Acne scarring-pathophysiology, diagnosis, prevention and education: Part I

755-nm Picosecond Laser With Diffractive Lens Array for Acne Scars in Fitzpatrick Skin Types V and VI

BACKGROUND

Patients commonly complain about the appearance of acne scars. While various lasers and energy-based devices can offer clinical improvement, many of them are limited in treating patients with skin of color. Concerns exist regarding efficacy and safety, including risks of scarring, prolonged dyspigmentation, necrosis, and burns.

OBJECTIVE

To examine the utility of a 755-nm picosecond laser with fractionated lens array in improving the clinical appearance of acne scars in patients with Fitzpatrick skin types V and VI.

MATERIALS AND METHODS

A prospective clinical study investigated this laser using up to 5 monthly treatments.

RESULTS

Twenty-four subjects were enrolled, while 17 subjects completed a 3-month follow-up. The mean age was 33.9 years, and 95.8% of the subjects were women. Fitzpatrick skin types V and VI were represented. Assessments compared baseline to 3-month follow-up. Two of the 3 blinded reviewers agreed on identifying pretreatment and post-treatment photographs for 82.4% of the cases. For physician Global Aesthetic Improvement Scale, 100% of the subjects had clinical improvement. Overall, 94.1% of subjects were satisfied with their treatment. No serious or unanticipated adverse events occurred.

CONCLUSION

A 755-nm picosecond laser with fractionated lens array can safely and effectively improve acne scars in patients with Fitzpatrick skin types V and VI.

Global, regional and national burdens of acne vulgaris in adolescents and young adults aged 10-24 years from 1990 to 2021: a trend analysis

BACKGROUND

Acne vulgaris is a common skin condition affecting adolescents and young adults worldwide, yet data on the burden and trends of this disease remain limited. We aimed to investigate trends in the burden of acne vulgaris among adolescents and young adults aged 10-24 years at global, regional and national levels.

METHODS

We retrieved data from the Global Burden of Disease Study 2021 for individuals aged 10-24 years in 204 countries and territories from 1990 to 2021. We analysed the numbers, age-standardized rates and average annual percentage changes (AAPCs) of the prevalence, incidence and disability-adjusted life years (DALYs) for acne vulgaris at the global, regional and national levels. Additionally, we examined these global trends by age, sex and Sociodemographic Index (SDI).

RESULTS

Globally, the age-standardized prevalence rate of acne vulgaris among adolescents and young adults increased from 8563.4 per 100 000 population [95% uncertainty interval (UI) 7343.5-9920.1] in 1990 to 9790.5 (95% UI 8420.9-11 287.2) per 100 000 population in 2021, with an AAPC of 0.43 [95% confidence interval (CI) 0.41-0.46]. The age-standardized incidence rate and age-standardized DALY rate also showed a similar upward trend. Regionally, Western Europe had the highest age-standardized prevalence, incidence and DALY rates, while North Africa and the Middle East had the largest increase in these rates. By SDI quintile, the high SDI region had the highest age-standardized prevalence, incidence and DALY rates from 1990 to 2021, whereas the low-middle SDI region had the lowest burden of acne vulgaris but experienced the most significant increase in these rates. Globally, the age-standardized prevalence rate of acne vulgaris in 2021 was approximately 25% higher in young women than in young men (10 911.8 per 100 000 population vs. 8727.8 per 100 000 population). Among all age groups, adolescents aged 15-19 years had the highest age-specific prevalence rate, while adolescents aged 10-14 years experienced the largest increase from 1990 to 2021 (AAPC 0.50, 95% CI 0.48-0.52).

CONCLUSIONS

The burden of acne vulgaris among adolescents and young adults has continued to increase in nearly all countries since the 1990s. Managing this condition remains a significant challenge, necessitating more effective and targeted interventions to control the acne burden.

Epidemiology and Healthcare of Juvenile and Late-Onset Acne: Claims Data Analysis

INTRODUCTION

Acne is the most frequent chronic inflammatory skin condition in adolescence but occurs also in later age. Our study aimed to characterise the epidemiology, geographical distribution, comorbidity and healthcare of acne juvenilis (AJ) and acne tarda (AT).

METHODS

Statutory health insurance (SHI) data from 2016 to 2020 were analysed. Prevalence rates, including geographical distribution, comorbidities and drug use by specialists group, were measured.

RESULTS

In 2020, the prevalence of acne among adults was 1.50% (AT > 25 years) and among adolescents was 3.88% (AT ≤ 25 years). The highest prevalence (13.02%) was observed at the age of 17 years. Sex differences were higher in AT (73.80% in women) than in AJ (64.55% in women). Compared with non-affected persons, individuals with acne - in particular with AT - showed significantly higher rates of skin-related comorbidities, including folliculitis (rate ratio (RR) 8.89), pyoderma (RR 7.27) and rosacea (RR 5.53), and non-skin-related comorbidities, such as ovarian dysfunction (RR 2.36), rhinitis allergica (RR 1.84) and Crohn's disease (RR 1.79). Preferred systemic therapeutics prescribed were anti-infectives in AT (46.86%) and retinoids in AJ (52.35%). In the majority of cases, dermatologists were involved in the treatment of acne (AT 65.77%; AJ 76.27%). The most commonly prescribed topical agents were adapalene with benzoyl peroxide (AT 87.72%; AJ 85.75%), while systemic isotretinoin (AT 81.20%; AJ 90.06%) was also a frequently used drug. General practitioners were more likely to prescribe anti-infectives, especially topical antibiotics such as chlortetracycline (AT 52.38%; AJ 44.44%) and systemic antibiotics, especially tetracycline (AT 58.33%; AJ 67.50%).

CONCLUSION

Acne affects a relevant proportion of the German population not only in adolescence, and management of this inflammatory skin disease does not naturally follow medical guidelines or specialist recommendations. These findings emphasise the importance of specialised care and comprehensive therapeutic management that should also consider the exploration of comorbidities.

Clinical factors influencing the effectiveness of microplasma fractional radiofrequency treatment for atrophic acne scars: A retrospective analysis

BACKGROUND

Microplasma fractional radiofrequency (MP FRF) technology has been increasingly used for acne scars. Nevertheless, little evidence has analyzed the factors influencing its effectiveness before and during treatment.

AIMS

To evaluate the clinical factors affecting the effectiveness of MP FRF therapy for atrophic acne scars.

METHODS

We analyzed retrospectively the clinical data of 79 acne scar patients treated with MP FRF technology. The outcome of interest included the effectiveness and adverse events after MP FRF treatment. Multivariable logistic regression was utilized to evaluate clinical factors associated with effectiveness after the initial session.

RESULTS

All patients received 115 sessions of MP FRF therapy (average: 1.5 sessions). Twenty-eight (35.4%) patients improved moderately to excellently after one session. We found that the severe grade before treatment was negatively correlated with the effectiveness according to Goodman-Baron qualitative scores (OR = 0.02, 95% CI [0.001, 0.37], p = 0.009). The presence of icepick scars was also a negative correlation factor for the effectiveness (OR = 0.06, 95% CI [0.004, 1.00], p = 0.049). Furthermore, after excluding the effects of icepick scars and Goodman-Baron scores before treatment, ECCA scores were also correlated with effectiveness (OR = 1.04, 95% CI [1.01, 1.06], p = 0.009).

CONCLUSION

MP FRF therapy was effective in treating atrophic acne scars with no permanent adverse events. The severity of Goodman-Baron qualitative scores and icepick scars were independent clinical factors affecting effectiveness, suggesting the possible requirement for additional treatments other than MP FRF for severe acne scars and icepick scars.

Fractional carbon dioxide laser combined with subcision for the treatment of three subtypes of atrophic acne scars: a retrospective analysis

Fractional carbon dioxide (CO2) laser combined with subcision has been widely used for the clinical treatment, but the efficacy of the combined therapy on three types of atrophic acne scars remains unreported. This retrospective study analyzed the clinical data of 413 patients with atrophic acne scars, treated with fractional CO2 laser combined with subcision in the combined group and with fractional CO2 laser in the control group. The treatment efficacy was evaluated by the Investigator's Global Assessment (IGA) and the Échelle d'évaluation clinique des cicatrices d'acné (ECCA). We reported adverse reactions such as erythema, lump, skin sensitivity, acne recurrence, and hyperpigmentation that occurred in both treatment groups. The treatment efficiency of the combined group was significantly higher than that of the control group (P < 0.001). Among the three subtypes of atrophic acne scars, the ECCA scores in the combined group of boxcar-type and rolling-type scars after treatment were lower than those in the control group (P = 0.041, P < 0.001, respectively), and no statistical difference in scores between the two groups for icepick-type scars was seen (P = 0.062). There was no statistical difference in adverse reactions between the two groups (P = 0.361). Fractional CO2 laser combined with subcision is more effective than fractional CO2 laser in the treatment of boxcar-type and rolling-type scars, but there is no significant difference in the treatment of icepick-type scars.

Clinical Factors Affecting the Effectiveness of 1550-nm Erbium-Doped Fractional Photothermolysis Laser for Individual Atrophic Acne Scar Types

INTRODUCTION

Although non-ablative fractional resurfacing is frequently used for atrophic acne scars, few studies have examined clinical factors affecting the effectiveness of non-ablative fractional laser in individual atrophic acne scar types (icepick, rolling, and boxcar scars). Herein, we evaluated the clinical factors affecting the effect of non-ablative fractional laser for individual atrophic acne scar types using objective assessment tools.

METHODS

Thirty-one patients who had been treated by 1550-nm erbium-doped fractional laser for atrophic acne scars were retrospectively reviewed. Icepick, rolling, and boxcar scars were counted using photographs, and acne scar reduction efficiency (ASRE%; the percentage reduction of post-acne scar count from baseline counts) was calculated.

RESULTS

The median count of each scar type was significantly reduced at the end of the final session. Boxcar scars responded better (median ASRE 59.2%) than rolling (ASRE 40.6%, p = 0.017) and icepick scars (ASRE 19.1%, p = 0.010). Concomitant isotretinoin use resulted in a greater ASRE and a significantly greater improvement in icepick scars. Patients aged 25 years or younger showed a higher ASRE, with a greater improvement in boxcar scars.

CONCLUSION

1550-nm fractional laser treatment for atrophic acne scars was more effective in patients who were younger and taking isotretinoin concurrently.

Identification of nanoparticle-mediated siRNA-ASPN as a key gene target in the treatment of keloids

Background: Keloid, also known as connective tissue hyperplasia, is a benign proliferative disorder with a global distribution. The available therapeutic interventions are steroid injections, surgical removal of keloids, radiotherapy, compression therapy, the application of cryosurgery, and many other methods.

Objectives: Existing treatments or approaches for keloids may lead to similar or even larger lesions at the site of keloid excision, leading to a high recurrence rate. Therefore, this study aims at identifying a new gene-based therapy for the treatment of keloids.

Methods: An ASPN-siRNA/nanoparticle combination (si-ASPN) and a negative siRNA/nanoparticle complex (NC) was developed on the basis of bioinformatics studies and used in vitro and in vivo experiments.

Results: The results showed a strong correlation between the development of keloids and high expression of ASPN protein. With the expression of ASPN protein greatly reduced in keloid fibroblasts and nude mice allografts after treatment with si-ASPN, the collagen and fibroblasts were also uniform, thinner, parallel and regular.

Conclusion: All the above experimental results suggest that keloid and ASPN are closely related and both fibroblast growth and metabolism of keloid are inhibited after silencing ASPN. Therefore, ASPN-siRNA delivered via nanoparticles can serve as a novel intervention therapy for the treatment of keloids.