Expert recommendations on supportive skin care for non-surgical and surgical procedures

The Effect of Fat Grafting on Scars Hyperpigmentation: A Systematic Review and Meta-Analysis

BACKGROUND

Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation.

METHODS

A systematic review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar pigmentation after fat grafting. Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool.

RESULTS

A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar pigmentation was noted after treatment with fat grafting according to observers' ratings, with a SMD of - 1.09 [95% CI: - 1.32; - 0.85], p<0.01. The SMD for patient-reported scar pigmentation after treatment with fat grafting was - 0.99 [96% CI: - 1.31; - 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations.

CONCLUSIONS

Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required.

LEVEL OF EVIDENCE IV

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 .

Hyper- and Hypopigmentation in a Subject with Fitzpatrick Skin Phototype VI: A New Treatment Option

Background: Laser therapies can cause hyper- and hypopigmentation of the skin. There is little evidence in the literature of effective treatments for these types of problems in Fitzpatrick skin phototypes IV-VI. The main aim of this retrospective study is to evaluate the effects of a new therapy that combines the application of electromagnetic fields and vacuum on a subject with Fitzpatrick skin phototype VI, who presented extensive, laser-induced facial dyschromia. The secondary aim is to test the effectiveness of a free imaging software for assessing skin pigmentation. Methods: The level of improvement after therapy was evaluated, with a 5-point Likert scale, one month after the end of the treatment by the subject and by the doctor who performed the treatment, and by two blinded dermatologists. With the free software, a three-dimensional reconstruction of the treated area and the evaluation of the color distribution were performed. Results: Both the subject and the doctors involved in the study positively evaluated the effects of the treatment. The image analysis highlighted the homogenization of the skin color in the treated area. Conclusions: The combination of electromagnetic fields and vacuum for dyschromia treatments appears promising. The new method of assessing melanin levels resulted particularly efficient.

A pilot study examining a double-conjugated, retinoid-based skincare regimen for darker, blemish-prone skin

BACKGROUND

Retinoids and alpha- and beta hydroxy acids are common components utilized in regimens for blemish-prone skin. However, balancing efficacy and tolerability is often challenging.

PATIENTS/METHODS

This pilot study evaluated a double-conjugated retinoid serum specifically formulated for blemish-prone skin (AHARet-SA) in combination with exfoliating peel pads (double-conjugated retinoid, glycolic, lactic, and salicylic acids), a cleanser, mineral-based sunscreen, and a lightweight moisturizer in female participants with mild-to-moderate blemish-prone skin. Fifty-five percent of participants were Fitzpatrick Skin Type (FST) IV and 27% were FST V. Participants used the exfoliating peel pads (3x/week for 8 weeks; 2x/week for 4 weeks) followed by nightly AHARet-SA and a moisturizer (as needed). Improvements in skin were assessed using the 5-point Investigator Global Assessment Scale, and participant satisfaction and tolerability were assessed over 12 weeks.

RESULTS

Significant mean improvement from baseline in skin clarity occurred after 4 weeks (14%; p = 0.04) with progressive improvements through week 12 (52%; p = 0.004). Eighty-eight percent of participants reported improvements in the appearance and texture of their skin and fewer blemishes/breakouts. Mild, transient adverse events were reported.

CONCLUSIONS

A regimen comprised of a double-conjugated serum and exfoliating peel pads formulated for blemish-prone skin led to significant improvements from baseline in skin clarity after 12 weeks in participants with predominately darker skin tones and mild-to-moderate blemish-prone skin.

Awareness of sun exposure risks and photoprotection for preventing pigmentary disorders in Asian populations: Survey results from three Asian countries and expert panel recommendations

BACKGROUND

In this article, we review and discuss the photoprotection behavior of Asians based on the literature, along with a subanalysis of an original online survey, and make recommendations to optimize photoprotection for Asian populations to prevent photoaging and pigmentary disorders.

METHODS

An international panel of eight dermatologists from Asia (China, Korea, Japan, Singapore, Indonesia, and Vietnam) met to discuss sunscreen photoprotection for Asian patients. Additionally, a subanalysis of an online survey by 3000 respondents from three Asian countries (China, Indonesia, and Japan) investigated general public awareness and attitudes to sun exposure.

RESULTS

A pre-meeting survey of the eight experts from Asia showed key concerns of Asian patients consulting dermatologists are pigmentary disorders, especially actinic/senile lentigo, post-inflammatory hyperpigmentation, melasma, vitiligo, and Hori's nevus. The survey subanalysis of participants from China, Indonesia, and Japan with predominantly Fitzpatrick skin types (FST) II to IV revealed that they are particularly concerned about sun exposure causing photoaging and pigmentary disorders. Most of the respondents indicated they have limited knowledge on sunlight radiation and appropriate sunscreen protection factors. Only 22%, 13%, and 3% for China, Indonesia, and Japan, respectively, systematically use multiple protective measures (using sunscreen, avoiding midday sun, staying in the shade, wearing a hat, protective clothing, and sunglasses) when exposed to the sun.

CONCLUSIONS

Further education is needed for Asian populations on the importance of comprehensive daily photoprotection, including broad-spectrum sunscreen, with high UVA and visible light protection, to reduce and prevent photoaging and pigmentary disorders.

Effect of the home care model in orthopedic wounds management

Objective

To explore the effect of home care on orthopedic wound management.

Materials and Methods

Patients with orthopedic wounds admitted from January 2020 to December 2022 were divided into a control group and a nursing group, with 23 cases in each group. After discharge, the control group was given routine health guidance and the nursing group was given home care. The mood score of the two groups of patients was evaluated, the time and cost were compared, and the patients' degree of trust and satisfaction with the medical staff were investigated.

Results

The patients received home care had higher scores in mood, degree of trust and satisfaction with medical staff, and spent less time (P < .05). However, the cost was significantly higher than that of the control group (P < .05).

Conclusions

Home care for patients with orthopedic wounds can significantly reduce the time spent on medical treatment. Moreover, improve patients' moods and trust and satisfaction with medical staff in a certain extent. However, better service often means more economic cost.

Scars

Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring. Although the underlying mechanisms of hypertrophic scars and keloid lesions are not well defined, evidence suggests that the changes in the extracellular matrix are perpetuated by ongoing inflammation in susceptible individuals, resulting in a fibrotic phenotype. The lesions then become established, with ongoing deposition of excess disordered collagen. Not only can abnormal scarring be debilitating and painful, it can also cause functional impairment and profound changes in appearance, thereby substantially affecting patients' lives. Despite the vast demand on patient health and the medical society, very little progress has been made in the care of patients with abnormal scarring. To improve the outcome of pathological scarring, standardized and innovative approaches are required.

Efficacy of fractional CO2 laser therapy combined with hyaluronic acid dressing for treating facial atrophic acne scars: a systematic review and meta-analysis of randomized controlled trials

The present work aimed to systematically identify the efficacy and safety of fractional carbon dioxide (CO2) laser plus hyaluronic acid (HA) dressing in dealing with facial atrophic acne scars. Randomized controlled trials (RCTs) concerning fractional CO2 laser in combination with HA dressing for treating atrophic acne scars were screened in 8 electronic databases (containing PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, Sinomed as well as VIP). Besides, for the purpose of evaluating the risk of bias of the enrolled RCTs, the Cochrane Collaboration tool was adopted. Statistical analysis was completed using Revman5.3 software and Stata 14.0 software. Meanwhile, the quality of evidence was assessed by the GRADE system. Finally, 6 studies involving 623 patients were enrolled. According to the findings in this study, compared with fractional CO2 laser alone, fractional CO2 laser therapy combined with HA dressing reduced the scores of ECCA (échelle d'évaluation clinique des cicatrices d'acné) grading scale (MD=-3.37,95% CI [-5.03, -1.70], P<0.0001), shortened the time of crust formation (MD=-0.42,95% CI [-0.80, -0.04], P=0.03) and the time of crust removal(MD=-1.31,95% CI [-1.67, -0.95], P<0.00001), enhanced patient satisfaction (RR=1.85, 95% CI [1.44, 2.38], P<0.00001). All the reported adverse events including hyperpigmentation, erythema, edema, mild itching, and slight burning pain were controllable. In addition, fractional CO2 laser combined with HA dressing therapy had a lower incidence of hyperpigmentation than fractional CO2 laser alone (RR=0.37, 95% CI [0.23, 0.61], P<0.0001). The level of evidence for outcomes was classified to be low to moderate. According to our findings, fractional CO2 laser combined with HA dressing is efficacious and safe option for facial atrophic acne scars. Nevertheless, more high-quality trials are required for further verification in the future.