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Ning X, Jiang L, Yu R, Sheng Y, Li M, Ouyang H, Xu J, Cui Y. Advances in the Application of Noninvasive Skin Imaging Techniques in Acne Scars. Am J Clin Dermatol 2024; 25:823-835. [PMID: 39134786 DOI: 10.1007/s40257-024-00882-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/29/2024]
Abstract
Acne scarring is a common sequela of acne vulgaris, which seriously affects facial esthetics. The treatment options for acne scars vary depending on the development stage, color, type, and location of scarring. The objective and precise assessment of acne scars is a prerequisite for treatment, and it is also an important means of monitoring the treatment effect. The traditional methods to evaluate the types and severity grade of acne scars are primarily based on subjective assessment by physicians, which lacks objectivity and accuracy. Novel noninvasive skin imaging techniques, such as skin surface imaging analysis systems, dermoscopy, reflectance confocal microscopy (RCM), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), and multiphoton tomography (MPT), provide new tools for the rapid and objective assessment of acne scars. This article reviews the progress of skin imaging techniques in the diagnosis, classification, and efficacy evaluation of acne scars.
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Affiliation(s)
- Xiaoli Ning
- Department of Dermatology, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Lingfan Jiang
- Department of Dermatology, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Ruixing Yu
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Yujun Sheng
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Mengmeng Li
- Department of Dermatology, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Hongfei Ouyang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingkai Xu
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, Capital Medical University, Beijing, China.
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.
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Siperstein R, Nestor E, Meran S. Prospective Clinical Trial Demonstrating the Efficacy of Hyaluronic Acid Filler for the Improvement of Atrophic Facial Scars up to 2 years. Dermatol Surg 2024:00042728-990000000-00869. [PMID: 38968085 DOI: 10.1097/dss.0000000000004315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
BACKGROUND Hyaluronic acid (HA) filler longevity has been studied for wrinkles. However, its long-term use for treating atrophic facial scars has not yet been analyzed in long-term prospective studies. OBJECTIVE Analyze the safety and duration of a HA filler for the use in atrophic scars. MATERIALS AND METHODS Fifteen subjects received VYC-17.5L in atrophic scars on 1 randomized cheek and saline on the other, with 1 optional touch-up treatment and crossover after the short-term trial. Grading for this long-term extension was done on Day 720, using the Global Aesthetic Improvement Scale (GAIS) and the Quantitative Global Scarring Grading System. RESULTS On Day 720, a live blind evaluator rated the VYC-17.5L assigned side as having significant reduction in scar severity (-7.2 [t(22) = -6.01, p = .00009]) and number of scars (-8.8 [t(22) = -6.25, p = .00006]) as compared with baseline. There was no significant difference in the results from Day 120 to Day 720. Ninety-two percent (11/12) of subjects reported improvement (GAIS), were satisfied with the treatment, thought it looked natural, and had fewer side effects than expected. There were no persistent or late-onset side effects. CONCLUSION VYC-17.5L improved rolling atrophic facial scars, and the results were sustained throughout the 2-year trial without side effects.
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Affiliation(s)
- Robyn Siperstein
- Florida Atlantic University, Boca Raton, Florida
- Siperstein Dermatology Group, Boynton Beach, Florida
| | | | - Suzanne Meran
- Siperstein Dermatology Group, Boynton Beach, Florida
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3
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Renzi M, McLarney M, Jennings T, Duffy R, Heymann WR, Lawrence N, Decker A. Procedural and surgical treatment modalities for acne scarring: Part II. J Am Acad Dermatol 2024; 90:1137-1150. [PMID: 35469981 DOI: 10.1016/j.jaad.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
The optimal treatment of acne scarring is challenging because several factors need to be considered, including the type and number of scars, Fitzpatrick skin type, and the amount of downtime permissible to the patient. This second article in the continuing medical education series discusses the procedural treatments available for acne scarring, including the use of chemical peels, fillers, radiofrequency microneedling, lasers, and surgical procedures. The indications for each modality, evidence for its benefits, and the adverse effects are discussed. This section aims to help guide the reader select and implement the most appropriate treatment based on the patient's preferences, acne scarring, and skin type.
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Affiliation(s)
- Michael Renzi
- Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey
| | - Matt McLarney
- Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey
| | - Tara Jennings
- Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey.
| | - Robert Duffy
- Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey
| | - Warren R Heymann
- Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey
| | - Naomi Lawrence
- Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey
| | - Ashley Decker
- Cooper University Hospital and Cooper Medical School of Rowan University, Camden, New Jersey
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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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Gao Y, Che Q, He Q, Wang W, Luo W, Tong Y, Liu L, Tang Q, Xie Y, Zhou Z, Wa Q. Treatment of periorbital aging with negative pressure fractional microneedle radiofrequency: A self-controlled clinical trial. J Cosmet Dermatol 2023. [PMID: 38013586 DOI: 10.1111/jocd.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Several treatment modalities are used for the treatment of periorbital rejuvenation with variable results. Recent studies showed that fractional radiofrequency may be an effective treatment modality for periorbital aging. This study aims to determine the efficacy and safety of negative pressure fractional microneedle radiofrequency (NPFMR) as a treatment for periorbital aging. METHODS Twenty-five patients with periorbital aging were involved in this study. They were treated two times with an interval of 1 month. The patients were evaluated before treatment and 1, 3, and 6 months after the final treatment. RESULTS The research findings suggest that periorbital wrinkles of the patients were significantly improved by VISIA system (p < 0.05). Physiological indicators detected by MPA10 system showed that compared with before treatment, the hydration increased (p < 0.05) and trans epidermal water loss (TEWL) decreased (p < 0.05) at 3 and 6 months after treatment. The glossiness increased at 1 month after treatment compared to pre-treatment (p < 0.05) and returned to the baseline level at 3 and 6 months after treatment. There was no significant change in melanin content (p > 0.05). Periorbital dermal thickness of the patients significantly increased at 1, 3, and 6 months after treatment according to skin ultrasound (p < 0.05). A periorbital skin biopsy revealed that the collagen fibers in the dermis were significantly thicker and more orderly after treatment, and the expression of type I collagen fibers and elastic fibers was increased compared with that before treatment. One patient developed post-inflammatory hyperpigmentation (PIH) at 1 month after the first treatment, which improved after active treatment. No other adverse reactions were observed. CONCLUSIONS NPMFR could be an effective and safe treatment modality for the treatment of periorbital aging.
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Affiliation(s)
- Yulian Gao
- Medical Cosmetic Center, Chengdu Second People's Hospital, Chengdu, China
| | - Qilei Che
- Medical Cosmetic Center, Chengdu Second People's Hospital, Chengdu, China
| | - Qiang He
- Medical Cosmetic Center, Chengdu Second People's Hospital, Chengdu, China
| | - Wenju Wang
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, China
| | - Wangsha Luo
- Department of Dermatology, Chengdu Fifth People's Hospital, Chengdu, China
| | - Yao Tong
- Department of Dermatology, Chengdu First People's Hospital, Chengdu, China
| | - Lufeng Liu
- Medical Cosmetic Center, Chengdu Second People's Hospital, Chengdu, China
| | - Qiuyue Tang
- Medical Cosmetic Center, Chengdu Second People's Hospital, Chengdu, China
| | - Yuhong Xie
- Medical Cosmetic Center, Chengdu Second People's Hospital, Chengdu, China
| | - Zixuan Zhou
- Medical Cosmetic Center, Chengdu Second People's Hospital, Chengdu, China
| | - Qingbiao Wa
- Medical Cosmetic Center, Chengdu Second People's Hospital, Chengdu, China
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Kneiber D, Amin M, Nguyen TA, Gharavi NM. Review of radiofrequency microneedling: history, devices and uses. J COSMET LASER THER 2023; 25:59-64. [PMID: 37844087 DOI: 10.1080/14764172.2023.2268308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
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.
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Affiliation(s)
- Diana Kneiber
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Mina Amin
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Tuyet A Nguyen
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Nima M Gharavi
- Department of Dermatologic Surgery & Mohs Micrographic Surgery, Cedars-Sinai Medical Center, Beverly Hills, CA, USA
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7
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Li MY, Huang YL, Chen JH, Kang YN, Chen C. Effectiveness and Safety of Energy-Based Devices for Acne Scars: A Network Meta-Analysis of Randomized Controlled Trials. Facial Plast Surg Aesthet Med 2023; 25:521-527. [PMID: 36946785 DOI: 10.1089/fpsam.2022.0383] [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: 03/23/2023] Open
Abstract
Background: Acne vulgaris is an inflammatory disease of the pilosebaceous unit in teenagers. Acne-induced inflammation leads to acne scarring. Scholars have discussed acne scar treatments; however, energy-based devices with satisfactory outcomes remain unidentified. Objective: To measure quartile grading scale and visual analog scale (VAS) to study the difference between energy-based devices. Methods: We included randomized controlled trials that evaluated patients with acne scars. The primary outcomes were the quartile grading scale and VAS scores. We used Confidence in Network Meta-Analysis to evaluate indirectness, imprecision, heterogeneity, and incoherence. Results: A total of 26 studies met the inclusion criteria. The quartile grading scale results revealed that ablative fractional laser was significantly more effective than nonablative fractional laser (standard mean difference [SMD]: 0.516, confidence interval [95% CI]: 0.281-0.750) and radiofrequency treatment (SMD: 0.941, 95% CI: 0.540-1.342). Moreover, nonablative fractional laser was significantly more effective than radiofrequency treatment (SMD: 0.426, 95% CI: 0.049-0.802). No significant difference in VAS score was found among the devices. Conclusion: Ablative fractional laser is an effective treatment for acne scars although it is associated with more pain.
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Affiliation(s)
- Man-Yun Li
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ya-Li Huang
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jin-Hua Chen
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
- Biostatistics Center, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Sullivan DA, da Costa AX, Del Duca E, Doll T, Grupcheva CN, Lazreg S, Liu SH, McGee SR, Murthy R, Narang P, Ng A, Nistico S, O'Dell L, Roos J, Shen J, Markoulli M. TFOS Lifestyle: Impact of cosmetics on the ocular surface. Ocul Surf 2023; 29:77-130. [PMID: 37061220 PMCID: PMC11246752 DOI: 10.1016/j.jtos.2023.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.
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Affiliation(s)
| | | | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | | | - Sihem Lazreg
- Lazreg Cornea and Ocular Surface Center, Blida, Algeria
| | - Su-Hsun Liu
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Alison Ng
- Centre for Ocular Research & Education, School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Steven Nistico
- Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | | | | | - Joanne Shen
- Department of Ophthalmology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Maria Markoulli
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
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Hendel K, Karmisholt K, Hedelund L, Haedersdal M. Fractional CO 2 -laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split-face trial. Lasers Surg Med 2023; 55:335-343. [PMID: 36934435 DOI: 10.1002/lsm.23655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/20/2023]
Abstract
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.
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Affiliation(s)
- Kristoffer Hendel
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Katrine Karmisholt
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lene Hedelund
- Department of Dermatology, Aaarhus University Hospital, Aarhus, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
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10
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Nobari NN, Tabavar A, Sadeghi S, Dehghani A, Kalantari Y, Ghassemi M, Atefi N, Goodarzi A. A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO 2, erbium YAG) in the treatment of atrophic and hypertrophic scars. Lasers Med Sci 2023; 38:67. [PMID: 36749436 DOI: 10.1007/s10103-022-03694-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/08/2022] [Indexed: 02/08/2023]
Abstract
The aim of this study is to compare needling (RF-needling, meso-needling, micro-needling) and ablative fractional lasers (CO2, erbium-YAG) in the treatment of atrophic and hypertrophic scars in a systematic review. The database was searched, and 10 articles were selected that were relevant in terms of content, topic, and purpose and met the inclusion criteria. Of all the articles reviewed in this study, there were 2 randomized split-face trials (20%), 1 controlled nonrandomized trial (10%), 1 controlled randomized phase III clinical trial (10%), 1 prospective trial (10%), 1 prospective nonrandomized open-label trial (10%), and 1 randomized comparative trial (10%), with the type of study not reported in 3 articles. We used Endnote X8 to review the articles and extract data. After review, the studies were analyzed and categorized. No statistically significant difference was found between the two methods, laser and micro-needling, in the treatment of atrophic and hypertrophic scars in 60% of the articles studied, and both showed significant improvement (70% or more improvement to complete response). Significant improvement was noted in 20% of the studies reviewed for the laser and micro-needling treatment methods. The results of this study show that needling and ablative fractional lasers are tolerable and safe procedures with no significant difference in the treatment of skin scars in sixty percent of the studies.
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Affiliation(s)
- Niloufar Najar Nobari
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Anahita Tabavar
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sara Sadeghi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Division of Dermatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Abbas Dehghani
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Yasamin Kalantari
- Department of Dermatology, Razi Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Ghassemi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Najmolsadat Atefi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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11
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Huang L, Liu Y, Fang W, Liu L, Sun Q, Lin X, Xu H, Yang Y. Efficiency and safety of microneedling fractional radiofrequency in the treatment of Chinese atrophic acne scars: A retrospective study of 3 consecutive treatments with 1-month intervals. J Cosmet Dermatol 2023; 22:497-504. [PMID: 36217740 DOI: 10.1111/jocd.15454] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/04/2022] [Accepted: 10/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrophic acne scars (AAS) impact the aesthetic appearance, inducing social and psychological problems. Effective and safe therapy for AAS is urgently needed now. Microneedling fractional radiofrequency (MFRF) has emerged as a minimal invasive alteration for treating AAS lately, while the existing data on Chinese population was few. AIMS We aimed to explore the effectivity and safety of MFRF in Chinese patients with facial AAS and analyze the response of different subtypes to MFRF treatment. METHODS We conducted a retrospective analysis using data from medical records and clinical photographs of 40 Chinese patients with AAS with Fitzpatrick skin type III-IV, all of them had received 3 MFRF treatments with 1-month intervals and were followed up 3 months after the last treatment. The clinical severity was assessed through échelle d'évaluation clinique des cicatrices d'acné (ECCA) score at each visit. Clinical photographs were taken by VISIA. Patients were asked to evaluate their satisfaction of the treatment using a 5-point Likert scale at the last visit. RESULTS ECCA score decreased more than a half at the last visit based on the baseline. Among the three types of AAS, the M-shaped scars respond most quickly to MFRF and the U-shaped scars improved the most after 3 months follow-up. A significant improvement was seen in clinical appearance, parallel to the change of ECCA, indicating the remarkable improvement of AAS after the MFRF treatment. Concomitant active acne was controlled along with the improvement of AAS. Statistics from VISIA showed excellent improvement in pores and texture as well. Side effects including pain and erythema were transient and mild. The number of MFRF treatment sessions was positively associated with the degree of improvement. Of the total 39 patients who had given a score of satisfaction, more than 89% (35 patients) were very satisfied or satisfied with the outcome. CONCLUSIONS To sum up, our study reveals that MFRF provides high efficiency in treating Chinese AAS patients with high satisfaction and low risk of adverse effects. M-shaped scars are the most sensitive type to the treatment, but the U-shaped scars improve most at the last visit. The simultaneous minimization of pores and improvement of skin texture imply the increased collagen stimulated by MFRF. Regular MFRF should be considered a good choice in treating AAS.
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Affiliation(s)
- Linting Huang
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Liu
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Fang
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lanjun Liu
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qilin Sun
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Xu
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yali Yang
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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Olesen UH, Jacobsen K, Lerche CM, Haedersdal M. Repeated exposure to fractional CO 2 laser delays squamous cell carcinoma formation and prevents clinical and subclinical photodamage visualized by line-field confocal optical coherence tomography and histology. Lasers Surg Med 2023; 55:73-81. [PMID: 36229986 PMCID: PMC10092156 DOI: 10.1002/lsm.23613] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Ablative fractional laser (AFL) is a well-established modality for treating ultraviolet radiation (UVR)-induced skin photodamage. We aimed to investigate the potential of AFL to delay squamous cell carcinoma (SCC) formation and prevent photodamage in a preclinical UVR-induced SCC model. MATERIALS AND METHODS Hairless C3.Cg-Hrhr /TifBomTac mice (n = 50) were exposed to UVR three times weekly throughout the study. UV-exposed mice were randomized to two groups that received dorsal CO2 AFL (10 mJ/mb, 10% density) or no treatment. AFL was performed every other week for a total of 16 weeks (nine treatments in total). The primary outcome was time to tumor occurrence. In a subset of mice on Day 150, prevention of clinical photodamage was assessed by examination of skin tightness and dyspigmentation. Concomitantly, assessment of subclinical photoprevention based on normalization of keratinocyte dysplasia, dermo-fiber morphology (collagen and elastin fibers), and skin thickness, was performed using line-field confocal optical coherence tomography (LC-OCT) and histology. RESULTS Repeated AFL treatments delayed SCC tumor development compared to UVR control mice by 12, 19, and 30 days for first, second, and third tumors, respectively (p ≤ 0.0017). Compared to UVR controls, AFL prevented photodamage both clinically and subclinically, based on LC-OCT and histology. In the epidermal layer, AFL imparted photopreventative effects including reduced dyspigmentation and keratinocyte dysplasia (1 vs. 2.5, p = 0.0079) and partial normalization of the epidermal thickness (p < 0.0001). In the dermis, AFL led to twofold greater skin tightness (p = 0.0079), improved dermo-fiber structure, and dermal thickness (p = 0.0011). CONCLUSION In conclusion, repeated AFL treatments of UVR-exposed skin significantly delayed SCC tumor formation and prevented clinical and imaging-assessed subclinical signs of photodamage, indicating a potential for AFL in prevention strategies for SCC and photodamage in high-risk populations.
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Affiliation(s)
- Uffe H. Olesen
- Department of DermatologyCopenhagen University Hospital—BispebjergCopenhagenDenmark
| | - Kevin Jacobsen
- Department of DermatologyCopenhagen University Hospital—BispebjergCopenhagenDenmark
| | - Catharina M. Lerche
- Department of DermatologyCopenhagen University Hospital—BispebjergCopenhagenDenmark
- Department of PharmacyUniversity of CopenhagenCopenhagenDenmark
| | - Merete Haedersdal
- Department of DermatologyCopenhagen University Hospital—BispebjergCopenhagenDenmark
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13
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Li J, Duan F, Kuang J. Meta-analysis of fractional radiofrequency treatment for acne and/or acne scars. J Cosmet Dermatol 2022; 21:6754-6766. [PMID: 36062400 DOI: 10.1111/jocd.15348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Fractional radiofrequency (FRF) is increasingly used for acne scars. The common coexistence of acne scars and active acne is a challenge in the timely management of acne scarring. AIMS We conducted a systematic review and meta-analysis to compare the efficacy and safety of FRF treatment with the lasers for acne and/or acne scars. METHODS A systematic search was performed on PubMed, Embase, Ovid, Cochrane Library, and Web of Science. Compared with the lasers, a meta-analysis was conducted to assess the clinical improvement and adverse events after FRF treatment. RESULTS Eight randomized controlled trials were included. FRF group was more effective than the laser group in patient-evaluated acne improvement (RR = 1.35, 95% CI: 1.01 ∼ 1.80). Regardless of observer assessment or patient evaluation, the FRF group was as effective as the laser group in treating atrophic acne scars (RR = 0.92, 95% CI: 0.78 ∼ 1.08; RR =1.15, 95% CI: 0.99 ∼ 1.34). Although there was no difference in pain level and crusting time between the two groups (SMD =0.20, 95% CI: -0.72 ∼ 1.12; SMD = -0.93, 95% CI: -2.38 ∼ 0.52), PIH incidence of FRF was significantly lower than that of the laser group (RR = 0.12, 95% CI: 0.04 ∼ 0.35). The duration of erythema after FRF treatment was also obviously shorter than that after the laser treatment (SMD = -0.78, 95% CI: -1.37 ∼ -0.18). Subgroup analysis showed that at least a 12-week follow-up was required to observe the full effects of FRF. CONCLUSIONS FRF could be a better choice for atrophic acne scar patients with active acne. FRF is superior in treating atrophic acne scar patients prone to pigmentation.
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Affiliation(s)
- Jing Li
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
| | - Fangfang Duan
- Fourth Medical College of Peking University, Beijing, China.,Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Kuang
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
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14
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Radiofrequency Microneedling for Skin Tightening of the Lower Face, Jawline, and Neck Region. Dermatol Surg 2022; 48:1299-1305. [DOI: 10.1097/dss.0000000000003607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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15
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Mandavia R, Cariati M, Shahidi S, Spencer C, Somenek M, Lapa T. Combination radiofrequency microneedling and carbon dioxide laser for acne scarring: A systematic review and retrospective case series across two centers. J Cosmet Dermatol 2022; 21:5672-5679. [PMID: 35896510 DOI: 10.1111/jocd.15276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/06/2022] [Accepted: 07/20/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Combination radiofrequency (RF) microneedling with fractional ablative carbon dioxide (CO2 ) laser is a new approach for acne scar treatment. AIMS (1) to systematically review the literature on the safety and effectiveness of this treatment for acne scarring; (2) to assess safety and effectiveness in a 2-center case series. METHODS Systematic review: Articles that assessed the safety and effectiveness of combination RF microneedling and fractional CO2 laser for acne scarring were included and quality assessed using the Downs and Black checklist. CASE SERIES Patient records were reviewed from 2 clinics, one in London, UK, and the other in Washington D.C., United States, to identify patients who underwent a single treatment with RF microneedling and fractional CO2 laser for acne scarring. Outcome assessment was via the Scar Global Assessment (SGA) scale. RESULTS Systematic review: Three articles were included and reported improvements in acne scar severity. Adverse effects included erythema, edema, pain, vesicle formation, erosion, petechiae, desquamation, post-inflammatory hyperpigmentation (PIH), and acne flare. Quality scores ranged from 14 to 15 (maximum of 21). CASE SERIES Twenty-six patients were included. Mean SGA Score was 3.0 at baseline and 1.3 at follow-up. All patients had an improved SGA score. Adverse effects included erythema, pain, edema, skin crusting, PIH, and acne flare. All patients resumed normal activities within 7 days of treatment. CONCLUSION Combination RF microneedling and fractional CO2 laser appears a safe and effective treatment for patients with acne scarring. A single treatment can result in noticeable improvements in acne scar severity with a short recovery time.
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Affiliation(s)
- Rishi Mandavia
- Dr Tatiana Aesthetic Dermatology Clinic, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | | | | | | | - Michael Somenek
- Somenek + Pittman MD Advanced Plastic Surgery, Chicago, Illinois, USA
| | - Tatiana Lapa
- Dr Tatiana Aesthetic Dermatology Clinic, London, UK
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16
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Chilicka K, Rusztowicz M, Szyguła R, Nowicka D. Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. J Clin Med 2022; 11:jcm11102744. [PMID: 35628870 PMCID: PMC9147527 DOI: 10.3390/jcm11102744] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/07/2023] Open
Abstract
Acne vulgaris is a chronic skin disease that, depending on its course, is characterized by the occurrence of various skin eruptions such as open and closed comedones, pustules, papules, and cysts. Incorrectly selected treatment or the presence of severe acne vulgaris can lead to the formation of atrophic scars. In this review, we summarize current knowledge on acne scars and methods for their improvement. There are three types of atrophic scars: icepick, rolling, and boxcar. They are of different depths and widths and have different cross-sections. Scars can combine to form clusters. If acne scars are located on the face, they can reduce the patient’s quality of life, leading to isolation and depression. There are multiple effective modalities to treat acne scars. Ablative lasers, radiofrequency, micro-needling, and pilings with trichloroacetic acid have very good treatment results. Contemporary dermatology and cosmetology use treatments that cause minimal side effects, so the patient can return to daily functioning shortly after treatment. Proper dermatological treatment and skincare, as well as the rapid implementation of cosmetological treatments, will certainly achieve satisfactory results in reducing atrophic scars.
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Affiliation(s)
- Karolina Chilicka
- Department of Health Sciences, Institute of Health Sciences, University of Opole, 45-040 Opole, Poland; (M.R.); (R.S.)
- Correspondence: ; Tel.: +48-665-43-94-43
| | - Monika Rusztowicz
- Department of Health Sciences, Institute of Health Sciences, University of Opole, 45-040 Opole, Poland; (M.R.); (R.S.)
| | - Renata Szyguła
- Department of Health Sciences, Institute of Health Sciences, University of Opole, 45-040 Opole, Poland; (M.R.); (R.S.)
| | - Danuta Nowicka
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wrocław, Poland;
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17
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Shen YC, Chiu WK, Kang YN, Chen C. Microneedling Monotherapy for Acne Scar: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Aesthetic Plast Surg 2022; 46:1913-1922. [PMID: 35426044 DOI: 10.1007/s00266-022-02845-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/12/2022] [Indexed: 11/26/2022]
Abstract
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 .
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Affiliation(s)
- Yu-Chun Shen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Medical University Hospital, Taipei, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Evidence-Based Medicine Center, Wan Fang Hospital, Medical University Hospital, Taipei, Taiwan.
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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18
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Fusano M, Bencini PL. Microneedle fractional radiofrequency for atrophic acne scars: in vivo evaluation of results by 3D analysis and reflectance confocal microscopy. Dermatol Ther 2022; 35:e15454. [PMID: 35297143 DOI: 10.1111/dth.15454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The efficacy of microneedle fractional radiofrequency (MFR) for the treatment of atrophic acne scars has been recently described, but accurate in vivo microscopic documentation of the processes occurring has never been reported. AIMS The aim of this study is to describe in vivo morphological atrophic acne scars' variations after treatment with MFR by means reflectance confocal microscopy (RCM) and three-dimensional (3D) imaging. PATIENTS/METHODS A total of 11 patients requiring treatment for atrophic facial acne scars were treated with four monthly sessions of MFR. 3D imaging and RCM were assessed at baseline and 1 months after last session. Clinical improvement, according to Global Assessment Improvement Scale (GAIS), and patients' satisfaction were evaluated. RESULTS Clinical improvement was observed in all the treated patients, although better results were obtained for boxcar scars (p= 0.043). 3D imaging revealed a significant improvement in terms of mean scars' depth (p<0.001). Otherwise, RCM highlighted collagen remodeling with restoration of a reticular structure. CONCLUSIONS Our study confirms the efficacy and safety of MFR in acne scars' treatment and provides the microscopic description of the results using RCM. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marta Fusano
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Via della Moscova 42, Milan, Italy
| | - Pier Luca Bencini
- Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.), Via della Moscova 42, Milan, Italy
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