Treatment of acne vulgaris with fractional radiofrequency microneedling

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.

Exploring Acne Treatments: From Pathophysiological Mechanisms to Emerging Therapies

Acne vulgaris is a common dermatological condition that can present across different ages but predominantly affects adolescents and young adults. Characterized by various lesion types, the pathogenesis of acne is complex, involving genetic, hormonal, microbial, and inflammatory factors. This review comprehensively addresses current and emerging acne management strategies, emphasizing both topical and systemic treatments, procedural therapies, and dietary modifications. Key topical agents include retinoids, benzoyl peroxide, antibiotics, and other specialized compounds. Systemic options like antibiotics, hormonal therapies, and retinoids offer significant therapeutic benefits, particularly for moderate to severe cases. Procedural treatments such as laser devices, photodynamic therapy, chemical peels, and intralesional injections present viable alternatives for reducing acne symptoms and scarring. Emerging therapies focus on novel biologics, bacteriophages, probiotics, and peptides, providing promising future options. This review underscores the importance of personalized approaches to treatment due to the multifaceted nature of acne, highlighting the potential of innovative therapies for improving patient outcomes.

Dissolving Hyaluronic Acid-Based Microneedles to Transdermally Deliver Eugenol Combined with Photothermal Therapy for Acne Vulgaris Treatment

A microneedle transdermal drug delivery system simultaneously avoids systemic toxicity of oral administration and low efficiency of traditional transdermal administration, which is of great significance for acne vulgaris therapy. Herein, eugenol-loaded hyaluronic acid-based dissolving microneedles (E@P-EO-HA MNs) with antibacterial and anti-inflammatory activities are developed for acne vulgaris therapy via eugenol transdermal delivery integrated with photothermal therapy. E@P-EO-HA MNs are pyramid-shaped with a sharp tip and a hollow cavity structure, which possess sufficient mechanical strength to penetrate the stratum corneum of the skin and achieve transdermal delivery, in addition to excellent in vivo biocompatibility. Significantly, E@P-EO-HA MNs show effective photothermal therapy to destroy sebaceous glands and achieve antibacterial activity against deep-seated Propionibacterium acnes (P. acnes) under near-infrared-light irradiation. Moreover, cavity-loaded eugenol is released from rapidly dissolved microneedle bodies to play a sustained antibacterial and anti-inflammatory therapy on the P. acnes infectious wound. E@P-EO-HA MNs based on a synergistic therapeutic strategy combining photothermal therapy and eugenol transdermal administration can significantly alleviate inflammatory response and ultimately facilitate the repair of acne vulgaris. Overall, E@P-EO-HA MNs are expected to be clinically applied as a functional minimally invasive transdermal delivery strategy for superficial skin diseases therapy in skin tissue engineering.

Recent advances in the treatment of acne using radiofrequency techniques

Acne is a long-lasting inflammatory skin condition that impacts the sebaceous units of the hair follicles, affecting around 85-90% of the population. Due to the potential for permanent facial scarring and negative social consequences, as well as the limitations of conventional medications like drug resistance and difficulties following treatment plans, it's crucial to investigate non-pharmacological options for treating acne, among which radiofrequency(RF) shows distinct superiority. To assess the impact of RF in the management of acne vulgaris, we conducted a thorough examination of scientific literature (including clinical trials and scientific reviews) through electronic databases like MEDLINE and PubMed. Our analysis indicates that RF could be a viable substitute for acne treatment due to its notable effectiveness and minimal adverse effects.

Review of radiofrequency microneedling: history, devices and uses

Radiofrequency microneedling (RFM) has recently become a popular choice for the treatment of various dermatologic conditions and rejuvenation. Many studies have sought to evaluate the efficacy of RFM. However, its role in the management of these conditions remains unclear. A comprehensive literature search including randomized controlled trials, cohort studies, and case series evaluating the efficacy of RFM in various skin conditions was performed. In this review, we discuss the history and mechanism of RFM, describe various device features, and discuss the use of RFM in various skin conditions and rejuvenation.

Targeting Inflammation in Acne: Current Treatments and Future Prospects

Acne is a common, chronic inflammatory condition affecting millions of people worldwide, with significant negative impact on quality of life and mental health. Acne is characterized by comedones, inflammatory papules, pustules, and nodulocystic lesions, with long-lasting sequelae including scarring and dyspigmentation, the latter of which is more common in skin of color. The four main pillars of acne pathophysiology include alteration of sebum production and concentration, hyperkeratinization of the follicular unit, Cutibacterium acnes strains, and an inflammatory immune response. Newer research has provided greater insight into these pathophysiologic categories. This greater understanding of acne pathogenesis has led to numerous new and emerging treatment modalities. These modalities include combinations of existing treatments, repurposing of existing agents historically used for other conditions, new topical treatments, novel antibiotics, topical and oral probiotics, and various procedural devices. This article will provide an overview of emerging treatments of acne and their link to our current and improved understanding of acne pathogenesis.

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.

Microneedling-Associated Procedures to Enhance Facial Rejuvenation

Microneedling, also referred to as percutaneous collagen induction therapy, uses small needles to create mechanical injury to the skin, stimulating the wound-healing cascade and new collagen formation. Compared with other skin resurfacing techniques, microneedling preserves the epidermis and is nonablative, therefore reducing inflammation, downtime, and risk of dyspigmentation. In addition to increasing collagen production in fibroblasts, microneedling also helps normalize cell function of keratinocytes and melanocytes and can be used to increase absorption of topical medications, growth factors, or deliver radiofrequency directly to the dermis. The benefits of microneedling, associated procedures, indications for use, technical considerations, and potential complications are discussed.

Fractional CO2 -laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split-face trial

BACKGROUND

Ablative fractional CO₂ laser (AFL) is an established first-line energy-based treatment for acne scars. Microneedle radiofrequency (MNRF) is an emerging treatment, also targeting the skin in fractions. No studies have so far compared AFL with MNRF for acne scars in a direct controlled, side-by-side comparison. In this study, we compared AFL and MNRF treatments for acne scars in a randomized split-face trial with blinded response evaluation, objective measures, and patient-reported outcomes.

STUDY DESIGN/MATERIALS AND METHOD

Fifteen patients with moderate to severe acne scars were included. At baseline each patient had two similar test areas identified, these were randomized to receive a single treatment with either AFL or MNRF. Standardized multilayer techniques were applied with AFL and MNRF, first targeting the scar base, thereafter the entire scar area. Outcome measures included blinded evaluation of clinical improvement of scar texture (0-10 scale) at 1- and 3-months follow-up, local skin reactions (LSR), pain according to Visual Analogue Scale (VAS), skin integrity quantified by transepidermal water loss, and patient satisfaction.

RESULTS

Fifteen patients completed the study with a median test area size of 24.6 cm² (interquartile range [IQR] 14.9-40.6). A single treatment with AFL or MNRF equally resulted in a median 1-point texture improvement after 3 months follow-up (p < 0.001). Best responders achieved up to a 3-point improvement (n = 3 test areas, 10% of treatment areas). Erythema and loss of skin integrity was more intense after AFL compared with MNRF after 2-4 days (p < 0.001). Patients reported MNRF (VAS 7.0) to be significantly more painful than AFL (5.5) (p = 0.009). Patients were generally satisfied with the overall outcome on a 10-point scale at median 6 for both treatments (IQR 5-7).

CONCLUSION

AFL and MNRF treatments are equally effective at improving texture in skin with acne scars. AFL resulted in more pronounced LSRs whereas MNRF was more painful. Patients were generally satisfied with the overall outcome.

A novel technique in reducing sebum production and improving atrophic acne scars

OBJECTIVE

Fractional microneedling radiofrequency (FMR) has gained popularity for the treatment of acne scars, owing to favorable outcomes and short downtimes. This study aimed to investigate FMR use in reducing facial sebum production and treating acne scars.

MATERIALS AND METHODS

This single-center, prospective, evaluator-blinded trial compared sebum production after three sessions of FMR (Fractora® 24-pin coated tip) performed one-month apart. Results were evaluated with a sebumeter (Cutometer®), sebaceous gland histology, and subjects' assessment. Acne scars were graded according to the Echelle d'Evaluation clinique des Cicatrices d'acné scale, Goodman and Baron's qualitative grading system, acne scar volume measurement, and subjects' assessments.

RESULTS

Sebumeter results revealed a significantly decreased (p < 0.05) sebum production since the first treatment, sustained throughout the study period. Histological assessment showed decreased density and size of sebaceous glands. The mean acne scar volume decreased significantly, without a significant increase in the mean melanin levels.

CONCLUSION

Fractora® 24-pin coated tip can be used as an alternative for patients with acne scars, who wish to concomitantly reduce their facial oiliness. A significant decrease in facial oiliness and acne scars' volume can be seen after a single treatment session, with up to 15.48% decrease in facial oil production.

Dermatologic facial applications of Morpheus8 fractional radiofrequency microneedling

Dermatologic patients are expressing increasing interest in minimally invasive procedures to address a wide range of common concerns from skin laxity to acne and scarring. Fractional radiofrequency (RF) microneedling offers an effective method for addressing a variety of dermatologic conditions with reduced downtime compared with historically more invasive procedural approaches. This article aims to describe the technology utilized in fractional RF microneedling (Morpheus8, InMode Aesthetics) and its studied applications in dermatology for treatment of the face.

Combined use of energy-based interventions with low-dose isotretinoin for the treatment of inflammatory acne: An retrospective cohort analysis

BACKGROUND

The combined use of oral isotretinoin with energy-based interventions including fractional microneedle radiofrequency, pulsed dye laser, and ablative fractional laser is an effective way to treat moderate-to-severe inflammatory acne lesions. However, studies regarding its efficacy and safety are limited.

AIMS

This study aimed to assess the efficacy and safety of a treatment using low-dose isotretinoin with energy-based interventions for inflammatory acne.

PATIENTS AND METHODS

This retrospective cohort study included 126 patients who were diagnosed with inflammatory acne and were treated with systemic isotretinoin for at least 3 months. Patients were divided into EBD (energy-based intervention) (n=82) and non-EBD groups (n=44). Clinical outcomes of both groups were assessed using medical records and digital photographs.

RESULTS

After treatment, the modified Global Acne Grading Score of the EBD and non-EBD groups decreased by 35.1±17.2 and 25.6±10.1, respectively. The improvement in acne severity was significantly greater in the EBD group than in the non-EBD group. Cumulated isotretinoin dose and frequency of drug-related side effects were significantly higher in the non-EBD group than in the EBD group.

CONCLUSION

Combined treatment with low-dose isotretinoin and energy-based intervention is well tolerated and associated with positive responses in patients with inflammatory acne.

Microneedling Monotherapy for Acne Scar: Systematic Review and Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

Acne scarring, formed by the deposition of collagen following inflammatory acne, not only represents a cosmetic problem but also poses a psychological health risk to patients. As microneedling has become a common treatment for acne scarring, an increasing number of studies have compared the efficacy and safety of microneedling. In this study, we conducted a meta-analysis of randomized controlled trials (RCTs) comparing microneedling with other treatments.

METHOD

Three databases, namely Embase, PubMED, and Cochrane library, were searched until June 20, 2021, for RCTs only. Studies using microneedling in both treatments were excluded.

RESULTS

Twelve studies, totaling 414 participants, were included in our meta-analysis. For objective scar improvement, the pooled estimate analysis of the first group, treated with microneedling without radiofrequency, yielded a mean difference of 0.42 (95% CI-0.12-0.73%) with a significant difference at the 5% significance level. The second group, treated with fractional radiofrequency microneedling, exhibited no significance at the 5% significance level. Regarding subjective satisfaction, most results exhibited no significant difference between microneedling and other treatments. Although no case of secondary scarring or infection was reported in our study, the pooled result of postinflammatory hyperpigmentation was significant at the 5% significance level and preferred microneedling treatment.

CONCLUSION

Microneedling without radiofrequency achieved superior results in terms of scar improvement. No form of microneedling caused postinflammatory hyperpigmentation-an advantage in acne scar treatment. Thus, microneedling is a favorable choice for the treatment of acne scarring.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Energy-based devices for the treatment of acne scars: 2021 international consensus recommendations

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.

Efficacy and safety of intense pulsed light using a dual-band filter for the treatment of facial acne vulgaris

Intense pulsed light (IPL) devices have been used in acne treatment in combination with conventional topical and oral medications. This study aimed to evaluate the efficacy and safety of IPL treatment using a dual-band filter (400-600 nm and 800-1200 nm) in facial acne vulgaris treatment. Twenty-three acne vulgaris patients were enrolled in this study. The patients were treated on both sides of the face. The treatments were performed in 2-week intervals for a total of five sessions. The final visit for the clinical evaluation was 2 weeks after the fifth treatment session. The mean number of papules, pustules, and comedones, and the melanin index, was significantly decreased at the final visit. However, sebum production and the erythema index showed no statistically significant differences after treatment. IPL treatment using a dual-band filter can be an alternative for patients who are unfit for systemic acne medication. It can also be used with conventional acne treatment for better treatment results.

Microneedles for Extended Transdermal Therapeutics: A Route to Advanced Healthcare

Sustained release of drugs over a pre-determined period is required to maintain an effective therapeutic dose for variety of drug delivery applications. Transdermal devices such as polymeric microneedle patches and other microneedle-based devices have been utilized for sustained release of their payload. Swift clearing of drugs can be prevented either by designing a slow-degrading polymeric matrix or by providing physiochemical triggers to different microneedle-based devices for on-demand release. These long-acting transdermal devices prevent the burst release of drugs. This review highlights the recent advances of microneedle-based devices for sustained release of vaccines, hormones, and antiretrovirals with their prospective safe clinical translation.

Recent Progress in Wearable Biosensors: From Healthcare Monitoring to Sports Analytics

Recent advances in lab-on-a-chip technology establish solid foundations for wearable biosensors. These newly emerging wearable biosensors are capable of non-invasive, continuous monitoring by miniaturization of electronics and integration with microfluidics. The advent of flexible electronics, biochemical sensors, soft microfluidics, and pain-free microneedles have created new generations of wearable biosensors that explore brand-new avenues to interface with the human epidermis for monitoring physiological status. However, these devices are relatively underexplored for sports monitoring and analytics, which may be largely facilitated by the recent emergence of wearable biosensors characterized by real-time, non-invasive, and non-irritating sensing capacities. Here, we present a systematic review of wearable biosensing technologies with a focus on materials and fabrication strategies, sampling modalities, sensing modalities, as well as key analytes and wearable biosensing platforms for healthcare and sports monitoring with an emphasis on sweat and interstitial fluid biosensing. This review concludes with a summary of unresolved challenges and opportunities for future researchers interested in these technologies. With an in-depth understanding of the state-of-the-art wearable biosensing technologies, wearable biosensors for sports analytics would have a significant impact on the rapidly growing field-microfluidics for biosensing.

Therapeutic effects of a new invasive pulsed-type bipolar radiofrequency for facial erythema associated with acne vulgaris and rosacea

Facial erythema from rosacea and acne is one of the most common problems encountered in dermatologic clinics. Effective therapeutic interventions for persistent erythema, which can cause patients frustration and psychological distress, are needed. The aim of this study was to evaluate the efficacy and safety of an invasive short pulsed-type bipolar radiofrequency device (IPBRF) for the treatment of intractable facial erythema. Thirty-one patients who had been diagnosed with rosacea or acne vulgaris and combined erythema underwent at least two IPBRF treatment sessions (maximum: 5) at 2-week intervals. Treatment outcomes were evaluated by investigator global assessment (IGA) based on clinical photographs, patient global assessment (PGA) score, and skin biophysical parameters including erythema index (EI), melanin index (MI), and transepidermal water loss (TEWL). Most patients showed significant clinical improvement. IGA scores for erythema, pores and smoothness improved after treatment. PGA also showed a trend toward improvement. Mean EI was significantly improved after the second treatment compared to baseline, which maintained until the study period. MI and TEWL showed a tendency toward improvement. There were no serious adverse events reported during the study. IPBRF led to rapid clinical improvement in facial erythema associated with rosacea and acne vulgaris and could be an effective and safe treatment option.

Microneedling Options for Skin Rejuvenation, Including Non-temperature-controlled Fractional Microneedle Radiofrequency Treatments

The use of microneedling with or without radiofrequency continues to expand in aesthetics. There are now many different devices available that have multiple indications, unique protocols, and low side effect profiles.

Topical Tazarotene Gel, 0.1%, as a Novel Treatment Approach for Atrophic Postacne Scars: A Randomized Active-Controlled Clinical Trial

Importance

Evidence is robust for the effectiveness of microneedle therapy in the management of postacne atrophic scarring. A home-based topical treatment with an efficacy comparable to microneedling would be a useful addition in the armamentarium of acne scar management.

Objective

To compare the efficacy of topical tazarotene gel, 0.1%, with microneedling therapy in the management of moderate to severe atrophic acne scars.

Design, Setting, and Participants

Prospective, observer-blinded, active-controlled, randomized clinical trial with 6 months of follow-up conducted between June 2, 2017, and February 28, 2018, at a tertiary care hospital in India. Thirty-six patients with grade 2 to 4 facial atrophic postacne scars and without a history of procedural treatment of acne scars within the previous year were recruited. Analyses were conducted using data from the evaluable population.

Interventions

Both halves of each participant's face were randomized to receive either microneedling or topical tazarotene therapy. Microneedling was conducted on 1 side of the face with a dermaroller having a needle length of 1.5 mm for a total of 4 sessions during the course of 3 months. Participants were instructed to apply topical tazarotene gel, 0.1%, to the other side of the face once every night during this same period.

Main Outcomes and Measures

Patients were followed up at 3 and 6 months by a blinded observer, and improvements in acne scar severity based on Goodman and Baron quantitative and qualitative scores and a subjective independent dermatologist score (range, 0-10, with higher scores indicating better improvement) were assessed. Patient satisfaction was assessed using a patient global assessment score (ranging from 0 for no response to 10 for maximum improvement) at these follow-up visits.

Results

There were 36 participants (13 men and 23 women; mean [range] age, 23.4 [18-30] years), and the median (interquartile range [IQR]) duration of acne was 6 (4-8) years. For the 34 participants included in the complete data analyses, the median (IQR) quantitative score for acne scar severity at the 6-month follow-up visit following treatment with either tazarotene (from a baseline of 8.0 [6.0-9.8] to 5.0 [3.0-6.0]) or microneedling (from a baseline of 7.0 [6.0-10.8] to 4.5 [3.0-6.0]) indicated significant improvement (P < .001) that was comparable for both treatments (median [IQR] change in severity score from baseline, 2.5 [2.0-4.0] vs 3.0 [2.0-4.0]; P = .42). By contrast, median qualitative acne scar scores were the same for both treatment groups at baseline and did not significantly change following either treatment.

Conclusions and Relevance

The present clinical trial showed comparable outcomes of both treatments for the overall improvement of quantitative facial acne scar severity.

Level of Evidence

1.

Trial Registration

ClinicalTrials.gov identifier: NCT03170596.

Radiofrequency Microneedling: Overview of Technology, Advantages, Differences in Devices, Studies, and Indications

Radiofrequency (RF) skin rejuvenation is improved using RF microneedling (RFM) devices. More aggressive treatments are performed safely with minimal downtime than previous RF devices. Optimizing treatment parameters is essential for safety and efficacy. Multiple RFM studies support minimal risks even in dark skin types. RFM has been used to treat acne scarring successfully as well as skin laxity and hyperhidrosis.

Combined treatment of recalcitrant papulopustular rosacea involving pulsed dye laser and fractional microneedling radiofrequency with low-dose isotretinoin

BACKGROUND

While a considerable number of cases with papulopustular rosacea (PPR) are resistant to conventional medications, therapeutic regimens are not currently established. Pulsed dye laser (PDL) and fractional microneedling radiofrequency (FMR) have previously demonstrated satisfactory results for anti-angiogenesis, anti-inflammation, and dermal remodeling.

AIMS

To evaluate the efficacy and safety of novel combination regimen with low-dose oral isotretinoin, PDL, and FMR in the treatment of recalcitrant PPR.

PATIENTS AND METHODS

A retrospective study was undertaken for recalcitrant PPR patients to evaluate the clinical course of novel combination regimen. Twenty-five PPR patients who had failed in previous first-line therapies were enrolled. They were treated with three sessions of PDL and FMR consecutively at 4-week intervals, maintaining daily oral administration of 10 mg isotretinoin for 8 weeks. Objective assessments, erythema index measurement, and patients' subjective satisfaction were evaluated at each visit and 16 weeks after the final treatment.

RESULTS

At the final follow-up visit, the number of papules and pustules decreased by 71%, and erythema index by 54% compared with baseline (P < 0.05 for both). Physician's global assessment based on rosacea severity score and patients' subjective assessments paralleled with these results. No serious side effect was observed during whole study periods.

CONCLUSION

This novel combination regimen demonstrated satisfactory efficacy with reasonable safety profiles for the treatment of recalcitrant PPR.

Novel device-based acne treatments: comparison of a 1450-nm diode laser and microneedling radiofrequency on mild-to-moderate acne vulgaris and seborrhoea in Korean patients through a 20-week prospective, randomized, split-face study

BACKGROUND

While device-based acne treatments are widely applied for patients not tolerating conventional medications, related controlled studies have been still limited. Recently, non-ablative 1450-nm diode laser (DL) and fractional microneedling radiofrequency (FMR) have been effectively used for acne, in addition to well-recognized dermal remodelling effects.

OBJECTIVE

To compare the clinical course of acne treatment between DL and FMR.

METHODS

Twenty-five Korean patients with mild-to-moderate facial acne completed treatments with DL and FMR through a 20-week, randomized split-face study. One randomly assigned half side of each patient's face received DL and the other side by FMR. Treatments were scheduled to receive three consecutive sessions at 4-week intervals. Objective assessments including revised Leeds grades, lesion counts, sebum output measurements, and patients' subjective satisfaction were investigated.

RESULTS

Both DL and FMR demonstrated steady improvement of acne and seborrhoea during treatment sessions. While results between two devices were similar during treatment sessions, FMR was superior to DL in the 12-week follow-up. Patients' subjective assessments for seborrhoea improvement were similar between two devices, while those for acne, skin texture, and acne scars were more satisfactory for FMR. For safety profile, no significant difference was observed between two regimens, while mild postinflammatory hyperpigmentation was observed only in DL side.

CONCLUSION

Both DL and FMR demonstrated efficacies for acne and seborrhoea, with reasonable safety profile. FMR was more effective than DL for the long-term maintenance, and subjective assessments for texture and scar improvements. Therefore, a few sessions of these devices would be a viable option for acne treatments.

Energy-Based Devices in Treatment of Acne Vulgaris

BACKGROUND

Acne vulgaris is a chronic dermatologic complaint with a multifactorial cause. Traditionally, antibiotics and retinoids have been used to manage the condition; patient compliance has been an ongoing issue. A variety of energy-based devices have been reported to be effective in the treatment of acne vulgaris.

OBJECTIVE

To review and summarize the current literature specific to treatment of acne vulgaris with energy-based devices.

METHODS

A review of the current literature of energy-based devices used for the treatment of acne vulgaris.

RESULTS AND CONCLUSIONS

Although limited randomized controlled trials for the treatment of acne have been performed, significant clinical improvement of acne vulgaris, especially of inflammatory lesions, has been demonstrated with a variety of energy-based devices. Newer approaches may lead to even better results.

Microneedling: Advances and widening horizons

Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including acne scar, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. Moreover, during the last 10 years, many new innovations have been made to the initial instrument, which was used for microneedling. This technique can be combined with other surgical techniques to provide better results. In particular, it is a very safe technique for dark skin types, where risk of postinflammatory pigmentation is very high with other techniques that damage the epidermis. In this review article, we are updating on the different instruments now available for this procedure, and its efficacy when performed alone or in combination with other techniques for various indications.

Microneedling in skin of color: A review of uses and efficacy

In ethnic skin, traditional skin resurfacing procedures such as dermabrasion, chemical peels, and laser therapy can be effective but can also be associated with prolonged recovery and risk of complications. These complications can include a higher risk of dyspigmentation and scarring, and unsatisfactory clinical outcomes. Microneedling is an evolving treatment technique for an expanding number of dermatologic conditions. Microneedling may offer a more advantageous safety profile, particularly in the skin-of-color population (Fitzpatrick skin types IV-VI), compared with more conventional resurfacing modalities. Thus far, it has been shown to be effective for a number of dermatologic conditions in this population, including scarring, melasma, melanosis, skin rejuvenation, acne vulgaris, and primary hyperhidrosis. This article aims to provide a comprehensive review of the literature regarding the efficacy and safety of microneedling in skin of color.