Quartile Grading Research Articles

Evaluating the Efficacy of Oral Ivermectin on Clinical Symptoms and Demodex Densities in Patients with Demodicosis.

Dermatologists consistently face challenges in treating demodicosis due to its high recurrence rate and difficulty normalizing the Demodex density (Dd) even after clinical improvement. Oral ivermectin has proven to be an effective treatment for demodicosis. However, there is a lack of comprehensive information on the clinical and acaricidal effects of oral ivermectin in treating demodicosis. This study aims to evaluate the effectiveness of oral ivermectin on clinical symptoms and Dds of patients with demodicosis. This prospective, quasi-experimental study included 40 demodicosis patients (20 with Demodex densities (Dds) < 20 D/cm2, 20 with Dds ≥20 D/cm2). Both groups of patients were treated with oral ivermectin (200µg/kg/week) until excellent clinical improvement (Grade 4 according to the Quartile Grading Scale), and Dds ≤ 5 D/cm2 or treated with oral ivermectin for a total of eight weeks period. In our study, 75% of patients achieved clinical remission, showing excellent clinical improvement with Dds ≤ 5 D/cm2. All patients with a Dds <20 D/cm² experienced remission, while 50% with a Dds ≥20 D/cm² achieved remission. The median time to remission after oral ivermectin treatment was 28 days for Dds <20 D/cm² and 56 days for Dds ≥20 D/cm² (p < 0.001). Oral ivermectin effectively improves clinical symptoms and normalizes Dds in patients with demodicosis. Patients with higher Dds require a longer treatment than those with lower Dds.

Comparative study between efficacy of Excimer light with topical Tacrolimus 0.1% versus excimer light with topical Bimatoprost 0.01% in treatment of facial Vitiligo

Loss and absence of melanocytes due to a number of factors is responsible for vitiligo; known to be the commonest disorder of pigmentation. The aim of the current work was to compare the efficacy and safety of excimer light with topical tacrolimus ointment 0.1% versus excimer light with topical bimatoprost gel 0.01% in treatment of facial vitiligo. The study was carried out on 48 patients presented with facial vitiligo. The patients were divided randomly using sealed envelope method into two groups (24 patients each). Group 1 were treated with excimer light plus topical tacrolimus ointment 0.1% and group 2 treated with excimer light plus topical bimatoprost gel 0.01%. Clinical improvement based on the quartile grading scale at the end of treatment did not show any statistically significant difference between groups. The majority of subjects in both groups experienced good to excellent improvement. Only 20.9% of patients in group 1 and 33.3% of subjects in group 2 achieved less than 50% repigmentation (p = 0.889). Our study demonstrated that 0.01% topical bimatoprost gel in combination with excimer light is considered safe and effective as treatment of nonsegmental facial vitiligo with comparable results to 0.1% tacrolimus.

Efficacy and safety of fractional micro-needling radiofrequency for the treatment of enlarged pores on the cheeks of a chinese cohort: a retrospective study.

To explore the efficacy and safety of fractional micro-needling radiofrequency (FMRF) in the treatment of enlarged pores on the cheek in a Chinese cohort. Patients with enlarged facial pores who underwent FMRF between January 2020 and December 2022 were included in this study. Blinded clinical assessments were performed by two independent dermatologists using a six-grade photographic enlarged pore scale and a quartile grading scale. Patients were asked to rate the degree of pain related to treatment on a visual analog scale (VAS), with scores ranging from 0 (no pain) to 10 (worst pain ever). A paired t-test was used to analyze the six-grade photographic enlarged pore scores. A total of 22 patients received three consecutive sessions of FMRF treatment, with intervals of 1-3 months, and underwent follow-up as scheduled. The mean six-grade photographic enlarged score was 3.55 ± 0.96 at baseline, while the score decreased significantly to 2.59 ± 0.59 after three treatment sessions (P < 0.05). The improvement score of the patients, assessed by two independent dermatologists, was 2.31 ± 0.71, according to the quartile grading scale. The mean VAS score was 6.42 ± 1.44. FMRF is effective and safe for the treatment of enlarged facial pores after three sessions.

Evaluation of combining ultrapulse CO2 with fractional CO2 laser for the treatment of atrophic scars in Asians.

Various treatment modalities have been applied to atrophic scars. Fractional CO2 laser treatment has attracted increasingly more attention because of its quicker recovery time and fewer side effects. However, its limitation of sculpting the edge is an urgent shortcoming. In order to achieve a more effective result with fewer complications, we have integrated ultrapulse CO2 and fractional CO2 lasers to for the treatment of facial atrophic scars. The study included 25 patients (10 males and 15 females) diagnosed with moderate to severe atrophic scars between August 2020 and July 2022. All subjects underwent the same surgical treatment. The effects were assessed at baseline, 1week, 1month, and 3months using photographic evidence. Objective evaluation of the results was conducted using a quartile grading scale, while the subjects' satisfaction and any adverse events were also recorded. The patients in the study underwent more than two laser sessions (2-5), resulting in substantial improvement in their appearance. The time interval between each session was 3-6months. The majority of the patients (19/25, 76%) had a significant or even excellent improvement. Any adverse events observed, such as erythema, superficial crusting, and PIH, were of a mild nature and temporary in duration. This treatment combined two CO2 lasers is an effective and safe choice for atrophic scars in Asians.

Effectiveness and Safety of Energy-Based Devices for Acne Scars: A Network Meta-Analysis of Randomized Controlled Trials.

Background: Acne vulgaris is an inflammatory disease of the pilosebaceous unit in teenagers. Acne-induced inflammation leads to acne scarring. Scholars have discussed acne scar treatments; however, energy-based devices with satisfactory outcomes remain unidentified. Objective: To measure quartile grading scale and visual analog scale (VAS) to study the difference between energy-based devices. Methods: We included randomized controlled trials that evaluated patients with acne scars. The primary outcomes were the quartile grading scale and VAS scores. We used Confidence in Network Meta-Analysis to evaluate indirectness, imprecision, heterogeneity, and incoherence. Results: A total of 26 studies met the inclusion criteria. The quartile grading scale results revealed that ablative fractional laser was significantly more effective than nonablative fractional laser (standard mean difference [SMD]: 0.516, confidence interval [95% CI]: 0.281-0.750) and radiofrequency treatment (SMD: 0.941, 95% CI: 0.540-1.342). Moreover, nonablative fractional laser was significantly more effective than radiofrequency treatment (SMD: 0.426, 95% CI: 0.049-0.802). No significant difference in VAS score was found among the devices. Conclusion: Ablative fractional laser is an effective treatment for acne scars although it is associated with more pain.

Treatment of striae albae with 1,550 nm Er: Glass vs. CO2 fractional laser: A self-controlled study.

The objective of this study was to compare the efficacy and safety of fractional CO2 laser and 1,550 nm Er: glass laser in the treatment for the patients with striae albae. The female adults with striae albae in the abdomen for at least 12 months were recruited. After informed consent obtained, the patient received three treatments at 2-month intervals. The lesions on the left abdomen were treated with 10,600 nm CO2 fractional laser and right side treated with 1,550 nm Er: glass fractional laser. The pictures were taken before each visit and 3 months after the final treatment. The criteria for the evaluations using a quartile grading scale were excellent (76-100%), good (51-75%), fair (26-50%), poor (1-25%), and no improvement (0%). The safety and efficacy of the two lasers were independently evaluated using before and after photographs by two dermatologists. In addition, the self-reports to investigate the pain and satisfaction from patients were also recorded. Totally, 27 cases were recruited, and 25 patients completed the treatments and follow-up. The excellent and good results (improvement of 51-100%) were achieved on the right abdomen in 84% of the patients, while 48% on the left site (p < 0.05). Hyper-pigmentation was seen in 20% of the patients assessed on the left abdomen and only in 8% on the right abdomen. During the treatments, average score of the pain on the right abdomen was 5.41 ± 2.13, which was higher than that on the left (4.19 ± 2.12) (p < 0.001). No permanent hyper-pigmentation was found on the both sides. Considering the whole treatments, the patients favored the modality used on the right side (80 vs. 68%, p < 0.05). Compared with CO2 fractional laser, 1,550 nm Er: glass fractional laser therapy provides the significantly better clinical outcomes and fewer side effects in the treatment of striae albae. The sample size and follow-up time were limited.

A Comparative Study on the Usefulness of Fractional CO2 and Fractional Er:YAG in Acne Scars: A Split-Face Trial.

Acne is a dermatologic condition with a high burden in terms of psychosocial consequences as a result of scars remaining on the skin. Its effects are severe in adolescence and finding treatments with short therapy courses, superior results, and fewer adverse effects are of high importance. We included 30 individuals with acne vulgaris scars in Al-Zahra academic training hospital from June 2018 to Jan 2019. Each individual received both fractional CO2 and fractional Er:YAG lasers on right and left sides of the face, respectively. Three sessions of laser treatment were applied to each side with one-month intervals. Results were evaluated by patients according to subjective satisfaction and physicians' assessment and photo evaluation by two blinded dermatologists. Improvement was graded by a quartile grading scale: less than 25%: mild, 25% to 50%: moderate, 51% to 75%: good, and 76% to 100%: excellent response. Assessments were obtained at baseline and one month after the last visit. Based on subjective satisfaction (p < 0.05) and physicians' assessment (p < 0.01), fractional CO2 laser was significantly more effective than Erbium:YAG laser. Also, Post-treatment side effects were mild and transient in both groups. Laser therapies are common in the treatment of scars and each modality has special advantages and disadvantages. Choosing among them should be based on various criteria. Fractional CO2 lasers have been revealed favorable results in most reports. Large comprehensive trials could help experts in choosing among alternatives for different subgroups.

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

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

Microneedling combined with botulinum toxin-A versus microneedling combined with platelet-rich plasma in treatment of atrophic acne scars: a comparative split face study

BackgroundAtrophic post-acne scarring constitutes a troublesome cosmetic concern for both patients and dermatologists. Old and new therapies as well as combinations are being introduced to achieve a satisfactory response. Microneedling has been used either alone or under different combinations for its treatment. The aim was to compare its combination with topical platelet-rich plasma versus its combination with topical Botulinum Toxin-A.Methods30 subjects with different types and grades of atrophic post-acne scars completed the study. Right side of the face was treated with microneedling and platelet-rich plasma while the left side was treated microneedling and Botulinum toxin-A. Response was assessed using two different scales. Patient satisfaction and pain were also assessed.ResultsRegarding response to therapy and according to the quartile grading scale, there was no statistically significant difference between the two sides where (23.4% & 13.3%) of the right and left sides, respectively, had an excellent response. Regarding the difference in the qualitative global scarring grading system before and after treatment, there was a highly statistically significant improvement on both sides with higher improvement on the right side than left side but in a non-statistically significant way.ConclusionsBoth combinations present efficacious options for treating acne scars with comparable efficacy.Trial registrationRegistered and approved prospectively by the ethical review board of the faculty of medicine, Zagazig University.

33213 Nonsurgical facelift: Clinical and histologic evaluation of fractional radiofrequency treatment on fine lines and skin laxity

Background: Fractional radiofrequency (FRF) microneedling technology has shown effectiveness in improving skin laxity and wrinkles. We report our nonsurgical face-lift experience using 5 pairs of electrically isolated 32-gauge microneedles. The device uses insulated needles which are inserted at a 25° angle to the skin surface. This allows selective thermal impact to the dermis while sparing the epidermis. Objective: This study was conducted to evaluate the efficacy and safety of a temperature controlled FRF microneedling device on fine lines and skin laxity. Methods: 15 patients with skin laxity and fine lines were treated with a single session of FRF with microneedling. All subjects were treated with local tumescent anesthesia prior to treatment. FRF treatment was administered through five 32 g needle electrode pairs at a preselected real-time fixed temperature of 62°C to 70°C, and an energy duration of 3 to 4 seconds. A punch biopsy was performed before and after treatment in 9 patients. Clinical photographs were obtained before treatment and at follow-up. Two blinded dermatologists assessed the clinical improvement in terms of skin laxity and fine lines using a quartile grading scale. Any adverse effects were assessed during the entire study period. Results: All patients experienced both subjective and objective improvement. No serious adverse effects were reported. Transient adverse events were transient edema, and erythema. Histologic evaluation revealed increased dermal collagen and straightening of elastic fibers in the reticular dermis after treatment. Conclusion: Fractional radiofrequency (FRF) microneedling technology may be successfully used for a nonsurgical facelift.

35101 Combination treatment of transdermal micro-jet using Er:YAG laser and ablative fractional 10,600-nm carbon dioxide laser for acne scar

Background: Various treatment modalities have been used to treat acne scars. Transdermal micro-jet using Er:YAG laser is a new concept called TDDS (Trans-Dermal Drug Delivery System) that sprays small amounts of drugs into the dermis without needles. Carbon dioxide (CO2) fractional laser is one of the most effective and commonly used tool for acne scar. This study aimed to evaluate the efficacy and safety of combination therapy transdermal micro-jet using Er:YAG laser and CO2 fractional laser for acne scar. Materials and methods: Fourteen patients with acne scars were treated 3 sessions of combining transdermal micro-jet using Er:YAG and CO2 fractional laser with 3∼4 week interval. Patients treated with a spot size of 4 mm, fluence of 2.0∼4.8 J/cm2 was performed by transdermal micro-jet using Er:YAG laser. Then CO2 fractional laser was performed. A punch biopsy was performed before and after treatment in 4 patients for histologic analysis. Clinical photographs were obtained before treatment and at follow-up. Two blinded dermatologists assessed the clinical improvement in terms of acne scar using a quartile grading scale. Results: All patients experienced both subjective and objective improvement. The patient satisfaction surveys showed that 12 patients (85.7%) perceived a moderate to excellent improvement (>50%) in their condition. No adverse reactions were reported. Histopathologic evaluation with hematoxylin and eosin staining showed new collagen generation in the dermis. Conclusion: Our preliminary findings suggest a safe therapeutic alternative for acne scars.

A pilot study of combined oral minocycline and narrowband UVB phototherapy in vitiligo: A randomized, double-blind, placebo-controlled trial.

Narrowband ultraviolet B (NBUVB) phototherapy is an effective therapeutic option for generalized vitiligo. Previous reports showed the potential benefit of minocycline to stop disease progression in vitiligo. Meanwhile, minocycline has antioxidative, anti-inflammatory, and immunomodulating properties. There is no clinical study combining oral minocycline and NBUVB for treating generalized vitiligo. This study aims to compare the efficacy and safety of the combination treatment of NBUVB plus oral minocycline with NBUVB alone in generalized vitiligo. A randomized, double-blinded, placebo-controlled pilot study was conducted. Patients were randomly treated with either combined oral minocycline 100 mg per day plus NBUVB phototherapy or placebo plus NBUVB. All patients recieved NBUVB two times per week, for 12 weeks. The outcomes were assessed using Vitiligo Area Scoring Index score (VASI) percent change, quartile grading scale (QGS) of repigmentation, and Vitiligo Disease Activity Index (VIDA) score. Fourteen generalized vitiligo patients were included, and seven cases were assigned in each group. At week 12, the mean VASI score was decreased by 28.87% (24.15) in the minocycline group compared to 27.26% (7.98) in placebo group (p= 0.886). No significant difference was observed between both treatment modalities in QGS of repigmentation and mean VIDA score change. Two of the seven patients (29%) receiving minocycline developed hyperpigmentation, dark-brown and muddy brown discoloration, which was only confined to some vitiliginous patches. In conclusion, combination therapy with oral minocycline does not enhance the efficacy of NBUVB in generalized vitiligo. Due to the high incidence of drug-induced skin hyperpigmentation, minocycline plus NBUVB should be avoided.

Microneedling with topical vitamin C versus microneedling with topical insulin in the treatment of atrophic post-acne scars: A split-face study.

Post acne scars following sebaceous injury and abnormal wound healing during the course of acne is a prevalent and challenging to treat condition To evaluate microneedling by dermapen with topical vitamin C versus microneedling with topical insulin in treating atrophic post-acne scars. A split-face comparative study included 30 subjects with atrophic post-acne scars. Human insulin was topically applied to the left side of the face and on the right side, vitamin C serum was applied. Scars were assessed via the Acne Scar Assessment Scale (ASAS) and Scar quartile grading scale (SQGS). After 1 month of 4 treatments, a statistically significant mean improvement in ASAS value was reported on both split sides of the face (2.13 and 1.83) compared to baseline (3.03 and 2.93) (p=0.005; p=0.001 respectively). When compared to baseline, the mean ASAS value improved significantly with a slight more improvement on the vitamin c treated side. Topical insulin and vitamin c combined with microneedling, may both achieve comparable significant improvement for treating post acne scars. Insulin can be a promising novel anti-scarring therapy pending larger controlled studies to verify its efficacy.

Efficacy of ablative fractional carbon dioxide laser combined with autologous platelet‐rich plasma versus ablative fractional carbon dioxide laser and placebo in the treatment of striae gravidarum: A randomized clinical trial

Striae gravidarum (SG) is a connective tissue disorder seen commonly in primigravidas. It is associated with impairment in the quality of life. To determine the efficacy of ablative fractional carbon dioxide (CO2 ) laser combined with autologous platelet-rich plasma (PRP) versus ablative fractional CO2 laser and placebo in the treatment of SG. Randomized, double-blinded, and placebo-controlled trial. The study was conducted in 16 patients with SG. The assigned treatment area (abdomen) was divided into two sides and was randomly assigned to the PRP side and the control side. All patients received ablative fractional CO2 laser. Immediately after each laser procedure, the PRP side received autologous PRP, while the control side received plain normal saline solution (pNSS) as a placebo. The study was done for three sessions, at intervals of 4weeks. An independent assessor used the photographs taken at Weeks 6, 10, 14, and 16 to assess the clinical improvement. The patient satisfaction was reported at the same intervals. A quartile grading scale was used to measure both the clinical improvement and patient satisfaction. Data were analyzed using the Jonckheere-Terpstra test. Histopathology was done before treatment and at the end of the study period. The combination of ablative fractional CO2 laser and autologous PRP had better clinical improvement and patients' satisfaction compared with ablative fractional CO2 laser and placebo. However, both outcome measures were not statistically significant. Ablative fractional CO2 laser combined with autologous PRP appears to be an effective treatment in SG.

Fractional erbium: YSGG laser compared to the combination of fractional erbium: YSGG laser and topical autologous platelet-rich plasma for treatment of atrophic acne scars: a case report

Background: Acne scar is the most common complication in acne that occurs in about 49% of acne individuals. Fractional resurfacing lasers such as CO2 laser and erbium-doped yttrium aluminum garnet (Er: YAG) have been widely used for acne scar treatment and give satisfying results have complications such as pain, hyperpigmentation, infection, prolonged erythema, and scarring. Fractional erbium: yttrium scandium gallium garnet (Er: YSGG) laser solves previous laser techniques' disadvantages. It has an ideal wavelength of 2790 nm, which balances the epidermis layer's vaporization and thermal damage in the dermis's superficial layer. Platelet Rich Plasma (PRP) is an autologous concentration of human platelets in a small plasma volume that secreted various growth factors that can speed up the scar healing process.Case report: A-24 years old male student came with a chief complaint of acne scars on his face four years before the examination. The patient's condition is classified as moderate-severe acne scarring based on Goodman and Baron's criteria (qualitative global acne scarring system). Acne scars treatment plan was single fractional erbium: YSGG laser for the left side of the face and combined fractional Er: YSGG laser with topical autologous PRP on the right side. This procedure was performed in 2 sessions with an interval of 4 weeks, the final evaluation at 12 weeks after the first procedure. Clinical improvement of acne scars was assessed using qualitative and quantitative scales based on Goodman and Baron's, patient and observer scar assessment scale (POSAS), quartile grading scale, and patient satisfaction level.Conclusion: In the final evaluation, there was an improvement on the entire grading scale on the right side of the face (Er: YSGG laser + PRP) and the face's left side (Er: YSGG laser only). Post-treatment erythema was found on both sides of the patient's face but disappeared within three days on the face's right side and five days on the face's left side.

Pseudofolliculitis barbae treatment: Efficacy of topical eflornithine, long‐pulsed Nd‐YAG laser versus their combination

Pseudofolliculitis barbae (PFB) is a chronic inflammatory disorder occurring mostly in regions of thick hair growth after shaving. PFB is characterized clinically by multiple painful, pruritic erythematous papules and, less commonly, pustules, nodules, or abscesses. To evaluate the efficacy of topical eflornithine cream only, long-pulsed Nd-YAG laser, versus their combination for PFB management. Overall, 40 male patients with PFB were allocated into 3 treatment groups; Group 1 (n=12): Treated by topical eflornithine cream twice daily for 16weeks, Group II (n=13): Treated by long-pulsed Nd-YAG laser for 4 sessions 4-week interval, Group III (n=15): Treated by this combination for 16weeks. The patients were evaluated after 16weeks and for a further 12weeks through serial photographs, Folliscopic evaluation, and a quartile grading system for improvement. After 16weeks of treatments, the mean improvement percentages of the inflammatory papules, as well as hair density in the long-pulsed Nd-YAG laser +eflornithine cream, treated group were significantly higher compared with either eflornithine cream treated group or laser-only treated group. The same relationship was demonstrated after 12weeks of follow-up but with lower improvements compared with 16weeks of treatment outcome. Topical eflornithine cream exerts an additive effect on long-pulsed Nd-YAG laser in enhancing the rate and degree of hair reduction and inflammatory papules in PFB cases with a further follow-up improvement. This combined approach should be long-established in larger sample sizes and long-term studies.

Treating Striae Distensae Albae in Asians: Efficacy and Safety of Combined MFU-V and CaHA.

Background:This study evaluated the efficacy and safety of a single treatment combining microfocused ultrasound with visualization (MFU-V) and subdermal diluted calcium hydroxylapatite with lidocaine (CaHA+) for Striae Distensae Albae (SDA).Methods:Ten prospectively enrolled women with abdominal, back or thigh SDA were treated with MFU-V at 3 focal depths (4.5, 3.0, and 1.5 mm), followed by 3–6 mL of diluted CaHA+ (1:1 ratio) in the same session. Outcomes were assessed at 1 month, 3 months, and 5 months postprocedure using a 5-point quartile grading scale, an SDA scoring scale, a 10-point visual analog score, and a global aesthetic improvement scale.Results:All patients exhibited improvement in SDA at 3 months, with further improvement at 6 months. Physicians’ assessment with the quartile grading scale showed that 8 patients improved moderately, whereas 2 had good improvement at 6 months. The mean overall SDA score was 11.6 at baseline, 11.1 (not significant) at 1 month, 7.9 (P = 0.005) at 3 months, and 6.2 (P = 0.005) at 6 months. All patients had improved global aesthetic improvement scale at 3 and 6 months, with 4 patients being much improved, and 3 patients being very much improved at 6 months. At the end of the study, all patients were less bothered with their SDA compared with baseline with a mean reduction of 2.7 in visual analog score, and all patients were satisfied or very satisfied with the treatment. No adverse events occurred.Conclusion:A single combination treatment of MFU-V and diluted CaHA+ improves SDA without side effects and may be considered for patients seeking to minimize SDA.

Combined autologous platelet‐rich plasma with microneedling versus microneedling with non‐cross‐linked hyaluronic acid in the treatment of atrophic acne scars: Split‐face study

Acne scarring causes cosmetic discomfort, depression, low self-esteem and reduced quality of life. Microneedling is an established treatment for scars. A multimodality approach to scar treatment is usually necessary to achieve the best cosmetic results. The objective of this study was to evaluate the efficacy and safety of platelet rich plasma (PRP) combined with microneedling in comparison with microneedling with non-cross-linked hyaluronic acid for the treatment of atrophic acne scars. Forty-one patients of 20-40 years of age with atrophic acne scars were included. Microneedling was performed on both halves of the face. Topical application of PRP was given on right half of the face, while the left half of the face was treated with topical application of non-cross-linked hyaluronic acid. Four treatment sessions were given at an interval of 1 month consecutively. Goodman's Qualitative scale and the quartile grading scale are used for the final evaluation of results. There was a statistically significant improvement in acne scars after treatment among the studied group. Right and left halves showed 85.4% and 82.9% improvement, So the difference of the improvement between the two modalities is statistically insignificant P > 0.05 We conclude that microneedling has efficacy in the management of atrophic acne scars. It can be combined with either PRP or noncross-linked hyaluronic acid to enhance the final clinical outcomes in comparison with microneedling alone. The difference between the two modalities is insignificant.

Non-Ablative 1927 nm Fractional Thulium Fiber Laser: New, Promising Treatment Modality for Riehl's Melanosis.

The treatment of Riehl's melanosis, also known as pigmented contact dermatitis, is highly challenging. Intense pulsed light (IPL) and 1064 nm Q-switched Nd:Yag (QS-Nd:YAG) laser are reported to have some efficacy. However, no single effective treatment has yet been identified. In this study, we demonstrated the efficacy and safety of the non-ablative 1927 nm fractional thulium fiber laser (TFL, LASEMD™; Lutronic Corp., Goyang, Korea) for patients with Riehl's melanosis. A retrospective chart and photographic review of nine patients with Riehl's melanosis, who had received at least three sessions of TFL treatment, was performed. Before the start of TFL treatment, combination treatment with a topical cream containing hydroquinone, low-fluence QS-Nd:YAG laser, pulsed dye laser, and IPL was used with variable and discouraging effects. Seven patients were treated on the face and two patients on the neck with three to seven sessions at 1-month intervals. Clinical improvement was assessed using clinical photos taken before and after every treatment session according to dermal pigmentation area and severity index (DPASI) and a quartile grading scale by two blinded dermatologists. Patients underwent three to seven sessions of TFL treatment depending on severity of pigmentation. Of nine patients, six demonstrated a clinical improvement of 51%-75%, one demonstrated an improvement of 76%-100%, and two showed an improvement of 26%-50% after treatment. The DPASI was significantly decreased from 9.55 to 5.25 on average. Melanin index was decreased after treatment in two patients whose melanin index were measured at initial visits. Treatment-related adverse events, such as scarring or postinflammatory hyperpigmentation (PIH), were not observed in all patients except for transient erythema and swelling. This report suggests that TFL could be an alternative and/or additive treatment option for hyperpigmentation in intractable Riehl's melanosis and might be a promising treatment for PIH caused by any reason including Riehl's melanosis. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

The Efficacy and Safety of a Variable Square Pulse (VSP) Erbium:YAG Laser for Treatment of Enlarged Pores in Asians.

Enlarged pores are one of the most common causes of skin surface irregularities. Existing studies supporting the benefit of lasers and energy-based devices (EBD) for this condition are limited, with a short duration of follow-up period. We aimed to evaluate the efficacy and adverse effects of Er:YAG laser for treatment of enlarged pores in dark-skinned patients. Nineteen subjects (aged 26-47 years) with skin phototypes III (21.1%) and IV (78.9%) and enlarged pores were treated with 4 monthly sessions of Erbium:YAG laser. Objective (ultraviolet light A video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline, 1-month after each treatment and at 1, 3, and 6 months after the final treatment. The weighted mean score of quartile grading scales showed significant improvement in pore size from baseline starting at 1-month after the third treatment and continued until 3 months after the fourth (final) treatment (P < 0.001). However, the improvement dropped significantly at 6 months after the final treatment. Objective measurements of the improvements in skin surface smoothness and wrinkles corresponded with the physician raters' clinical evaluation. Erbium:YAG laser is a safe and effective treatment for enlarged pores in dark-skinned individuals. Maintenance treatments are recommended to achieve a longer-lasting outcome. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.