The Efficacy and Safety of Fractional 1064 nm Nd:YAG Picosecond Laser Combined With Intense Pulsed Light in the Treatment of Atrophic Acne Scar: A Split-Face Study

Prospective Clinical Trial Demonstrating the Efficacy of Hyaluronic Acid Filler for the Improvement of Atrophic Facial Scars up to 2 years

BACKGROUND

Hyaluronic acid (HA) filler longevity has been studied for wrinkles. However, its long-term use for treating atrophic facial scars has not yet been analyzed in long-term prospective studies.

OBJECTIVE

Analyze the safety and duration of a HA filler for the use in atrophic scars.

MATERIALS AND METHODS

Fifteen subjects received VYC-17.5L in atrophic scars on 1 randomized cheek and saline on the other, with 1 optional touch-up treatment and crossover after the short-term trial. Grading for this long-term extension was done on Day 720, using the Global Aesthetic Improvement Scale (GAIS) and the Quantitative Global Scarring Grading System.

RESULTS

On Day 720, a live blind evaluator rated the VYC-17.5L assigned side as having significant reduction in scar severity (-7.2 [t(22) = -6.01, p = .00009]) and number of scars (-8.8 [t(22) = -6.25, p = .00006]) as compared with baseline. There was no significant difference in the results from Day 120 to Day 720. Ninety-two percent (11/12) of subjects reported improvement (GAIS), were satisfied with the treatment, thought it looked natural, and had fewer side effects than expected. There were no persistent or late-onset side effects.

CONCLUSION

VYC-17.5L improved rolling atrophic facial scars, and the results were sustained throughout the 2-year trial without side effects.

Picosecond lasers in cosmetic dermatology: where are we now? An overview of types and indications

Q-switched lasers have undeniably revolutionized the field of laser dermatology since four decades ago. Just as the first-generation laser emits its photonic signal in a few nanoseconds, the picosecond laser delivers pulse widths of at least ten times shorter. These devices offer a powerful tool for treating a wide range of skin conditions with a minimal downtime for visible improvement. For the current study, a literature research was performed on the dermatological applications of picosecond laser. The literature searched on this topic between 1999 and 2023 accessible through various platforms produce a result of 62 articles. The included studies have discussed the application of picosecond laser technology in tattoo removal, treatment of epidermal and dermal pigmentation, and collagen remodeling. After sifting the data from the articles into tables, the results were discussed in detail. The study shows a lot of evidence towards the efficacy of picosecond laser, yet it draws attention to its downsides.

Truncal Acne and Scarring: A Comprehensive Review of Current Medical and Cosmetic Approaches to Treatment and Patient Management

Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.

Efficacy and safety of low-dose oral isotretinoin monotherapy versus combined therapy with picosecond laser for the treatment of acne scars in Asian population

PURPOSE

Acne scars are common in patients with moderate to severe acne. Isotretinoin is the first-line treatment for those patients, but whether oral isotretinoin can improve acne scar is not clear. Picosecond lasers (FxPico) has been reported to improve acne scars. In the present study, we evaluated the clinical efficacy of low-dose isotretinoin with or without FxPico treatment for acne scars.

MATERIALS AND METHODS

A total of 48 patients with acne scars were enrolled and were randomly assigned to receive low dose oral isotretinoin or not. For all the patients in both treatment groups, one side of face were randomly assigned to be treated with picosecond laser. Assessments, including photos, échelle d'évaluation clinique des cicatrices d'acné (ECCA) and Global Acne Grading System (GAGS) score, the number of lesions, melanin and erythema indexes, transepidermal water loss were assessed at 0, 1, 2, and 3 month. Side effects, Dermatology Life Quality Index (DLQI) and satisfaction were recorded before and after the study.

RESULTS

A total of 44 patients completed the study (24 received oral low dose isotretinoin and 20 did not). Low dose oral isotretinoin treated group showed significant improvement on ECCA (from 112.5 [50-180] to 105 [50-160]), GAGS score (from 12.6 ± 3.3 to 10.1 ± 3.0), the count of papules (from 4.3 ± 3.7 to 1.0 ± 1.5) than the blank group, and higher improvement were noticed after isotretinoin combined with FxPico. All the side effects were temporary and tolerable, no adverse effects were observed. Higher DLQI and patients' satisfaction were achieved by oral isotretinoin alone and isotretinoin combined with FxPico.

CONCLUSIONS

This is the first paper showing the improvement of scars by early low dose-isotretinoin intervention with or without the combination of picosecond laser. Early intervention with oral low-dose isotretinoin is effective for the treatment and prevention of acne scars, the combined therapy with FxPico can achieve better outcome.

The comparison of the efficacy and safety of fractional 1064 nm Nd:YAG picosecond laser and nonablative fractional 1565 nm laser in the treatment of enlarged pores: A prospective split-face study

BACKGROUND AND OBJECTIVES

To compare the efficacy and safety of fractional 1064 nm Nd:YAG picosecond laser and nonablative fractional 1565 nm laser in the treatment of enlarged pores.

STUDY DESIGN/MATERIALS AND METHODS

Twenty patients received five monthly treatments at months 0, 1, 2, 3, and 4 and were followed up at months 5, 6, and 7. All patients were treated by fractional 1064 nm Nd:YAG picosecond laser (FxPico) on the left face, and nonablative fractional 1565 nm laser (ResurFx) on the right face as a control.

RESULTS

For the 19 patients who completed the study, both sides demonstrated significant improvement on pore counts (p < 0.01), while there was no significant difference between the two sides 3 months after the final treatment (p = 0.092). Excellence rate on the FxPico side (57.9%) was significantly better than the ResurFx side (36.8%) (p < 0.05). Sebum secretion and porphyrin value significantly decreased on both sides after five treatments and there was a higher reduction of sebum level on the ResurFx side. There was no difference between the two therapies in terms of overall satisfaction. Pain of treatment for the ResurFx side (average VAS 4.45 ± 1.60) is significantly higher than that for the FxPico side (average visual analog scale [VAS] 1.48 ± 1.36) (p < 0.001). Erythema, edema, and petechiae were common adverse effects and were mild to moderate. There was significantly higher incidence of hyperpigmentation for the ResurFx side (52.6%) compared with that for the FxPico side (5.3%) (p < 0.001).

CONCLUSION

Fractional 1064 nm Nd:YAG picosecond laser and nonablative fractional 1565 nm laser both are effective, efficient, and safe treatment regimens for enlarged pores, while fractional 1064 nm Nd:YAG picosecond laser has better clinical response with less treatment pain, shorter recovery period and much lower induction of hyperpigmentation.

An update on fractional picosecond laser treatment: histology and clinical applications

Picosecond lasers have a very short pulse duration and a high peak power density. When fractional optical delivery systems are attached to picosecond lasers, they generate an array of concentrated microspots with a high fluence surrounded by areas with a low fluence. This article discusses the histologic characteristics and clinical applications of fractional picosecond laser treatment. Fractional picosecond laser produces laser-induced optical breakdown (LIOB) and laser-induced cavitation (LIC) in the epidermis and dermis respectively, and can encourage skin regeneration and dermal remodeling. It has been shown that fractional picosecond laser has a positive effect on facial photoaging, enlarged facial pores, dyspigmentation, wrinkles, and atrophic scars. Further research is still needed to confirm the benefits of fractional picosecond lasers.

Early acne scar intervention with 1064 nm picosecond laser in patients receiving oral isotretinoin: a randomized split-face controlled pilot study

Early acne scar intervention is important. Oral isotretinoin is widely used in patients with moderate to severe acne. Picosecond laser has shown a promising effect on scar clearance. However, there is a lack of reports on the efficacy and safety of early acne scar management by using 1064-nm picosecond laser in patients receiving low-dose oral isotretinoin. Twenty-four patients with atrophic acne scars of Fitzpatrick skin type III to V were enrolled. All patients were receiving low-dose oral isotretinoin (0.12-0.22 mg/kg/day) during the treatment. The face of the participants was randomly assigned to receive 2 sessions of fractional picosecond 1064 nm Nd: YAG laser (FxPico) treatment and 2 follow-ups, with an interval of 1 month (month 0-3). Clinical efficacy and safety were assessed by photographs, ECCA grading scale, the number of scar lesions melanin and erythema indexes (MI and EI), TEWL, DLQI, and patient satisfaction and the adverse events were recorded on every visit. FxPico significantly decreased the ECCA score and showed higher improvement in the ECCA score. FxPico treated side achieved a significant reduction in all acne scar types, while only boxcar scars and rolling scars showed higher improvement. TEWL but not MI or EI were significantly improved. DLQI and patient satisfaction were higher with the FxPico-treated side than control side. No adverse effects were observed and all the side effects observed were temporary and tolerable. Early intervention by FxPico on patients receiving low-dose oral isotretinoin is a safe and effective modality to improve atrophic acne scars.

Evaluation of the safety and efficacy of a fractional picosecond 1064 nm laser for post-acne erythema in adult Chinese patients

OBJECTIVE

To evaluate the efficacy and safety of fractional 1064 nm picosecond Nd:YAG laser (FPNYL) in the treatment of post-acne erythema (PAE) of adult Chinese.

MATERIALS AND METHODS

A total of 22 patients received 1 session of treatment and were followed up at the eighth week. Primary outcomes were measured by the Clinician erythema assessment scale (CEAS). Secondary outcomes included a global aesthetic improvement scale (GAIS) and patients' assessment of satisfaction on a five-point scale. Pain scores and adverse effects were also evaluated.

RESULTS

Twenty-two patients with Fitzpatrick skin types III and IV were enrolled in the study and completed all treatments and follow-up visits. The mean CEAS scores fell from 2.74 ± 0.80 to 1.95 ± 0.75 (p < 0.05). The mean GAIS of PAE improvement was 2.46 ± 0.68. Erythema percentile scores by VISIA increased from 32.63 ± 7.0 to 45.75 ± 11.45 (t = 5.442, p = 0). The patient satisfaction score was 1.86 ± 1.17. The pain scores were 3.27 ± 1.17 for the FPNYL treatment (varied from 2 to 6). There were moderate erythema and oedema, which last for 3.84 ± 0.78 days. There were overall 68.18% (15/22) patients who felt pruritus in different degrees and 27.27% patients who encountered acne eruptions (white head type). No scar, hyperpigmentation or hypopigmentation was found.

CONCLUSION

Treatment with fractional 1064 nm picosecond Nd:YAG laser is effective and safe for PAE of Chinese patients.

Low-level laser treatment promotes skin wound healing by activating hair follicle stem cells in female mice

The aim of the study was to explore the effect and mechanism of a low-level laser on hair follicle stem cells in full-thickness skin wound healing in mice. Full-thickness skin defects were generated by a 5-mm punch biopsy tool on the backs of depilated C57/BL6N mice, which were randomly divided thereafter into a low-dose laser treatment group (LLLT-Low), a high-dose laser treatment group (LLLT-High), and a control group (control). From the day of modeling to the day before the skin samples were taken, the wound area and wound edge of the mice in the LLLT-Low and LLLT-High groups were irradiated with a laser comb every 24 h, and the energy density was 1 J/cm2 and 10 J/cm2, respectively. The control group was irradiated with an ordinary fluorescent lamp. At 0, 3, 5, 10, and 14 days after modeling, pictures of each wound were taken, and the percent wound closure was analyzed. At 3, 5, 10, and 14 days after modeling, the samples were observed by hematoxylin and eosin (HE) and immunofluorescence (IF) staining. Whole transcriptome sequencing (RNA-Seq) was performed on the samples on day 10. Gene Ontology (GO) analysis was performed, and the results were validated by Western blot analysis and enzyme-linked immunosorbent assay (ELISA). The analysis of the percent of wound closure showed that healing was accelerated (significantly from 5 to 10 days) in the LLLT-Low group, but there was no clear change in the LLLT-High group. HE staining showed that the LLLT-Low group had an increasing number of hair follicles and a tendency to migrate to the center of the wound. There was no significant increase in the number of hair follicles and no obvious migration in the LLLT-High group. Immunofluorescence staining showed that the total number of CK15 + hair follicle stem cells in the LLLT-Low group was higher than that in the control group and LLLT-High group at all time points. The number and farthest migration distance of CK15 + hair follicle stem cells increased significantly with time, and after 5 days, they were significantly higher than those in the control group and LLLT-High group. RNA-Seq and Western blot analysis showed that the expression of related genes in hair follicle stem cells, including CK15, in the LLLT-Low group was upregulated. GO analysis and ELISA showed that the expression of many cytokines, represented by IL34, in the LLLT-Low group was upregulated. Low-level laser treatment can promote the proliferation, differentiation, and migration of CK15 + hair follicle stem cells by upregulating the cytokine IL34, thereby promoting skin wound healing in mice.

Treatment protocols and efficacy of light and laser treatments in post-acne erythema

BACKGROUND

Post-acne erythema is described as erythema due to release of inflammatory cytokines, dilatation of microcapillaries within papillary dermis and thinning of epidermis. The erythema usually fades; however, it can persist for months.

AIM

In this review, we decided to evaluate efficacy of light and laser treatments in acne-induced erythema.

METHODS

We searched PUBMED, Embase, Cochrane, and Google Scholar for relevant key words. Inclusion criteria were randomized clinical trials (RCTs) that evaluated efficacy of laser or light in PAE until September 2021.

RESULTS

Twelve RCTs were selected for the final assessment. Light and laser treatments included pulsed dye laser (PDL), intense pulsed light (IPL), Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG), fractional photothermolysis, alexandrite, solid-slate 589-1319 nm, and pro-yellow laser.

CONCLUSION

Light and laser treatments are effective treatment modalities in reduction of acne-induced erythema along with active acne lesions and atrophic acne scars.

Dermatology: how to manage acne vulgaris

Background

Acne vulgaris is the most common skin disease that can lead to disfigurement and psychological distress. This article aims to provide a narrative updated review on the management of acne vulgaris.

Methods

A PubMed search was performed with Clinical Queries using the key term “acne”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to articles published in English.

Results

Treatments of acne include proper skin care, topical medications, oral medications and procedural therapies. Topical agents are the first-line treatment for mild-to-moderate acne and can be used as combination therapy for more severe acne. Systemic therapies are usually prescribed for the initial treatment of moderate-to-severe acne as well as for acne that is refractory to topical therapies.

Conclusion

Topical retinoids are the drugs of choice for the treatment and maintenance therapy of patients with mild-to-moderate acne vulgaris. Depending on the severity of the acne, topical retinoids may be used alone or in combination with benzoyl peroxide and topical or oral antibiotics. Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy. Neither topical nor oral antibiotics should be used as monotherapy. Oral contraceptives and/or spironolactone are useful for many women with acne. Oral isotretinoin is the drug of choice for severe, extensive, nodular acne vulgaris but is also often used in moderate cases where scarring is evident, acne-related psychosocial distress is significant or other treatment modalities have failed.