Comparative efficacy and safety of six photoelectric therapies for the atrophic acne scars: A network meta-analysis

Objectives: This network meta-analysis assessed the relative efficacy and safety of six common photoelectric therapies including 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG), fractional carbon dioxide laser(FSCO2), fractional micro-plasma radiofrequency(Plasma), micro-needling fractional radiofrequency (MRF), 1550nm or 1540nm erbium-glass non-ablative fractional laser (NAFL) fractional erbium-doped yttrium aluminum garnet (Er: YAG). Methods: A comprehensive search to identify relevant studies was conducted using four electronic databases. Outcome measures were extracted based on subjective and objective indexes, including the dermatologists’ evaluation(DE), the patients’ overall satisfaction(PS), VAS score, and Postinflammatory hyperpigmentation (PIH). Results: Eleven published clinical research studies, involving 405 patients were included in this study. Ranking of DE from large to small is as follows: Nd: YAG, FSCO2, Er: YAG, Plasma, NAFL, MRF. In terms of PS, the rand from high to low can be described as follows: Er: YAG, Nd: YAG, FSCO2, Plasma, NAFL, MRF. In connection with the sequencing of adverse events, pain severity from slight to severe as follows: Er:YAG, Nd:YAG, FSCO2, NAFL, MRF, Plasma. The probability of having PIH are presented in order from lowest to highest as follows: MRF, Plasma, Nd: YAG, NAFL, Er: YAG, FSCO2. Conclusion: FSCO2 remains the mainstream of potentially curative treatment, then again Nd: YAG and Er: YAG require greater efforts to prove their superior effectiveness. NAFL might be appropriate for mild and moderate improvement with its strengths of good tolerance while Plasma fits into patients with higher pain thresholds but an expectation of higher results. MRF has not given expression on absolute predominance for the present. Registration: PROSPERO CRD42021242160(available from https://www.crd.york.ac.uk/PROSPERO)

Effects of lattice superpulsed CO 2 laser combined with asiaticoside cream ointment on repair of facial depression acne scar / 中华医学美学美容杂志

Objective:To investigate the effect of lattice superpulsed CO 2 laser combined with asiaticoside cream ointment on the repair of facial depression acne scar. Methods:A total of 124 patients with facial acne depression scar who visited the dermatology department of Zhengzhou People's Hospital from January 2019 to December 2020 were selected as subjects, including 60 males and 64 females, aged 16-38 (27.2±4.8) years. According to the random number table, the patients were divided into the control group ( n=62) and observation group ( n=62). The control group were treated with lattice superpulsed CO 2 laser, and the observation group were treated with lattice superpulsed CO 2 laser combined with asiaticoside cream ointment for 6 months. The therapeutic efficacy, Vancouver scar scale (VSS), ECCA score, skin barrier related indicators, pain duration, healing time, delayed duration and adverse reactions were compared between the two groups. Results:The total effective rate in the observation group (91.94%) was significantly higher than that in the control group (77.42%) (χ 2=5.04, P<0.05), pain duration, scab formation time, scab removal time, complete healing time, delay period and the incidence of adverse reactions were significantly lower than those in the control group [(2.76±1.04) h, (2.64±1.03) d, (6.18±1.47) d, (8.87±1.75) d, (7.89±2.16) d, 3.23% vs. (4.11±1.29) h, (3.87±1.14) d, (7.24±1.56) d, (11.05±1.93) d, (10.52±3.01) d, 12.90%, detection value = 6.42, 6.30, 3.90, 6.59, 5.59, 3.92, P<0.05]. After treatment, the VSS scale and ECCA score in the observation group were significantly lower than those in the control group (5.71±1.06, 39.12±10.64 vs. 6.42±1.17, 42.61±11.51, t=3.54, 2.26, P<0.05). After treatment, the water content of cuticle in the observation group was significantly higher than that in the control group [(40.02±14.14) vs. (34.35±11.50) AU, t=2.45, P<0.05], and transepidermal water loss, lactic acid stimulation test score and cuticle protein content were significantly lower than those in the control group [(19.07±5.70) g/(h·m 2), (2.62±1.27) score, (30.12±10.63) μg vs. (21.39±6.51) g/(h·m 2), (3.25±1.89) score, (35.10±11.19) μg, t=2.11, 2.18, 2.54, P<0.05]. Conclusions:Lattice superpulsed CO 2 laser combined with asiaticoside cream ointmentis can effectively treat acne scar and reduce adverse reactions, and the curative effect is better than single laser treatment.

Clinical Observation of Recombinant Bovine Basic Fibroblast Growth Factor as an Adjuvant Therapy for Patients with Atrophic Acne Scar / 中国医学科学院学报

Objective To study the influence of recombinant bovine basic fibroblast growth factor as an adjuvant therapy on scar alleviation and inflammatory cytokines in patients with atrophic acne scar. Methods The random number table was employed to randomly assign 120 patients with atrophic acne scar into a test group and a control group.Both groups of patients were treated with CO2 lattice laser.After the operation,the control group was routinely smeared with erythromycin ointment and the test group was coated with recombinant bovine basic fibroblast growth factor gel.The clinical efficacy,clinical indicators,scar alleviation,and inflammatory cytokine levels before and after treatment were compared,and adverse reactions were counted. Results The test group had higher total effective rate(P=0.040) and lower total incidence of adverse reactions(P=0.028) than the control group.Compared with the control group,the test group showcased short erythema duration after treatment(P=0.025),early scab forming(P=0.002),and early edema regression(P<0.001).After treatment,the proportion of grade 1 scars graded by Goodman and Baron's acne scar grading system in the test group and control group increased(P=0.001,P=0.027),and the proportion of grade 4 scars decreased(P<0.001,P=0.034).Moreover,the proportion of grade 1 scars in the test group was higher than that in the control group(P=0.031) after treatment,and the proportion of grade 4 scars presented an opposite trend(P=0.031).After treatment,the levels of tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) in both groups declined(all P<0.001),and the test group had lower TNF-α and IL-1β levels than the control group(all P<0.001). Conclusion The recombinant bovine basic fibroblast growth factor gel as an adjuvant therapy of CO2 lattice laser can effectively alleviate the atrophic acne scar,relieve local inflammatory reaction,and has good curative effect and less adverse reactions.

Effect of gold micro needle radiofrequency combined with syringe needle subsicion therapy on scar release operation / 中华医学美学美容杂志

Objective:To explore the efficacy of gold micro needle radiofrequency combined with syringe needle subsicion therapy in the treatment of facial acne scars.Methods:A total of 58 patients with facial depression acne scars admitted to our hospital from May 2018 to May 2020 were selected as subjects. There were 28 cases in the control group and the rest was the experimental group. The control group was treated with gold micro needle radiofrequency, and the experimental group was given a small syringe needle on the basis of the control group. After the treatment, the treatment effect and delayed construction period were observed.Results:According to the results of two independent samples Wilcoxon rank sum test, the treatment results of the two groups were different ( Z=2.742 and P=0.006). The effect of experimental group (mean rank 34.74) was better than that of control group (mean rank 23.88). According to =0.05 level, there was no statistically significant difference between the two groups in terms of missed work time after three treatments. There was no significantly difference between the two groups. Conclusions:Gold micro needle radiofrequency combined with syringe needle subsicion therapy for the treatment of facial acne scar has a satisfactory effect, and it is worthy of clinical promotion.

Adipose Stem Cells with Conditioned Media for Treatment of Acne Vulgaris Scar

This study was to investigate the effect of subcutaneous injection of the adipose stem cells (ASCs) with conditioned media (CM) in the treatment of acne vulgaris scar. We used Adult male New Zealand white rabbit ears as an animal model and induced acne formation by Kignman method. Adipose tissue was isolated and harvested from the scapula of rabbits, and ASCs were cultured and expanded until passage 1. There have four groups in our experiment, include phosphate buffered saline (PBS), ASCs with PBS (ASC + PBS), CM, and ASCs with CM (ASC + CM) group. This solution of 0.6 ml injected to subcutaneous in each group. ASC + PBS and ASC + CM groups were containing ASCs of 5.0 × 106 cells/ml. We analyzed the treatment of 4 groups to scar tissue after 2 and 4 weeks by hematoxylin and eosin stain, immunohistochemistry, and RNA expression level of tumor necrosis factor-α (TNF-α), interleukin-1α (IL-1α), and matrix metalloproteinase-2 (MMP-2). Also, the expression of keratin 16 (K16) was detected by western blot analysis. H&E stain showed that infiltration of inflammation cells was significantly reduced at 2 and 4 weeks, as well as re-epithelialization was improved in the ASC + CM group. The ASC + CM gourp was reduced both expression levels of TNF-α, IL-1α, and MMP-2 and K16 protein level. In conclusion, the ASCs with CM has a significant curative effect on acne vulgaris scar, more to the point, the CM has a key role on treatment. It could be applied to a therapeutic approach to regenerate to treat acne vulgaris scar.

Platycodin D May Improve Acne and Prevent Scarring by Downregulating SREBP-1 Expression Via Inhibition of IGF-1R/PI3K/Akt Pathway and Modulating Inflammation with an Increase in Collagen

BACKGROUND: Although many therapeutic agents have been developed, only a few drugs are known to target multiple pathogenic factors in the treatment of acne. OBJECTIVE: The purpose of this study was to identify a new drug candidate, platycodin D, which is a substance extracted from the root of Platycodon grandiflorum. METHODS: Using western blotting and Cell Counting Kit-8 assay, we studied the effects of platycodin D on SEB-1 sebocytes, fibroblasts, and keratinocytes. We investigated its effects in view of lipogenesis, collagen production, anti-inflammatory activity, and dyskeratinization. RESULTS: In SEB-1 sebocytes, platycodin D showed a sebosuppressive effect by downregulating ERK and insulin- like growth factor-1R/PI3K/Akt/sterol-regulatory element binding protein-1 signaling pathways. In addition, adiponectin, one of the adipokines responsible for sebum production, was decreased in platycodin D-treated SEB-1 sebocytes. In fibroblasts, platycodin D increased collagen production and reduced inflammation by inhibiting nuclear factor kappa B and matrix metalloproteinases. Platycodin D also showed anti-inflammatory effects on keratinocytes. It also suppressed keratin 16 expression induced by lipopolysaccharide. Furthermore, platycodin D showed no cytotoxicity on both SEB-1 sebocytes and fibroblasts. CONCLUSION: Our data demonstrate the clinical feasibility of platycodin D for acne treatment and the prevention of acne scarring by sebosuppressive and anti-inflammatory effects, as well as through an increase in collagen levels.

Multiple Piloleiomyoma Resembling Acne Scarring / 대한피부과학회지

No abstract available.

Application of Fractional Microneedling Radiofrequency and Autologous Platelet-Rich Plasma in Managing Facial Acne Scars.

Background: Many treatment modalities were tried to treat acne scar & still big challenge for dermatologists. Radiofrequency is a non-ionizing electromagnetic radiation used in medicine for nearly 75 years and the application of autologous Platelet-Rich Plasma has been safely used and documented in many fields of medicine. In dermatology and cosmetics they also are used in treating different conditions. Aim of Study: To evaluate the clinical efficacy of fractional microneedling radiofrequency (FMR) and autologous Platelet-Rich Plasma (PRP) a for treatment of facial acne scars. Patients and Methods: A therapeutic comparative study carried out in Dermatology Sulaimani Private Center for period from 1st of November, 2014 to end of June, 2015. Forty patients with acne scar were included, we divided these patients into 2 groups; group –A (22 patients were treated with FMR alone) & group- B (18 patients treated with both FMR & autologous PRP). Both groups were treated by 3 sessions at 4 weeks interval in between sessions. Clinical assessment of improvement was assessed by the patient himself (patient assessment) and two dermatologists by using standardized digital photography (physician assessment). Results: Most of the patients in both groups had showed a good improvement in their facial acne scar with the use of our treatment. Females were more than males with mean age of 30 years. There was a significant association between excellent improvement (by physician assessment and patients assessment) and patients acne scar treated in group- B (FMR & PRP) (p=0.02). Conclusion: Combination of FMR & autologous PRP is highly effective method for treating acne scars and it had an excellent satisfaction rate among patients.

Efficacy of non-ablative 1550-nm fractional laser on acne scars / 中华医学美学美容杂志

Objective To evaluate the clinical efficacy of the non-ablative 1550 nm fractional laser on post-acne atrophic scarring and post-acne erythema.By following up,the correlative factors were analyzed to guide the further use of the non-ablative 1550 nm fractional laser.Methods Twentyseven patients who received the non-ablative 1550 nm fractional laser therapy from Dec.2011 to June 2013 were enrolled in this retrospective study.We used a quartile grading scale for evaluation of postacne atrophic scarring and post-acne erythema.Results The effective rate was 13.0％ (3/23) for post-acne atrophic scarring and 44.0％ (11/25) for post-acne erythema.Nonparametric test showed that there was no statistical correlation of the efficacy with gender,age and courses of disease.But there was positive correlation between efficacy and treatment frequencies on post-acne erythema (r=0.619,P＜0.05).No severe adverse effect was observed.Conclusions We suggest that the nonablative 1550 nm fractional laser may provide a new treatment algorithm in some cases of post-acne atrophic scar and post-acne erythema.

The Consideration of Dermoscopic Findings during Atrophic Acne Scar Treatment: a Pilot Study / 대한피부과학회지

BACKGROUND: Dermoscopy has been suggested as a useful tool for diagnosing various skin diseases. Recently, the possibility of using dermoscopy to predict the response to treatment has emerged. OBJECTIVE: The purpose of this study was to determine whether dermoscopic findings corresponded to clinical acne scar types. This study also aimed to discover which dermoscopic findings predict the response to acne scar treatment. METHODS: The dermoscopic findings of 39 participants undergoing atrophic acne scar treatment with fractional photothermolysis were evaluated. Patients were divided into two groups according to the duration of acne scar persistence. RESULTS: Patients with a relatively short duration of acne scar persistence usually achieved better treatment outcomes. Dermoscopic findings showed no obvious differences according to clinical acne scar type. But high hair follicle density can be considered a predictive factor of treatment effects. CONCLUSION: Our study indicated that acne scar improvements can be predicted by dermoscopically observing hair follicle density.

A Comparative Study of the Efficacy and Safety of 100% TCA CROSS and Phenol CROSS for Atrophic Acne Scarring / 대한피부과학회지

BACKGROUND: Atrophic acne scars have been treated using various modalities. The CROSS (Chemical Reconstruction of Skin Scars) technique using 100% TCA has the advantage of reconstructing acne scars by focusing on dermal thickening and collagen production. However, the phenol CROSS technique is not widely used for acne scarring. OBJECTIVE: The purpose of this study was to evaluate the clinical effectiveness and safety of 100% TCA CROSS and phenol CROSS in the treatment of facial atrophic acne scars. METHODS: Twenty-four participants were randomly and equally divided into 2 groups: group 1 received 2 sessions (8 weeks apart) of 100% TCA CROSS, while group 2 received 2 sessions (8 weeks apart) of phenol CROSS. The severity of atrophic acne scarring and treatment efficacies were evaluated by standardized photography, patient satisfaction, physician global assessment, and the ECCA grading scale. Side effects were assessed at the 8- and 20-week visits. RESULTS: At the 0-, 8-, and 20-week visits, both groups showed an acceptable improvement in patient satisfaction and physician global assessment. ECCA grading scale scores improved by a mean of 22.2% (p<0.05) in group 1 and 19.1% (p<0.05) in group 2. The between-group difference in the degree of ECCA score improvement was not statistically significant (p=0.392). Complications such as pain, crust, postcrust erythema, postcrust dryness, and postinflammatory hyperpigmentation were observed in both treatment groups. However, no severe side effects occurred in either group. CONCLUSION: Both 100% TCA CROSS and phenol CROSS are effective treatment modalities for atrophic acne scarring without significant side effects.

Treatment of Acne Scars and Wrinkles in Asian Patients Using Carbon-Dioxide Fractional Laser Resurfacing: Its Effects on Skin Biophysical Profiles

BACKGROUND: Although ablative fractional resurfacing is known to be effective against photoaging and acne scars, studies on its efficacy, safety and changes in the skin characteristics of Asians are limited. OBJECTIVE: The aim of this study is to assess the efficacy and safety of carbon dioxide fractional laser (CO2FL) in Koreans treated for wrinkles and acne scars, and to define the changes in skin characteristics during recovery period. METHODS: We administered one session of CO2FL on 10 acne scar patients and 14 wrinkles patients with skin types IV and V. The surveillance of efficacy and side effects along with the measurement of biophysical properties was carried out before 1 day, 1 week, 1 month and 3 months after treatment. RESULTS: Using a non-invasive method, skin barrier damage, erythema and bronzing of skin during the recovery period were assessed, and all of the items eventually returned to the pre-treatment level. Skin elasticity was measured in the wrinkle group, and the statistically significant effect was sustained throughout the next three months. The outcome of treatment was found to be better than 'moderate improvement' in both the acne scar and wrinkle groups. Further, there were no serious side effects three months post-procedure. CONCLUSION: CO2 FL is thought to be an effective and safe method for treating moderate to severe acne scars and wrinkles in Asians.

Skin Characteristics after Fractional Photothermolysis

BACKGROUND: Fractional photothermolysis makes thousands of minute areas called microthermal treatment zones on the skin surface and transmits thermal injury to facilitate heat shock protein formation around the dermis. Potential side effects include acneiform eruption, herpes simplex virus outbreak, erythema, and post-inflammatory hyperpigmentation. OBJECTIVE: To investigate and compare the changes in the skin of Asian patients after two different fractional photothermolysis systems (FPS) on a split face. METHODS: A half-split face study was performed with 10,600 nm carbon dioxide FPS on the left and 1,550 nm erbium-doped FPS on the right side of the face. Only one session of laser irradiation and several biophysical measurements were done. RESULTS: Although both FPS proved to be effective in treating acne scar and wrinkle patients, a slightly higher satisfaction rating was seen with the 10,600 nm FPS treatment. Both types of FPS showed a significant increase in transepidermal water loss which decreased gradually after treatment and returned to pre-treatment level after 1 week. A decreased reviscometer score was sustained for a longer period in wrinkle areas treated with 10,600 nm FPS. CONCLUSION: Even though the changes in skin varied according to different FPS wave-length, adverse outcomes, such as increased erythema and TEWL were entirely subdued within 3 months of treatment.

Clinical Application of BCA Focal Treatment for Various Skin Diseases: Surgical Gems II / 대한피부과학회지

Bichloroacetic acid(BCA), one of the chloroacetic acids, is an effective tissue cauterant when used in high concentration. In dermatologic surgery, BCA, in the form of 100% solution, has been used to treat xanthelasma, sebaceous hyperplasia, verrucae, hard and soft corn, seborrheic keratosis, ingrowing nail, cysts. The cauterization with BCA 100% solution can be used with a simpler technique than the surgical excision or electrical cauterization, without complicated appliance such as LASER generators, so the dermatologic surgical technique - BCA chemical cauterization, topical treatment - can be selected as a treatment of choice for many dermatologic conditions in outpatient offices. BCA destroys the barrier function of the epidermis and penetrates deeply through the papillary dermis and then creates the effect in the papillary dermis and reticular dermis. As a result, regeneration of new dermal collagens and a new epidermis occurs. This pharmacologic effect of BCA makes 100% solution of BCA to be used in the treatment of xanthelasma, pigmented nevi, acne scars with good clinical outcomes.

Cutaneous Resurfacing of the Pitted Acne Scars with the Erbium:YAG laser in 100 Patients

BACKGROUND: Laser resurfacing of cutaneous scars, rhytides, and photodamaged skin has become very popular. Pulsed erbium:YAG laser resurfacing has recently come into favor for the treatment of pitted acne scars. OBJECTIVE: This study was designed to investigate the efficacy and safety of pulsed erbium:YAG laser in cutaneous resurfacing of pitted acne scars. METHODS: 100 patients with pitted acne scars were enrolled in this study. All patients were treated by means of a pulsed erbium:YAG laser with a 2 mm handpiece at the setting of 500 to 1000mJ/pulse and fluences used varied between 5-15J/cm2. Photographs of the face were obtained at baseline and 2 week postoperatively. Two weeks after treatment, postoperative care such as applying hydroquinone 4% and tretinoin 0.05% was recommended for 2 to 4 weeks. RESULTS: Out of 100 patients, 20% of patients showed an excellent response, 50% a good response, 21% a fair response and 9% a poor response. After 6 months, erythema had developed in two patients and and three patients had developed postinflammatory hyperpigmentation, hypopigmentation and delayed contact dermatitis. CONCLUSION: Treatment with pulsed erbium:YAG laser shows high efficacy and low morbidity in pitted acne scar resurfacing.

The Study of Surgical Treatment for Acne Scars:the Principle of a Three Staged Operation

BACKGROUND: Acne scars are not effectively corrected by a single treatment modality because of their widely varied depths and widths. OBJECTIVE: This study was performed to assess the effectiveness of staged combinations of several surgical modalities in the treatment of various acne scars. METHODS: Chemical peeling, CO₂ laserbrasion, scar excision, punch grafting, and dermabrasion were included in this study as surgical modalities. Initially, chemical peeling was performed on all patients and then CO₂ laserbrasion, scar excision and punch grafts were used for deep scars. Finally, dermabrasion was done for the remaining scars. Questionnaires were completed for clinical assessments by the patients and clinicians. RESULTS: Clinicians assessed the results as "excellent and good" in 75% of patients. However, only 53% of patients gave this same result. The degree of satisfaction escalated as the followup periods and number of chemical peeling procedures increased and as the sequence of the 3 staged operation progressed. CONCLUSION: We suggest that the principle of 3 staged operations would be effective in the treatment of patients with various types of acne scars.

The Effect of TCA Chemical Peel on Acne Scars / 대한피부과학회지

BACKGROUND: Trichloroacetic acid(TCA) chemical peel has been used for variable skin lesions. However, the effect of TCA chemical peel on acne scars has not been studied. OBJECTIVE: The object of this study is to evaluate the effect of TCA chemical peel on atrop hic acne scars. METHOD: Twenty three patients with atrophic acne scars, who were treated with TCA chemical peel were included. The patieits were interviewed for evaluation of the therapeutic efficacy of TCA chemical peel regarding the number of treatment and satisfaction rates. RESULTS: Those who received treatment for more than 6 times with good or excellent results were 13 out of 15 patients, whereas, those who received treatment for 4 times with good or excellent results were 4 out of 7 patients Thus, chemical peel on acne scars showed that the more often the treatment was carried out, the better the therapeutic effect. There was no significant complication. CONCLUSION: TCA chemical peel is safe and effective for the treatment of atrophic acne scars.