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Las cicatrices de acné, especialmente las de tipo atrófico, constituyen una complicación frecuente del acné vulgar que se asocia a un importante impacto psicológico. Múltiples terapias se han utilizado para mejorar su aspecto, sin embargo, ninguna ha demostrado ser completamente eficaz y segura. El tratamiento quirúrgico en acné cicatricial incluye técnicas como escisión elíptica, escisión o elevación por punch, subcisión y distintos tipos de láser. El objetivo de esta revisión es presentar la evidencia disponible respecto a las técnicas quirúrgicas y dispositivos láser utilizados en cicatrices atróficas de acné.
Acne scars, especially the atrophic type, are a common complication of acne vulgaris, which is associated with a major psychological impact. Multiple therapies have been used to improve its appearance, however, none has proven completely effective and safe. Surgical treatment includes surgical techniques such as elliptical excision, punch excision or elevation, subcision and different types of lasers. The aim of this review is to present the available evidence regarding the surgical techniques and laser devices used in atrophic acne scars.
Subject(s)
Humans , Cicatrix/surgery , Acne Vulgaris/complications , Atrophy , Cicatrix/etiology , Patient Selection , Laser TherapyABSTRACT
Objective To explore the efficacy of cold packs combined with ice compress in treatment of pain after erbium fractional photothermal therapy on acne scars. Methods Eighty cases which were confirmed to the criteria were randomized into two groups:treatment group and control group. The treatment group (n=40) treated with cold packs combined with cold icy compress immediately after the surgery for 30~40 mins. The control group (n=40) was given icy compress therapy immediately after the surgery for 30~40 mins. The therapy continued for three days after the surgery on the two groups. The self-feeling symptom and pain relieving time were compared between the two groups. Result The time for pain relief in the wounds and the time for scabbing were both significantly shorter than those in the control group (P<0.01). Conclusion The cold packs combined with ice compress therapy can relieve the pains effectively and it can shorten the recovery time after fractional photothermal therapy.
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Objective To investigate the clinical efficacy of fractionated ultrapulse carbon dioxide laser combined with microneedle for depressed acne scars.Methods Totally 86 patients with depressed acne scar were randomly divided into 2 groups:the treatment group received fractionated ultrapulse carbon dioxide laser combined with microneedle technology and the control group only received fractionated ultrapulse carbon dioxide laser.The treatment interval was 1 to 3 months,and the whole course was 2-8 times.The total effective rate and the adverse reaction were analyzed in the facial acne scar.Results The surface of depressed acne scars was significantly improved.ECCA score of all patients declined obviously after treatment,the score of the treatment group declined from 61± 11 to 45± 15,and the control group declined from 57± 14 to 40± 16.There were significantly statistical differences in the results of each group (P＜0.05).More treatment times resulted in better surface improvement.The total effective rate were 81.8％ (18/22) and 100％ (24/24) in the treatment group,and 80.0％ (16/20) and 100％ (20/22) in the control group.The course was 6.8± 1.6 months in the treatment group and 20.8±4.6 months in the control group (P＜0.05) to get a similar satisfied result.There were no obvious adverse reactions except two cases of erythema and pigmentation in the treatment group and 5 cases in the control group.The former was with less adverse reactions.Conclusions Ultrapulse carbon dioxide laser combined with microneedle technique is effective for facial acne scars,with less complications and shorten treatment course.
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Objective To observe the effect and safety of bFGF auxiliary fractional Er :YAG laser in the treatment of facial a-trophic acne scar .Methods After fractional Er :YAG laser treatment ,64 cases of facial atrophic acne scar patients were randomly divided into two groups ,the observation group was applied facial ice collagen dressing and sprayed fibroblast growth factor ,the con-trol group was only applied facial ice collagen dressing .Treatment in two groups last for 10 consecutive days .Postoperative to ob-serve the wound healing time ,adverse reactions ,using B .Dreno′s ECCA grading scale to identify and quantify facial atrophic scars before and after treatment and statistics the satisfactory rate of patients .Results The wounds of two groups were conventional healing ,in the observation group the average healing time was 7 .2 days ,and that of control group was 10 .4 days ,there was signifi-cant difference (P<0 .05) .For all patients at the end of treatment and followed-up 3 months later ,scar were all improved ,with an efficiency of 100% .Conclusion Fractional Er :YAG laser combined with bFGF is a safe and effective treatment method for treat-ment of facial atrophic acne scars .
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Background: Treatment of acne scars with ablative fractional laser resurfacing has given good improvement. But, data on Indian skin are limited. A study comparing qualitative, quantitative, and subjective assessments is also lacking. Aim: Our aim was to assess the improvement of facial acne scars with Erbium-doped Yttrium Aluminium Garnet (Er:YAG) 2940 nm fractional laser resurfacing and its adverse effects in 25 patients at a tertiary care teaching hospital. Methods: All 25 patients received four treatment sessions with Er:YAG fractional laser at 1-month interval. The laser parameters were kept constant for each of the four sittings in all patients. Qualitative and quantitative assessments were done using Goodman and Barron grading. Subjective assessment in percentage of improvement was also documented 1 month after each session. Photographs were taken before each treatment session and 1 month after the final session. Two unbiased dermatologists performed independent clinical assessments by comparing the photographs. The kappa statistics was used to monitor the agreement between the dermatologists and patients. Results: Most patients (96%) showed atleast fair improvement. Rolling and superficial box scars showed higher significant improvement when compared with ice pick and deep box scars. Patient's satisfaction of improvement was higher when compared to physician's observations. No serious adverse effects were noted with exacerbation of acne lesions forming the majority. Conclusion: Ablative fractional photothermolysis is both effective and safe treatment for atrophic acne scars in Indian skin.Precise evaluation of acne scar treatment can be done by taking consistent digital photographs.
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Objective To evaluate the effect of resurfacing facial atrophic acne scars with 2790 nm YSGG fractional laser.Methods 38 patients with facial atrophic acne scars were treated with the 2790 nm YSGG fractional laser.All patients were randomly divided into two groups:group A using the combination with ablative and non-ablative mode of treatment; group B only using the non-ablative mode throughout the entire face,four treatment sessions for each patient,6 weeks interval.Comparative photographs were taken by using VISIA.Specific complexion analysis was used to identify and quantify depressed scars and texture,and patient satisfaction was graded with a 4-point scale.Results All of facial atrophic acne scars obtained different degree of improvement were treated by 4 times.In groups A and B,cure rate achieved 56.0 ％ and 30.8 ％,respectively.All the 38 patients had a chieved efficacy (81.6 ％),and they were satisfied with the results (84.2 ％).No severe side effect was observed.Conclusions 2790 nm YSGG laser is easy to manipulate and is more exactly than other lasers.It is especially effective in enhancing the clinical outcomes of scar revision with less complications and pigmentation,and thereby 2790 nm YSGG fractional laser can provide the patients with superficial scar in face as an additional therapeutic option.
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Introduction: Fractional laser technology is a new emerging technology to improve scars, fine lines, dyspigmentation, striae and wrinkles. The technique is easy, safe to use and has been used effectively for several clinical and cosmetic indications in Indian skin. Devices: Different fractional laser machines, with different wavelengths, both ablative and non-ablative, are now available in India. A detailed understanding of the device being used is recommended. Indications: Common indications include resurfacing for acne, chickenpox and surgical scars, periorbital and perioral wrinkles, photoageing changes, facial dyschromias. The use of fractional lasers in stretch marks, melasma and other pigmentary conditions, dermatological conditions such as granuloma annulare has been reported. But further data are needed before adopting them for routine use in such conditions. Physician qualification: Any qualified dermatologist may administer fractional laser treatment. He/ she should possess a Master's degree or diploma in dermatology and should have had specific hands-on training in lasers, either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist or plastic surgeon with experience and training in using lasers. Since parameters may vary with different systems, specific training tailored towards the concerned device at either the manufacturer's facility or at another center using the machine is recommended. Facility: Fractional lasers can be used in the dermatologist's minor procedure room for the above indications. Preoperative counseling and Informed consent: Detailed counseling with respect to the treatment, desired effects and possible postoperative complications should be provided to the patient. The patient should be provided brochures to study and also adequate opportunity to seek information. A detailed consent form needs to be completed by the patient. Consent form should include information on the machine, possible postoperative course expected and postoperative complications. Preoperative photography should be carried out in all cases of resurfacing. A close-up front and 45-degree lateral photographs of both sides must be taken. Laser parameters: There are different machines based on different technologies available. Choice parameters depend on the type of machine, location and type of lesion, and skin color. Physician needs to be familiar with these requirements before using the machine. Anesthesia: Fractional laser treatment can be carried out under topical anesthesia with eutectic mixture of lidocaine and prilocaine. Some machines can be used without any anesthesia or only with topical cooling or cryospray. But for maximal patient comfort, a topical anesthetic prior to the procedure is recommended. Postoperative care: Proper postoperative care is important in avoiding complications. Post-treatment edema and redness settle in a few hours to a few days. A sunscreen is mandatory, and emollients may be prescribed for the dryness and peeling that could occur.
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BACKGROUND: Laser resurfacing has beneficial effects for the treatment of several skin conditions. Recently, the pulsed erbium:YAG laser has been shown to be a highly effective treatment for several kinds of pitted facial scars. OBJECTIVE: The purpose of this study was to assess the efficacy and safety of pulsed erbium:YAG laser skin resurfacing at the setting of low or high energy for pitted acne scars. METHODS: 65 patients with pitted acne scars were included in this study. All patients had skin types III or IV. All patients were instructed to use tretinoin cream 0.05% nightly for 2-4 weeks prior to the laser treatment. The pulsed erbium:YAG laser with a 2 mm handpiece at the setting of 500 mJ/pulse, 3.5-5 W in 45 patients and 1,000 mJ/pulse, 7-10 W in 20 patients was used. Two weeks after laser treatment, topical application of hydroquinone 4%, tretinoin 0.05%, and hydrocortisone 1% cream was recommended for 2-4 weeks. Facial photographs were obtained at baseline and 2 week intervals postoperatively. The results of treatment were evaluated for the changes of skin texture and color at 1 month, 3 months, and 6 months. RESULTS: In 45 cases treated with 500 mJ/pulse energy, pitted acne scars were improved about 46.7 % on average and no erythema and postinflammatory hyperpigmentation was observed after 6 months. In 20 cases treated with 1,000 mJ/pulse energy, pitted acne scars were improved about 64% on average and erythema in two patients and postinflammatory hyperpigmentation in one patient were observed after 6 months. CONCLUSION: The results of laser treatment for pitted facial acne scars at the setting of high energy are better than those of laser treatment at the setting of low energy.
Subject(s)
Humans , Acne Vulgaris , Cicatrix , Erbium , Erythema , Hydrocortisone , Hyperpigmentation , Lasers, Solid-State , Skin , TretinoinABSTRACT
Tricholroacetic acid (TCA) chemical peeling is an effective, versatle and safe therapeutic method for patients with pigmentary disorders, acne scars and aging skin. With an experienced and skilled operator, the associated complications are rare and tend to be mild. No. ystemic toxicity is known to be induced by TCA. We observed the effect of TCA chemical peeling, evaluated by 242 patients themselves with melasma, freckles, senile lentgines, pigmented nevi, seborrheic keratosis, skin tags or acne scars. The patients evaluated TCA peeling as excellent for the treatment of seboirheic keratosis, pigmented nevi, skin tags and acne scars, and as selectively recommendable for the treatment of melasma, freckles and senile lentigines.