Objective Evaluation of the Clinical Efficacy of Fractional Radiofrequency Treatment for Acne Scars and Enlarged Pores in Asian Skin

Efficacy and safety of microneedling radiofrequency in acne scars

Objectives

To study the efficacy and safety of microneedling radiofrequency (MNRF) in the treatment of acne scars.

Material and Methods

This is a hospital-based and prospective interventional study. A total of 44 patients (18- 55 years old), skin types III-V, with acne scars, were enrolled. Four sessions of MNRF (Lumenis legend PRO Machine, with non-insulated needle tips GEN6, GEN6L; Israel) were done with an interval of 3 weeks between each session and followed up 1 month after the last session. The outcome was assessed by Goodman and Baron's qualitative and quantitative acne scar grading, physician global assessment (PGA), and patient satisfaction score (PSS).

Results

Out of 44 patients, four patients could not complete the study. Goodman and Baron's qualitative assessment showed patients with Grades 2, 3, and 4 were 6 (15%), 17 (42.5%), and 17 (42.5%), respectively. At the end of follow-up, patients with Grades 1, 2, 4, and 4 acne scars were 5 (12.5%), 24 (60%), 10 (25%), and 1 (2.5%), respectively, which were statistically significant (P < 0.05). Seven patients showed no improvement. Goodman and Baron's quantitative assessment showed an initial mean of 12.65 and an after-follow-up mean of 8.3, which was statistically significant (P < 0.05). PGA and PSS scores showed excellent to good responses of 70% and 82.5%, respectively. Adverse effects such as post-treatment erythema were seen in all patients, and edema was observed in 12 patients. Post-inflammatory hyperpigmentation was noted in two patients.

Conclusion

MNRF was found to be effective with a better safety profile for acne scars.

Efficacy of fractional radiofrequency in the treatment of erythematous capillary rosacea: A split-face study

OBJECTIVE

To assess the effectiveness and safety of treating erythematotelangiectatic rosacea using fractional radiofrequency (FRF).

METHODS

Twenty patients with a confirmed diagnosis of erythema capillaris rosacea were selected, and one side of each patient's face was randomly assigned to receive FRF treatments for three to six times, with an interval of 2 weeks between each treatment. VISIA, dermoscopy, and the Clinician's Erythema Evaluation Scale (CEA) were applied to evaluate the efficacy of the treatment before and after the treatment, to record the VAS scores and adverse reactions, and to conduct a patient satisfaction survey.

RESULTS

The characteristic counts and scores of red zone and porphyrin as assessed by VISIA test were significantly decreased, and the difference between the treated side and the pretreatment side was statistically significant (p < 0.05), and the efficacy of the treatment was statistically insignificant compared with the control side, except for the red zone and porphyrin which were statistically significant before and after the treatment (p > 0.05). By CEA score, the difference between the treated side after treatment and the control side was statistically significant (p < 0.05), and the difference between the treated side before and after treatment was statistically significant (p < 0.05); the difference between the control side before and after treatment was not statistically significant (p > 0.05). Dermatoscopic observation showed reduction in pore size, reduction of yellowish-white and black horn plugs within the pores, lightening of the red background and thinning and blurring of the capillary structure on the treated side of the skin compared to the control side, and the skin on the treated side showed the above mentioned changes before and after the treatment as well. The mean pain score of the subjects was obtained by VAS score 3.67 ± 0.90. Adverse effects included mild edema, erythema, and microscopic crusting; no long-term adverse effects were seen in all patients. The efficacy of FRF treatment was evaluated 1 month after the final treatment, and 85% of the subjects rated it as satisfactory, very satisfactory, and very satisfactory.

CONCLUSION

FRF for the treatment of erythematous capillary dilatation rosacea is effective, safe, and suitable for clinical promotion.

Fractional Radiofrequency and Oral Isotretinoin-A Prospective Randomized Controlled Split-Face Trial Comparing Concurrent Versus Delayed Fractional Radiofrequency Treatment for Acne Scars

BACKGROUND

Therapeutic dogma has been to treat acne scars no less than 6 months after isotretinoin (ITN) cessation.

OBJECTIVE

To evaluate the safety and efficacy of fractional radiofrequency (FRF) in patients treated concurrently with ITN.

METHODS

We conducted a prospective randomized control 3-arm comparative trial to evaluate the treatment of acne scars. Patients received one of three treatment options: (A) ITN and FRF concurrent treatment, (B) ITN monotherapy, and (C) FRF 6 months post-ITN treatment. Patients in the FRF cohorts received three monthly sessions. Patients were followed for adverse effects up to 6-9 months post-FRF treatment. Final cosmesis was scored by three independent dermatologists using two scales: the Echelle d'Evaluation Clinique des Cicatrices d'Acne (ECCA) and an internal 5-point investigator's scale, indicating the percentage of improvement. Subjective analyses by patients were also assessed.

RESULTS

Objective and subjective analyses revealed improvement in the ITN-FRF cohort, which was superior to the delayed FRF cohort and the ITN monotherapy cohort. Specifically, the concurrently treated cohort (ITN-FRF) had a significant reduction in acne scar volume from baseline mean (151.1 ± 44.7 to 97.0 ± 31.2, p < 0.005), outperforming both the delayed FRF and monotherapy ITN treatment cohorts, respectively (155.4 ± 37.8 to 122.0 ± 46.2, 144.6 ± 82.8 to 132.4 ± 62.7). Additionally, the concurrently treated cohort demonstrated improved ECCA scores (36.8 ± 15.5), significantly better than the ITN monotherapy cohort (101.5 ± 20.1, p < 0.01).

LIMITATIONS

Limited patient sample size: 38 patients completed the study; mostly Fitzpatrick Type II-III skin; photographic assessments utilized.

CONCLUSION

Per our prospective trial, concurrent treatment of ITN-FRF is superior to delayed FRF treatment 6 months post-ITN cessation.

Nonablative monopolar radiofrequency for the reduction of facial pores and sebum excretion in Thai patients: A novel approach

BACKGROUND

Enlarged facial pores are visible topographic features of the skin that have been associated with cutaneous photoaging and increased sebum production. It has remained a common dermatologic concern, gaining a significant number of in-clinic consults. Available treatment modalities often operate on a single mode of action, consequently offering limited and short-term outcomes.

OBJECTIVE

This study aimed to evaluate the long-term efficacy and safety of a nonablative monopolar radiofrequency (NMRF) for pore tightening and sebum output reduction in Thai patients.

METHODS

Nineteen patients with enlarged pores underwent two sessions of NMRF treatments at 4-week intervals. The measurements of pore volume, skin texture, average pore size, sebum production, and skin elasticity were quantified using Antera® 3D imaging system, dermoscopic image analysis with ImageJ software, Sebumeter® and Cutometer®. Clinical evaluation by two dermatologists was done using blinded clinical photographs. All objective and subjective assessments were done at the baseline, a month after the first treatment, and during follow-up visits 1, 3, and 6 months after the last treatment. Adverse effects were also recorded during each visit.

RESULTS

Seventeen out of the 19 subjects completed the study protocol. The mean pore volume significantly reduced by 24% from the baseline at 1 month after the first treatment (p < 0.016). The pore volume continued to decrease by 34% and 38% a month (p < 0.001) and 6 months (p < 0.001) following the final treatment, respectively. Sebum excretion likewise significantly decreased from baseline by 39% (p = 0.002) and 36% (p < 0.001), 3 and 6 months after the second treatment, respectively. Skin texture and elasticity also significantly improved following two NMRF sessions. The objective assessments of the pore appearance corresponded to subjective clinical evaluations. The treatment was well-tolerated without significant side effects, such as dyspigmentation, textural alteration, and scarring.

CONCLUSION

NMRF appears to be effective and safe for the reduction of pore size and sebum production, with therapeutic outcomes persisting up to 6 months after two treatment sessions.

Clinical evaluation of the efficacy of fractional radiofrequency for the treatment and reduction of stretch marks: A prospective study

BACKGROUND/OBJECTIVES

Skin resurfacing with fractional radiofrequency results in reepithelization, collagen shrinkage, fibroblast stimulation, and neocollagenesis which may be beneficial for the improvement of various skin lesions. This clinical study was conducted to evaluate the safety and efficacy of fractional radiofrequency device (FRF) for the treatment of striae.

METHODS

Seventeen subjects, totaling 67 treatment zones were evaluated. Subjects had 4 FRF treatment sessions to the striae areas, at 4-weeks interval. 3D-standardized photographs of the treatment area with a 3D camera were used to evaluate striae volumetric improvement from baseline to follow up (FU) visits at 12 and 16 weeks post-final treatment. A satisfaction questionnaire was completed by subjects at each of the follow-up visits. Additionally, the mean scores of the live investigator assessments of Global Aesthetic Improvement Scale (GAIS), Subject Satisfaction Scale, Pain Visual Analog Scale and Tolerability Score were calculated.

RESULTS

A total of 15 subjects completed the study (Fitzpatrick skin type I-III, average age 36.2 years) received 4 FRF treatments on multiple different body zones with multiple passes over stretch marks on the abdomen, inner arms, lower buttocks, inner thighs, and/or flanks. Analysis of 3D photographs of the striae affected zones at 16-week FU revealed an average reduction in the striae volume of 19.1%, a reduction of redness of 14.3%, a reduction of pigmentation of 11.2%, and a reduction of striae color of 8.82%. The GAIS improved by 1.7-points when compared to baseline. Treatments were well tolerated with subjects reporting a mean score of 3.8 out of 10 for pain and 3.1 out of 4 for tolerability (indicating the treatment was "tolerable"), with no occurrences of serious adverse events. The average subject satisfaction at 16-week follow-up was 3.1, out of a total of 4, which signified subjects were "satisfied" with their treatment.

CONCLUSION

3D Image analysis of the treated zones presented overall reductions in the color and texture of striae after four treatments with FRF. A combination of ablation and coagulation introduced by FRF treatment resulted in improvement to the appearance of the treated striae.

Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review

Acne vulgaris is a chronic skin disease that, depending on its course, is characterized by the occurrence of various skin eruptions such as open and closed comedones, pustules, papules, and cysts. Incorrectly selected treatment or the presence of severe acne vulgaris can lead to the formation of atrophic scars. In this review, we summarize current knowledge on acne scars and methods for their improvement. There are three types of atrophic scars: icepick, rolling, and boxcar. They are of different depths and widths and have different cross-sections. Scars can combine to form clusters. If acne scars are located on the face, they can reduce the patient’s quality of life, leading to isolation and depression. There are multiple effective modalities to treat acne scars. Ablative lasers, radiofrequency, micro-needling, and pilings with trichloroacetic acid have very good treatment results. Contemporary dermatology and cosmetology use treatments that cause minimal side effects, so the patient can return to daily functioning shortly after treatment. Proper dermatological treatment and skincare, as well as the rapid implementation of cosmetological treatments, will certainly achieve satisfactory results in reducing atrophic scars.

Evaluation of the cumulative effect of Radiofrequency Microneedling and fractional Erbium: Glass 1565 laser in moderate to severe acne scars in skin of color

AIM AND OBJECTIVES

Evaluation of the cumulative effect of Radiofrequency Microneedling and fractional Erbium: Glass 1565 laser in moderate to severe acne scars in skin of color.

MATERIAL AND METHODS

This retrospective study was conducted on 20 patients of skin types III -V having moderate to severe atrophic acne scars. The study was carried out over 1 year from March 2019 to March 2020.

PROCEDURE

All patients underwent 4 sessions of non-ablative Fractional Erbium: Glass 1565 laser to alternate with 4 sessions of Fractional Radiofrequency Microneedling once a month over 8 months.

RESULTS

Of the 20 patients enrolled, 18 completed treatment protocol. Two patients were withdrawn from the study because they were unable to attend follow-up treatment sessions. The subjective evaluation was performed using photographs at baseline, 8 months, and 12 months. A photographic evaluation was performed using the following numeric responses: <25%, 25-50%, 51-75%, and 76-100% difference in severity. None of the patients had worsening of their scars. The improvement in scars was statistically significant.

CONCLUSION

The combination of Fractional Erbium: Glass 1565 laser and Fractional Radiofrequency Microneedling can be used in the treatment of acne scars in skin of color. Our protocols helped achieve significant improvement of scars.

Efficacy and adverse reactions of fractional CO2 laser for atrophic acne scars and related clinical factors: a retrospective study on 121 patients

OBJECTIVE

This study was performed to analyze the efficacy, adverse reactions of fractional CO₂ laser for atrophic acne scars, and related clinical factors.

METHODS

The clinical data of 121 patients with atrophic acne scars treated with ultra-pulsed fractional CO₂ laser in the Cosmetic Dermatology from August 2014 to March 2020 were retrospectively analyzed. The efficacy and adverse reactions of atrophic acne scar after fractional CO₂ laser therapy were statistically analyzed. The clinical factors related to efficacy and adverse reactions after the first therapy session were analyzed by multivariate logistic regression.

RESULTS

A total of 121 patients received 206 sessions of fractional CO₂ laser therapy, with an average of 1.7 sessions. Moderate to excellent improvement rate reached 50.4% after the first session. Multivariate logistic regression analysis indicated that rolling scars responded better to fractional CO₂ laser treatment than icepick scars (OR = 7.3, 95% CI [1.2, 43.4], P = 0.029), and scar improvement was more significant in the high-energy laser group than in the low-energy laser group (OR = 10.9, 95% CI [1.1, 106.8], P = 0.041). The main adverse reactions after fractional laser surgery were pigmentation, skin sensitivity, persistent erythema and acneiform eruption. Multivariate logistic analysis revealed that the longer the scar duration, the higher incidence of postoperative adverse reactions (OR = 1.3, 95% CI [1.1, 1.5], P = 0.008). Compared with icepick scars, rolling scars (OR = 10.4, 95% CI [2.3, 47.7], P = 0.003) and boxcar scars (OR = 12.0, 95% CI [3.3, 44.0], P < 0.001) had higher risk of developing adverse reactions. The incidence of postoperative adverse reactions was also higher in the combined mode group (DeepFX mode + ActiveFX mode) than in the single mode group (OR = 7.8, 95% CI [2.4, 25.5], P < 0.001).

CONCLUSION

Fractional CO₂ laser was effective in the treatment of atrophic acne scars, without serious adverse reactions. Scar type and laser energy were independent clinical factors affecting its efficacy. Scar course, scar type and fractional laser mode were independent clinical factors affecting its adverse reactions.

Safety and efficacy of fractional radiofrequency for the treatment and reduction of acne scarring: A prospective study

OBJECTIVES

Skin rejuvenation with radiofrequency has been a widely used treatment modality for the safe and efficient remodeling of the dermis and revision of textural irregularities, achieved with minimal downtime. The efficacy of fractional radiofrequency (FRF) specifically for acne scarring has not been widely established. The objective of this clinical trial was to establish the efficacy and safety of FRF for moderate to severe acne scarring in a wide range of Fitzpatrick skin types using two different applicator tips to deliver energy to the skin (80-pin of up to 124 mJ/pin and 160-pin of up to 62 mJ/pin).

METHODS

Enrolled subjects received a series of three FRF treatments to the full face, each 4 weeks apart. A visual analog scale was utilized to assess pain of the treatment. Subject satisfaction questionnaires were completed at follow-up visits at 6 and 12 weeks post final treatment. Photographs were graded for change by three blinded evaluators using the Global Aesthetic Improvement Scale (GAIS).

RESULTS

Image sets of 23 enrolled subjects were assessed by blinded evaluation, showing a statistically significant improvement (p = 0.009) from the baseline visit to the 12-week follow-up on the GAIS for acne scarring. Subject satisfaction was high with subjects giving an average satisfaction score of 3.27 ("satisfied") out of 4. Pain was "mild" as treatments were rated an average of 2.15 on a 10-point visual analog scale. The GAIS score of the 80-pin tip improved patients' acne scars treated with that applicator by 1.06 points and 0.85 for the 160-pin tip. Ninety-five percent (95.5%) of subjects reported either a mild, moderate, or significant improvement to their treatment area. Ninety-one percent of subjects reported that they would recommend the treatment to a friend.

CONCLUSION

FRF produced a statistically significant improvement in acne scarring when assessed by independent blinded evaluators. No serious adverse events resulted from treatment by either applicator tip. Treatment pain was low and tolerable among subjects of all Fitzpatrick skin types. Subjects had high levels of satisfaction with the results.

The pathogenesis of melasma and implications for treatment

BACKGROUND

Melasma is a complex and poorly understood disorder, with high rates of treatment failure and recurrences.

OBJECTIVES

We aimed to review the current knowledge of the pathogenesis of melasma and apply this knowledge to clinical implications on relevant therapeutic interventions.

METHODS

A systematic PubMed search was performed using the search term "((melasma[Text Word]) OR facial melanosis[Text Word]) AND (pathogenesis OR causality[MeSH Terms])" for articles published between 1990 and 2020. Included articles were then evaluated by two authors and assessed for relevant pathomechanistic pathways, after which they were divided into groups with minimal overlap. We then reviewed current treatment modalities for melasma and divided them according to the involved pathomechanistic pathway.

RESULTS

A total of 309 search results were retrieved among which 76 relevant articles were identified and reviewed. Five main pathomechanisms observed in melasma were identified: (1) melanocyte inappropriate activation; (2) aggregation of melanin and melanosomes in dermis and epidermis; (3a) increased mast cell count and (3b) solar elastosis; (4) altered basement membrane; and (5) increased vascularization. Treatment modalities were then divided based on these five pathways and detailed in 6 relevant tables.

CONCLUSION

The pathophysiology of melasma is multifactorial, resulting in treatment resistance and high recurrence rates. This wide variety of pathomechanisms should ideally be addressed separately in the treatment regimen in order to maximize results.

Quantitative assessment of the long-term efficacy and safety of a 1064-nm picosecond laser with fractionated microlens array in the treatment of enlarged pores in Asians: A case-control study

Background

Enlarged facial pores are one of the common skin signs of photoaging that patients seek treatment for. However, objective data and long‐term assessment on the efficacy and safety of therapeutic procedures for this condition are limited.

Objective

To objectively evaluate the efficacy and safety of a 1064‐nm picosecond laser with microlens array (MLA) for pore tightening.

Methods

Twenty‐five patients with enlarged pores received three treatments with a 1064‐nm picosecond laser coupled with MLA at 4‐week intervals. Patients were evaluated using objective (measurement of pore volume using three‐dimensional photography) and subjective (clinical evaluation by two blinded dermatologists) assessments at baseline and at the 1‐, 3‐, and 6‐month follow‐ups. Adverse effects were also recorded during each visit.

Results

After three treatments, there was a significant reduction of pore size from baseline (p < 0.001). The improvement in pore size appearance significantly continued from the 1‐month to the 6‐month follow‐up visits (p = 0.013). The total average pore size was 1.15652 ± 0.614322 and 0.8087 ± 0.50515 at baseline and at 6 months after the final treatment, respectively, resulting in an average of 30% reduction in pore size. No cases of dyspigmentation, textural alteration, or scarring were documented.

Conclusion

Fractional 1064‐nm picosecond laser appears to be effective and safe for reducing pore size in Asians with minimal transient side effects.

Identifying and appraising patient-reported outcome measures on treatment satisfaction in acne: a systematic review

BACKGROUND

After dermatitis, acne is the next skin disease to contribute most to the burden of skin diseases worldwide. Recently, seven core outcome domains have been identified, which together form an Acne Core Outcome Set (ACORN). One of these was satisfaction with acne treatment.

OBJECTIVES

To identify studies that described the development of patient-reported outcome measures (PROMS), evaluated one or more measurement properties of a PROM, or evaluated the interpretability of a PROM in patients with acne regarding treatment satisfaction.

METHODS

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy for identifying PROMS on acne treatment satisfaction was used. We searched PubMed, MEDLINE, Embase, LILACS, Web of Science, Cochrane Library, Emcare, PsycINFO and Academic Search premier (June 2020). Study selection, data extraction and assessment of methodological quality according to COSMIN guidance were carried out independently by two authors.

RESULTS

Only one study could be included, describing the development of a treatment satisfaction measure in patients with acne. The development was assessed as inadequate and data on measurement properties were lacking. Additionally, we found 188 studies reporting treatment satisfaction solely as an outcome, using a wide variety of methods, none of them standardized or validated.

CONCLUSIONS

We could not find a PROM on treatment satisfaction to recommend for a core outcome set in acne. There is an unmet need for a PROM on treatment satisfaction in acne that is robustly developed, designed and validated.

The Efficacy and Safety of a Variable Square Pulse (VSP) Erbium:YAG Laser for Treatment of Enlarged Pores in Asians

BACKGROUND AND OBJECTIVES

Enlarged pores are one of the most common causes of skin surface irregularities. Existing studies supporting the benefit of lasers and energy-based devices (EBD) for this condition are limited, with a short duration of follow-up period. We aimed to evaluate the efficacy and adverse effects of Er:YAG laser for treatment of enlarged pores in dark-skinned patients.

STUDY DESIGN/MATERIALS AND METHODS

Nineteen subjects (aged 26-47 years) with skin phototypes III (21.1%) and IV (78.9%) and enlarged pores were treated with 4 monthly sessions of Erbium:YAG laser. Objective (ultraviolet light A video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline, 1-month after each treatment and at 1, 3, and 6 months after the final treatment.

RESULTS

The weighted mean score of quartile grading scales showed significant improvement in pore size from baseline starting at 1-month after the third treatment and continued until 3 months after the fourth (final) treatment (P < 0.001). However, the improvement dropped significantly at 6 months after the final treatment. Objective measurements of the improvements in skin surface smoothness and wrinkles corresponded with the physician raters' clinical evaluation.

CONCLUSIONS

Erbium:YAG laser is a safe and effective treatment for enlarged pores in dark-skinned individuals. Maintenance treatments are recommended to achieve a longer-lasting outcome. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Fractional microneedling radiofrequency in striae alba: Do growth factors add value?

BACKGROUND

Various treatment modalities have been applied to treat striae alba (SA) with low satisfaction rate. Fractional microneedling radiofrequency (FMR) provides deep dermal coagulation, thereby inducing collagen synthesis and tissue tightening. The addition of platelet-derived lyophilized growth factors may add to the effect of FMR.

OBJECTIVES

To evaluate and compare the efficacy and safety of FMR alone or combined with lyophilized growth factors in the treatment of SA.

METHODS

In this left-right comparative study, 25 patients suffering from SA on the abdomen received four sessions of FMR with lyophilized growth factors on one side and with saline (as placebo) on the other side at 4 weeks interval. Photographic and biopsy documentation of the progress of the SA was carried out before the start of the treatment and 4 weeks after the last session. Calculation of the width of SA before treatment and after 4 sessions was done by Adobe Photoshop CS6.

RESULTS

There was a significant improvement in SA width after treatment in both the lyophilized growth factors (P = <.0001) and placebo sides (P = <.0001), the lyophilized growth factors being superior (P = .002). Patient satisfaction was more on the lyophilized growth factors (LGF) side (P = .034). Erythema and hyperpigmentation were less on the lyophilized growth factors side. Histopathologically, both showed improvement with no difference between LGF and placebo (epidermal thickness (P = .456), collagen content (P = .297), elastin content (P = .239)).

CONCLUSION

The combination of FMR and lyophilized growth factors improves SA outcome.

Efficacy and Safety of a Sublative Bipolar Fractional Radiofrequency System Combined With Topical Tretinoin in Treating Striae Gravidarum: A Randomized Pilot Study

BACKGROUND

Striae gravidarum is a common skin condition resulting after pregnancy, caused by fibroblast dysfunction. Although not considered a disease, it may be considered cosmetically unpleasant to sufferers and remains as a therapeutic challenge to date.

OBJECTIVE

To evaluate the efficacy and safety of a sublative bipolar fractional radiofrequency (FRF) system, associated with 0.1% topical tretinoin, in treating striae gravidarum.

MATERIALS AND METHODS

Eighteen Chinese women with striae gravidarum on the abdomen were enrolled in the study. The target area of each patient was divided into 4 sites randomly: control, tretinoin, FRF, and tretinoin and FRF. Fractional RF was used 3 times, with 3-month intervals. Changes to striae gravidarum were evaluated through subjective scaling and objective measures, using both high-frequency ultrasound and histological study.

RESULTS

Both subjective assessment and skin thickness differences demonstrated significant improvement in the combination site (p < .001). Average optical density and density percentage of neocollagen and elastic fibers were also markedly increased in the combination site (p < .05). The adverse effects of FRF were limited to mild pain and transient erythema, edema, and microcrusts.

CONCLUSION

The combined therapy of FRF and topical tretinoin may be a potential method in treating striae gravidarum, with satisfactory efficacy and limited side effects.

Radiofrequency Therapy and Noncosmetic Cutaneous Conditions

BACKGROUND

The need for noninvasive methods in treatment of cutaneous disease has continued to evolve exponentially. Amidst the search for technologies, radiofrequency (RF) has proven efficacious in numerous skin disease processes. Although RF is well known for its cosmetic utility, its mechanism is valued in the treatment of many noncosmetic cutaneous conditions of various etiologies.

OBJECTIVE

To identify and describe studies in which RF was used to treat noncosmetic skin conditions and to explore the potential of this modality for further application in dermatologic diseases.

MATERIALS AND METHODS

The PubMed database was used to find relevant articles.

RESULTS

This search strategy yielded 54 articles that met the eligibility criteria. Noncosmetic indications discussed in these articles include varicose veins (n = 10,550), lymphangioma circumscriptum (n = 72), cutaneous neoplasms (n = 42), cutaneous leishmaniasis (n = 743), acne and acne scarring (n = 158), non-acne scarring (n = 43), primary axillary hyperhidrosis (n = 76), and acute and chronic wounds (n = 94).

CONCLUSION

Treatment with RF is an effective, generally noninvasive modality with a relatively short postprocedure recovery time and little potential for severe adverse effects in the treatment of several cutaneous conditions. Further clinical studies would prove useful to assess the efficacy and cost-effectiveness of this treatment.

A Face-Split Study to Evaluate the Effects of Microneedle Radiofrequency with Q-Switched Nd:YAG Laser for the Treatment of Melasma

Background

Laser toning using a low-fluence 1,064 nm Q-switched Nd:YAG laser is one of the most frequently used treatment modalities for melasma. However, this therapy is time consuming because it requires a lot of treatment sessions. Recently, it has been reported that transdermal radiofrequency (RF) is effective for the treatment of melasma.

Objective

To determine whether microneedle RF conduction could be an adjunct therapy for melasma, we have studied the effect of simultaneous treatments with laser toning and RF for melasma.

Methods

Fifteen patients with melasma underwent five sessions of laser toning and microneedle RF on the right side of the face, and only laser toning on the left side. Responses to treatments were evaluated using the Mexameter® (Courage Khazaka, Germany) score, the pigmentation and severity index (PSI) score, and the patient's overall assessment. Additionally, an electron microscopic study of a skin biopsy was performed.

Results

Both laser toning and combination therapy showed significant decreases in the Mexameter® and PSI score after five treatment sessions. Combination therapy showed a more significant improvement of melasma than laser toning. No remarkable side effects were reported. Electron microscopic analysis showed a greater number of vacuolar changes and increased loosening of melanocytes and adjacent epidermal cells after combination therapy.

Conclusion

The combination treatment of laser toning and microneedle RF therapy showed a better therapeutic effect for melasma than laser toning alone. Therefore, the microneedle RF technique could be a new and safe adjunct therapy for the treatment of melasma.

Acne Scarring Management: Systematic Review and Evaluation of the Evidence

BACKGROUND

Modalities for atrophic acne scarring can be classified depending upon the needs they satisfy; that is, resurfacing, lifting/volumization, tightening, or surgical removal/movement of tissue that is required for correction. A plethora of treatment options have resulted from the need to treat various acne scar types, variability of responses noted in various skin types, and increasing popularity of minimally invasive modalities. Still, there is a lack of consensus guidelines on treatment or combination therapies for various clinical scenarios.

OBJECTIVE

This systematic review includes a critical evaluation of the evidence relevant to these modalities and various multimodality therapies.

METHODS

We performed a systematic literature search in Medline and EMBASE databases for studies on acne scar management. Also, we checked the reference lists of included studies and review articles for further studies. A total of 89 studies were included in our quality of evidence evaluation.

RESULTS

The efficacy of lasers and radiofrequency in atrophic acne scarring is confirmed by many comparative and observational studies. Other modalities can be used as an adjunct, the choice of which depends on the type, severity, and number of atrophic scars. Minimally invasive procedures, such as fractional radiofrequency and needling, provide good outcomes with negligible risks in patients with dark or sensitive skin types.

CONCLUSIONS

There is a lack of high-quality data. Fractional lasers and radiofrequency offer significant improvement in most types of atrophic acne scars with minimal risks and can be combined with all other treatment options. Combination therapies typically provide superior outcomes than solo treatments.

Efficacy of fractionated microneedle radiofrequency with and without adding subcision for the treatment of atrophic facial acne scars: A randomized split-face clinical study

BACKGROUND

There is no gold standard treatment for facial acne scars, and overall, little literature exists about the combination therapy for treatment of acne scar.

AIMS

The aim of this study was to evaluate the efficacy of fractionated microneedle radiofrequency (FMR) vs FMR combined with subcision for the treatment of atrophic acne scars.

PATIENTS/METHODS

This was a randomized, split-face clinical study of 25 patients with II-IV Fitzpatrick skin types with moderate to severe facial atrophic acne scars. Initially, standard subcision by Nokor needle was performed on one side. Two weeks after subcision, FMR treatment was performed on both cheeks of each participant. Second and third FMR treatment sessions were performed within 4-week intervals. Two-blinded dermatologists performed clinical assessments using a quartile grading scale, and patients were also asked to judge their satisfaction using a visual analog scale (VAS) scoring system.

RESULTS

The age of the patients varied from 24 to 40 years (mean: 30.08±4.94 years). Only nine patients (36%) were males. Clinical assessment by two-blinded dermatologists showed statistically significant improvement in the combination (FMR+subcision) group (P=.009). Patient satisfaction was statistically significantly better in the combination group (P=.001). A darkening of skin phototype was associated with a decrease in patient's satisfaction VAS score (P=.07).

CONCLUSION

The combination of subcision and FMR is a safe and effective modality for mixed type acne scars. Additional randomized clinical study with long-term follow-up is necessary for further evaluation of FMR in combination with other procedures. The full trial protocol can be accessed in: http://www.irct.ir/searchresult.php?keyword=%20%20IRCT2016103130597N1&id=30597&number=1&field=a&prt=1&total=1&m=1. The clinical trial registration number is IRCT2016103130597N1.

Fractional resurfacing in the Asian patient: Current state of the art

BACKGROUND AND OBJECTIVE

Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient.

METHODS

A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO₂ ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors.

CONCLUSION

Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment efficacy. Lasers Surg. Med. 49:45-59, 2017. © 2016 Wiley Periodicals, Inc.

Effects of low-level laser therapy, electroacupuncture, and radiofrequency on the pigmentation and skin tone of adult women

[Purpose] In this study, the effects of low-level laser therapy (LLLT), electroacupuncture (EA), and radiofrequency (RF), which are used in physical therapy, on the pigmentation and skin tone of adult women’s faces were investigated to provide basic data for skin interventions. [Subjects and Methods] Thirty adult females were assigned to either an LLLT group (n=10), an EA group (n=10), or an RF group (n=10). The intervention was performed in two 15-minute sessions per week for six weeks. Subjects’ skin tone and pigmentation were observed before and after the intervention. [Results] The EA group showed significant reductions in pigmentation in the left and right eye rims, as well as in the left cheek. The RF group showed significant post-intervention reductions in pigmentation under the left eye, as well as in the left and right eye rims and the left cheek. The LLLT group showed significant increases in skin tone in the forehead and both eye rims. The RF group showed significant increases in skin tone under both eyes. [Conclusion] The application of LLLT, EA, and RF had positive effects on pigmentation and skin tone of adult women’s faces.

Safety and efficacy of hybrid energy and trifractional technologies in the treatment of acne scars: An open-label clinical trial

INTRODUCTION

This study determines the safety and efficacy of a novel device--Surgen that utilizes hybrid energy (HE) technology and trifractional (TF) technology in the treatment of acne scars in Filipino patients.

METHODS

Open-label clinical trial on eight subjects who underwent 4 weekly HE treatments followed by 2 TF treatments spaced 3 weeks apart. Efficacy was evaluated by dermatologists' (investigator and two blinded dermatologists) and patients' assessment and grading of post-treatment digital photographs. Subjects also reported level of satisfaction and comfort. Adverse events were recorded.

RESULTS

Dermatologists' grading of acne scars improvement--58.3% of subjects showed slight to moderate improvement, 8.3% showed marked improvement, and 33.3% was graded as unchanged after HE treatments. After 2 additional TF treatments grades improved further, with 37.5% showing mild to moderate improvement, 37.5% showing marked improvement, and 25% graded as unchanged. Dermatologist's scoring using the global acne scoring system resulted in improvement of 75% of patients after 4 HE sessions and 100% after TF treatments. Subjects' grading showed a similar trend: 75% of subjects reported that they were satisfied and 25% slightly satisfied after the complete protocol.

CONCLUSION

A treatment protocol combining HE and TF technology is safe, effective, and comfortable in the treatment of acne scars.

High versus moderate energy use of bipolar fractional radiofrequency in the treatment of acne scars: a split-face double-blinded randomized control trial pilot study

Bipolar fractional radiofrequency (FRF) device was firstly FDA-approved for treating atrophic acne scar in 2008 through the process of dermal coagulation and minimal epidermal ablation. The average energy at 60 mJ/pin was widely used to treat atrophic acne scars. However, the higher energy was delivered, the deeper ablation and coagulation were found. At present, the new generation of a device with bipolar FRF technology with electrode-pin tip was developed to maximize ability to deliver energy up to 100 mJ/pin. The objective of the study was to explore and compare the efficacy of utilizing high energy (100 mJ/pin) and moderate energy (60 mJ/pin) of bipolar fractional radiofrequency in treatment of atrophic acne scar in Asians. This is a split-face, double-blinded, randomized control trial, pilot study by using parallel group design technique. Thirty healthy subjects with Fitzpatrick skin phototype III-IV diagnosed as atrophic acne scares were enrolled. All subjects received four monthly sessions of bipolar FRF treatment. Left and right facial sides of individual patients were randomly assigned for different energy (high energy at 100 mJ/pin versus moderate energy at 60 mJ/pin). Acne scars improvement was blinded graded by dermatologist using global acne scarring score (GASS) which was subjectively evaluated at baseline, 1-, 3-, and 6-month follow-up. Objective scar analysis was also done using UVA-light video camera to measure scar volume, skin smoothness, and wrinkle at baseline, 3-, and 6-month follow-up after the last treatment. Side effects including pain, erythema, swelling, and crusting were also recorded. Thirty subjects completed the study with full 4-treatment course. The mean GASS of high energy side and moderate energy side was significantly reduced at 1-, 3-, and 6-month follow-up visits. At 1 month follow-visit, high energy side demonstrated significant improvement compared with moderate energy side (p = 0.03). Postinflammatory hyperpigmentation (PIH) developed in 21/120 sessions in high energy side (17.5 %) and 16/120 sessions in moderate energy side (13.3 %). Pain score and the duration of erythema after treatments were significant higher on the side that was treated with high energy. Bipolar FRF device was safe and effective in the treatment of atrophic acne scars in Asians. High energy setting demonstrated significant higher efficacy at 1 month follow-visit. However, the efficacy of both energy settings was comparable at 3- and 6-month follow-up. In addition, side effects were significantly more intense on the side treated with high energy.