Types Of Scars Research Articles

An Update on Molecular Mechanisms of Scarring—A Narrative Review

Fibroblasts, the principal cellular mediators of connective tissue remodeling, play a crucial role in the formation of physiological and pathological scars. Understanding the intricate interplay between fibroblasts and other cellular and molecular components is essential for elucidating the underlying mechanisms driving scar formation. Hypertrophic scars, keloids and atrophic scars arise from dysregulated wound healing processes characterized by persistent inflammation, aberrant collagen deposition, and impaired extracellular matrix remodeling. Fibroblasts play a central role in the pathogenesis of such pathological scars, driving aberrant extracellular matrix remodeling, subsequently contributing to the formation of raised or depressed fibrotic lesions. The investigation of complex interactions between fibroblasts and the microenvironment is crucial for developing targeted therapeutic interventions aimed at modulating fibroblast activity and improving clinical outcomes in patients with pathological scars. Further research into the molecular pathways governing fibroblast behavior and their heterogeneity holds promise for advancing scar management strategies. This narrative review was performed to shed light on the mechanisms behind scar formation, with a special focus on the role of fibroblasts in the formation of different types of scars, providing insights into the pathophysiology of these conditions. Through the analysis of current knowledge, this review seeks to identify the key cellular and molecular mechanisms involved in fibroblast activation, collagen synthesis, and extracellular matrix remodeling in hypertrophic scar, keloid, or atrophic scar formation.

Low-tech Treatments for Acne Scarring: CROSS, Subcision, and Injectables

Dermatologists routinely treat acne with the objective of preventing acne scarring. Once control of acne has been achieved, our patients are often keen to improve textural skin changes such as atrophic acne scars. We often equate the management of atrophic acne scars with the need to reach for high-tech devices such as resurfacing lasers or radiofrequency-microneedling. While these modalities can play a pivotal role in resurfacing the skin, low-tech treatments can also be used in monotherapy or combination treatment to improve specific types of acne scars. In this article, we discuss the CROSS technique, subcision, and the use of injectables for acne scars.

Efficacy and adverse reactions of fractional CO2 lasers for treating papular acne scars: a retrospective study of 35 patients.

Papular acne scars are a special type of acne scar, and the prevalence and treatment of this disease have rarely been reported in the literature; moreover, the prevalence of this disease is often neglected, and treatment is difficult. Our study revealed a high prevalence of this type of acne scar in the clinic and explored an effective and safe method. This retrospective study aimed to analyse the prevalence of papular acne scarring among patients attending our Dermatology Laser Clinic and evaluate the clinical efficacy of fractional CO2 lasers. We retrieved the data of 370 patients with acne scarring who visited our hospital between April 2021 and November 2022 and analysed the prevalence of papillary acne scarring among them. Among these patients, 35 underwent CO2 laser treatment using an artificial grid pattern. A total of three treatments were administered, with a two-month interval between each session. Scar assessment was conducted using the Global Scar Scale (GSS) and the Acne Scar Clinical Assessment (ECCA) scale, along with physician visual evaluation and patient satisfaction surveys, both before the first treatment and one month after the final treatment. Adverse reactions were recorded during follow-up visits after each treatment. Among the 370 patients with acne scarring, 128 exhibited papular acne scarring, resulting in a prevalence rate of 34.6%. Among them, 37.5% were male and 32.6% were female. A total of 90.6% of patients had combined other types of acne scarring, while 9.4% had papular acne scarring exclusively. Following CO2 laser grid treatment, there was a significant reduction in GSS scores and ECCA values, accompanied by a noticeable improvement in physician visual evaluation and patient satisfaction scores. Papular acne scarring has a relatively high incidence rate, and there is no significant sex difference. It often coexists with other types of acne scarring. CO2 laser treatment using an artificial grid pattern effectively improved papular acne scarring with a good safety profile.

The Potential of Chat-Based Artificial Intelligence Models in Differentiating Between Keloid and Hypertrophic Scars: A Pilot Study.

Lasting scars such as keloids and hypertrophic scars adversely affect a patient's quality of life. However, these scars are frequently underdiagnosed because of the complexity of the current diagnostic criteria and classification systems. This study aimed to explore the application of Large Language Models (LLMs) such as ChatGPT in diagnosing scar conditions and to propose a more accessible and straightforward diagnostic approach. In this study, five artificial intelligence (AI) chatbots, including ChatGPT-4 (GPT-4), Bing Chat (Precise, Balanced, and Creative modes), and Bard, were evaluated for their ability to interpret clinical scar images using a standardized set of prompts. Thirty mock images of various scar types were analyzed, and each chatbot was queried five times to assess the diagnostic accuracy. GPT-4 had a significantly higher accuracy rate in diagnosing scars than Bing Chat. The overall accuracy rates of GPT-4 and Bing Chat were 36.0% and 22.0%, respectively (P = 0.027), with GPT-4 showing better performance in terms of specificity for keloids (0.6 vs. 0.006) and hypertrophic scars (0.72 vs. 0.0) than Bing Chat. Although currently available LLMs show potential for use in scar diagnostics, the current technology is still under development and is not yet sufficient for clinical application standards, highlighting the need for further advancements in AI for more accurate medical diagnostics. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online instructions to authors www.springer.com/00266 .

Scar Formation, Healing Stages, and Advanced Treatment Strategies – Review

Introduction and Aim of the Study: Scarring is a major concern in clinical dermatology, affecting individuals' quality of life due to both physical and psychological impacts. This review aims to explore the pathophysiology of various scar types—hypertrophic, keloid, and atrophic—and evaluate the effectiveness of current and emerging treatments to inform better clinical practices and therapeutic strategies. Description of the State of Knowledge: Scar formation involves complex biological processes: inflammation, proliferation, and remodeling. The nature of the scar varies with the underlying cause and biological response, influenced by genetic factors, skin tension, and environmental elements such as UV exposure. Recent advances in treatments range from surgical techniques to laser therapy and biological agents like cytokines. Conclusion: The studies reviewed underscore the complexity of scar management, influenced by diverse genetic, biological, and environmental factors. No single treatment is universally effective, but a combination of preventative and therapeutic strategies shows the best promise.

Single-cell sequencing analysis and bulk-seq identify IGFBP6 and TNFAIP6 as novel differential diagnosis markers for postburn pathological scarring

BackgroundIf not accurately diagnosed and treated, postburn pathological scars, such as keloids and hypertrophic scars, can lead to negative clinical outcomes. However, differential diagnosis at the molecular level for postburn pathological scars remains limited. Using single-cell sequencing analysis, we investigated the genetic nuances of pathological scars at the cellular level. This study aimed to identify molecular diagnostic biomarkers to distinguish between postburn keloids and hypertrophic scars. MethodsSingle-cell sequencing, differential expression, and weighted co-expression network analyses were performed to identify potential key genes for discriminating between keloids and hypertrophic scars. Postburn clinical samples were collected from our centre to validate the expression levels of the identified key genes. ResultsSingle-cell sequencing analysis unveiled 29 and 30 cell clusters in keloids and hypertrophic scars, respectively, predominantly composed of fibroblasts. Bulk differential gene analysis showed 96 highly expressed genes and 69 lowly expressed genes in keloids compared to hypertrophic scars. By incorporating previous research, Gene Set Enrichment Analysis was conducted to select fibroblasts as the focus of research. According to the single-cell data, 301 genes were stably expressed in fibroblasts from both types of pathological scars. Consistently, Weighted Gene Co-expression Network Analysis revealed that the blue module genes were mostly hub genes associated with fibroblasts. After intersecting fibroblast-related genes in single-cell data, Weighted Gene Co-expression Network Analysis-hub module genes, and bulk differential expression genes, insulin-like growth factor binding protein 6 and tumour necrosis factor alpha-induced protein 6 were identified as key genes to distinguish keloids from hypertrophic scars, resulting in diagnostic accuracies of 1.0 and 0.75, respectively. Immunohistochemical Staining and Quantitative Reverse Transcription PCR revealed that the expression levels of tumour necrosis factor alpha induced protein 6 and insulin-like growth factor binding protein 6 were significantly lower in postburn keloids than in hypertrophic scars- ConclusionsTumour necrosis factor alpha induced protein 6 and insulin-like growth factor binding protein 6, exhibiting high diagnostic accuracy, provide valuable guidance for the differential diagnosis and treatment of postburn pathological scars-

Advances in the Application of Noninvasive Skin Imaging Techniques in Acne Scars.

Acne scarring is a common sequela of acne vulgaris, which seriously affects facial esthetics. The treatment options for acne scars vary depending on the development stage, color, type, and location of scarring. The objective and precise assessment of acne scars is a prerequisite for treatment, and it is also an important means of monitoring the treatment effect. The traditional methods to evaluate the types and severity grade of acne scars are primarily based on subjective assessment by physicians, which lacks objectivity and accuracy. Novel noninvasive skin imaging techniques, such as skin surface imaging analysis systems, dermoscopy, reflectance confocal microscopy (RCM), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), and multiphoton tomography (MPT), provide new tools for therapid and objective assessment of acne scars. This article reviews the progress of skin imaging techniques in the diagnosis, classification, and efficacy evaluation of acne scars.

Evaluation of Ultrasound Changes With the Use of Microneedling Versus Fractional CO2 Laser in Atrophic Acne Scars.

Atrophic acne scarring, a common sequela of acne, can be treated by different interventions, including microneedling and laser resurfacing. We sought to evaluate the comparative efficacy of microneedling versus fractional CO2 laser in treating atrophic acne facial scars using imaging with high and ultra-high frequency ultrasound. Participants received 2 sessions, separated by 1 month, of microneedling on the left side of the face and fractional CO2 laser on the right. Color Doppler ultrasound evaluations (24 and 70 MHz) were conducted at baseline and 3 months after treatment. Each patient completed questionnaires on satisfaction, pain, and adverse effects. Nine subjects were enrolled. The frequency order of scar types was boxcar, ice-pick, and rolling. At 3 months, using the acne scar clinical evaluation scale, a decrease in scar scores of both methods was observed for total scars (P = 0.0005), ice-pick scars (P = 0.0128), and rolling scars (P = 0.0007). Twenty-two scars analyzed by ultrasound demonstrated a trend to decrease in size; however, no significant changes were observed for either microneedling or CO2 laser treatments. Moreover, there were no significant differences between these methods. Both treatments were rated as good or very good by patient assessments. There was a low frequency of pain and hyperpigmentation reported with both modalities, albeit somewhat higher with microneedling. Both microneedling and CO2 laser improved atrophic acne scars. Ultrasound did not show significant differences between these modalities.

Morphological variants of Rouviere's sulcus and its significance in a patient undergoing laparoscopic cholecystectomy: An emerging paradigm.

Laparoscopic cholecystectomy (LC) is the gold-standard treatment for symptomatic cholelithiasis. To prevent bile duct injuries, various practices are recommended, one of which is the identification of Rouviere's sulcus (RS) and starting dissection above its level. So far, no uniform anatomical description of RS is available in the literature. After prospective observation of 302 patients, we have proposed a new classification based solely on gross morphology. The purpose of this study is to make surgeons well acquainted with its different anatomical variations and its significance for the prevention of complications. We performed a prospective analysis of 302 patients during LC, and various morphological variants of RS and its relationship with hepatobiliary anatomy were recorded. We have used the nomenclature as described by previous authors and added a few. A total of 330 patients were included in our study. We could not visualise the sulcus due to dense adhesion in 28 patients. RS was absent in 24.1% of cases and was present in various forms in 75.8% of cases. Amongst these, the open type was found in 28.8% of cases, fused type was found in 4.8% of cases, groove type was found in 24.8% of cases, pit type was found in 8.2% of cases, close type was found in 14.4% of cases, slit type was found in 8.7% of cases and scar type was found in 10% of cases. Using RS as a landmark, we could perform surgery safely in all cases. The RS can be described as closed, slit, open, fused, groove, pit or scar type.

Variations Observed in the Muscle Scars of Left Valve of Pododesmus patelliformis (Linnaeus, 1761) [Bivalvia: Anomiidae

This study investigates the unusual muscle scars observed in some specimens of Pododesmus patelliformis (Linnaeus, 1761). Materials were collected between 1964 and 1977 from 18 stations across the Sea of Marmara and the Aegean Sea. In only 49 out of the 85 specimens examined (57,7%), the muscle scars were distinctly separated from each other as described in the general literature. Thirty-six specimens (42,3%) exhibited muscle scars that differed from the known pattern. These atypical muscle scar types were categorized into five types, explained, photographed, and illustrated in this study.

Retrospective Analysis of the Effectiveness of Laser Therapy in the Treatment of Acne Scarring.

This retrospective analysis aimed to estimate the efficiency of laser therapy in the management of acne scarring, assessing changes in scar severity, patient satisfaction, and adverse events. A cohort of 150 subjects with clinically diagnosed acne scarring who underwent laser therapy. Data were extracted from electronic medical records, and baseline characteristics, scar types, and management parameters were analyzed. Outcome measures included changes in scar severity scores, patient-reported satisfaction, and documentation of adverse events. Statistical analyses were conducted using appropriate methods, with sub-group analyses based on scar type and laser modality. Following laser therapy, a statistically significant decrease in scar severity scores was seen across all scar types (P < 0.05). Patient satisfaction was high, with 75% reporting significant improvement. Adverse events were mild and transient, including erythema and post-inflammatory hyperpigmentation. Sub-group analyses did not reveal significant differences in management outcomes based on scar type or laser modality. Laser therapy demonstrates effectiveness in reducing acne scarring with a favorable safety profile. The research supports its role as a versatile management modality for diverse scar presentations, emphasizing the need for further research to optimize protocols and explore combination therapies.

Understanding Public Perceptions of Nipple and Scar Characteristics After Chest Wall Masculinization Surgery.

Surgical chest masculinization procedures, especially gender-affirming top surgery (GATS), are becoming increasingly prevalent in the USA. While a variety of surgical techniques have been established as both safe and effective, there is limited research examining ideal aesthetic nipple appearance and incision scar pattern. This study employs patient images to understand the public's perception on top surgery outcomes when adjusting for BMI ranges and Fitzpatrick skin types. Images from RealSelf modified via Adobe Photoshop depicted various scar types and nipple-areolar complex (NAC) sizes/positions. A Qualtrics survey was distributed utilizing Amazon Mechanical Turk. Statistical analysis was performed through JMP Pro 17 for ordinal and categorical values, with a p value less than or equal to 0.05 statistically significant. A moderately sized and laterally placed NAC was preferred. A transverse scar that resembles the pectoral border between the level of the inframammary fold and pectoral insertion was deemed most masculine and aesthetic. Majority of results demonstrated that this is unaffected by Fitzpatrick skin types. Increased BMI images impacted public preferences, as a nipple placed farther from the transverse incision (p=0.04) and a transverse scar position closer to the IMF was preferred in higher BMI patients. An understanding of the most popular NAC and scar choices, as well as how these factors may differ when considering a Fitzpatrick skin type or BMI categorization was attained. This validates the importance of patient-centered approach when employing surgical techniques in GATS. Future studies intend to obtain reports from actual patients considering GATS. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable.

Stretch marks: Efficacy of herbal remedies (Cocoa and shea butter, vitamin E, calendula oils) and student survey

The study sought to assess the efficacy of herbal remedies for treating stretch marks by conducting a comprehensive literature review and administering a survey to gauge the knowledge and opinions of pharmacy students. This initiative aimed to bridge existing gaps in understanding and perceptions surrounding stretch marks and available treatment modalities. The survey was conducted among 40 first-year pharmacy students and comprised two sets of questions and demographic data: knowledge-based and opinion-based. Descriptive statistical analysis and Chi-square tests were performed using SPSS software were conducted to determine statistical significance. Among the participants, 75% were female with 90% of them within the age range of 18 to 30 years. The knowledge-based survey revealed a solid understanding of aspects related to stretch marks among participants. Almost all (97%) of respondents correctly identified that stretch marks usually appear on the skin due to rapid weight changes. Eighty percent correctly acknowledged stretch marks as a type of scar, while two-thirds answered affirmatively regarding their potential to cause irritation and itching. Misconceptions were identified, such as respondents incorrectly believing that stretch marks are exclusively formed through pregnancy. In the opinion-based survey, participants expressed varying viewpoints on stretch marks and herbal treatments. Statistical analysis revealed several significant correlations between demographic factors and participants' understanding of stretch marks. The survey findings provide valuable insights into stretch mark management and students' perceptions of herbal remedies. Overall, the study underscores the significance of further research and targeted educational initiatives in dermatological conditions like stretch marks.

PLANT RAW MATERIAL AS A SOURCE OF METABOLITES FOR WOUND HEALING AND ANTI-SCARRING PRODUCT

Cosmeceutical products based on plant raw materials have a complex effect, are available, and low-toxic. The creation of new natural products for wound healing without tissue scarring is topical. For this, the secondary metabolites of the plant must demonstrate antibacterial, anti-inflammatory, and antioxidant effects, and have low cytotoxicity. Aim. To conduct an analysis of literary sources in electronic databases, regarding products on the market with a wound healing effect and plant raw materials that would have a therapeutic effect on wound healing without the formation of scars. Results. The characteristics of four types of scars are described. Plants and secondary metabolites are listed according to their action: antibacterial, antioxidant, anti-inflammatory, collagenstimulating, and anti-scarring. Lupeol, allicin, and cinnamaldehyde show antibacterial effect; quercetin, resveratrol, luteolin, naringenin, gallic acid, and curcumin show antioxidant effect; asiatic acid, pinocembrin, and myricetin show anti-inflammatory effect. Cryptotanshinone, bexarotene, taspine, sesamol, and astragaloside IV contribute to the deposition of fresh collagen in the wound. On the Ukrainian market, there are natural wound healing products in the form of a balm, cream, and gel. They include vegetable oils, essential oils, extracts of Thymus L., Arnica montana, Inula helenium, Aloe vera, Matricaria chamomilla, etc. Wound healing medicinal products of a chemical nature occupy a large part of the Ukrainian market, among them the products with dexapentanol predominate. The use of the cell culture method as an alternative source of plant raw materials for wound and scar treatment is perspective. The biotechnological method helps preserve biodiversity and obtain chemically pure plant raw materials regardless of environmental conditions. Conclusions. The study demonstrates the possibilities of using plant raw materials to create new cosmeceuticals with wound healing and anti-scaring effects for use in combined therapy.

Split face randomized, evaluator blinded study on the effect of multiple subcisions on rolling acne scars.

Acne scarring results from a common inflammatory condition present in many people. These scars can have an impact on quality of life by influencing self-esteem and social acceptance. Current acne scarring treatments, such as chemical peels and laser treatments, often have limited success due to their time-consuming nature and the variability of acne scar types. The subcision technique has shown promise for the treatment of rolling acne scars. There are few studies to date that examine the effects of multiple subcision treatments on rolling acne scars. We evaluated whether the use of multiple subcision treatments improved the appearance of rolling acne scars compared to no treatment. Five patients with rolling acne scars on both sides of their face who met inclusion and exclusion criteria were enrolled in the study. One side of the face was randomized to receive treatment, while the contralateral side of the face received no treatment. Subjects underwent five sequential subcision treatments, spaced 4 weeks apart, with two follow-up visits at weeks 20 and 36 from the 1st treatment. Photographs were taken before and after the initial treatment visit and at each subsequent visit. Acne scar appearance was evaluated by the subject, a blinded live rater, and two double-blinded dermatologist raters. Evaluations of treatment outcomes involved overall acne scar appearance on a 5-point scale, acne scar improvement on a percentage scale, a modified quantitative global scarring grading system, and potential treatment side effects. There was a greater decrease in global scarring scores in the multiple subcision side compared to the control side. There was a greater difference in the average acne scar appearance scores between the Week 36 follow-up visit and baseline for the multiple subcision side compared to that of the control side. 50% of patients reported being more satisfied with the treatment side compared to the control side in regard to overall improvement. The study results suggest that multiple subcision treatments may improve the appearance of rolling acne scars compared to no treatment.

‘Y’ Modification of the cutaneous incision of the preseptal transconjunctival approach for the management of zygomatico-maxillary complex fractures: A prospective clinical study

AimThe purpose of this clinical study was to evaluate the efficacy of the preseptal transconjunctival approach with Y modification of the cutaneous extension for the management of zygomaticomaxillary complex (ZMC) fractures. MethodsThis prospective interventional study was conducted at our institute from 2012 to 2020. The study included patients aged 15–65 years with displaced ZMC fractures. Patients with uncontrolled systemic conditions, infected and/or comminuted fractures were excluded. The variables evaluated were age, gender, mechanism of injury, fracture side, clinical features, surgical exposure time, adequacy of exposure, complications, scar evaluation scores and cosmetic outcomes. The parameters for comparison were operated versus non operated side Eye Fissure Index (EFI) and surgical exposure time was compared with respect to the types of scars. ResultsA total of 49 patients were included in this study. The average exposure time was 18.87 ± 1.92 min. The exposure of fracture site was excellent in 73.5 % and satisfactory in 26.5 %. The mean EFI of operated side was 34.2 ± 5.04 mm while that of non-operated side was 34.22 ± 5 mm. On comparison of the same there was no significant difference. Invisible scars were noted in 71.4 % and barely visible scars in 22.4 %. The comparison of exposure time with type of scars showed a significant association (p = 0.02). The complications noted were chemosis, lower eyelid edema, conjunctival granuloma and entropion. Cosmetic outcomes were fairly satisfactory. ConclusionThe Y modification of the transconjunctival approach can provide excellent surgical exposure without the need for a second incision. Although this approach is technique sensitive and requires experience, the advantages outweigh the learning curve. Since this approach has been widely studied, a systematized review is recommended to further substantiate its reliability and advantages.

Evaluation and comparison of the efficacy and safety of the combination of topical phenytoin and microneedling with microneedling alone in the treatment of atrophic acne scars: A controlled blinded randomized clinical trial.

Severe acne breakouts often lead to atrophic acne scars, which affect millions of people worldwide and can significantly affect a person's self-confidence and self-image. Given the difficulty in treating atrophic acne scars, this study aims to investigate the efficacy of topical phenytoin in the treatment of atrophic acne scars. This split face clinical trial on 25 patients between the ages of 18 and 40 involved the application of microneedling on one side of the face, with three sessions taking place over the course of a month. On the other side, a 1% phenytoin cream was administered three times daily for 1 week following the microneedling procedure. Baseline information was collected for all patients, and follow-up assessments were conducted during the treatment sessions and 2 months after the last session. The assessments included evaluating the number and area of pores and spots, determining scar severity, assessing patient satisfaction, and recording any potential complications. Among patients, 20 individuals (80%) were females, and the average age of the participants was 35.96±9.23. In terms of the fine pore area, despite the fine pore count, both groups showed improvement over time (p: 0.03vs. 0.06). Also, regarding large pore count and area, and the count and area of spots, both groups showed improvement over time (p: 0.001). However, there were no significant differences between the two groups (p>0.05). On the other hand, when it comes to acne scar grade and patients' satisfaction, the phenytoin group outperformed the control group in all follow-up sessions and this difference was found to be significant (p: 0.001). It is worth noting that no complications were observed among any of the patients. It appears that combining phenytoin cream with microneedling has a more effective therapeutic outcome in enhancing atrophic acne scars, when compared to microneedling alone, and this method can be regarded as a viable alternative in treating these types of scars.

Evaluation of the Efficacy of Platelet-Rich Plasma Injections With and Without Microneedling for Managing Atrophic Facial Acne Scars: A Prospective Comparative Study.

Background and aim The majority of acne has the potential to transform into facial scars, which have a physical and psychological effecton the individual. There are plenty of treatment optionsto manage such scars. The aim of this study is to assess the comparative effect of the injection of platelet-rich plasma (PRP) alone, with that of the injection of PRP with microneedling, in the reduction of atrophic facial acne scars. Methods A total of 30 participants were included in this study, divided into two groups (n = 15). Patients inGroup I received intradermal injection of PRP only, and Group II included patients receiving intradermal injection of PRP with microneedling. The scar appearance was evaluated at baseline, after one, two, and three months using Goodman Baron's scar scale. The statistics were analysed using the Chi-square and Student's t-tests. Results Patients in the PRP with microneedling group had lower acne scar scores on the Goodman Baron scale compared to those who received only PRP. The acne scores were statistically significant (p-value < 0.05) in the second and third months of treatment in Group II. Conclusion The addition of microneedling to PRP has proven to be effective in the reduction of facial acne scars. However, different types of scars require different modalities of treatment, and the final decision lies in the hands of the operator and the requirements of the patients.

The possibilities of using injectables in the treatment of atrophic scars

Atrophic scars are a common complication that accompanies the healing of vulgar acne. The condition is quite widespread among young people, and their physical and psychological consequences with improper treatment can persist throughout life. There are many therapies for atrophic scars, but limited efficacy and high frequency of side effects limit use of these methods. For optimal treatment of a patient’s scar, it is necessary to predict which treatment will prtovide the most satisfactory result in the short period of time with the minimum number of side effects. Analysis of numerous studies shows that there is no panacea for the treatment of atrophic scars, which explains the developing trend towards the development of combined treatment methods. The purpose of our review is to analyze injectable methods of therapy for atrophic scars with an emphasis on the latest achievements of the previous decade, since in recent years these methods have shown themselves not only as one of the most successful in therapy, but also, according to most authors, there is a huge potential to increase the efficacy of treatment in severe cases. Although, it is difficult to make an unbiased comparison of each therapy method due to the different sample sizes of studies, the strength of evidence, the specifics of therapy and other factors, nevertheless, there is a possibility of reaching consensus on which treatment methods are optimally suited for certain types of scars. This should be an absolute determining factor for choosing the best therapeutic strategy, whether it is monotherapy or combination therapy, in the treatment of atrophic scars with minimum side effects.

Fractional Ablative Carbon Dioxide Laser versus Fractional Non-Ablative 1410 nm Diode Laser in the Treatment of Acne Scars: A Clinical and Immunohistochemical Study

Background: Effectively managing acne scars while minimizing consequences is still a challenging task. The primary determinant in selecting and continuing therapy for a specific device is stimulating collagen production and dermal remodeling with the fewest possible complications. Objective: To evaluate the clinical and immunohistochemical results of ablative fractional carbon dioxide (FCO2) laser versus fractional non-ablative diode laser for treating facial acne scars. Methods and Materials: Thirty patients with atrophic acne scars were included in a split-face comparative study. Right and left facial sides received three sessions of FCO2 and diode laser, respectively, at one-month intervals. One month after the third session, patients were evaluated using photographs, the Goodman and Baron qualitative and quantitative global scarring grading system, the investigator’s global assessment, and patient satisfaction. A sample was collected from the area that had been treated, and the tissue was examined using hematoxylin and eosin (H–E) staining and immunohistochemistry staining for collagen I. Results: Goodman and Baron global scores showed a statistically significant difference compared to baseline on both sides of the face. However, there was no statistically significant difference between the two treatment modalities. Biopsy specimens showed an increased deposition of collagen I by both laser devices, which was validated and described by immunohistochemistry staining. Conclusion: Both FCO2 and fractional non-ablative diode lasers proved their efficacy in treating different types of acne scars. For patients who are interested in no downtime and no complications, fractional non-ablative diode laser is recommended as an efficient alternative modality.