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Dac Thuy LN, Thuy Trang VT, Tran NN, Phuong Thao DT. Comparing the Use of 80% Trichloroacetic Acid and 50% Trichloroacetic Acid for the Treatment of Ice Pick Acne Scars. Dermatol Surg 2024; 50:847-850. [PMID: 38722745 DOI: 10.1097/dss.0000000000004228] [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: 08/29/2024]
Abstract
BACKGROUND Chemical reconstruction of skin scars (CROSS) using high concentration trichloroacetic acid (TCA) is a safe, effective, and low-cost treatment for ice pick acne scars. OBJECTIVE To compare the efficacy and effectiveness of the CROSS technique using 50% TCA and 80% TCA for treating ice pick scars. MATERIALS AND METHODS A nonrandomized, single-blinded, and self-controlled clinical trial was undertaken. Four CROSS sessions were conducted using 50% TCA on the left hemiface and 80% TCA on the right hemiface. The E' chelle d'Evaluation Clinique des Cicatrices d'Acne (ECCA) acne grading scale was used to assess the scars pretreatment and posttreatment. Complications were evaluated after each session. RESULTS Thirty-one patients participated in our study. Significant differences were found between pretreatment and posttreatment ECCA scores ( p < .0001) on both hemifaces. Scores were significantly lower on the side treated with 80% TCA; however, there was no statistical significance in mean ECCA score differences (pretreatment minus posttreatment) between the 2 treatment sides. The adverse events were more serious on the sides treated with 80% TCA. CONCLUSION The CROSS method using TCA was well-tolerated and effective for treating ice pick acne scars. Less severe complications were associated with 50% TCA, whereas efficacy was the same as 80% TCA.
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Ding Z, Guo Y, Guo Y, Tang Y, Yin X, Hua H, Zhou Z, Zhou B. Efficacy and safety of fractional microneedle radiofrequency for atrophic acne scars: A real-world clinical study of 126 patients. Lasers Surg Med 2024; 56:150-164. [PMID: 38282120 DOI: 10.1002/lsm.23759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To analyze the clinical efficacy and safety of fractional microneedle radiofrequency (FMR) for facial atrophic acne scars in a real-world setting. METHODS The clinical data of patients with atrophic acne scars who had received FMR therapy from February 2018 to August 2022 were retrospectively analyzed. The improvement of atrophic acne scars was assessed using the ECCA Grading Scale (échelle d'évaluation clinique des cicatrices d'acné), Global Aesthetic Improvement Scale (GAIS), and modified Manchester Scar Scale (mMSS). Adverse reactions during FMR treatment were also recorded. Univariate and multivariate logistic regression analyses were performed to evaluate the efficacy and safety of FMR for atrophic acne scars. RESULTS A total of 126 patients with facial atrophic acne scars were included. A total of 590 FMR treatment sessions were accomplished, with each of 82 patients receiving 4 or more treatment sessions, and 1 receiving a maximum of 14 sessions. All patients showed improvement in symptoms after FMR treatment, with moderate to significant improvement (ECCA score reduction of 26%-100%) in 92 (73.0%) patients. As the number of treatment sessions increased, the ECCA score gradually decreased from an average of 85.6 before to 35.0 after FMR. The average scores for distortion, color, and visual analogue scale (VAS) of mMSS all showed certain reductions. The change in GAIS score indicated improvement after treatment, with minimal improvement in 16 patients (12.7%), good improvement in 57 patients (45.2%), significant improvement in 45 patients (35.7%), and optimal improvement in 8 patients (6.4%). The univariate and multivariate logistic regression analyses revealed that the long pulse width and the number of FMR treatment sessions were positively associated with clinical efficacy. Compared to the short pulse-width group (200 ms), the longer pulse-width group (300 ms) (odds ratio [OR] = 8.3, p = 0.003) and the even longer pulse-width group (400-500 ms) (OR = 52.6, p < 0.001) demonstrated stronger efficacies. Patients who received more than three treatment sessions had better outcomes compared to those who received three or fewer treatment sessions (OR = 4.0, p = 0.036). All patients experienced posttreatment transient erythema, but no crusting, infection, or blister. Six cases developed grid-like erythema around 1 month posttreatment and one case experienced hyperpigmentation, both of which resolved within 1-3 months after appropriate management. CONCLUSION FMR is a safe and effective treatment modality for improving facial atrophic acne scars, and the number of FMR treatment sessions and pulse width are associated with clinical efficacy.
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Affiliation(s)
- Ziwei Ding
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Cosmetic Dermatology, Dr. Zhou's Cosmetic Dermatological Clinic, Nanjing, China
| | - Yuan Guo
- Department of Cosmetic Dermatology, Dr. Zhou's Cosmetic Dermatological Clinic, Nanjing, China
| | - Yuehong Guo
- Department of Cosmetic Dermatology, Dr. Zhou's Cosmetic Dermatological Clinic, Nanjing, China
| | - Yanqiu Tang
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xufeng Yin
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Hua
- Department of Dermatology, Nantong Third People's Hospital Affiliated to Nantong University, Nantong, China
| | - Zhanchao Zhou
- Department of Cosmetic Dermatology, Dr. Zhou's Cosmetic Dermatological Clinic, Nanjing, China
| | - Bingrong Zhou
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Kim EY, Wong JH, Hussain A, Khachemoune A. Evidence-based management of cutaneous scarring in dermatology part 2: atrophic acne scarring. Arch Dermatol Res 2023; 316:19. [PMID: 38059974 DOI: 10.1007/s00403-023-02737-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 12/08/2023]
Abstract
Atrophic acne scars are the most common type of acne scars and are classified into three main types: icepick, boxcar, and rolling scars. Various procedures and techniques for atrophic acne scarring are discussed in detail, with stronger evidence-based support for lasers (non-fractional, fractional, ablative, and non-ablative), platelet-rich plasma as adjunctive treatment, chemical peels (glycolic acid, trichloroacetic acid, and Jessner's solution), dermal fillers such as hyaluronic acid, and microneedling, and lesser quality evidence for microdermabrasion, subcision, and lipoaspirate grafting. Further research is needed to optimize treatment protocols, assess the efficacy of monotherapies, and establish standardized guidelines for clinicians. This paper will provide a comprehensive review of the evidence-based management of atrophic acne scars, including currently commonly utilized therapies as well as more innovative treatment options.
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Affiliation(s)
- Emily Y Kim
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jasmine H Wong
- Georgetown University School of Medicine, Washington, DC, USA
| | - Aamir Hussain
- Galaria Plastic Surgery and Dermatology, LLC, Chantilly, VA, USA
| | - Amor Khachemoune
- Department of Dermatology, Veterans Affairs Medical Center, SUNY Downstate, 800 Poly Place, Brooklyn, NY, 11209, USA.
- Department of Dermatology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA.
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Tam C, Khong J, Tam K, Vasilev R, Wu W, Hazany S. A Comprehensive Review of Non-Energy-Based Treatments for Atrophic Acne Scarring. Clin Cosmet Investig Dermatol 2022; 15:455-469. [PMID: 35359828 PMCID: PMC8963193 DOI: 10.2147/ccid.s350040] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Scarring is a dire consequence of acne vulgaris. Particularly, atrophic acne scarring is highly prevalent among young adults, and its physical and psychological effects can persist throughout their lives if left untreated. This literature review will analyze various non-energy-based approaches to treating atrophic acne scarring, emphasizing recent advances within the last 5 to 10 years. To accomplish this, we performed a PubMed search for various acne scar treatments such as chemical peels, dermabrasion, microdermabrasion, subcision, microneedling, punch techniques, dermal fillers, and thread lifting. Our findings and analysis show that there is no panacean solution to treating atrophic acne scars, which explains the evolving trend towards developing unique combinatorial treatments. Although a fair comparison of each treatment approach is difficult to achieve due to the studies’ varying sample sizes, strength of evidence, treatment execution, etc, there still remains a level of consensus on what treatments are well suited for particular scar types.
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Affiliation(s)
- Curtis Tam
- Salar Hazany M.D. Inc, Beverly Hills, CA, USA
| | | | - Kevin Tam
- Salar Hazany M.D. Inc, Beverly Hills, CA, USA
| | | | - Wesley Wu
- Department of Dermatology, Veterans Affairs Medical Center, Seattle, WA, USA
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5
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Mohammed GF, Al‐Dhubaibi MS. Triple steps acne scar revision technique a new combination therapeutic modality for atrophic acne scars. J Cosmet Dermatol 2022; 21:4659-4668. [DOI: 10.1111/jocd.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ghada F. Mohammed
- Department of Dermatology and Venereology Faculty of Medicine Suez Canal University Ismailia Egypt
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6
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Kamel MM, Hegazy RA, Hegazy AA, Fotoh OMAE, Amer MA. Combined subcision, autologous platelet-rich plasma, and CROSS technique in the treatment of atrophic acne scars: Prospective split face study. Clin Dermatol 2021; 39:1018-1024. [PMID: 34920819 DOI: 10.1016/j.clindermatol.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acne scars represent a therapeutic dilemma. This study aimed to evaluate the efficacy of combined subcision, autologous platelet-rich plasma (PRP), and chemical reconstruction of skin scars (CROSS) technique in the treatment of acne scars. In 20 patients with atrophic acne scars, one facial side was treated with subcision plus PRP, and the other was treated with the same combination plus CROSS technique (trichloroacetic acid 50%) for 3 sessions at 3-week intervals. Clinical evaluation, digital photography, quantitative global scarring grading system, and Lipper and Perez score were done at baseline, every session, and 1 month after the last session. Participants assessed their improvement at the end of the follow-up period using a scale (0 to 10). There was a significant reduction in quantitative global scarring grading system (P < .001) and Lipper and Perez score (P < .001) after treatment compared with baseline in both sides. No significant difference was found when the two treated sides were compared after treatment by both scores. Patients' satisfaction was excellent (12 patients [60%]) and good (eight patients [40%]) with no significant difference between both sides. In conclusion, combined subcision and PRP is recommended for acne scars. Adding CROSS technique (trichloroacetic acid 50%) did not further ameliorate the condition.
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Affiliation(s)
| | - Rehab Aly Hegazy
- Dermatology Department, Faculty of Medicine, Cairo University. Cairo, Egypt
| | - Amira Aly Hegazy
- Public Health and Community Department, Faculty of Medicine, Cairo University. Cairo, Egypt
| | | | - Marwa Ahmed Amer
- Dermatology Department, Faculty of Medicine, Cairo University. Cairo, Egypt..
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7
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Horovitz T, Salameh F, Shehadeh W, Koren A, Artzi O. Painting CROSS TCA technique: Modification of the CROSS method for the treatment of atrophic acne scars-Case series. J Cosmet Dermatol 2021; 21:327-330. [PMID: 34773721 DOI: 10.1111/jocd.14611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Chemical Reconstruction of Skin Scars (CROSS) technique was first described in 2002 and has since demonstrated safety and efficacy in multiple studies. We describe the treatment of six patients with a modified version of the CROSS method-the Painting CROSS trichloroacetic acid (TCA) technique. This technique has the advantage of offering even higher tissue selectivity and better control of the scar edges, enhancing both safety and efficacy. METHODS We retrospectively evaluated 31 scars of six patients who underwent a single treatment by the Painting CROSS TCA method. A 0.3 ml insulin syringe with a 30-gauge needle was filled with 0.05 ml of 85% TCA solution and then applied to the scar base with slight pressure until frosting was achieved. Patients were evaluated before and 3 months after treatment for scar volume deficit by a high-resolution three-dimensional imaging system. RESULTS The average volume of the 31 scars assessed in our study was 2.71 mm3 before treatment and 1.96 mm3 after treatment. There was a 26.3% average decrease in the volume of the scars after one treatment. Transient mild hyperpigmentation was noted in two patients after the treatment. CONCLUSION Painting CROSS TCA technique has demonstrated efficacy in the treatment of acne scars after a single treatment.
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Affiliation(s)
- Tamir Horovitz
- Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Fares Salameh
- Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Waseem Shehadeh
- Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Koren
- Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofir Artzi
- Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Dr. Artzi and Associates - Treatment and Research Center, Tel-Aviv, Israel
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8
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Bhargava S, Goldust M, Singer H, Negbenebor N, Kroumpouzos G. Evaluating resurfacing modalities in aesthetics. Clin Dermatol 2021; 40:274-282. [DOI: 10.1016/j.clindermatol.2021.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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9
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van Zuuren EJ, Arents BWM, Miklas M, Schoones JW, Tan J. Identifying and appraising patient-reported outcome measures on treatment satisfaction in acne: a systematic review. Br J Dermatol 2020; 185:36-51. [PMID: 33176002 PMCID: PMC8359297 DOI: 10.1111/bjd.19675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- E J van Zuuren
- Dermatology Department, Leiden University Medical Centre, Leiden, the Netherlands
| | - B W M Arents
- Skin Patients Netherlands (Huidpatiënten Nederland), Nieuwegein, the Netherlands
| | - M Miklas
- Windsor Clinical Research Inc., Windsor, ON, Canada
| | - J W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Tan
- Windsor Clinical Research Inc., Windsor, ON, Canada.,Western University, London, ON, Canada
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10
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Chung HJ, Al Janahi S, Cho SB, Chang YC. Chemical reconstruction of skin scars (CROSS) method for atrophic scars: A comprehensive review. J Cosmet Dermatol 2020; 20:18-27. [PMID: 32573079 DOI: 10.1111/jocd.13556] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/21/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chemical reconstruction of skin scars (CROSS) applies a high strength acid focally to treat atrophic scars. Although this method has gained popularity over the past two decades, no standardized treatment guideline exists for CROSS method in the treatment of atrophic scars. AIMS The purpose of this comprehensive review was to evaluate the indications, detailed techniques, efficacy, and safety of CROSS method. MATERIALS AND METHODS An extensive literature review was conducted to identify articles relating to CROSS method for atrophic scars from 2002 to 2018. RESULTS The literature search yielded 19 articles meeting criteria. CROSS method has been used for the treatment of acne scars, varicella scars, enlarged pores, and depressed surgical scars. In studies using the quantile grading scale for acne scars, 60%-100% of patients showed >25% improvement. In two studies for varicella scars, 83%-100% of patients showed >25% improvement. CROSS method seems to be effective specifically for ice-pick scars. It is well tolerated and safe in Fitzpatrick skin phototypes I-V. Most reported complications are temporary and include postinflammatory dyspigmentation, erythema, pain, pruritus, infection, and widening of scars. CONCLUSION This literature review suggests that CROSS method is a safe and effective treatment for atrophic scars, especially ice-pick scars, in skin types I-V. However, current published works have several limitations, including small sample sizes, lack of control group, different concentrations of acid, different frequency of treatments, and follow-up periods. Larger, randomized, controlled studies are needed to elucidate the optimal treatment protocol of CROSS method.
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Affiliation(s)
- Hye Jin Chung
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sara Al Janahi
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Sung Bin Cho
- Yonsei Seran Dermatology and Laser Clinic, Seoul, Korea
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11
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Bahl A, O'Connor K, Chung HJ. Treatment of atrophic acne scars with combination therapy of chemical reconstruction of skin scars method and fractionated nonablative laser: A retrospective analysis. J Cosmet Dermatol 2020; 19:2591-2595. [PMID: 32472975 DOI: 10.1111/jocd.13514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/20/2020] [Accepted: 05/21/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patients with acne scarring often have several types of acne scars, and combination therapies have demonstrated superior success to single treatment modalities. Chemical reconstruction of skin scars (CROSS) has gained popularity as the treatment for ice-pick scars and fractionated laser therapy for rolling and boxcar scars. However, no study has looked at combination therapy with CROSS and fractionated nonablative laser for the treatment of atrophic acne scars. AIMS We sought to evaluate the efficacy and safety of combination therapy with CROSS and fractionated nonablative laser for atrophic acne scars. METHODS We conducted a retrospective analysis of patients treated with CROSS followed by fractionated nonablative laser treatment in the same visit for acne scars from 2016 to 2020. Treatment efficacy, defined as the percentage improvement in the appearance of acne scars, was assessed using a 5-point scale: score 0 (worsening or 0% improvement), 1 (1% - 25%), 2 (26% - 50%), 3 (51%-75%), and 4 (76%-100%). RESULTS Twenty-five patients (14 females and 11 males, Fitzpatrick Skin Type II -V) were enrolled. The average improvement score was 2.07 after 3 sessions and 2.78 after 5 sessions. All subjects reported satisfaction, while 24% were very satisfied. There were no permanent adverse effects, and only one patient developed a temporary hypertrophic scar. CONCLUSION We concluded that combination therapy with CROSS and fractionated nonablative laser in the same visit is an effective and safe treatment option for atrophic acne scars in patients with various skin types, including skin of color.
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Affiliation(s)
- Aanchal Bahl
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Kelly O'Connor
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Hye Jin Chung
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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12
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A Review and Update of Treatment Options Using the Acne Scar Classification System. Dermatol Surg 2019; 45:411-422. [DOI: 10.1097/dss.0000000000001765] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
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.
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Kravvas G, Al-Niaimi F. A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques. Scars Burn Heal 2017; 3:2059513117695312. [PMID: 29799567 PMCID: PMC5965325 DOI: 10.1177/2059513117695312] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Acne is a common condition that can result in permanent scarring. We have
performed a comprehensive literature search of the last 10 years in order to
determine the efficacy and side effects of commonly used treatments against
post-acne scarring. A total of 36 relevant articles were identified on the
following interventions: subcision (10), dermabrasion (one), microneedling
(eight), dermal fillers (five), and chemical peeling (12). Post acne scarring is
a common and challenging condition with no easy and definitive solution. The
above interventions have been used with varying degrees of efficacy, each having
both pros and cons. All have been deemed to be safe with few and transient
adverse reactions. However, further trials with larger number of patients are
necessary in order to reach more concrete conclusions regarding their
efficacy.
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Affiliation(s)
- Georgios Kravvas
- Department of Dermatological Surgery and Lasers, St John's Institute of Dermatology, London, UK
| | - Firas Al-Niaimi
- Department of Dermatological Surgery and Lasers, St John's Institute of Dermatology, London, UK
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15
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Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol 2017; 3:S21-S37. [PMID: 28492036 PMCID: PMC5419061 DOI: 10.1016/j.ijwd.2017.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 12/19/2022] Open
Abstract
Skin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA).
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Abstract
Chemical peeling is a widely used procedure in the management of acne and acne scars. It causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. The most frequently used peeling agents are salicylic acid, glycolic acid, pyruvic acid, lactic acid, mandelic acid, Jessner solution, trichloroacetic acid, and phenol. The appropriate peel is chosen based on the patient's skin type, acne activity, and type of acne scars. Combination peels minimize side effects. In acne scars, chemical peels may be combined with other procedures to achieve better clinical results. A series of chemical peels can lead to significant improvement over a short period, leading to patient satisfaction and maintenance of clinical results. © 2016 Elsevier Inc. All rights reserved.
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Affiliation(s)
| | - Eftychia Platsidaki
- Department of Dermatology and Venereology, Andreas Sygros Skin Hospital, Athens, Greece.
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17
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Abstract
BACKGROUND Acne scarring is a common sequela of acne for which no single treatment method is uniformly effective. The chemical reconstruction of skin scars (CROSS) therapy using high-concentration trichloroacetic acid (TCA) has shown promise as a cheap, safe, and effective modality of treatment in acne scars. OBJECTIVE To assess the therapeutic response of 70% TCA CROSS on atrophic acne scars and to evaluate the adverse effects of this therapy. MATERIALS AND METHODS Fifty-three patients with postacne atrophic scars were treated with 70% of TCA focal application every 2 weeks by the CROSS technique and results evaluated on 3 parameters: physician assessment, patient assessment, and satisfaction level of patients, after a follow-up of 3 months. RESULTS Good or excellent improvement (>50%) was seen in 66% of patients on physician and patient assessments. The patients were either very satisfied or satisfied in 81.1% of cases. Patients with predominantly boxcar scars and higher pretreatment scar severity were associated with better treatment outcomes. Age, sex, duration of scars, or type of skin did not significantly influence the treatment outcome and adverse effects. CONCLUSION The study showed that 70% of TCA is a safe and effective treatment option in all types of atrophic acne scars, especially in severe boxcar scars.
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Lawson CN, Hollinger J, Sethi S, Rodney I, Sarkar R, Dlova N, Callender VD. Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol 2015; 1:59-75. [PMID: 28491960 PMCID: PMC5418751 DOI: 10.1016/j.ijwd.2015.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 12/19/2022] Open
Abstract
Skin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA).
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Affiliation(s)
- Christina N Lawson
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia.,Callender Dermatology & Cosmetic Center, Glenn Dale, Maryland
| | - Jasmine Hollinger
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Sumit Sethi
- Department of Dermatology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Ife Rodney
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Ncoza Dlova
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Valerie D Callender
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia.,Callender Dermatology & Cosmetic Center, Glenn Dale, Maryland
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Patel L, McGrouther D, Chakrabarty K. Evaluating evidence for atrophic scarring treatment modalities. JRSM Open 2014; 5:2054270414540139. [PMID: 25352991 PMCID: PMC4207294 DOI: 10.1177/2054270414540139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Atrophic scars cause significant patient morbidity. Whilst there is evidence to guide treatment, there does not appear to be a systematic review to analyse the efficacy of treatment options. Objectives To retrieve all evidence relating to atrophic scar treatment and evaluate using the Clinical Evidence GRADE score in order to allow clinicians to make evidence-based treatment choices. Method Searches were performed in Medline, EMBASE, CINHL and Cochrane to identify all English studies published evaluating treatment of atrophic scars on adults excluding journal letters. Each study was allocated a GRADE score based on type of study, quality, dose response, consistency of results and significance of results. The end score allowed categorisation of evidence into high, moderate, low or very low quality. Results A total of 41 studies were retrieved from searches including randomised controlled trials, observational studies, retrospective analyses and case reports of which 7% were allocated a high-quality score, 10% a moderate score, 7% a low score and 75% a very low score. Treatment modalities included ablative laser therapy, non-ablative laser therapy, autologous fat transfer, dermabrasion, chemical peels, injectables, subcision, tretinoin iontophoresis and combination therapy. Conclusion There is a paucity of good-quality clinical evidence evaluating treatment modalities for atrophic scarring. Evidence supports efficacy of laser, surgery and peel therapy. Further biomolecular research is required to identify targeted treatment options and more randomised controlled trials would make the evidence base for atrophic scar treatment more robust.
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Affiliation(s)
- Lopa Patel
- Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK
| | - Duncan McGrouther
- Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK
| | - Kaushik Chakrabarty
- Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK
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Ahmed R, Mohammed G, Ismail N, Elakhras A. Randomized clinical trial of CO2LASER pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars. J COSMET LASER THER 2013; 16:8-13. [DOI: 10.3109/14764172.2013.854633] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mohammed G. Randomized clinical trial of CO2laser pinpoint irradiation technique with/without needling for ice pick acne scars. J COSMET LASER THER 2013; 15:177-82. [DOI: 10.3109/14764172.2013.793584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Handog EB, Datuin MSL, Singzon IA. Chemical peels for acne and acne scars in asians: evidence based review. J Cutan Aesthet Surg 2013; 5:239-46. [PMID: 23378705 PMCID: PMC3560163 DOI: 10.4103/0974-2077.104911] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Chemical peeling is a widely used procedure in the management of acne and acne scars, but there are very few studies on Asian populations who are more prone to develop hyper pigmentation. This article aims to summarize and evaluate the existing studies on the role of chemical peels in the treatment of acne and acne scars among Asians. An online search was conducted to identify prospective studies published in English that evaluated the use of chemical peels in active acne and acne scars in Asian populations. There were six studies for acne and eight studies for acne scars that were identified using our search parameters. Most were single-centre, open label and with small sample sizes. Acne severity was not uniformly reported and the objective outcome measures of some studies were not explicitly reported as well. The general trend of the results of the studies support the safety and efficacy of chemical peels for acne and acne scars including those of darker skin types. The existing studies support the use of chemical peels in the treatment of acne and acne scars in Asians. Further clinical trials with better study design and more subjects are needed to further establish the role of chemical peels in Asian acne patients.
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Affiliation(s)
- Evangeline B Handog
- Department of Dermatology, Asian Hospital and Medical Center, Muntinlupa, Philippines
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