Treatment Of Atrophic Scars Research Articles

Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians

Treatment of atrophic scars with a fractional laser resurfacing technique has demonstrated favorable outcomes, although data on the efficacy and adverse effects of this procedure in persons with dark-skinned phototypes are limited. This study was conducted to evaluate the efficacy and safety of carbon-dioxide ablative fractional resurfacing on atrophic acne scars in Asian individuals. Thirteen subjects (8 female and 5 male, aged 25-52 years) with skin phototype IV and atrophic acne scars were treated with 3 sessions of carbon-dioxide ablative fractional resurfacing laser on an average of 7-week interval. Objective (ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment. At the 6-month follow-up, 85% of the subjects were rated as having at least 25% to 50% improvement of scars. Improvement significantly progressed from the 1-month follow-up to the 6-month follow-up (P = .002). At 1 month after 3 treatments, surface smoothness (P = .03) and scar volume (P < .001) significantly improved, compared with baseline measurements. Of the subjects, 62% rated themselves as having at least 50% improvement in their scars. Mild postinflammatory hyperpigmentation was the most common adverse effect observed in 92% of the subjects or 51% of treatment sessions, and was completely resolved in an average of 5 weeks. The small sample size was a study limitation. Carbon-dioxide ablative fractional resurfacing appears to be effective and well tolerated for the treatment of atrophic acne scars in Asians.

CROSS technique: chemical reconstruction of skin scars method

Skin scars remain a therapeutic challenge to dermatologists. Over the past several decades, numerous surgical techniques have been used to improve the appearance of scarring. The objective of this study is to evaluate the efficacy of a local application of a (50%) concentration of trichloroacetic acid (TCA) for the treatment of atrophic acne scars (grade 3 in Goodman classification), as opposed to the higher (90%) TCA concentration used in previous studies, in order to reduce adverse local effects. The primary goal was the resolution of acne or chickenpox scars. Secondary goals were physician and subject assessments of scar improvement. Fifty percent TCA was applied locally to atrophic scars in five patients. Three patients had treated scars on the face and two patients had treated scars on the back. Wooden applicators were used to apply TCA locally and the treatment was repeated at 4-week intervals for a total of three sessions. Digital photographic analysis of lesions supported clinical observations. Histologic examination was performed only on two samples of patients with treated scars on the back. Clinical examination revealed cosmetic improvements in both depth and appearance of skin scars. We believe that the 50% TCA CROSS can be an effective technique for the treatment of atrophic scars.

Clinical trial of a pinpoint irradiation technique with the CO2 laser for the treatment of atrophic acne scars

Ablative laser resurfacing is an effective treatment for atrophic acne scars. However, it often induces complications such as edema, prolonged erythema, scarring and hyperpigmentation. Therefore, a new concept of laser treatment called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation treatment of atrophic acne scars. This study was designed to prospectively evaluate the use of a technique similar to fractional photothermolysis using only the standard CO2 laser without the fractional laser device in the treatment of atrophic scars and demonstrates it as a safe, effective and economical treatment option. Clinical improvement was achieved in all 35 patients with minimal adverse effects.

The Use of Fractional Laser Photothermolysis for the Treatment of Atrophic Scars

The Use of Fractional Laser Photothermolysis for the Treatment of Atrophic Scars

The Use of Fractional Laser Photothermolysis for the Treatment of Atrophic Scars

Patients with atrophic scars commonly seek treatment for their removal but are often concerned about the prolonged recovery, short-lived results, and/or ineffectiveness of available therapies. A novel treatment using a 1,550-nm erbium-doped fiber laser to induce fractional photothermolysis of treated skin has been used to resurface photodamaged skin but has not been studied previously in patients with atrophic scars to determine its effectiveness for this condition. To determine the effectiveness and safety of 1,550-nm erbium-doped fiber laser treatment on atrophic scars. Fifty-three patients (skin phototypes I-V) with mild to moderate atrophic facial acne scars received monthly treatment with a 1,550-nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc., San Diego, CA). Clinical response to treatment was determined at each treatment visit and 6 months after the final treatment session by two independent assessors using a quartile grading scale. Side effects and patient satisfaction were monitored at each follow-up visit. Clinical improvement averaged 51% to 75% in nearly 90% of patients after three monthly laser treatments. Mean improvement scores increased proportionately with each successive laser session. Clinical response rates were independent of age, gender, or skin phototype. Side effects included transient erythema and edema in most patients, but no dyspigmentation, ulceration, or scarring. Atrophic scars can be effectively and safely reduced with 1,550-nm erbium-doped fiber laser treatment.

Histometric and Histochemical Analysis of the Effect of Trichloroacetic Acid Concentration in the Chemical Reconstruction of Skin Scars Method

Atrophic scars can be induced by various causes, including severely inflamed acne, chicken pox, and trauma. Many treatment modalities are used for reconstructing and improving the appearance of scars with various treatment results. A recent report shows the clinical efficacy of the chemical reconstruction of skin scars (CROSS) method, which consists of the focal application of trichloroacetic acid (TCA) in a higher concentration. Histometric analysis of the CROSS method, however, has not yet been established. In this study, five hairless mice were used to evaluate the effect of the CROSS method and to analyze the difference between the CROSS method and simple TCA application. Similar histologic changes were observed in the two methods, including epidermal and dermal rejuvenation with new collagen deposition. These changes, however, were more prominent in the CROSS method-treated areas, particularly when 100% TCA was used. The results of this study suggest that treatment of atrophic scars using the CROSS method is more effective than simple application of TCA in activating fibroblasts in the dermis and increasing the amount of collagen.

Histometric and Histochemical Analysis of the Effect of Trichloroacetic Acid Concentration in the Chemical Reconstruction of Skin Scars Method

BACKGROUND Atrophic scars can be induced by various causes, including severely inflamed acne, chicken pox, and trauma. Many treatment modalities are used for reconstructing and improving the appearance of scars with various treatment results. OBJECTIVE A recent report shows the clinical efficacy of the chemical reconstruction of skin scars (CROSS) method, which consists of the focal application of trichloroacetic acid (TCA) in a higher concentration. Histometric analysis of the CROSS method, however, has not yet been established. METHODS In this study, five hairless mice were used to evaluate the effect of the CROSS method and to analyze the difference between the CROSS method and simple TCA application. RESULTS Similar histologic changes were observed in the two methods, including epidermal and dermal rejuvenation with new collagen deposition. These changes, however, were more prominent in the CROSS method–treated areas, particularly when 100% TCA was used. CONCLUSION The results of this study suggest that treatment of atrophic scars using the CROSS method is more effective than simple application of TCA in activating fibroblasts in the dermis and increasing the amount of collagen.

Foreword: Emerging Role of Topical Immunomodulatory Therapies in Dermatology

During the last decade, advancements in the development and application of topical therapies, whether as monotherapy or adjunctive therapy, have provided dermatologists with greater options in the management of cutaneous disease. This special issue of the Journal of Cutaneous Medicine and Surgery provides readers with current and novel strategies for the treatment of several important dermatologic conditions that may present in the clinic. Articles were contributed by leading US experts in the diagnosis and management of dermatoses. These clinicians/researchers have a special interest in the topics they cover in this supplement. The supplement begins with my overview on the mechanism of action of immune response modifiers (IRMs) currently available for the treatment of a variety of common dermatologic conditions. Proinflammatory IRMs include the Toll-like receptor agonist imiquimod 5% cream, which applies a novel mechanism of action and stimulates the body s natural defenses to target diseased tissue. Immunosuppressive IRMs discussed include anti-tumor necrosis factor agents (e.g., infliximab and etanercept) and anti–T-cell agents (e.g., pimecrolimus and tacrolimus). Although IRM activity encompasses several different mechanisms of action, these immunomodulatory agents leverage the body s immune system to effectively treat numerous dermatoses. The next article, by Joseph Jorizzo, highlights a number of topical therapies currently available for the treatment of actinic keratosis. Several topical therapies are available including 5-fluorouracil, diclofenac, photodynamic therapy, and imiquimod 5% cream. The article reviews data on the newer formulation of 5-fluorouracil, 0.5%, and discusses newer treatment strategies using photodynamic therapy (e.g., shorter incubation times and various topical formulations of aminolevulinic acid). This review article also highlights exciting data on imiquimod 5% cream in the treatment of superficial actinic keratosis. With a number of dosing regimens already clinically evaluated, topical therapies such as imiquimod 5% cream will provide the opportunity for healthcare providers to tailor treatment to individual patient needs. The article by Robert Skinner provides a comprehensive overview of topical agents effective in the treatment of a number of conditions. Data are reviewed on the efficacy and safety of imiquimod 5% cream in the treatment of several dermatoses, including condyloma acuminata, basal cell carcinoma, and lentigo maligna. The efficacy and safety of pimecrolimus 1% cream and tacrolimus ointment (0.1% and 0.03%) in the treatment of atopic dermatosis in children and adults are also reviewed. Data suggest that topical immunotherapy will continue to play an important and useful role in managing dermatologic conditions during the next decade. Finally, the article by Brian Berman explores new opportunities for the treatment and prevention of hypertrophic scars, keloids, and atrophic scars. Although abnormal scarring represents a difficult and continuing challenge for healthcare providers, published studies suggest that several novel modalities may be effective for scarring. Discussions include the use of laser therapy for the treatment of atrophic scars, and surgical excision, in combination with topical therapies (e.g., imiquimod 5% cream), for the treatment and management of keloids and hypertrophic scars. In summary, it is my hope that you will find this special issue of Journal of Cutaneous Medicine and Surgery to be an important educational resource, providing a state-of-the-art synopsis on several important dermatologic conditions that readers may encounter in their clinical practice.

Use of 1,320 nm Nd:YAG laser for wrinkle reduction and the treatment of atrophic acne scarring in Asians.

The role of 1,320 Nd:YAG in non-ablative skin rejuvenation in Asians is has not been established. Furthermore, no study has investigated the effectiveness of 1,320 Nd:YAG laser in the treatment of atrophic scarring in Asians. The objective of our study was to investigate the effectiveness of 1,320 Nd:YAG laser in wrinkle reduction and the treatment of atrophic acne scarring in Asians. Twenty-seven female patients were included in the study: seven were treated for acne scarring and the others for wrinkle reduction. A 1,320 nm Nd:YAG laser (Cooltouch II, Roseville, CA) was used to treat both the cheeks and forehead for the patients with wrinkles, and both cheeks only for patients with atrophic acne scarring. All patients received treatment in the post-auricular areas. A spot size of 10 mm was used, and three passes were performed (two pre-cooling and one post-cooling). Patients were treated monthly for 6 months. All patients were subjectively assessed before and after their last treatment sessions using a structured questionnaire, and objectively assessed by the use of clinical photographs for by independent observers. A cutometer was used to assess viscoelasticity, and biopsies were taken at the post-auricular site for assessment by a pathologist. The overall degree of patients' satisfaction was rated as 4.9 (range 0-9.8) for wrinkle reduction and 4 (range 0-10) for acne scarring. In terms of objective assessment by independent observers, the degree of improvement was considered to be mild or no change in most cases. The independent pathologist who assessed the degree of improvement in terms of increased collagen production detected no change in 8 patients, mild improvement in 9, and moderate improvement in 10. There was also improvement in term of epidermal thickness in 13 cases. Assessment by viscoelasticity indicated a significant degree of improvement in most parameters in both groups of patients. Blistering occurred in five cases, all in the central facial areas, and post-inflammatory hyperpigmentation occurred in three cases. All cases of PIH resolved after the use of 4% hydroquinoine. There was no scarring or hypopigmentation. The 1,320 nm Nd:YAG laser is effective for wrinkle reduction and atrophic acne scar improvement, but to further enhance the clinical outcome a combination approach with another device such as IPL and a surgical technique such as subcision is necessary.

Management of post-acne scarring. What are the options for treatment?

Post-acne scarring is a very distressing and difficult problem for physician and patient alike. Recently, newer techniques and modifications to older ones may make this hitherto refractory problem more manageable. Options for dealing with post-acne scarring are explored. The patient, his or her overall appearance and the morphology of each scar must be assessed and treatment designed accordingly. To adequately address the patient with scarring, a thorough knowledge of the pathophysiology and anatomy of the different types of scars should be sought. Once an understanding of what the pathology is and where it is occurring is attained, the most pertinent treatment for that scar may be devised. A variety of post-acne scars is produced including superficial macules, dermal troughs, ice picks, multi-channelled fistulous tracts and subcutaneous atrophy. The wide variety of new treatment methods for post-acne scarring includes newer resurfacing tools such as CO2 and erbium infrared lasers, dermasanding and possibly some future techniques such as non-ablative and radiofrequency resurfacing. Dermal and subcutaneous augmentation with autologous and nonautologous tissue augmentation and the advent of tissue undermining have greatly improved treatment of atrophic scars. Use of punch techniques for sharply marginated scars (such as ice picks) is necessary if this scar morphology is to be treated well. One should attempt to match each scar against an available treatment as far as possible. Many of these techniques may be performed in a single treatment session but repeat treatments are often necessary. The treatment of hypertrophic acne scarring remains difficult, but silastic sheeting, vascular laser, and intralesional cytotoxics are interesting developments. Most often occurring extra-facially and in males these distressing scars often require multiple treatments and modalities before adequate improvement is achieved.

LASER RESURFACING OF ATROPHIC SCARS

Many patients seek treatment for the disfigurement caused by obvious variations in skin texture secondary to atrophic scarring. Many different procedures, including dermabrasion, chemical peels, punch grafting, and augmentation with filling materials, have been implemented for the treatment of atrophic scars. With the advent of high-energy, pulsed and scanned CO2 laser technology, precisely controlled, layer-by-layer tissue vaporization may be achieved with minimal thermal damage to adjacent skin. Atrophic scars resulting from acne, surgery, or trauma respond more favorably to laser resurfacing than to other, more conventional forms of treatment when proper techniques are employed.