all p’s < 0.05).ConclusionsA combination of microneedling and chemical peeling produces the best, objectively measured effects in the treatment of atrophic post-acne scars. All examined treatments, even if not producing a clinically significant treatment outcome, improve patients’ HRQoL.

Combined use of laser therapy and autologous plasma with cells in patients with post-acne atrophic scars

Background. Acne scar formation is a common consequence of acne vulgaris, in most cases atrophic scars resulting from tissue loss caused by inflammation of the pilosebial units.&#x0D; Aims: To study the effectiveness of combined laser therapy with Nd:YAG laser and Er: YAG laser with autologous plasma with cells in patients with different phenotypes of post-acne atrophic scars.&#x0D; Materials and methods. Depending on the method of treatment of post-acne scars, the patients were divided into 2 groups: Group 1 (n=28) with ice pick scars 10 patients; boxcar 9 patients; rolling 9 patients and group 1 (n=30) among them with ice pick scars 10; boxcar 9; rolling 11 patients. In group 1A, phototherapy was performed using a combination of Nd:YAG laser and Er:YAG laser. Immediately after laser exposure, autologous plasma was applied to the skin of the face of group 1B patients. To assess the effectiveness, the Manchester scale of assessment of scar deformities was used. The effectiveness was also evaluated using the Global Aesthetic Scale (GAIS) on a 3-point system. In this study, cutometry and ultrasound were performed to assess the elasticity of the skin in the foci of atrophy.&#x0D; Results. The indicator "color" on the MSS scale improved in the 1st group by 54.8%, in the 2nd by 83.7%, the indicator "texture" by 57.1 and 78.1%, the indicator "relief" by 43.8 and 66.7%, the indicator "displacement" by 54.9 and 82.1%, respectively. There were no patients with a deterioration or lack of effect on the GAIS scale in any of the study groups. According to the ultrasound scan data, the greatest effectiveness was observed in the group of complex treatment .&#x0D; Conclusion. Complex treatment, including the use of combined laser therapy (erbium and neodymium lasers) and autologous plasma with cells, is a highly effective technique for the treatment of atrophic post-acne scars.

Hypertrophic post-acne scarring is associated with a single nucleotide polymorphism (rs243865) in the matrix metalloproteinase-2 gene.

Aberrant tissue expression of matrix metalloproteinases has been observed in acne. Our objective was to study the relevance of MMP-2 (-1306 C/T, rs243865) and TIMP-2 (-418 G/C, rs8179090) single nucleotide polymorphisms (SNP) in acne and post-acne scarring. 512 patients (169 having acne without scarring, 319 having atrophic acne scarring, 24 having hypertrophic acne scarring) and 161 age-matched controls were recruited from the Dermatology Outpatient Department after obtaining informed written consent. Venous blood (5 ml) was collected for genotyping by Polymerase Chain Reaction (PCR)-Restriction Fragment Length Polymorphism (RFLP) method. The severity of acne and acne-scarring were graded. Males had a significantly increased risk of developing severe acne (P = 0.012), extra-facial acne (P = 0.047) and extra-facial acne scarring (P = 0.0001). The presence of inflammatory acne positively correlated with severity of scarring (P = 0.001). Subjects with a homozygous CC genotype of MMP-2 (-1306 C/T) had 1.0, 7.8 and 8.2 times the odds of developing hypertrophic scarring when compared to controls (P = 0.05, 95% CI: 0.7-1.6), subjects having acne without scarring (P = 0.047, 95% CI: 1.0-59.9) and subjects having atrophic scarring, respectively (P = 0.041, 95% CI: 1.1-59.9). A significant association was observed between hypertrophic post-acne scarring and the CC genotype of MMP-2 (-1306 C/T).

Fractional carbon dioxide laser-assisted delivery of lyophilized-growth factors is a promising treatment modality of post-acne scars.

Lyophilized-growth factors (L-GFs), is a new platelet rich plasma (PRP) preparation that is standardized in growth factors concentrations. The aim of this study was to compare the therapeutic efficacy of ablative fractional CO2 laser in combination with L-GFs vs PRP in post-acne scars. This study was conducted on 45 patients presented with facial post-acne scars. Each patient received three sessions of fractional CO2 laser on both sides of the face followed by topical application of L-GFs on one side and conventional PRP on the other side. Assessment was done before and after treatment semiquantitatively by Echella d'Èvaluation Clinique des Cicatrices d'Acné (ECCA) score and qualitatively by Goodman and Baron's qualitative scar (GBQS) scale, in addition to dermoscopic evaluation. The current study reported significant clinical improvement of post-acne scars on both sides of the face evidenced by significant reduction of both ECCA score and GBQS scale with minimal side effects. The degree of clinical improvement and patients' satisfaction were significantly higher with shorter downtime in response to fractional CO2 laser combined with L-GFs rather than its combination with PRP. In conclusion, laser assisted delivery of L-GFs via fractional CO2 laser could be considered a novel successful therapeutic modality for post-acne scars.

Micro Needling with Platelet Rich Plasma Versus Fractional CO2 Laser with Platelet Rich Plasma in Patients with Post Acne Scars

Background: Facial scaring has always been challenged to treat and there are many treatments available to decrease the appearance of scars like topical retinoids, chemical peeling, microneedling, dermabrasion, soft tissue fillers, botulinum toxoid injection and laser resurfacing The aim of this study was to evaluate and compare the efficacy of microneedling and fractional CO2 laser in the treatment of post acne scars. A comparative studyOf thirty patients (12 males and 18 females) aged 19 – 36 years with atrophic acne scars were devided into Group (A): treated with Fractional Co2 laser combined with topical platelet rich plasma. Group (B): treated with skin microneedling combined with topical platelet rich plasma. Platelet rich plasma can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser or microneedling and decrease the duration of related side effects including oedema and erythema. Regarding patient’s satisfaction grades there was an improvement after both treatment modalities with insignificant differences between both treatment modalities. PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser or microneedling and decrease the duration of laser-related side effects including oedema and erythema.

Serum Elafin in acne patients with and without post acne scar

Serum Elafin in acne patients with and without post acne scar

A comparative study of efficacy of resurfacing with fractional carbon dioxide laser versus derma roller in the treatment of post acne scars

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Acne vulgaris is a chronic skin disease which can present as non-inflammatory lesions, inflammatory lesions, or a mixture of both, resulting in distressing and difficult to treat scars. The objective of this study is to compare the efficacy of fractional carbon dioxide (CO&lt;sub&gt;2&lt;/sub&gt;) laser technique (FCLT) versus derma roller therapy (DT) with respect to post-acne scars and to study their respective side effects.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 200 patients of post acne scars were enrolled for this study from the outpatient Department of Dermatology, Venereology and Leprology, Navodaya Medical College Hospital and Research Centre, Raichur. The patients were randomly allocated into two groups of 100 patients each in which one group was treated with derma roller therapy and the other group was treated with fractional CO&lt;sub&gt;2&lt;/sub&gt; laser every 4 weeks over a period of 24 weeks each.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In the derma roller group, 89 patients completed the treatment with 11 drop out cases. The percentage reduction in the mean objective scores was found to be 37.63%. In the fractional CO&lt;sub&gt;2 &lt;/sub&gt;laser group, 93 patients completed the treatment with 7 drop out cases. The percentage reduction in mean objective scores was found to be 41.22%.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Comparing the efficacy of derma roller therapy and fractional CO&lt;sub&gt;2&lt;/sub&gt;laser resurfacing method in the treatment of post acne scars, both the modalities were found to be equally efficacious.&lt;/p&gt;

SKIN MICRONEEDLING PLUS SPOT TRICHLOROACETIC ACID PEEL IN THE TREATMENT OF ATROPHIC POST ACNE SCARS: COMPARATIVE SPLIT FACE STUDY

Background: Post Acne scarring is an unfortunate and frequent complication of acne vulgaris that results in many psychological and emotional problems for patients and the families. Acne scarring may be either atrophic or hypertrophic. Atrophic acne scars are further subdivided morphologically into boxcar, icepick, or rolling scars. Objective: To compare between the effect of microneedling using dermapen and microneedling plus medium depth chemical peeling using T.C.A 30% in post acne atrophic scars. Patients and methods: This study was carried out on 30 patients with different clinical variants of atrophic post acne scars diagnosed clinically on the basis of typical appearance of skin lesions. Patients were recruited from Dermatology Department outpatient clinic in Al-Azhar University hospitals from April 2019 to December 2019. Their ages ranged from 18: 30 years. Assessment of scars in both sides of face was done for their type, number, depth (severity) before and after each session and when the follow up period became completed (2 weeks after the last session). Digital Facial photographs for right and left sides of the face were obtained before treatment, during each session, and when the follow up period became completed (2 weeks after the last session). Results: Most of the patients (60%) achieved marked improvement, 30% achieved good improvement and 10% achieved excellent improvement on the left side of the face, while on the right side of the face most of patients (73.3%) achieved good response and 26.7 % achieved poor response. The mean percentage of improvement of the left side was 55.5 %, while the percentage of improvement of the right side was 33%. Conclusion: Automated microneedling (Dermapen) and T.C.A 30% chemical peel were minimally invasive simple, cheap and effective techniques in the treatment of post acne atrophic scars and improved skin homogeneity and texture. Microneedling plus spot T.C.A 30% have the advantage of rapid healing, short down time, eliminating most of risks and negative side-effects of laser resurfacing or cross technique. The treatment can be performed in an office setting and did not need any extensive special training or expensive instruments and can be used for rejuvenation of the skin, remodeling of the scar. Combination of automated microneedling with other modalities as spot T.C.A 30% for the treatment of post acne atrophic scars gave better results than the use of single modality of treatment as microneedling alone.

Autologous plasma gel injection combined with scar subcision is a successful technique for atrophic post-acne scars: a split-face study

Background Different therapeutic options can be used for post-acne scarring. Scar subcision alone or in combination with other treatments have been used by many dermatologists to treat post-acne scarring. Objectives We thought to study and compare the efficacy and safety of scar subcision combined with platelet gel injection versus scar subcision combined with PRP injection for atrophic post-acne scarring. Patients and methods Scar subcision was done 1st on both sides of the face. Plasma gel injection was done on the right side and PRP injection was done on the left side. The sessions were done monthly for 4 months followed by a 6-month follow-up period. Evaluation of the results and any complications were recorded. Results There was a significant improvement (p = .035) of the scars on the subcision-gel-side at one month following the 1st treatment session. However, along with the following sessions, there were no significant differences between both sides. Finally, at the follow-up visit after 6 months following the end of the treatment course there was a significant difference between the two sides of the face in favor of the subcision-gel-side. Conclusions Subcision combined with autologous plasma gel injection is a successful technique for atrophic post-acne scars.

Innovative methods in treatment of patients with atrophic post-acne scars

Atrophic scars after acne are a widespread condition that can have a negative impact on the patient’s quality of life. Correction methods for acne scars include chemical peeling, dermabrasion, ablative or non-ablative laser resurfacing, filler insertion and surgical techniques. Depending on the type and severity of the scar, an individual approach is required to obtain satisfactory results.Material and methods. Under observation were 61 patients with various manifestations of post-acne. Among them 21 (34.44 %) men and 40 (65.57 %) women. Depending on the therapy, the patients were divided into two groups and two subgroups depending on the type of scar. Efficiency was evaluated using ultrasound scanning.Results. The RF microneedle method and fractional photothermolysis have a positive effect on the epidermo-dermal structure of the skin, which is expressed in the approximation of the acoustic density and thickness of the epidermis and dermis to normal values. The most pronounced positive effect in both methods was noted in the correction of post-acne hypertrophic scars. When analyzing the results of correction of atrophic scars, more pronounced positive dynamics was observed after the use of RF microneedles.

Treatment of Moderate to Severe Acne and Scars With a 650-Microsecond 1064-nm Laser and Isotretinoin

Background: Laser procedures for acne and acne scars have traditionally been postponed for at least 6 to 8 months after the end of systemic isotretinoin therapy. Lower dosages with more modern laser devices having unique energy parameters of high power in microsecond pulse durations have made it possible to administer laser therapy during or shortly after completion of isotretinoin therapy, thus reducing the risk of side effects of isotretinoin.Methods: Patients with moderate to severe facial acne (n=46) and atrophic scars enrolled in a 6-month study. Genetic analysis of patients revealed the presence of polymorphisms of genes Col1A2, MMP3, ESR1, MMP1, and MMP7, which can lead to scar formation. Patients underwent low-dosage isotretinoin therapy (0.2-0.3 mg/kg/day) in combination with facial laser treatment using a 650-microsecond, 1064-nm Nd: YAG laser. Acne severity was graded using the Investigators Global Assessment (IGA) scale and quality of life was evaluated by the Dermatology Life Quality Index (DLQI). Results: IGA parameters decreased from 1.8 ± 0.2 (mean ± SD) initially to 0.5 ± 0.4 at the end of the study, a 72.3% reduction which was significant (P<0.01). The DLQI index decreased from 10.1 ± 1.3 initially to 2.8 ± 1.2, a 72.3%, a significant reduction (P<0.01). Inflammatory elements resolved without scarring. Laser treatment was well tolerated and improvement in pre-existing scars was noticeable. Conclusions: The 650-microsecond, 1064-nm laser in combination with low-dose isotretinoin is safe and effective in patients with acne complicated by atrophic scars and genetically prone to post-acne scarring. J Drugs Dermatol. 2020;19(6): doi:10.36849/JDD.2020.5108

Serum Level of Follistatin in Patients with Scarring and non Scarring Acne Vulgaris

Acne vulgaris is a chronic cutaneous inflammatory disorder. Four factors play vital roles in acne pathophysiology: hyperseborrhea , altered keratinization of the pilosebaceous duct, propionobacterium acnes (p. acnes) and inflammation. to assess serum level of follistatin in patients with scarring and non scarring AV aiming at understanding the pathogenesis of post acne scars. serum FST level was assessed in 60 acne patients (30 non scarring patients - 30 scarring patients) and 20 apparently healthy subjects as control with matched age and sex. Every patient included in the study was subjected to detailed history taking, complete general and dermatological examination and assessment of serum level of FST by using commercial ELISA kits.AV, non scarring and scarring patients had significantly higher frequency with positive family history, sun exposure and excess stress when compared to control group (p value 0.010, 0.005 and <0.001 respectively. However , No significant differences were found in risk factors between acne groups. serum FST level was significantly lower in patients with acne than control group although its level was significantly lower in scarring acne patients than non scarring patients.

Evaluation of Microneedling Therapy in Management of Facial Scars.

Appearance and beauty always have been playing a major aspect of human's lives, regardless of the era. The desire for man to look better had led to various treatment modalities. One among them is microneedling therapy, also called as percutaneous collagen induction therapy or dermaroller therapy. Henceforth, the aim of the study was to evaluate the efficacy of microneedling therapy in the management of facial scars. An observational clinical study was conducted with a total of 14 patients who needed treatment and presented to the out-patient department of Department of Oral and Maxillofacial Surgery. The patients who were cooperative, motivated, and esthetically conscious with facial scars due to trauma, soft-tissue injury following incision and drainage, postsurgical scars, scars following surgery of cleft lip correction, and postacne scars were randomly selected. In the present study, a statistically significant difference was observed with pre- and postsurgical patient satisfaction scale (PSS) and observed satisfaction scale (OSS; P = 0.001). Preoperatively there were 64.3% with depressed scars and 35.7% with elevated scars. The clinical response of height of scar postoperatively was 100% flattening with the surrounding skin surface. Results showed that all atrophic and hypertrophic scars showed improvement, and color of the scar which was darker or lighter than the surrounding skin got the same color as the surrounding skin after microneedling therapy. Pain during the procedure was easily tolerable by the patient and no postoperative pain was noted. Microneedling therapy can be considered as an effective modality of treatment for facial scars in patients with an added advantage of minimal downtime and effective improvement. It is simple and cost-effective technique in the treatment of facial scars.