Treatment Of Scars Research Articles

Fractional CO2 Laser for Burn Scars: A Comparison of Patient-Reported Outcomes Between Those With and Without Laser Treatment

Abstract Burn reconstruction outcomes are an area of growing investigation. Although there is evidence of measured physical improvements in scar characteristics after laser treatment, there is little information on patient-reported outcomes. The purpose of this study is to compare patient-reported outcomes between burn survivors with and without laser treatment. The study included participants in the Burn Model System National Database at a single center; participants that received outpatient laser treatment for burn scars were compared to a matched group of burn survivors that did not receive laser. The following outcomes were examined: Satisfaction With Life Scale, Mental and Physical Component Summary of the Veterans Rand Survey, and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Scale. Regression analyses examined the associations between laser treatment and each outcome at 12 and 24 months. The study population included 287 adult burn survivors (65 laser group and 222 control group). The significant differences found between the 2 groups included: burn size (laser: 14.9, 13.5 SD, control: 8.9, 11.1 SD; P < .001), insurance type (P = .036), inhalation injury (laser: 17.2%, control: 2.7%; P < .001), and ventilator requirement (laser: 27.7%, control: 13.5%; P = .013). Laser treatment was not associated with any of the outcomes at both follow-up time points. Further research is needed to develop patient-reported outcome measures that are more sensitive to the clinical changes experienced by burn survivors receiving laser treatment.

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.

A simple approach for CTAB-free and biofunctionalized gold nanorods to construct photothermal active nanomedicine for potential in vivo applications in cancer cells and scar treatment

A simple approach for CTAB-free and biofunctionalized gold nanorods to construct photothermal active nanomedicine for potential in vivo applications in cancer cells and scar treatment

Triple therapy for the treatment of keloid scars: a case series

triple therapy for the treatment of keloid scars: a case series

Minimally invasive surgical approach to model hypertrophic scarring in the rabbit ear.

Current strategies for hypertrophic scar prevention and treatment are limited. To facilitate these efforts, a minimally invasive hypertrophic scar model was created in a rabbit ear for the first time based on previous methods used to induce ischemia. Six New Zealand white rabbits (12 ears total) were studied. First, ischemia was achieved by ligating the cranial artery, cranial vein and central artery, while preserving the caudal artery, caudal vein and central vein, respectively. The relative level of ischemia induced at time of surgery, both baseline and maximum perfusion, was assessed with a fluorescent light-assisted angiography and demonstrated lower rates of perfusion in the ischemic ears. Following vascular injury, a 2-cm full thickness linear wound was created on the ventral ear and closed with 4 - 0 Nylon sutures under high tension. For each rabbit, one ear received a combination of ischemia and wounding with suture tension (n = 6), while the other ear was non-ischemic with wounding and suture tension alone (n = 6). Four weeks post-operatively, ischemic ears developed scar hypertrophy (histological scar thickness: 1.1 ± 0.2mm versus 0.5 ± 0.1mm, p < 0.05). Herein, we describe a novel, prototypical minimally invasive rabbit ear model of hypertrophic scar formation that can allow investigation of new drugs for scar prevention.

Dezocine as preemptive analgesia alleviates ultrapulse CO2 fractional laser treatment induced pain in patients with acne scars.

Ultrapluse CO2 fractional laser technology has emerged as an effective treatment for scar management. However, one drawback of this modality is the pain caused during the procedure. This study aims to explore the efficacy and safety of dezocine (DZC) as preemptive analgesia for reduction of pain induced by ultrapulse CO2 fractional laser treatment for acne scars. The study cohort included 78 outpatients with acne scars between February and April 2023. Patients were randomly assigned into three groups with intravenous injection (iv) of DZC prior to laser treatment: (1) control, iv of saline; (2) DZC group 1 (DZC_1), iv of DZC at 0.15 mg/kg; and (3) DZC_2, iv of DZC at 0.20 mg/kg. After 30 min, one session of ultrapulse CO2 fractional laser treatment on acne scars was performed. Hemodynamics, visual analogue scale (VAS), and anxiety visual analog test (AVAT) were monitored prior to, during, and after the procedure. Operative success rates for patients in the control, DZC_1, and DZC_2 groups were 34.6%, 84.6%, and 100%, respectively. DZC administered with either dosage significantly reduced the VAS and AVAT scores of patients in treatment groups as compared with the subjects in the control group during the course of ultrapulse CO2 fractional laser treatment. Patients in DZC_1 and DZC_2 groups did not show any significant difference in hemodynamic parameters, VAS, and AVAT scores. Temporary adverse effects such as nausea and dizziness were observed in some subjects after treatment; the symptoms were quickly dissolved after a rest in supine position. DZC as preemptive analgesia could effectively reduce pain and anxiety induced by ultrapulse CO2 fractional laser treatment in patients. This study provided an option of preemptive anesthesia to minimize the pain and discomforts associated with laser treatments in clinical practices.

Comparison of the fractionated Nd: YAG 1064-nm picosecond laser with holographic optics and the fractional CO2 laser in atrophic acne scar treatment: a prospective, randomized, split-face study.

The 1064-nm picosecond laser with holographic optics demonstrated significant efficacy in treating atrophic acne scars. Picosecond lasers with fractionated optics have enabled the development ofa breakthrough skin rejuvenation method. The authors compared the fractionated, non-ablative neodymium-doped yttrium aluminum garnet 1064-nm picosecond laser with holographic optics and the fractional CO2 laser in treating atrophic acne scars. One side of each patient's face was randomly allocated and treated with three sessions of the 1064-nm picosecond laser with holographic optics at 2-month intervals. In contrast, the other side was treated with the fractional CO2 laser. Participants were followed up 3 months after the final session. The primary outcome included the physicians' evaluation using the ECCA grading scale and a four-point scale to assess improvement. The patients' assessment of progress, their overall satisfaction and preferences, and the side effects were also evaluated. No significant difference was observed between the two lasers in terms of the mean ECCA scores after treatments (P = 0.209). The physicians' improvement assessment was more significant for the fractional CO2 laser (P = 0.001). The patients' evaluation of improvement and subjective satisfaction were consistent with physicians' four-point scale results. The picosecond laser side had fewer adverse effects (P < 0.001). The fractionated, non-ablative Nd: YAG 1064-nm picosecond laser with holographic optics and the fractional CO2 laser were effective and safe in treating atrophic acne scars. Significantly better clinical outcomes were observed with the fractional CO2 laser, whereas fewer adverse effects were noted with the 1064-nm picosecond laser with holographic optics.

Four-layer technique for tracheostomy scar treatment.

One important complication of the tracheostomy procedure is the depressed scar left after the tube is removed. A depressed tracheostomy scar can be aesthetically and functionally unacceptable. Tracheostomy scar treatment aims to fill lost soft tissue volume and correct tracheal skin tug. There are various techniques described to manage post-tracheostomy scars, including the use of autologous tissue or allogenic material and the creation of muscle flaps. In this article, the authors introduce a surgical method using four layers: the scar, the strap muscles, the platysma muscle, and the skin. This procedure has been used in two patients with depressed scar after prolonged tracheostomy placement. The tracheal tug was eliminated in each patient, and an imperceptible cutaneous scar remained. In each case, patient satisfaction was complete. The authors recommend this technique as a simple and effective method of closure for these troublesome tracheostomy scars.

The Efficacy of Onion Extract on the Prevention or Treatment of Scars: A Systemic Review.

Scars are common and debilitating outcomes of burn injury, with no current consensus regarding the gold standard in scar management. Non-invasive interventions such as silicone gels are popular adjuvant treatments due to ease of application. Onion extract (OE) has been proposed as a potential scar treatment modality due to its anti-microbial and anti-inflammatory properties. A systematic search of the literature was conducted using PubMed, Scopus, and Cochrane for articles published between January 2000 and December 2021. Inclusion criteria were studies: (a) involved OE gel or OE treatment, and (b) those assessing scar prevention or treatment outcomes. Patient and physician reported scar outcomes after treatment and adverse effects were recorded. A total of 21 articles were included in the final review. Five studies found statistically significant improvements in overall scores and individual VSS components in the OE treatment group compared to the silicone groups. Several studies found combined treatment of OE with other topical treatment modalities such as triamcinolone or silicone gel produced significant improvements in scar symptoms. In this review, reported adverse effects were minimal, often consisting of self-resolving pruritus, irritation, and erythema. This review supports OE's potential utility in scar prevention and treatment. Most studies reported minimal adverse events with OE application and significant benefits in specific scar characteristics. Further research is needed to investigate scar outcomes after treatment with OE with larger sample sizes and a follow up period greater than a year.

Fractional Radiofrequency and Oral Isotretinoin-A Prospective Randomized Controlled Split-Face Trial Comparing Concurrent Versus Delayed Fractional Radiofrequency Treatment for Acne Scars.

Therapeutic dogma has been to treat acne scars no less than 6 months after isotretinoin (ITN) cessation. To evaluate the safety and efficacy of fractional radiofrequency (FRF) in patients treated concurrently with ITN. We conducted a prospective randomized control 3-arm comparative trial to evaluate the treatment of acne scars. Patients received one of three treatment options: (A) ITN and FRF concurrent treatment, (B) ITN monotherapy, and (C) FRF 6 months post-ITN treatment. Patients in the FRF cohorts received three monthly sessions. Patients were followed for adverse effects up to 6-9 months post-FRF treatment. Final cosmesis was scored by three independent dermatologists using two scales: the Echelle d'Evaluation Clinique des Cicatrices d'Acne (ECCA) and an internal 5-point investigator's scale, indicating the percentage of improvement. Subjective analyses by patients were also assessed. Objective and subjective analyses revealed improvement in the ITN-FRF cohort, which was superior to the delayed FRF cohort and the ITN monotherapy cohort. Specifically, the concurrently treated cohort (ITN-FRF) had a significant reduction in acne scar volume from baseline mean (151.1 ± 44.7 to 97.0 ± 31.2, p < 0.005), outperforming both the delayed FRF and monotherapy ITN treatment cohorts, respectively (155.4 ± 37.8 to 122.0 ± 46.2, 144.6 ± 82.8 to 132.4 ± 62.7). Additionally, the concurrently treated cohort demonstrated improved ECCA scores (36.8 ± 15.5), significantly better than the ITN monotherapy cohort (101.5 ± 20.1, p < 0.01). Limited patient sample size: 38 patients completed the study; mostly Fitzpatrick Type II-III skin; photographic assessments utilized. Per our prospective trial, concurrent treatment of ITN-FRF is superior to delayed FRF treatment 6 months post-ITN cessation.

Role of platelet rich plasma therapy in the treatment of alopecia areata and atrophic acne scars

Role of platelet rich plasma therapy in the treatment of alopecia areata and atrophic acne scars

Psychosocial aspects of acne tarda

Acne is a chronic inflammatory dermatosis, which mainly affects teenagers, but it can appear de novo, in adulthood, or persist in the continuation of acne vulgaris. Acne tarda is defined by the persistence of acne vulgaris or the appearance of acne after the age of 25. This skin condition is seen by those around as a real social disability, due to its chronic evolution, but also to the unsightly post-acne scars. The etiology of acne tarda is multifactorial, but it seems to be closely related to hormonal disorders, cosmetic products, psycho-emotional stress, foods with a high fats content or some medications. Hyperandrogenism is an important endogenous factor in acne tarda, which is frequently identified in polycystic ovary syndrome. The multidisciplinary approach, for patients with endocrinological or psychiatric disorders, is extremely important to obtain encouraging therapeutic results. The psycho-social impact of acne tarda is a major, given the fact that, most of the time, acne is seen as strictly an adolescent condition. Although there are currently few studies on integrated dermatological and psychiatric care, this approach is promising for acne patients. Psychotherapy sessions performed concurrently with dermatological treatment or laser treatments for post-acne scars can provide significant improvements in patients' quality of life, but can also lead to better adherence to treatment, thus reducing the recurrence of episodes of depression, anxiety and social isolation.

Inhibition and reversal of a TGF-β1 induced myofibroblast phenotype by adipose tissue-derived paracrine factors

BackgroundHypertrophic scarring results from myofibroblast differentiation and persistence during wound healing. Currently no effective treatment for hypertrophic scarring exists however, autologous fat grafting has been shown to improve scar elasticity, appearance, and function. The aim of this study was to understand how paracrine factors from adipose tissues and adipose-derived stromal cells (ADSC) affect fibroblast to myofibroblast differentiation.MethodsThe transforming growth factor-β1 (TGF-β1) induced model of myofibroblast differentiation was used to test the effect of conditioned media from adipose tissue, ADSC or lipid on the proportion of fibroblasts and myofibroblasts.ResultsAdipose tissue conditioned media inhibited the differentiation of fibroblasts to myofibroblasts but this inhibition was not observed following treatment with ADSC or lipid conditioned media. Hepatocyte growth factor (HGF) was readily detected in the conditioned medium from adipose tissue but not ADSC. Cells treated with HGF, or fortinib to block HGF, demonstrated that HGF was not responsible for the inhibition of myofibroblast differentiation. Conditioned media from adipose tissue was shown to reduce the proportion of myofibroblasts when added to fibroblasts previously treated with TGF-β1, however, conditioned media treatment was unable to significantly reduce the proportion of myofibroblasts in cell populations isolated from scar tissue.ConclusionsCultured ADSC or adipocytes have been the focus of most studies, however, this work highlights the importance of considering whole adipose tissue to further our understanding of fat grafting. This study supports the use of autologous fat grafts for scar treatment and highlights the need for further investigation to determine the mechanism.

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.

Subcision with and without suction for acne scars: a split-faced, rater-blinded randomized control trial.

Therapeutic options for acne scars include subcision and suction with microdermabrasion, but these treatment modalities have not been studied in conjunction. To compare effectiveness of subcision alone versus subcision with suction for the treatment of facial acne scars. Randomized, split-faced, evaluator-blinded control trial. Participants underwent one subcision treatment on both sides of the face followed by 10 sessions of suction to one side. Photographs at baseline, 1-month, and 4-months were assessed. Primary outcome measures were the validated Acne Scar Severity Scale (ASSS) (0 = no acne scarring, 4 = severe), Acne Scar Improvement Grading Scale (ASIGS) (-100to100%), and modified Quantitative Global Scarring Grades (QGSG) (point-based questionnaire instrument), as well as subject preference. Twenty-eight treatment areas and 154 treatments were analyzed. Dermatologist raters found no differences between subcision alone and subcision-suction at 1-month or 4-months. Mean subject-assessed percent improvement for subcision-suction was higher than that for subcision alone at 1-month (37% versus 24%, p = 0.04) but not at 4-months (p = 0.37). Subjects preferred combination therapy to monotherapy at 1-month (50% vs. 21%) and 4-months (43%vs.21%). While blinded raters did not detect significant differences, subjects perceived combination treatment as working more quickly than monotherapy, and preferred combination treatment at all time points.Clinical trial registration NCT01696513 on Clinicaltrials.gov.

Dissolvable microneedles loaded with asiaticoside nanocrystals stabilized by Panax Notoginseng saponins for hypertrophic scar treatment

Hypertrophic scars (HS) are fibroproliferative disorders caused by overgrowth of connective tissue during wound repair, for which effective treatment is lacking. Although Asiaticoside (AS) facilitates scarless wound healing, its low permeability through the skin and poor solubility in water pose major barriers to clinical application. Dissolvable microneedles (DMNs) have emerged as a potent transdermal drug delivery technique capable of penetrating the stratum corneum barrier. However, due to the lipid-soluble nature of AS, it is incompatible with water-soluble microneedle matrices. This incompatibility could result in an uneven dispersion of drugs, making the creation of DMNs loaded with AS challenging. In this study, a pharmacodynamic molecule called Panax Notoginseng Saponins (PNS), which similarly encourages scarless wound healing, was used as a stabilizer. Asiaticoside-Panax Notoginseng Saponin (AS-PNS-NCs) were prepared by solvent evaporation coupled with ultrasonication to improve the water solubility of AS. The average particle size was 158.70 ± 10.99 nm, Polydispersity index (PDI) was 0.18 ± 0.012, and Zeta potential was −15.5 ± 1.08 mV. A centrifugal filling technique was then used to create AS-PNS-NCs-DMNs. After 24 h of in vitro transdermal drug release, the cumulative transdermal release of AS-PNS-NCs-DMNs of 319.00 ± 50.01 μg and skin retention of 80.61 ± 48.46 μg were significantly higher than those of AS-PNS-NCs- Gels (134.84 ± 27.66 μg and 5.23 ± 1.86 μg, respectively). Furthermore, it was demonstrated that AS-PNS-NCs-DMNs may suppress human skin fibroblasts (HSF) in vitro migration rate and proliferative activity. In rabbit ear keloid model, AS-PNS-NCs-DMNs (containing AS 1536.49 ± 93.14 μg/patch) reduced the collagen volume fraction (CVF) and improved the collagen fiber arrangement by inhibiting the overexpression of transforming growth factor-β1 (TGF-β1) and α-Smooth muscle actin (α-SMA) at the scar site, resulting in a reduction of scar thickness. It is demonstrated that AS-PNS-NCs-DMNs can effectively inhibit scar proliferation.

Imaging of Vesicoureteral Reflux: AJR Expert Panel Narrative Review.

Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract that can present with collecting system dilation or as a febrile infection. VUR can lead to permanent renal sequelae requiring surgery but can also spontaneously resolve without complication. Therefore, recognizing patient populations who warrant imaging for screening, confirmation, or ongoing surveillance for VUR is important, as is avoiding overdiagnosis. In the appropriate patient populations, an accurate diagnosis of VUR allows early treatment and prevention of pyelonephritis and scarring. Various imaging modalities are available to diagnose and grade VUR, including voiding cystourethrography, radionucleotide cystography, and contrast-enhanced voiding urosonography (ceVUS). The objective of this article is to summarize the current understanding of VUR diagnosis and management and to discuss these imaging modalities' strengths and pitfalls. Considerations include indications for VUR imaging, patient preparation, conduct of the examination, issues related to radiologic reporting, and cost-effectiveness. An emphasis is placed on ceVUS, which is the most recently introduced of the three imaging modalities and is receiving growing support among pediatric radiologists.

A Comprehensive Review of Non-Surgical Treatments for Hypertrophic and Keloid Scars in Skin of Color.

Hypertrophic and keloid scars are fibroproliferative growths resulting from aberrant wound healing. Individuals with Fitzpatrick skin types (FSTs) IV-VI are particularly predisposed to hypertrophic and keloid scarring, yet specific guidelines for these populations are still lacking within the literature. Therefore, this comprehensive review provides a list of various treatments and considerations for hypertrophic and keloid scarring in patients with skin of color. We constructed a comprehensive PubMed search term and performed quadruple-blinded screening on all resulting studies to achieve this objective. Our findings demonstrate 1) the lack of efficacious treatments for raised scars within this population and 2) the need to empirically investigate individualized and multimodal therapeutic options for those with skin of color.

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.

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.