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Liu F, Zhou Q, Tao M, Shu L, Cao Y. Efficacy and safety of CO 2 fractional laser versus Er:YAG fractional laser in the treatment of atrophic acne scar: A meta-analysis and systematic review. J Cosmet Dermatol 2024. [PMID: 38733085 DOI: 10.1111/jocd.16348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/01/2024] [Accepted: 04/16/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND To date, a consensus on the relative efficacy and safety of CO2 fractional laser versus erbium-doped yttrium aluminum garnet (Er:YAG) fractional laser treatments for atrophic acne scars has not been reached. This meta-analysis aims to systematically assess and compare their effectiveness and safety in clinical practice. METHODS For this meta-analysis, we conducted comprehensive searches in Pubmed, Embase, and Cochrane databases, covering publications from their inception up to August 2023. Our focus was on studies comparing fractional CO2 laser with Er:YAG fractional laser treatments for atrophic acne scars. We excluded duplicate publications, research lacking full-text access, incomplete data, or cases where data extraction was not feasible. Additionally, animal experiments, reviews, and systematic reviews were not considered. Data analysis was performed using STATA 15.1. RESULTS Eight studies (seven randomized controlled trials (RCTs) and a retrospective study) were included in this meta-analysis. The sample size ranged from 28 to 106 with a total of 418 patients, including 210 in the CO2 fractional group and 208 in Er:YAG fractional group. The pooled results showed that the effective rate of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (OR = 1.81, 95% CI: 1.08-3.01) and the downtime of CO2 fractional laser in treating atrophic acne scar was significantly shorter than that of Er:YAG fractional laser (Weighted Mean Difference (WMD) = -2.11, 95% CI: -3.11 to -1.10). In addition, VAS of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (WMD = 1.77, 95% CI: 1.32-2.21) and the duration of erythema of CO2 fractional laser in treating atrophic acne scar was significantly longer than that of Er:YAG fractional laser (WMD = 1.85, 95% CI: 1.63-2.07). However, there was no significant difference in the duration of pain and incidence of PIHbetween CO2 fractional laser and of Er:YAG fractional laser. CONCLUSION When it comes to treating atrophic acne scars, CO2 fractional laser demonstrates superior efficacy and leads to shorter downtime. However, it is important to note that CO2 fractional laser treatments tend to result in higher pain intensity and may carry a higher risk of post-treatment pigmentation compared to Er:YAG fractional laser procedures.
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Affiliation(s)
- Fei Liu
- Jinhua People's Hospital, Jinhua, China
| | - Qiujun Zhou
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Maocan Tao
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Luying Shu
- Jinhua Shuhe Plastic Surgery Clinic, Jinhua, China
| | - Yi Cao
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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Juch RNS, Bik L, Boeijink N, de Vos J, Dobbe IJGG, Bloemen PR, van Doorn MBA, Velthuis P, Aalders MCG, Wolkerstorfer A. Home-Use Hyaluronic Acid Jet Injectors: Unreliable and Unsafe. Dermatol Surg 2024; 50:62-68. [PMID: 37815475 DOI: 10.1097/dss.0000000000003971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Needle-free hyaluronic acid (HA) jet injectors are gaining popularity for rejuvenation treatment. The devices are widely available online and are used for self-injection or in beauty salons by nonphysicians. However, little is known about their performance and safety. OBJECTIVE To explore the injection efficiency and cutaneous biodistribution patterns administered with home-use compared with medical jet injectors and to assess safety aspects. MATERIALS AND METHODS The authors injected HA into ex vivo human skin with 4 home-use and 2 medical injectors. The intracutaneous dose of HA was calculated, and the cutaneous biodistribution of HA was assessed using a 3-dimensional Fluorescent Imaging Cryomicrotome System (3D-FICS). Safety aspects were evaluated based on the presence of a manual, CE (conformité européenne) mark, and sterility. RESULTS The intracutaneous dose delivered by the home-use injectors was markedly lower compared with the medical injectors. 3D imaging for home-use injectors showed superficial epidermal distribution with low distribution volumes. For medical injectors, volumes were substantially larger and mainly middermal. All evaluated safety aspects were lacking. CONCLUSION Results of this study suggest that the specific combinations of home-use injectors and HA used in this study are unreliable and unsafe, which casts doubts on the performance of these treatments in general.
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Affiliation(s)
- Rosalie N S Juch
- Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Liora Bik
- Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Neill Boeijink
- Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Judith de Vos
- Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Iwan J G G Dobbe
- Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health-Restoration and Development, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Paul R Bloemen
- Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Peter Velthuis
- Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maurice C G Aalders
- Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Wolkerstorfer
- Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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Almukhadeb E, Binkhonain F, Alkahtani A, Alhunaif S, Altukhaim F, Alekrish K. Dermal Fillers in the Treatment of Acne Scars: A Review. Ann Dermatol 2023; 35:400-407. [PMID: 38086353 PMCID: PMC10733075 DOI: 10.5021/ad.22.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/08/2023] [Accepted: 05/18/2023] [Indexed: 12/22/2023] Open
Abstract
Acne vulgaris (AV) is the eighth most common disease in the world. This condition can impair the affected patients' social and psychological functioning and lower their quality of life. In general, scar reduction, rather than complete scar removal, is the aim of AV treatment. Dermal abrasion, chemical peeling, laser resurfacing, subcision, punch methods, tissue-improving substances, and dermal fillers are the currently available therapeutic options. In this study, we focused on the rapidly developing field of dermal fillers used alone or in combination with other therapies to reconstruct skin affected by acne scars and to evaluate the improvement of facial appearance after using different types of dermal fillers.
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Affiliation(s)
- Eman Almukhadeb
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Binkhonain
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abeer Alkahtani
- Department of Dermatology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Sarah Alhunaif
- Department of Dermatology, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Feras Altukhaim
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alekrish
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Salameh F, Shumaker PR, Goodman GJ, Spring LK, Seago M, Alam M, Al-Niaimi F, Cassuto D, Chan HH, Dierickx C, Donelan M, Gauglitz GG, Haedersdal M, Krakowski AC, Manuskiatti W, Norbury WB, Ogawa R, Ozog DM, Paasch U, Victor Ross E, Clementoni MT, Waibel J, Bayat A, Goo BL, Artzi O. Energy-based devices for the treatment of acne scars: 2021 international consensus recommendations. Lasers Surg Med 2021; 54:10-26. [PMID: 34719045 DOI: 10.1002/lsm.23484] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs. STUDY DESIGN/MATERIALS AND METHODS An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence. RESULTS The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome. CONCLUSION Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.
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Affiliation(s)
- Fares Salameh
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Peter R Shumaker
- VA San Diego Healthcare System and University of California, San Diego, California, USA
| | - Greg J Goodman
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Leah K Spring
- Micrographic Surgery and Surgical Oncology, SkinCare Physicians, Chestnut Hill, Massachusetts, USA
| | - Meghan Seago
- VA San Diego Healthcare System and University of California, San Diego, California, USA.,Micrographic Surgery and Surgical Oncology, Scripps Clinic, La Jolla, California, USA
| | - Murad Alam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Henry Hl Chan
- Private Practice and Department of Medicine (Dermatology), University of Hong Kong, People's Republic of China
| | | | - Matthias Donelan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children-Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig Maximillian University, Munich, Germany
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew C Krakowski
- Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania, USA
| | | | - William B Norbury
- Department of Surgery, University of Texas Medical Branch, Shriners Hospital for Children-Galveston, Galveston, Texas, USA
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Uwe Paasch
- Department of Dermatology, Venereology, and Allergy, University of Leipzig, Leipzig, Germany
| | | | | | - Jill Waibel
- Miami Dermatology and Laser Institute, Miami, Florida, USA
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester, England, UK.,MRC-SA Wound Healing Unit, Hair & Skin Research Laboratory, Division of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Boncheol Leo Goo
- Naeum Dermatology and Aesthetic Clinic/Skin Rehabilitation Center, Seoul, Korea
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Han HS, Hong JY, Kwon TR, Lee SE, Yoo KH, Choi SY, Kim BJ. Mechanism and clinical applications of needle-free injectors in dermatology: Literature review. J Cosmet Dermatol 2021; 20:3793-3801. [PMID: 33682249 DOI: 10.1111/jocd.14047] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Needle-free jet injectors are devices that deliver drugs using a high-speed jet without a needle. Recent studies have significantly increased our understanding of the mechanisms of needle-free jet injectors, and technical advancements have broadened the scope of application of the device. AIMS We aimed to provide an up-to-date review of previous literature regarding the mechanism of action and clinical applications of needle-free jet injectors in dermatology field. METHODS We conducted a PUBMED search for studies on needle-free jet injectors using the following parameters: "Pneumatic injector" OR "needleless injector" OR "needle-free injector" OR "jet injector." Among 191 results, 72 articles focusing on their mechanisms of action, cutaneous delivery patterns, and clinical applications in dermatology were selected for review. RESULTS Significant clinical evidence has been published confirming the potential of needle-free jet injectors in treating various dermatologic conditions. In particular, these devices have the potential to be used in various skin remodeling treatment, especially in skin rejuvenation procedures by injecting various esthetic materials. CONCLUSION As proven by accumulated experience, the applications of NFJIs are not restricted to vaccine or insulin delivery in dermatology field. However, this literature review shows that until now, there are no clinical guidelines that standardize the optimal parameters when using NFJIs on various clinical settings. Therefore, further studies should be performed in order to investigate the full potential of these devices in dermatology, to ensure safe and effective outcomes in clinical practice.
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Affiliation(s)
- Hye Sung Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Ji Yeon Hong
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae Rin Kwon
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sung Eun Lee
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kwang Ho Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sun Young Choi
- Department of Dermatology, Seoul Paik Hospital Inje University College of Medicine, Seoul, South Korea
| | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
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Zhao W, Wang J, Zhang Y, Zheng B. A retrospective study comparing different injection approaches of 5-aminolevulinic acid in patients with non-melanoma skin cancer. J DERMATOL TREAT 2020; 33:1465-1472. [PMID: 33016837 DOI: 10.1080/09546634.2020.1832186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND 5-aminolevulinic acid through a needle-free, plum-blossom needle or conventional needle followed by photodynamic therapy are available options for non-melanoma skin cancer treatment. AIM To compare these three techniques of injection of 5-aminolevulinic, regarding treatment response and adverse effects in patients with non-melanoma skin cancer. PATIENTS AND METHODS Non-melanoma skin cancer patients have received six cycles of 0.5 mL intralesional 20% w/v 5-aminolevulinic acid through a conventional needle (CPT cohort, n = 158), or plum-blossom needle (BPT cohort, n = 118), or needle-free injection (NPT cohort, n = 105) followed by irradiation with a red light. Data regarding treatment response and adverse effects were collected and analyzed. RESULTS The treatment response was higher among patients of NPT cohort than those of CPT (p = .012, q = 3.981) and BPT (p = .012, q = 3.472) cohorts. Conventional and plum-blossom needle injections therapies were reported scar, local redness, and worse cosmetic appearance in the follow-up period. CONCLUSIONS Needle-free injection of intralesional 5-aminolevulinic acid followed by irradiation with red light therapy were reported high treatment response with manageable adverse effects for non-melanoma skin cancer patients than that of conventional and plum-blossom needle injections. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Weihong Zhao
- Department of Dermatology, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Jun Wang
- Department of Dermatology; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Ying Zhang
- Department of Dermatology, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Baoyong Zheng
- Department of Dermatology, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
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