Carboxytherapy Versus Skin Microneedling in Treatment of Atrophic Postacne Scars: A Comparative Clinical, Histopathological, and Histometrical Study

Microneedles as an Emerging Platform for Transdermal Delivery of Phytochemicals

Phytochemicals, which are predominantly found in plants, hold substantial medicinal value. Despite their potential, challenges such as poor oral bioavailability and instability in the gastrointestinal tract have limited their therapeutic use. Traditional intra/transdermal drug delivery systems offer some advantages over oral administration but still suffer from issues such as limited penetration depth, slow drug release rates, and inconsistent drug absorption. In contrast, microneedles (MNs) represent a significant advancement in intra/transdermal drug delivery by providing precise control over phytochemical delivery and enhanced penetration capabilities. By circumventing skin barriers, MNs directly access dermal layers rich in blood vessels and lymphatics, thus facilitating efficient phytochemical delivery. This review extensively discusses the obstacles of traditional oral delivery and the benefits of intra/transdermal delivery routes with a particular focus on the transformative potential of MNs for phytochemical delivery. This review explores the complexities of delivering phytochemicals through intra/transdermal routes, the development and types of MNs as innovative delivery tools, and the optimal design and properties of MNs for effective phytochemical delivery. Additionally, this review examines the versatile applications of MN-mediated phytochemical delivery, including its role in administering phytophotosensitizers for photodynamic therapy, and concludes with insights into relevant patents and future perspectives.

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

Acne scarring is common and can occur even with effective acne management. In addition, patients with acne scarring suffer from significant psychosocial morbidity, including depression and suicidality. Despite the availability and advancement of therapeutic modalities, treatment for acne scarring is not always optimized and often overlooked in patients with acne encounters. Using acne scarring assessment tools and identifying specific acne scar subtypes allows for a tailored therapeutic approach. Part I of this continuing medical education series covers the pathophysiology and morphology of textural and pigmented acne scars, scarring assessment tools, and medical treatment options. The principles reviewed will aid in approaching and initiating acne scar treatment in the outpatient setting.

Modern techniques in addressing facial acne scars: A thorough analysis

BACKGROUND

Facial acne scars are a prevalent concern, leading to the development of various treatment modalities.

OBJECTIVES

This review aims to explore the latest advancements in the treatment of facial acne scars, focusing on both surgical and non-surgical methods.

METHODS

The non-surgical treatments reviewed include topical medications (such as retinoids and alpha hydroxy acids) and non-invasive procedures (like microdermabrasion and chemical peels). Surgical options discussed are punch excision, subcision, and fractional laser treatments.

RESULTS

Combination therapy, integrating both surgical and non-surgical approaches, is frequently utilized to achieve optimal results in scar improvement.

CONCLUSION

Recent advancements in the treatment of facial acne scars provide promising options for individuals seeking improvement. However, these treatments have associated risks and potential adverse effects, highlighting the importance of consulting a dermatologist before beginning any treatment regimen.

An overview of the role of carboxytherapy in dermatology

BACKGROUND

Carboxytherapy is defined as intradermal and/or subcutaneous microinjections of sterile purified carbon dioxide into different parts of the body for therapeutic aims. The vasodilatation effect and intradermal collagen reorganization associated with carboxytherapy have advantages for aesthetic dermatology and cosmetology.

OBJECTIVE

In the current article, we have reviewed some of the most important indications of this modality in dermatology and aesthetic dermatology.

METHOD

Our review is a narrative one which has gathered some of the most important indications of carboxytherapy in dermatology and cosmetology.

RESULTS

Carboxytherapy has successfully been applied for some dermatologic and cosmetic conditions among which skin aging, cellulite, localized fat deposits, striae distensae, infraorbital hyperpigmentation, scar, lymphedema, androgenetic alopecia, alopecia areata, psoriasis, morphea, and vitiligo are the most important.

CONCLUSION

Carboxytherapy can be considered as a safe, minimally-invasive modality used for rejuvenation, restoration, and recondition of the skin.

Preliminary results of the use of carboxytherapy in the treatment of pathologic scars: A minimally invasive alternative

BACKGROUND

Carboxytherapy involves injecting carbon dioxide in the dermal and subcutaneous layers to achieve an increase in the local microvascularization of the tissue where it is applied. Our aim is to analyze its effectiveness in the treatment of pathological scars, as well as its adverse effects.

METHODS

We conducted a prospective single-center study in patients under 18 years of age with atrophic and hypertrophic scars caused by surgical interventions or trauma, mainly burns. Each patient underwent two sessions, 6 weeks apart in time. Scar quality was evaluated using the Vancouver Scar Scale before the first session and 6 weeks after the second session. Adverse effects observed during the procedure and at follow-up in outpatient clinic were collected.

RESULTS

A total of 16 patients were included (5 males; 11 females), with a median age of 12.7 years (interquartile range 8.5-15.2), in whom 25 pathologic scars were treated (14 atrophic and 11 hypertrophic). All sessions were performed under sedation, and patients were discharged the same day, without the need for hospitalization. Regarding scar quality, an improvement was observed in the median Vancouver scale score at 6 weeks after the second session (7 points) compared to the initial median score (12 points), this difference being statistically significant (p = 0.031). No serious adverse effects were observed during the procedure or during subsequent follow-up, with a median follow-up of 14 weeks.

CONCLUSIONS

Carboxytherapy is an effective and safe minimally invasive therapy for pathologic scars, achieving a significant improvement in scar quality, with almost no contraindications.

LEVEL OF EVIDENCE

Level IV.

TYPE OF STUDY

Prospective Single-Center Case Series.

Objective, measurable assessment of the elasticity of the skin around the eyes following the carboxytherapy treatment

BACKGROUND

Carboxytherapy is one of the most popular procedures used in dermatology. The treatments are known to be minimally invasive and highly effective for various skin disorders. Therefore, the research carried out in the paper is purposeful and addresses an important area of aesthetic therapies.

AIMS

Objective, apparatus-based assessment of the effect of carboxytherapy on skin elasticity around the eyes.

PATIENTS/METHODS

The study included a group of 39 Caucasian individuals aged 35-55 years. Participants were subjected to a series of five carboxytherapy treatments of eye area at weekly intervals. The Cutometer measuring probe was used to assess skin elasticity. Additionally, photographic documentation was out using the Fotomedicus system.

RESULTS

In this study, statistically significant increase in R2 parameter was found as the result of applied treatment. This parameter is considered to be the most important indicator of changes in skin elasticity. In 29 out of 39 subjects, the carboxytherapy treatment significantly improved skin tension and elasticity. Such therapy may also exert a beneficial effect on flexibility since in 28 participants the favorable change in the R7 parameter was visible.

CONCLUSIONS

The objective analysis of the impact of carboxytherapy treatment on parameters determining skin elasticity revealed that this therapy can be used as an anti-aging method in the eye area. Obtained results are in agreement with other biochemical, histological, and photographical documentation analyses of the effect of carboxytherapy on skin, performed by independent researchers.

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.

A Prospective, Open-Label Study to Evaluate the Impact of VYC-12L Injection on Skin Quality Attributes in Healthy Volunteers

Purpose

Age-related changes in skin structure and function can negatively impact skin quality. VYC-12L is a crosslinked hyaluronic acid filler for treating fine lines and improving hydration and elasticity. The goal of this study was to understand skin quality, histologic, and genomic changes underlying long-term clinical benefits of VYC-12L treatment.

Patients and Methods

In this prospective, nonrandomized, open-label study, 11 healthy men (n = 2) and women (n = 9) received intradermal VYC-12L treatment on the volar forearm. Clinical probes assessed skin quality at baseline and months 1 and 3 post-treatment. Punch biopsies were collected 1 and 3 months post-treatment to evaluate histologic and genomic changes. Safety was evaluated throughout.

Results

Participants had a mean age of 41 years and Fitzpatrick skin phototypes II (54.5%) and III (45.5%). At months 1 and 3, VYC-12L-treated skin had higher hydration in the stratum corneum than untreated skin. Cutometer measurements indicated treated skin that was firmer and more resistant to deformation. Histology showed increased epidermal AQP3 and Ki67 expression 1 and 3 months post-treatment and a qualitative increase in papillary dermal collagen I at month 3. Genomic analyses demonstrated treatment-related upregulation of genes involved in adipocyte differentiation, lipid metabolism, keratinocyte renewal, and dermal extracellular matrix (ECM) maintenance. Injection site reactions were mild-to-moderate in severity and resolved by month 1. Five participants reported 19 adverse events; most (68.4%) were related to the biopsy and none to VYC-12L.

Conclusion

VYC-12L produced changes in hydration, firmness, and ECM density and composition consistent with improved skin properties, demonstrating that VYC-12L can act as a substrate for tissue repair.

Microneedling for the Treatment of Scars: An Update for Clinicians

Background

Microneedling (MN) is used for the treatment of scars, amongst other indications. Although used in Asia and the Middle East for decades, related to the supposed lack of post-procedure pigmentary alterations even in darker skin types, MN only recently gained attention in the United States as an effective, well-tolerated aesthetic treatment.

Materials and Methods

A systematic review of the Medline database was completed using search terms “microneedle” or “microneedling” or “micro needle” or “micro needling” and “scar”. Included articles were written in English and discussed the use of MN for the treatment of scars in human subjects.

Results

Fifty-eight studies were included for review, with a total of 1845 patients treated for acne scarring, hypertrophic or keloid scars, and those resulting from surgery, trauma, varicella or smallpox. MN and its counterpart fractional radiofrequency MN (FRF-MN) were used as monotherapy or in combination with topical, surgical or systemic modalities. MN and FRF-MN treatment resulted in clinical improvement of scar appearance from baseline. No serious adverse events occurred.

Conclusion

MN is a well-tolerated, minimally invasive procedure that can be used for the treatment of scars with a high level of patient satisfaction. Further clinical studies are needed to develop standardized treatment protocols.

Effects of carboxytherapy on skin laxity

BACKGROUND

Carboxytherapy is capable of inducing tissue repair which results in an increase in elastic and collagen fibers.

OBJECTIVES

To evaluate the effects of carboxytherapy upon human skin collagen and elastic fiber synthesis.

METHODS

Case study of nine volunteers who received a single application of carboxytherapy in the left infraumbilical region, with infusion rate of 100 mL/min and 0.6 mL/kg weight over an area of 25 cm² . After 60 days on average, the skin was collected for histological analysis and stained with picrosirius red for collagen and Verhoeff for elastic fibers. The percentage of fibers found was marked by the Image J^® program and recorded in a Microsoft Excel spreadsheet. Statistical analysis was performed using SPSS (version 20), with a significance level of 95%.

RESULTS

An increase in the collagen and elastic fibers sample was observed in the treated group. Morphometrically, a significant increase in the percentage of collagen in the Carboxytherapy group (41.44 ± 4.50%) was observed compared with the control group (37.44 ± 3.87%) with P = .04; for elastic fibers, the percentage showed no significant difference between the control group (10.55 ± 4.33%) and the carboxytherapy group (10.44 ± 3.71%).

CONCLUSIONS

Carboxytherapy with the parameters used in this study was able to stimulate collagen and elastic fiber synthesis, with significant differences in the morphometry for collagen fibers.

Amniotic fluid-derived mesenchymal stem cell products combined with microneedling for acne scars: A split-face clinical, histological, and histometric study

BACKGROUND

Postacne scars are still a challenge in its management. Microneedling is a popular minimally invasive technique in treatment of such scars. However, the addition of topical stem cell products after microneedling is considered a new treatment regimen for these scars.

OBJECTIVE

To compare efficacy of amniotic fluid-derived mesenchymal stem cell-conditioned media (AF-MSC-CM) and microneedling vs microneedling alone in management of atrophic acne scars.

METHODS

Ten cases with atrophic postacne scars received five sessions of microneedling, with 2-week interval on both sides of the face. Then, AF-MSC-CM was topically applied to right side of the face after microneedling. Clinical examination with histopathological and computerized histometric analysis was done 1 month after the sessions.

RESULTS

There was significant increase in the improvement percentage of acne scars on right side (dermaroller and AF-MSC-CM) vs left side of face (dermaroller; P < 0.001). Histologically, improvement of character of collagen and elastic fibers was noticed, especially on right side. Meanwhile, significant increase in epidermal thickness on both sides of face was detected.

CONCLUSION

Amniotic fluid-derived mesenchymal stem cell-conditioned media combined with microneedling is more effective in management of atrophic postacne scars than microneedling alone.