Cicatrices d’acné : épidémiologie, physiopathologie, clinique, traitement

Lasers for the treatment of erythema, dyspigmentation, and decreased elasticity in macular acne scars: a systematic review

Scarring is one of the most esthetically challenging and psychologically burdening aspects following inflammatory acne. While "macular" disease is the scar subtype with the least complicated outcome, its phase can be regarded as the most defining in the ultimate scar appearance. Moreover, with lasers recently gaining much popularity in the scientific community for managing several dermatologic conditions, we aimed to evaluate whether they would lead to significant benefits. For this systematic review, four databases consisting of PubMed, Scopus, Embase, and Web of Science were searched using a comprehensive string, with the data from the relevant yet eligible identified records qualitatively synthesized. After investigating the data obtained from the nine included studies, we found the utilized lasers, namely neodymium-doped yttrium aluminum garnet, fractional carbon dioxide, pulsed dye, erbium:glass, pro-yellow, and high-power optically pumped semiconductor, to be highly effective in managing the erythematous or dyspigmented appearance with the reduced elasticity also significantly improving. Moreover, the adverse events were both bearable and minimal, and transient. However, the degree of improvement each type of scar demonstrated following laser therapy varied based on the laser used. Neodymium-doped yttrium aluminum garnet, fractional carbon dioxide, and pulsed dye are the most commonly investigated lasers for managing macular acne scars, demonstrating eye-catching capabilities in managing either erythema or dyspigmentation. However, we still recommend that further comparative interventional studies be carried out, while the intended outcomes also assessed with objective measures for further clarification.

Post-acne symptom complex. Approaches to therapy

Postacne-persistent skin changes that appear as a result of long-term acne, inadequate therapy and manipulations performed in the management of this group of patients. The post-acne symptom complex is stable skin changes that appear as a result of long-term acne inadequate therapy and manipulations performed during the management of this group of patients. The pathogenetic mechanisms underlying the launch of acne currently look as follows: androgens cause hyperseborrhea, sebum lipids activate innate immunity; pathological keratinization due to the production of IL-1 inflammatory mediator and androgen hyperproduction; Cutibacterium acnes activate innate immune responses through toll-like receptors and metalloproteinases, stimulate the production of antimicrobial peptides and sebum production. The subsequent rupture of the follicles activates the wound healing process. Depending on the genetically determined features of the course of the inflammatory process, various individual postacne changes of the skin will prevail in different patients. The article highlights the main factors influencing the formation of post-acne, pathogenetic mechanisms underlying the formation of these changes, systematizes modern data on the classification, morphological and pathohistological characteristics of scars. Quantitative and qualitative scales of assessment of post-acne scars for determining the severity of the pathological process are presented, differentiated approaches to modern methods of therapy are discussed in detail, including the advantages and disadvantages of the most common methods of treating patients based on the principles of evidence-based medicine using a number of personalized methods.

Ablative Fractional Carbon Dioxide Laser and Autologous Platelet-Rich Plasma in the Treatment of Atrophic Acne Scars: A Comparative Clinico-Immuno-Histopathological Study

BACKGROUND AND OBJECTIVES

To compare the efficacy of autologous platelet-rich plasma (PRP), ablative fractional carbon dioxide (FCO₂ ) laser, and their combination in the treatment of atrophic acne scars, both clinically and immuno-histopathologically.

STUDY DESIGN/MATERIALS AND METHODS

Sixty patients were randomly divided into three equal groups. Group 1 received intradermal PRP injection sessions. Group 2 received FCO₂ laser sessions. Group 3 received FCO₂ laser followed by intradermal PRP injection sessions. Each group received three sessions at monthly intervals. The final assessment took place 3 months after the last session. Skin biopsies were obtained before and 1 month after treatment sessions with pathological evaluation.

RESULTS

Combined PRP and FCO₂ laser-treated patients had a better clinical response, fewer side effects, and shorter downtime than FCO₂ laser alone. PRP-treated patients had some improvement but significantly lower than the other two groups.

CONCLUSION

The current study concluded that a combination of PRP and FCO₂ laser is an effective and safe modality in the treatment of atrophic acne scars with better results than PRP or FCO₂ laser alone. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne

Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.

Acne scars: pathogenesis, classification and treatment

Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%-14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options.