Risk Of Dyspigmentation Research Articles

Percutaneous collagen induction: an effective and safe treatment for post-acne scarring in different skin phototypes

Background: Atrophic scars can complicate moderate and severe acne. There are, at present, several modalities of treatment with different results. Percutaneous collagen induction (PCI) has recently been proposed as a simple and effective therapeutic option for the management of atrophic scars. Objective:The aim of our study was to analyze the efficacy and safety of percutaneous collagen induction for the treatment of acne scarring in different skin phototypes. Methods & materials: A total of 60 patients of skin types phototype I to VI were included in the study. They were divided into three groups before beginning treatment: Group A (phototypes I to II), Group B (phototypes III to V), and Group C (phototypes VI). Each patient had three treatments at monthly intervals. The aesthetic improvement was evaluated by using a Global Aesthetic Improvement Scale (GAIS), and analyzed statistically by computerized image analysis of the patients' photographs. The differences in the GAIS scores in the different time-points of each group were found using the Wilcoxon's test for nonparametric-dependent continuous variables. Computerized image analysis of silicone replicas was used to quantify the irregularity of the surface micro-relief with Fast Fourier Transformation (FFT); average values of gray were obtained along the x- and y-axes. The calculated indexes were the integrals of areas arising from the distribution of pixels along the axes. Results:All patients completed the study. The Wilcoxon's test for nonparametric-dependent continuous variables showed a statistically significant (p < 0.05) reduction in severity grade of acne scars at T5 compared to baseline (T1). The analysis of the surface micro-relief performed on skin replicas showed a decrease in the degree of irregularity of skin texture in all three groups of patients, with an average reduction of 31% in both axes after three sessions. No short- or long-term dyschromia was observed. Conclusion: PCI offers a simple and safe modality to improve the appearance of acne scars without risk of dyspigmentation in patient of all skin types.

Percutaneous Collagen Induction Therapy as a Novel Therapeutic Option for Striae Distensae

Sir: The occurrence of striae distensae is a well-recognized, common skin condition that rarely causes any significant medical problems but is often a significant source of distress to those affected. Striae are atrophic linear plaques, most often found on the breasts, abdomen, hips, and thighs in the dermal layer. This disruption of collagen-elastic matrix may develop in a variety of circumstances, such as during adolescent growth spurts, and during hormonal changes, such as Cushing syndrome. Striae gravidarum are widely known to occur in pregnancy and, aesthetically, they can be a cause of great concern for many women. Maternal age, body mass index, weight gain, and neonatal birth weight were independently associated with the occurrence of striae gravidarum.1 It appears that the group at highest risk of developing severe striae are teenagers. Treatment is often anecdotical. To date, no therapeutic option offers complete treatment.2 Cocoa butter was recently studied in a randomized controlled trial for prevention of striae gravidarum but failed to be effective.3 Percutaneous collagen induction therapy is capable of dermal rejuvenation by smoothing of the skin by thickening the epidermal layers and expression of genes and proteins relevant for dermal regeneration without the risk of dyspigmentation.4,5 Percutaneous collagen induction works best in combination with a scientific skin care program. In contrast to ablative laser therapy, the epidermis remains intact. Thus, the procedure can be repeated safely if needed, and it is also applicable to regions where laser treatments or deep peelings cannot be performed. Twenty-two female patients with stretch marks underwent single percutaneous collagen induction therapy in an outpatient setting. All patients had conventional tumescence anesthesia. The procedure took a mean time of 30 minutes, without any immediate adverse effects, such as abdominal perforation or infection. Follow-up assessment was performed 6 months after the intervention. Assessment of the result revealed improved skin texture, skin tightening, dermal neovascularization, and no change of pigmentation (Fig. 1). Biopsy specimens obtained 6 months after the intervention revealed an increase of collagen I and elastin (Fig. 2). Collagen III was not affected at all.Fig. 1.: Preoperative (above) and postoperative (6 months after treatment) (below) clinical images.Fig. 2.: Preoperative (above) and postoperative (6 months after treatment) (below) histologic photomicrographs of striae distensae showing a considerable normalization of the collagen/elastin matrix in the reticular dermis and an increase in collagen deposition at 6 months postoperatively. The collagen appears not to have been laid down in parallel bundles but is rather in the normal lattice pattern. Masson's trichrome staining. Scale bar = 50 μm (representative example).Given this preliminary clinical observation of percutaneous collagen induction therapy in striae distensae, we strongly believe that further large-scale and possibly randomized controlled trials are mandatory to elucidate the value of this promising technique. DISCLOSURE Dr. Aust is a medical consultant for Care Concept, distributors for Environ Skin Care Products and Roll-CitR in Germany. Neither of the other authors has any financial information to disclose. Matthias C. Aust, M.D. Karsten Knobloch, M.D., Ph.D. Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery Hannover Medical School Hannover, Germany

Percutaneous collagen induction–regeneration in place of cicatrisation?

Ablative procedures that are used for the improvement of a degenerative process that leads to a loss of skin elasticity and integrity, injure or destroy the epidermis and its basement membrane and lead to fibrosis of the papillary dermis. It was recently shown in clinical and laboratory trials that percutaneous collagen induction (PCI) by multiple needle application is a method for safely treating wrinkles and scars and smoothening the skin without the risk of dyspigmentation. In our study, we describe the effect of PCI on epidermal thickness and the induction of genes relevant for regenerative processes in the skin in a small animal model. The purpose of this study in a rat model was to determine the effects of PCI on the skin both qualitatively and quantitatively. The epidermal and dermal changes were observed by histology and immunofluorescence. The changes in gene expression were measured by array analysis for cytokines, such as vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF)-7, epidermal growth factor (EGF) and extracellular matrix molecules such as collagen type I and type III. The present study showed that PCI with topical vitamins resulted in a 140% increase in epidermal thickness; an increase in gene and protein expression of collagen I, glycosaminoglycans (GAGs) and growth factors such as VEGF, EGF and FGF7. The collagen fibre bundles were increased, thickened, and more loosely woven in both the papillary and reticular dermis. We were able to show that PCI modulates gene expression in skin of those genes that are relevant for extracellular matrix remodelling.

Percutaneous Collagen Induction: Minimally Invasive Skin Rejuvenation without Risk of Hyperpigmentation—Fact or Fiction?

Photoaging is generally treated by ablative procedures that injure the epidermis and basal membrane and lead to fibrosis of the papillary dermis. Damaging the epidermis significantly can cause potential adverse effects such as dyspigmentation. It was recently shown in clinical trials that percutaneous collagen induction therapy is an alternative for safely treating wrinkles and scars and for smoothening the skin without the risk of dyspigmentation. The purpose of this study was to increase current knowledge regarding whether percutaneous collagen induction therapy presents an effective means for skin rejuvenation without risk of dyspigmentation, as the authors' clinical data suggested. Fifty-six rats were assigned to three groups: group A (n = 24), percutaneous collagen induction therapy plus skin care; group B (n = 24), skin care; and group C (n = 8) controls. The authors evaluated the effect of percutaneous collagen induction therapy on the epidermis, melanocytes, and the pigmentation markers interleukin-10 and melanocyte-stimulating hormone. Percutaneous collagen induction therapy left the epidermis intact without any damage to the stratum corneum, any other layers of the epidermis, or the basal membrane. No signs of dermabrasive reduction of epidermal thickness were evident 24 hours after the procedure. The number of melanocytes neither increased nor decreased in any of the groups. DNA microarray experiments demonstrated that interleukin-10 was increased in percutaneous collagen induction therapy-treated skin after 2 weeks. Concerning the MC1R (melanocyte-stimulating hormone) gene, gene expression microarray analysis indicated a faint down-regulation both 24 hours and 2 weeks after percutaneous collagen induction therapy. Percutaneous collagen induction therapy offers a modality with which to rejuvenate and improve skin appearance and quality without risk of dyspigmentation.

Comparison study of a long‐pulse pulsed dye laser and a long‐pulse pulsed alexandrite laser in the treatment of port wine stains

Background: Port wine stains (PWSs) are commonly treated by the pulsed dye laser. Recently, a long‐pulse pulsed alexandrite laser was used to treat bulky vascular malformations. Objective: In the present study, we compare the efficacy and complications of the long‐pulse pulsed dye laser (LPPDL) and the long‐pulse pulsed alexandrite laser (LPPAL) in the treatment of PWSs. Methods: Eleven patients with Fitzpatrick skin types III–IV were enrolled in this study. One section of each patient's PWS was treated with LPPDL and another section was treated with LPPAL. The patients' PWSs were evaluated for efficacy of elimination of erythema and for treatment‐related side effects. Results: Both LPPDL and LPPAL treatment are effective in the treatment of PWSs. Hyperpigmentation was seen in two areas treated with LPPDL and in three areas treated with LPPAL. Hypopigmentation was seen in one area treated with LPPAL, but not in any of the areas treated with LPPDL. There was no scarring. Conclusion: LPPAL works best with hypertrophic, purple PWSs, while LPPDL yields better clinical improvements with the flat, pink PWSs. Targeting of deoxyhemoglobin, deeper penetration, and higher fluence may explain the effectiveness of LPPAL in purple, hypertrophic PWSs. However, there is a risk of dyspigmentation when using the LPPAL.

Laser Resurfacing in Pigmented Skin

Laser skin resurfacing is a very promising new treatment for solar elastosis and acne scars. The Ultrapulse carbon dioxide (CO2) laser and the SilkTouch flashscanner allow precise depth control and char-free ablation. Earlier studies have been done mainly on Caucasian skin types I and II, but very little data were available on pigmented skin. The purpose of this study is to assess the efficacy and safety of laser skin resurfacing in skin types III and IV. Thirty Asian and Hispanic patients were treated for facial rhytides and acne scars. All patients were instructed to use tretinoin cream 0.05%, hydroquinone 5%, and desonide 0.1% cream nightly for 2-4 weeks prior to the laser treatment. The Ultrapulse 5000C CO2 laser with the Truespot 3-mm collimated handpiece at the setting of 250-450 mJ per pulse, or the Silk-Touch flashscanner at the setting of 5-7 W, 0.2-second pulse duration, and 4-mm (M) spot size, was used. Patients were evaluated clinically, and global response was assessed by both clinicians and patients. The facial rhytides and acne scars improved 25-50% in all patients after one laser treatment. The most common side effects were persistent erythema that resolved on the average of 6 weeks. Hyperpigmentation occurred, but was reduced with regular use of tretinoin, hydroquinone, and desonide cream both pre- and postoperatively along with use of broad spectrum sunscreen after treatments. Laser skin resurfacing can be used to treat facial rhytides and acne scars in skin phototypes III and IV. When proper pre- and postoperative management is implemented, the risk of dyspigmentation can be reduced.