Treatment Of Atrophic Scars Research Articles

Combined treatment of atrophic scars using radiofrequency microneedling and hyaluronic acid fillers with subcision

Introduction. Atrophic scars may be associated with significant psychological stress and a substantial negative impact on quality of life. Despite the great relevance of the atrophic scars therapy, existing treatment methods do not always provide their complete elimination.Aim. To study the efficacy of combined therapy of atrophic scars with radiofrequency microneedling (RF-MN), subcision and hyaluronic acid filler injection.Materials and methods. Ten female patients aged 28–44 years with a clinical diagnosis of atrophic scars were randomly assigned to two groups. Group 1 received RF-MN alone, while Group 2 received a combination treatment comprising RF-MN, subcision, and hyaluronic acid injections. Clinical effectiveness was assessed using the Goodman-Baron scar rating scale and the Global Aesthetic Improvement Scale (GAIS). Ultrasound was used to determine the changes in dermal thickness. The volume of depressions and skin texture were measured using the Antera 3D®. The safety of the treatment was evaluated by recording adverse events.Results. The combined method demonstrated superior efficacy compared to RF-MN alone in the majority of efficacy parameters. In Group 2, a statistically significant reduction in Goodman-Baron scale was observed in 100% of patients (p = 0.026). 3D measurements of the face demonstrated a more pronounced improvement in skin texture in Group 2 relative to Group 1. Statistically significant changes (p = 0.027) in the Face-Q scale were exclusively observed in the group that received the combined treatment. Ultrasonic imaging demonstrated a restoration of dermal thickness following treatment. No serious adverse events were observed. Expected local adverse events (pain, erythema, swelling, and bruising) were mild and resolved spontaneously within 1–7 days.Conclusion. The combined treatment with RF-MN followed by subcision and hyaluronic acid filler injections demonstrated its efficacy in patients with atrophic scars.

Poly‐d,l‐lactic acid‐enhanced atrophic scar treatment via transdermal microjet drug delivery in Asians

Acne vulgaris often results in permanent scars, with atrophic scars being the most common type and posing a significant therapeutic challenge due to their prevalence and impact on patients' quality of life. Various treatment options exist, including the use of poly-d,l-lactic acid delivered via different methods. This study aimed to assess the efficacy and safety of poly-d,l-lactic acid delivered via laser-assisted needle-free microjet injection for treating atrophic scars. Five Korean participants with atrophic facial scars were recruited. Poly-d,l-lactic acid solution was administered via the Mirajet system in five sessions, with clinical assessments conducted at baseline, before each session, and at 12-week and 22-week follow-ups. Outcome measures included the Global Aesthetic Improvement Scale and patient satisfaction scores. Positive results were observed at the 12-week and 22-week follow-ups, with high patient satisfaction and improvements in atrophic scars and skin texture. Mild discomfort and transient side effects were reported, with no adverse events observed during the follow-up period. Poly-d,l-lactic acid delivered by a laser-assisted needle-free microjet injector was judged to be effective for improving atrophic the facial area. Further research, particularly through randomized controlled trials, is needed to validate these findings and assess the longer-term safety and sustainability of outcomes.

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.

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.

New comprehensive method for treatment of atrophic skin scars

Striae distensae, commonly known as stretch marks, are visible linear atrophic scars. Despite quite numerous studies, the lack of a unified approachto the problem of treating atrophic scars, a detailed clinical and morphological classification leads to the fact that doctors empirically choosepatient management tactics, which leads to unreliability or even lack of effect, the need for numerous repeated courses of therapy, and significanteconomic costs. The article presents data on studying the effectiveness of various methods of therapy. Depending on the method of therapy,patients were divided into three groups by simple randomization. The study used a visual analogue scale (VAS) to assess the clinical symptomsof AR. The combined use of fractional ablative laser and PDT with the topical photosensitizer chlorin e6 is highly effective in the treatment ofatrophic scars lasting more than a year (VAS dynamics – 74.9 %), fractional ablative laser is moderately effective in long-term atrophic scars (VASdynamics – 65.6 %), while PDT in the form of monotherapy is insufficiently effective (VAS dynamics – 45.6 %).

MORPHOLOGICAL CHARACTERISTICS AND CAUSES OF ATROPHIC SCAR TREAT WITH SUBCISION AND PLATELET-RICH PLASMA AT THE CAN THO DERMATO-VENEREOLOGY HOSPITAL IN 2021-2023

Background: Atrophic scars are the result of natural healing leading to the formation of replacement fibrous tissue. The atrophic scar is a common undesirable complication of acne, chickenpox, herpes, trauma, etc. Although the disease does not cause dangerous complications, due to the location of the lesions on the face, it causes great aesthetic and psychological obstacles, and the patient is less confident in communication, profoundly affecting the patient's quality of life. and labor productivity. The combination of subcision and platelet-rich plasma (PRP) in the treatment of atrophic scars is a new method applied in recent years. The morphological characteristics and causes of them may affect the results of subcision and platelet-rich plasma treatment. Objectives: To describe the clinical characteristics and causes of atrophic scars in patients at Can Tho Dermato-Venereology Hospital from 4/2021 to 6/2023. Materials and methods: A cross-sectional descriptive study was carried out on 30 patients with atrophic scars who were treated with subcision and platelet-rich plasma at Can Tho Dermato-Venereology Hospital in 2021 –2023. Results: the average age of onset of atrophic scars was 21.27 ± 4.085 years old, and the average duration of atrophic scars was 6.33 ± 4.31 years. The majority of patients had acne scars, accounting for 90%; only 6.7% had post-varicella scars; and 3.3% had traumatic scars. 70% with mixed scars, and the common rate of boxscar (83.3%). Scars on the cheek were 100%, and 80% of patients appear to have atrophic scars in multiple locations. Scars color as normal skin accounted for 66.7%. The most atrophic scar patients classified as grade 3 accounted for 66.7%, grade 4 accounted for 23.3%, and at least level 2 accounted for 10%. Conclusions: Facial atrophic scars are mainly the result of acne. Most of them have mixed scars, boxscar are common. Atrophic scars are mainly distributed on the cheeks and in multiple locations. And grade 3 accounts for the majority.

A thread: A new modality in treatment of atrophic scars

A thread: A new modality in treatment of atrophic scars

Effectiveness of combined methods of treatment of atrophic scars of skin

Atrophic post-acne scars are severe manifestations of the post-acne symptom complex, which occur as a result of inflammation due to the loss of collagen fibers and subcutaneous fat during the healing of inflammatory acne elements. The incidence of post-acne scars has been little studied, but according to some authors, about 90 % of patients with severe and moderate acne suffer from them. The aim of the study was to study the effect of the combined use of IPL- and PRP-therapy, fractional microneedle radiofrequency therapy and PRP-therapy, as well as microneedling of autologous plasma with cells on the clinical symptoms of atrophic skin scars, taking into account the duration of the pathological process, based on the dynamics of the indicators of the Manchester Assessment Scale of Scar Deformations. Complex methods showed higher efficiency than the use of hardware techniques in relation to all clinical signs of atrophic scars.

Ablative fractional carbon dioxide laser combined with autologous platelet-rich plasma in the treatment of atrophic acne scars: A systematic review and meta-analysis.

Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80%-90% of all acne scars. Ablative fractional carbon dioxide (FCO2 ) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars. Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review sought to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD). Eleven RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR=2.56, 95% CI 1.37-4.78 and OR=3.38, 95% CI 1.80-6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD=-0.40, 95% CI -0.65 to -0.14). The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars.

CO2-laser treatment of atrophic scars

Linear atrophy of the skin or striae (striae distensae) is a widespread cosmetic defect that leads to a significant decrease in patients` quality of life. To date, one of the most effective modalities of striae distensae treatment are laser therapy methods. A wealth of clinical experience has been accumulated in the use of ablative laser techniques, namely the carbon dioxide CO2 laser (10600 nm) in the treatment of striae albae. This article presents a review of current literature and a clinical observation of a patient with different types of linear atrophies.

Fractional Q-Switched 1064 nm Laser for Treatment of Atrophic Scars in Asian Skin.

Background and Objectives: Asian patients with Fitzpatrick skin type III–IV are a less studied subtype of patients in the medical literature. Q-Switched, 1064 nm neodymium-doped yttrium aluminum garnet (Nd: YAG) laser with a fractionated beam profile (QSF) is a new modality that was reported to be effective in the treatment of scars. This study aims to evaluate the efficacy and safety of QSF Nd: YAG laser in treating scars in Asian patients. Materials and Methods: A total of 29 Subjects were treated with 1064 nm QSF laser. Each patients had three treatments with a fractionated microlens array handpiece every 8 weeks). Efficacy of treatment was evaluated using the Goodman and Baron’s quantitative grading scale before and 3 months after the last treatment. Results: All 29 patients treated had significant improvement of acne scars according to Goodman and Baron’s Quantitative Global Acne Scarring Grading System. No side effect has been observed except some minor erythematous reactions in three patients. Conclusions: Our results confirm that the 1064 nm QSF Nd: YAG laser is a safe and effective technique for treating scars in Asians.

Efekti trihlorsirćetne kiseline u tretmanu postaknoznih atrofičnih ožiljaka

Introduction: The atrophic scar treatment lasts for several months. The therapy should prevent or reduce scarring. The pathogenesis is the result of sebum hyperproduction, follicular epidermal hyperkeratinisation, the activity of Cutibacterium (Propionibacterium) acnes, and immune response. The TCA peeling stimulates tissue regeneration causing protein deposition, coagulation necrosis and exfoliation of photo-damaged cells. Goal: To demonstrate the effects of TCA peels and the significance of skin care in the treatment of atrophic scars. Methodology: The prepared skin was TCA solution-treated, in circular motions, in five steps. The eyes were covered and protected. The next peeling layers were applied in 3 steps. Case study: subject, skin phototype 3, with post-acne atrophic scars. The therapy: the treatment of TCA - 50% to atrophic regions, follow up on the frosting (coagulation of epidermal and dermal proteins) under the physician supervision. Results and Discussion: The first treatment decreased the number of active acne lesions and inflammation, atrophic scars were less visible. The skin was smooth and gentle. There were no postinflammatory hyperpigmentation. The chemical peels are simple to perform at the histological level, have a low complication rate, low costs. Skin care after surface chemical peeling involves gentle cleansing. Moisturizing, pH neutral creams are recommended for skin care. Sun protection is mandatory. Conclusion: TCA is stable, inexpensive, does not cause systemic toxicity. Peeling is easy to perform, the depth of peeling correlates with the intensity of frosting. There is no need to neutralize TCA. If performed correctly, TCA peels achieve histological and clinical improvement of the skin.

OPPORTUNITIES OF PLATELET RICH PLASMA APPLICATION IN THE TREATMENT OF SKIN SCARS

The number of patients with hypertrophic skin scars is increasing every year. Scar tissue is formed as a result of healing of a wound defect. Therefore, in order to develop optimal methods for the treatment of scarring skin changes, it is necessary to understand the pathogenesis of the wound process. The purpose of this work was to analyze the literature data on the effectiveness of the use of plateletrich plasma (PRP) in the treatment of scarring that appeared in patients with acne. PRP contains epidermis growth factor, vascular endothelial growth factor, which help accelerate the healing of skin wounds. Conclusion: PRP can be successfully used in the treatment of atrophic scars on the skin after acne. Therefore, this method can be used both in monotherapy and in combination with surgical methods of treatment.

OPPORTUNITIES OF PLATELET RICH PLASMA APPLICATION IN THETREATMENT OF SKIN SCARS

The number of patients with hypertrophic skin scars is increasing every year. Scar tissue is formed as a result of healing of a wound defect. Therefore, in order to develop optimal methods for the treatment of scarring skin changes, it is necessary to understand the pathogenesis of the wound process. The purpose of this work was to analyze the literature data on the effectiveness of the use of plateletrich plasma (PRP) in the treatment of scarring that appeared in patients with acne. PRP contains epidermis growth factor, vascular endothelial growth factor, which help accelerate the healing of skin wounds. Conclusion: PRP can be successfully used in the treatment of atrophic scars on the skin after acne. Therefore, this method can be used both in monotherapy and in combination with surgical methods of treatment.

Microneedling in the treatment of atrophic scars: A systematic review of randomised controlled trials.

To date, treatment of atrophic acne scars remains a therapeutic challenge for dermatologists, yet there is no standard option on the most effective treatment. Microneedling (MN) is a minimally invasive technology that involves repetitive skin puncture using sterile microneedles to disrupt dermal collagen that connects the scar tissue. Recent studies have demonstrated the potency of MN, such as dermaroller and fractionated microneedle radiofrequency, in the treatment of atrophic scars. The objective of this review is to evaluate systematically the current literature on MN for atrophic acne scars. A systematic search of literature was performed from PubMed, Medline, Cochrane Central, and Google Scholar databases for articles published during the last 20 years. Only randomised controlled trials (RCTs) with full‐text version of the manuscript available were included in our study. Nine RCTs were included in this review. All treatment modalities demonstrated consistent results that MN was efficacious in treating atrophic acne scars as a monotherapy or in combination with other treatments. Moreover, no serious adverse effects were reported in all studies after MN treatment. MN is a well‐tolerated and effective therapeutic modality in treating atrophic acne scars. Further research is required to validate the efficacy of MN with a larger sample size and lengthy follow‐up.

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.

Comparative study between the efficacy of subcision versus subcision with poly-L-lactic acid threads in facial atrophic scar treatment

Background Subcision is defined as an office surgical technique that has been considered for treatment of atrophic scars. Thread insertion is a well-known effective therapy for face lifting. Recently, some studies proved their efficacy in atrophic facial scar treatment. Aim To evaluate the safety and efficacy of subcision versus subcision with poly-L-lactic acid (PLLA) threads in treatment of facial atrophic scars. Patients and methods Thirty patients with facial atrophic scars were included. They were divided into two groups, group I treated with subcision and group II treated with subcision and PLLA threads. All patients were evaluated clinically after 3 months. Results After 3 months, in group I, the mean clinical improvement was 58.40±20.52. In group II, the mean clinical improvement was 68.40±13.88. The degree of improvement of group II was better than group I but did not show a statistically significant difference (P=0.796). The side effects were very minimal in both groups. Conclusion For atrophic facial scar treatment, combined subcision with PLLA thread insertion seems to be more effective than subcision alone.

Atrophic scars treatment with subcutaneous insulin

Atrophic scars treatment with subcutaneous insulin

Safety and efficacy of platelet-rich plasma vs carboxytherapy in the treatment of atrophic scars: A comparative clinical and histopathological study.

Atrophic scars that occur after surgical procedure or trauma are considered as a cosmetic problem for patients. Atrophic scarring results usually during wound healing with inadequate production of collagen and connective tissue. Factors that precipitate to the formation of depressed scars include: individual variations in wound healing, wound tension, tissue apposition, and scar contraction. To evaluate the safety and efficacy of PRP vs carboxytherapy in treatment of atrophic scars. This study included 40 patients with atrophic scars divided into two groups; group A including 20 patients received PRP injection, group B including 20 patients received CO2 injection. They received the treatment every 4 weeks for four sessions and had follow up for 6 months after the end of treatment. Skin biopsies were taken before and after treatment to evaluate clinical results. There was statistically significant difference between both groups in treating atrophic scars, regarding clinical improvement and patients' satisfaction with better results in group B. Histopathological examination showed significant expression of MMP-1 in group B more than group A. Both methods were safe and effective with minimal side effects with better improvement in patients treated with carboxytherapy than those treated with PRP.

Chemical reconstruction of skin scars (CROSS) method for atrophic scars: A comprehensive review.

Chemical reconstruction of skin scars (CROSS) applies a high strength acid focally to treat atrophic scars. Although this method has gained popularity over the past two decades, no standardized treatment guideline exists for CROSS method in the treatment of atrophic scars. The purpose of this comprehensive review was to evaluate the indications, detailed techniques, efficacy, and safety of CROSS method. An extensive literature review was conducted to identify articles relating to CROSS method for atrophic scars from 2002 to 2018. The literature search yielded 19 articles meeting criteria. CROSS method has been used for the treatment of acne scars, varicella scars, enlarged pores, and depressed surgical scars. In studies using the quantile grading scale for acne scars, 60%-100% of patients showed >25% improvement. In two studies for varicella scars, 83%-100% of patients showed >25% improvement. CROSS method seems to be effective specifically for ice-pick scars. It is well tolerated and safe in Fitzpatrick skin phototypes I-V. Most reported complications are temporary and include postinflammatory dyspigmentation, erythema, pain, pruritus, infection, and widening of scars. This literature review suggests that CROSS method is a safe and effective treatment for atrophic scars, especially ice-pick scars, in skin types I-V. However, current published works have several limitations, including small sample sizes, lack of control group, different concentrations of acid, different frequency of treatments, and follow-up periods. Larger, randomized, controlled studies are needed to elucidate the optimal treatment protocol of CROSS method.