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Mar K, Khalid B, Maazi M, Ahmed R, Wang OJE, Khosravi-Hafshejani T. Treatment of Post-Inflammatory Hyperpigmentation in Skin of Colour: A Systematic Review. J Cutan Med Surg 2024:12034754241265716. [PMID: 39075672 DOI: 10.1177/12034754241265716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Post inflammatory hyperpigmentation (PIH) affects all skin types with a heightened predilection for darker skin tones. Its course is chronic once developed and treatment is often difficult. This systematic review aims to summarize the treatment outcomes for PIH with a focus on skin of colour (SOC) individuals. A literature search was conducted using MEDLINE (from 1946), Embase (from 1974), PubMed, and Cochrane in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. Results from 48 studies summarized 1356 SOC individuals. The mean age was 29 years (n = 1036) and 78% were female (n = 786). The ethnic prevalence was 70% Black, 27% Asian, and 3% Latin. Overall, 20% were Fitzpatrick skin type (FST) III, 40% FST IV, 34% FST V, and 6% FST VI. Most cases were precipitated by inflammatory conditions (89%) and localized to the face (83%). The most frequently reported interventions were topical retinoids (22%) and laser therapy (17%). Partial improvement was seen in 85% and 66% of participants, respectively. Laser was the only intervention that offered complete resolution in a subgroup of patients (26%); however, there were reported cases of PIH exacerbation following treatment. Chemical peels (9%) and hydroquinone (7%) were among other treatments with less effective outcomes. PIH and its persistence is a prevalent issue, significantly affecting many affected individuals with darker skin tones. Our results show a lack of robust efficacy across all treatment modalities. There is considerable room for improvement in interventions for at-risk populations.
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Affiliation(s)
- Kristie Mar
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bushra Khalid
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mahan Maazi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rayan Ahmed
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ou Jia Emilie Wang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Kashetsky N, Feschuk A, Pratt ME. Post-inflammatory hyperpigmentation: A systematic review of treatment outcomes. J Eur Acad Dermatol Venereol 2024; 38:470-479. [PMID: 37843491 DOI: 10.1111/jdv.19566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023]
Abstract
Post-inflammatory hyperpigmentation is a common consequence of inflammatory dermatoses. It is more common in patients with darker skin and has significant morbidity. This systematic review summarizes treatment outcomes for post-inflammatory hyperpigmentation to help physicians better predict clinical response and improve patient outcomes. Embase, MEDLINE, PubMed databases and clinicaltrials.gov were searched in accordance with PRISMA guidelines using a combination of relevant search terms. Title, abstract and full text screening were done in duplicate. Studies were included if they met our predetermined PICOS framework criteria. Results are presented in descriptive form. In total, 41 studies representing 877 patients were included. Complete response was achieved by laser and energy-based devices in 18.1% (n = 56/309) of patients, topicals in 5.4% (n = 20/369) and combination therapies in 2.4% (n = 4/166). Partial response was achieved by combination modalities in 84.9% (n = 141/166) of patients, topicals in 72.4% (n = 267/369), laser and energy-based devices in 61.2% (n = 189/309) and peels in 33.3% (n = 5/15). Poor to no response occurred with peels in 66.7% (n = 10/15) of patients, topicals in 22.2% (n = 82/369), laser and energy-based devices in 18.1% (n = 56/309) and combination modalities in 12.7% (n = 21/166). Additionally, in 2.6% (n = 8/309) of patients treated with laser and energy-based devices, post-inflammatory hyperpigmentation worsened. Adverse events were reported in 10 patients, all while using topical treatments. In conclusion, the current treatment approaches yielded unsatisfactory rates of complete response. However, combination therapies, laser and energy-based devices and topical therapies showed high rates of partial response. Of note, the majority of post-inflammatory hyperpigmentation cases included were associated with acne, and therefore, the findings and conclusions drawn may have limited applicability to other types of post-inflammatory hyperpigmentation.
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Affiliation(s)
- N Kashetsky
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - A Feschuk
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - M E Pratt
- Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Sowash M, Alster T. Review of Laser Treatments for Post-Inflammatory Hyperpigmentation in Skin of Color. Am J Clin Dermatol 2023; 24:381-396. [PMID: 36781686 DOI: 10.1007/s40257-023-00759-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
Post-inflammatory hyperpigmentation is an extremely common disorder of pigmentation in skin of color. It most frequently and severely affects phototypes that are rich in melanin and often has a chronic and unpredictable course. It presents significant treatment challenges and often requires a multi-factorial approach. We review the literature available for the optimal use of laser-based devices in the treatment of post-inflammatory hyperpigmentation, particularly for Fitzpatrick skin phototypes III-VI. For the treatment of post-inflammatory hyperpigmentation in skin of color, lasers remain second line to topical agents based on the variable response, cost, and risk of complications with laser use. For post-inflammatory hyperpigmentation resistant to topicals, laser devices, particularly neodymium:yttrium-aluminum-garnet and fractional photothermolysis systems, can provide adjunctive treatment in skin of color patients when appropriate parameters are used. Future studies would benefit from an objective and consistent assessment to assist with a systematic analysis.
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Affiliation(s)
- Madeleine Sowash
- Department of Dermatology, Medstar Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA.
| | - Tina Alster
- Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
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Alavi S, Goodarzi A, Nilforoushzadeh MA, Mansouri P, Jafari MA, Hejazi S, Azizian Z. Evaluation of Efficacy and Safety of Low-Fluence Q-Switched 1064-nm Laser in Infra-orbital Hyperpigmentation Based on Biometric Parameters. J Lasers Med Sci 2022; 13:e16. [DOI: 10.34172/jlms.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/11/2021] [Indexed: 11/09/2022]
Abstract
Introduction: Dark circles and wrinkles under the eyes are common cosmetic problems, caused by various conditions, especially aging and overproduction of melanin in the epidermis or dermis of the skin. Iin addition to the application of topical lightening agents, different types of lasers, especially the Q-Switched ND:YAG laser, have been used for the treatment of cutaneous hyperpigmentation. Because of a high prevalence of idiopathic eye dark circles (EDCs) or periorbital melanosis and a poor response to available therapies, we decided to evaluate the efficacy and safety of the Fractional QS 1064 nm ND:YAG Laser through a before-after trial. Methods: 18-65-year-old patients with skin Fitzpatrick phototype of I-V and without any usage of a topical or systemic therapeutic regimen (2-4 weeks before the trial) were enrolled in the study. Each patient was treated with 6 sessions of the Fractional QS 1064 nm ND:YAG Laser at 2-week intervals and assessed for response and possible side effects or recurrences through 4 outcome measures, including Visoface-based color and erythema, melanin index and lightness (Before the fourth and sixth sessions of the therapy; also 1 week and 3 months after finishing the trial). Results: The changes of Visoface-based color and erythema, the melanin pigment amount by the Mexameter (melanin index) and the degree of lightness by the Colorimeter of patients after 6 months of intervention were statistically significant (P<0.001). Conclusion: The fractional QS 1,064 nm ND:YAG Laser is an effective and safe therapy in EDCs since objective outcomes like the reduction of the melanin index and improving lightness and subjective ones like the reduction of darkness and erythema were confirmed.
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Affiliation(s)
- Shiva Alavi
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Parvin Mansouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Jafari
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Somayeh Hejazi
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Azizian
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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5
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Prospective study of Q-switched Nd:YAG laser treatment of hyperpigmented split-thickness skin grafts. Lasers Med Sci 2022; 37:2381-2386. [DOI: 10.1007/s10103-021-03476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
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Liu Y, Han Y, Zhu T, Wu X, Yu W, Zhu J, Shang Y, Lin X, Zhao T. Targeting delivery and minimizing epidermal diffusion of tranexamic acid by hyaluronic acid-coated liposome nanogels for topical hyperpigmentation treatment. Drug Deliv 2021; 28:2100-2107. [PMID: 34596008 PMCID: PMC8491700 DOI: 10.1080/10717544.2021.1983081] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hyperpigmentation is a common complaint and distressing problem in dermatology, and tranexamic acid (TA) is an effective treatment agent but limited by the delivery to melanocytes in the epidermis. Herein, a novel TA naogels (named HA/TA-LP), combining the advantages of liposomes and hyaluronic acid (HA), are prepared and assessed for topical hyperpigmentation treatment with targeting delivery and minimizing epidermal diffusion. Morphological characteristics indicate numerous TA-loaded liposomes packed in HA gels. In vitro cell studies using human A375 melanoma cells show that HA/TA-LP can promote the uptake of TA by targeting delivery with resulting inhibition of tyrosinase activity and melanin production. Guinea pigs are used to construct hyperpigmentation models and investigate the topical delivery and treatment efficacy of HA/TA-LP. In vivo topical delivery studies indicate HA/TA-LP realize the effective delivery into melanocytes with an ideal balance of effective permeability and minimizing epidermal diffusion. Subsequently, hyperpigmentation treatment assessments reveal that HA/TA-LP inhibit tyrosinase activity and melanin production under the radiation of UVB. Our study identifies favorable properties of HA/TA-LP for treating hyperpigmentation, and provides an experimental basis for further clinical application.
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Affiliation(s)
- Ying Liu
- Department of Plastic and Cosmetic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of Laser and Aesthetic Medicine, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Han
- Department of Plastic and Cosmetic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Tingting Zhu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xianglei Wu
- Department of Laser and Aesthetic Medicine, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenxin Yu
- Department of Laser and Aesthetic Medicine, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiafang Zhu
- Department of Laser and Aesthetic Medicine, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Shang
- Department of Laser and Aesthetic Medicine, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Laser and Aesthetic Medicine, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianlan Zhao
- Department of Plastic and Cosmetic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Kaufman BP, Aman T, Alexis AF. Postinflammatory Hyperpigmentation: Epidemiology, Clinical Presentation, Pathogenesis and Treatment. Am J Clin Dermatol 2018; 19:489-503. [PMID: 29222629 DOI: 10.1007/s40257-017-0333-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Postinflammatory hyperpigmentation (PIH) is a reactive hypermelanosis that develops following cutaneous inflammation. Common causes of PIH include intrinsic skin conditions (e.g., acne and eczema) as well as external insults to the skin, such as burn injuries and dermatologic procedures. PIH more commonly occurs in individuals with darker skin, for whom it is often a source of significant psychological distress. Several therapeutic modalities are available for the treatment of PIH, including topical agents, chemical peels, and energy-based devices. We review the epidemiology, clinical presentation, pathogenesis, and treatment of PIH.
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Affiliation(s)
- Bridget P Kaufman
- Mount Sinai St. Luke's and West, 1090 Amsterdam Avenue, Suite 11B, New York, NY, 10025, USA.
| | - Taulun Aman
- New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY, 10595, USA
| | - Andrew F Alexis
- Mount Sinai St. Luke's and West, 1090 Amsterdam Avenue, Suite 11B, New York, NY, 10025, USA
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Al Qarqaz F, Al-Yousef A. Skin microneedling for acne scars associated with pigmentation in patients with dark skin. J Cosmet Dermatol 2018. [DOI: 10.1111/jocd.12520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Firas Al Qarqaz
- Department of Dermatology; Jordan University of Science and Technology; Irbid Jordan
| | - Ali Al-Yousef
- Computer Department; Computer and Information Technology College; Jerash University; Jerash Jordan
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10
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Zawar VP, Agarwal M, Vasudevan B. Treatment of Postinflammatory Pigmentation Due to Acne with Q-Switched Neodymium-Doped Yttrium Aluminum Garnet In 78 Indian Cases. J Cutan Aesthet Surg 2016; 8:222-6. [PMID: 26865787 PMCID: PMC4728904 DOI: 10.4103/0974-2077.172196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Postinflammatory hyperpigmentation (PIH) is a common sequela seen in the Indian population following affliction by acne. It is psychologically extremely disturbing for the patients and can severely affect the quality of life. Very few therapeutic modalities have proved to be really efficacious in this condition. AIMS The aim was to review our experience with 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QSNY) laser in the treatment of PIH. MATERIALS AND METHODS Seventy-eight patients with postacne hyperpigmentation were included in the study. They were treated with six sessions at two weekly intervals using a 1,064-nm QSNY laser. Patient and physician scores were assessed at 1 month and 3 months after the last treatment. Clinical photographs also were reviewed to determine the efficacy. Adverse effects were noted. RESULTS Seventy percent of the patients reported significant improvement in hyperpigmentation as compared to the baseline. The majority of the adverse events were limited to mild, brief erythema. CONCLUSION The 1,064-nm QSNY laser is an effective modality for the treatment of PIH caused by acne.
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Affiliation(s)
- Vijay P Zawar
- Department of Dermatology, Skin Diseases Centre, Nashik, Maharashtra, India
| | - Madhuri Agarwal
- Department of Dermatology, Skin and Aesthetic Clinic, Mumbai, Maharashtra, India
| | - Biju Vasudevan
- Department of Dermatology and STD, INHS Ashwini, Mumbai, Maharashtra, India
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Treatment of Persistent Facial Postinflammatory Hyperpigmentation With Novel Pulse-in-Pulse Mode Intense Pulsed Light. Dermatol Surg 2016; 42:218-24. [DOI: 10.1097/dss.0000000000000627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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El Samahy MH, Attia EA, Abd El-Aziz YA, Elsayed SB, Tawfiek SK. A pilot study on serum cutaneous T-cell-attracting chemokine in acne patients. JOURNAL OF THE EGYPTIAN WOMENʼS DERMATOLOGIC SOCIETY 2014; 11:103-108. [DOI: 10.1097/01.ewx.0000443806.24424.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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13
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Hexsel D, Hexsel C, Porto M, Siega C. Triple combination as adjuvant to cryotherapy in the treatment of solar lentigines: investigator-blinded, randomized clinical trial. J Eur Acad Dermatol Venereol 2014; 29:128-33. [DOI: 10.1111/jdv.12484] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- D. Hexsel
- Brazilian Center for Studies in Dermatology; Porto Alegre Brazil
| | - C. Hexsel
- Brazilian Center for Studies in Dermatology; Porto Alegre Brazil
| | - M.D. Porto
- Brazilian Center for Studies in Dermatology; Porto Alegre Brazil
| | - C. Siega
- Brazilian Center for Studies in Dermatology; Porto Alegre Brazil
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Ilankovan V. Upper face rejuvenation. Int J Oral Maxillofac Surg 2013; 42:423-31. [PMID: 23290567 DOI: 10.1016/j.ijom.2012.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 10/05/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
The area of the upper face occupies about one third of the surface area of the whole face. The anatomical landmarks involve the forehead, brow, glabella and the upper lids. Gravitational and intrinsic changes, as well as familial problems affect the aesthetics of the upper face. The author describes the anatomy and pathophysiology of ageing and the importance of making a correct diagnosis. Surgical and non surgical solutions are discussed. The concept of the beneficial effect of antioxidants such as curcumin is introduced. The efficacy of non ablation laser in dermal rejuvenation is explained. The author aims to impart a thorough understanding of the different surgical and non-surgical options for rejuventating the upper face to achieve an unoperated outcome with a healthy looking forehead.
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Affiliation(s)
- V Ilankovan
- Department of Oral and Maxillofacial Surgery, Poole Hospital NHS Foundation Trust, Dorset, UK.
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Eimpunth S, Wanitphadeedecha R, Manuskiatti W. A focused review on acne-induced and aesthetic procedure-related postinflammatory hyperpigmentation in Asians. J Eur Acad Dermatol Venereol 2012. [DOI: 10.1111/jdv.12050] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Levy LL, Zeichner JA. Management of acne scarring, part II: a comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol 2012; 13:331-40. [PMID: 22849351 DOI: 10.2165/11631410-000000000-00000] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acne scarring is a commonly encountered yet extremely challenging problem to treat for the dermatologist. As acne scarring can lead to significant psychological distress and low self-esteem, it is of utmost importance to have effective and satisfying treatments in the physician's armamentarium. However, many treatments are unsatisfying, leading to patient disappointment and frustration. Although early treatment of acne lesions and inflammation with isotretinoin is beneficial in preventing acne scarring, many patients still present with troubling noticeable scars. Despite the advances in pharmacology and technology, scar treatment still remains suboptimal and is tainted with several adverse effects. However, some treatments can provide benefits. This review article exhaustively discusses and analyzes the various minimally invasive approaches to the treatment of acne scarring with an emphasis on pharmacologic agents, such as isotretinoin for atrophic acne scars and corticosteroids and chemotherapeutic drugs for hypertrophic scars. Intralesional injections of corticosteroids are efficacious in reducing keloid scar formation in addition to preventing recurrence following surgical excision. In-office and minimally invasive procedural management, including chemical peels, dermabrasion, tissue augmentation, and punch excision is also discussed. Superficial chemical peels are efficacious in treating atrophic scars with relatively few adverse effects and complications. Although dermabrasion is used less often with the advent of laser resurfacing, this technique remains as a viable option for those with atrophic scars. Post-inflammatory hyperpigmentation can be managed successfully with topical agents such as azelaic acid and hydroquinone. The efficacy of various treatment modalities is highlighted with a focus on choosing the correct modalities for specific scar types.
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