1
|
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.
Collapse
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
| |
Collapse
|
2
|
Tahiliani S, Mysore V, Ganjoo A, Udare S, Rajendran SC, Reddy R, Rathore VS, Bhatia S, Verma S, Katke V, Patil CY. Practical Aspects of Acne Scar Management: ASAP 2024. Cureus 2024; 16:e55897. [PMID: 38595878 PMCID: PMC11003649 DOI: 10.7759/cureus.55897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/11/2024] Open
Abstract
Acne scars are one of the most common complications of acne. They can significantly affect the patient's quality of life. Often, several types of atrophic acne scars are observed simultaneously; therefore, consideration must be given to the type of scar while choosing the treatment modality. Effective treatment is not only important to prevent and improve acne scars but also crucial in preventing psychosocial effects. Treatment of acne scars requires an algorithmic approach that targets each component of the scars, and combination therapy on a patient-specific basis may offer the best chance for significant improvement. The goal of the current article is to discuss the practical aspects of management of atrophic acne scars using the vast modalities of treatment available. The panel of dermatologists and plastic surgeons, each one with at least 20 years of experience in acne scar treatment, participated in a series of 'Practical Aspects of Acne Scar Management' (ASAP) meetings: ASAP 2024. ASAP meetings were organized by "Scar Forum India" from March 2023 to July 2023 in four Indian cities (Mumbai, Delhi, Bengaluru, and Kolkata), each one for a duration of at least three hours. During these meetings and discussions, panelists reviewed and discussed the acne scar-related literature, their clinical experience in its management, available treatment options, along with recent advances. Consequently, a summary of the discussion and practical approach for the management of acne scars is developed. It was concluded that, though there is no specific guideline available to optimize acne scar management despite the multitude of treatment options, the best results can be achieved through the synergy of multiple treatment modalities and using the algorithmic approach.
Collapse
Affiliation(s)
- Sushil Tahiliani
- Dermatology, Dr. Sushil Tahiliani Clinic, Mumbai, IND
- Dermatology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, IND
| | - Venkatraman Mysore
- Dermatology, The Venkat Centre for Skin and Plastic Surgery, Bengaluru, IND
| | - Anil Ganjoo
- Dermatology, Skinnovation Clinics, New Delhi, IND
| | - Satish Udare
- Dermatology, Dr. Udare Skin and Hair Clinic, Navi Mumbai, IND
| | - S C Rajendran
- Dermatology, Cosmetic Skin Care Clinic, Bengaluru, IND
| | - Raghunatha Reddy
- Dermatology, Roots Institute of Dermatological Sciences, Bengaluru, IND
| | - V S Rathore
- Plastic Surgery, Kaayakalp Clinic, Kolkata, IND
| | | | | | - Vaishali Katke
- Medical Affairs, A. Menarini India Pvt Ltd., Mumbai, IND
| | - Chetan Y Patil
- Medical Affairs, A. Menarini India Pvt Ltd., Mumbai, IND
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Kandhari S, Ganjoo A, Talathi A, Aurangabadkar S, Bhatia S, Goel A, Patil CY. Efficacy and safety of innovative acne scar serum in Indian patients (ESTEEM India study). J Cosmet Dermatol 2023; 22:880-889. [PMID: 36437741 DOI: 10.1111/jocd.15536] [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: 10/13/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Scarring is a common and undesirable outcome of acne vulgaris. There are limited effective topical formulations for acne scar treatment. The investigational product, acne scar serum (HEXILAK® Acne Scar Serum) is latest topical formulation developed for treatment of acne scar with unique ingredients, Kollaren and Exo-T. OBJECTIVE Evaluate safety and efficacy of latest acne scar serum on the reduction of acne scars in Indian population. MATERIALS AND METHODS Subjects, diagnosed clinically with acne scars with or without hyperpigmentation, of either gender in the age group of 15 to 45 years were enrolled in the study. The investigational acne scar serum was applied twice daily for 3 months with monthly follow for outcome evaluation. RESULTS Out of 72 subjects enrolled, 67 completed the study. Most of the subjects, 79.1% showed improvement in acne scar at Day 90. Significant reduction of mean total post-acne hyperpigmentation index (PAHI) was seen at all follow up visits compared with baseline. Significant improvement in mean acne scar depth, mean acne scar volume, and mean L value using 3D imaging were observed at all visits compared with baseline. All side effects reported were mild and overall, it was well tolerated by all subjects. CONCLUSION We found that there was a significant reduction in acne scar and post-acne pigmentation with new acne scar serum as a monotherapy, this needs further confirmation in larger randomized controlled studies. Therefore, topical acne scar serum with unique ingredients Kollaren and Exo-T can be a safe, effective, and new option in the armamentarium of acne scar management.
Collapse
|
5
|
Wang Y, Sun Z, Cai L, Zhang F. Comparative efficacy and safety of six photoelectric therapies for the atrophic acne scars: A network meta-analysis. Indian J Dermatol Venereol Leprol 2023; 89:353-362. [PMID: 37067138 DOI: 10.25259/ijdvl_572_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/01/2022] [Indexed: 02/05/2023]
Abstract
Objectives
This network meta-analysis assessed the relative efficacy and safety of six common photoelectric therapies including 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG), fractional carbon dioxide laser(FSCO2), fractional micro-plasma radiofrequency(Plasma), micro-needling fractional radiofrequency (MRF), 1550nm or 1540nm erbium-glass non-ablative fractional laser (NAFL) fractional erbium-doped yttrium aluminum garnet (Er: YAG).
Methods
A comprehensive search to identify relevant studies was conducted using four electronic databases. Outcome measures were extracted based on subjective and objective indexes, including the dermatologists’ evaluation(DE), the patients’ overall satisfaction(PS), VAS score, and Postinflammatory hyperpigmentation (PIH).
Results
Eleven published clinical research studies, involving 405 patients were included in this study. Ranking of DE from large to small is as follows: Nd: YAG, FSCO2, Er: YAG, Plasma, NAFL, MRF. In terms of PS, the rand from high to low can be described as follows: Er: YAG, Nd: YAG, FSCO2, Plasma, NAFL, MRF. In connection with the sequencing of adverse events, pain severity from slight to severe as follows: Er:YAG, Nd:YAG, FSCO2, NAFL, MRF, Plasma. The probability of having PIH are presented in order from lowest to highest as follows: MRF, Plasma, Nd: YAG, NAFL, Er: YAG, FSCO2.
Conclusion
FSCO2 remains the mainstream of potentially curative treatment, then again Nd: YAG and Er: YAG require greater efforts to prove their superior effectiveness. NAFL might be appropriate for mild and moderate improvement with its strengths of good tolerance while Plasma fits into patients with higher pain thresholds but an expectation of higher results. MRF has not given expression on absolute predominance for the present.
Registration
PROSPERO CRD42021242160
(available from https://www.crd.york.ac.uk/prospero).
Collapse
Affiliation(s)
| | | | - Lingling Cai
- Department of Dermatology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Fengchuan Zhang
- Department of Dermatology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
6
|
Lee SR, Cho S. Clinical Factors Affecting the Effectiveness of 1550-nm Erbium-Doped Fractional Photothermolysis Laser for Individual Atrophic Acne Scar Types. Dermatol Ther (Heidelb) 2023; 13:609-616. [PMID: 36631628 PMCID: PMC9884716 DOI: 10.1007/s13555-022-00887-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Although non-ablative fractional resurfacing is frequently used for atrophic acne scars, few studies have examined clinical factors affecting the effectiveness of non-ablative fractional laser in individual atrophic acne scar types (icepick, rolling, and boxcar scars). Herein, we evaluated the clinical factors affecting the effect of non-ablative fractional laser for individual atrophic acne scar types using objective assessment tools. METHODS Thirty-one patients who had been treated by 1550-nm erbium-doped fractional laser for atrophic acne scars were retrospectively reviewed. Icepick, rolling, and boxcar scars were counted using photographs, and acne scar reduction efficiency (ASRE%; the percentage reduction of post-acne scar count from baseline counts) was calculated. RESULTS The median count of each scar type was significantly reduced at the end of the final session. Boxcar scars responded better (median ASRE 59.2%) than rolling (ASRE 40.6%, p = 0.017) and icepick scars (ASRE 19.1%, p = 0.010). Concomitant isotretinoin use resulted in a greater ASRE and a significantly greater improvement in icepick scars. Patients aged 25 years or younger showed a higher ASRE, with a greater improvement in boxcar scars. CONCLUSION 1550-nm fractional laser treatment for atrophic acne scars was more effective in patients who were younger and taking isotretinoin concurrently.
Collapse
Affiliation(s)
- Soo Ran Lee
- Department of Dermatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae Road 5-gil, Dongjak-gu, Seoul, 07061 South Korea
| | - Soyun Cho
- Department of Dermatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae Road 5-gil, Dongjak-gu, Seoul, 07061 South Korea
| |
Collapse
|
7
|
Tsao SB, Wu CC, Lee CC. Purse-string suture combined with subcision and dermal graft for the treatment of wide depressed scars and boxcars. J Cosmet Dermatol 2022; 21:5969-5976. [PMID: 35984570 DOI: 10.1111/jocd.15291] [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: 03/16/2022] [Revised: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Dermal layer injuries can result in depressed or indented scars even when there is no subcutaneous injury. These scars can result from acne, chickenpox, trauma, or skin infection. Several procedures, including primary closure, subcision, microneedling, and dermal grafting, have been reported to be used to treat depressed scars, boxcars, or acne cosmetics. These procedures have not, however, been shown to be very effective when applied to the treatment of deep depressed scars, boxcars, or acne cosmetics. In this retrospective study, we assessed scar improvement in patients with deep depressed facial scars and boxcars treated with our novel combination of techniques. METHODS This study included all patients treated for deep depressed scars and boxcars at our clinic from 2018 to 2021. To be included, patients had to present in our clinic for the treatment of deep depressed scars or boxcars, have no prominent subcutaneous layer injury, and have full set of clear pre-and post-procedure photographs. All patients initially received technique combination including scar subcision, inner purse-string suturing, and dermal grafting for the first stage surgery treatment. In cases of residual uneven superficial scars, laser dermabrasion resurfacing was used as second-staged treatment. Preoperative and six-month postoperative scar appearance photographs were assessed for improvement by our three nonmedical staff members and divided into four improvement groups, as minimal, moderate, good, and excellent. RESULTS This study included a total of 24 patients (20 females and four males) with facial scarring. Two patients (8.3%) had moderate, 13 (54.2%) good and nine (37.5%) excellent improvement post-treatment. There were no instances of minimal improvement. Four patients received second stage laser dermabrasion resurfacing for residual uneven superficial scars. CONCLUSION We concluded deep depressed scars and boxcars can be easily, safely, and effectively treated using our novel combined scar subcision, inner purse-string suturing, and dermal grafting treatment with possible second-staged laser dermabrasion, and without major complications.
Collapse
Affiliation(s)
- Su-Ben Tsao
- Dr. Tsao's Clinic of Plastic Surgery, Kaohsiung, Taiwan
| | - Cheng-Chun Wu
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Salameh F, Shumaker PR, Goodman GJ, Spring LK, Seago M, Alam M, Al-Niaimi F, Cassuto D, Chan HH, Dierickx C, Donelan M, Gauglitz GG, Haedersdal M, Krakowski AC, Manuskiatti W, Norbury WB, Ogawa R, Ozog DM, Paasch U, Victor Ross E, Clementoni MT, Waibel J, Bayat A, Goo BL, Artzi O. Energy-based devices for the treatment of acne scars: 2021 international consensus recommendations. Lasers Surg Med 2021; 54:10-26. [PMID: 34719045 DOI: 10.1002/lsm.23484] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs. STUDY DESIGN/MATERIALS AND METHODS An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence. RESULTS The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome. CONCLUSION Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.
Collapse
Affiliation(s)
- Fares Salameh
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Peter R Shumaker
- VA San Diego Healthcare System and University of California, San Diego, California, USA
| | - Greg J Goodman
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Leah K Spring
- Micrographic Surgery and Surgical Oncology, SkinCare Physicians, Chestnut Hill, Massachusetts, USA
| | - Meghan Seago
- VA San Diego Healthcare System and University of California, San Diego, California, USA.,Micrographic Surgery and Surgical Oncology, Scripps Clinic, La Jolla, California, USA
| | - Murad Alam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Henry Hl Chan
- Private Practice and Department of Medicine (Dermatology), University of Hong Kong, People's Republic of China
| | | | - Matthias Donelan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children-Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig Maximillian University, Munich, Germany
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew C Krakowski
- Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania, USA
| | | | - William B Norbury
- Department of Surgery, University of Texas Medical Branch, Shriners Hospital for Children-Galveston, Galveston, Texas, USA
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Uwe Paasch
- Department of Dermatology, Venereology, and Allergy, University of Leipzig, Leipzig, Germany
| | | | | | - Jill Waibel
- Miami Dermatology and Laser Institute, Miami, Florida, USA
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester, England, UK.,MRC-SA Wound Healing Unit, Hair & Skin Research Laboratory, Division of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Boncheol Leo Goo
- Naeum Dermatology and Aesthetic Clinic/Skin Rehabilitation Center, Seoul, Korea
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
10
|
Shimshak SJE, Tolaymat LM, Haga CB, Dawson NL, Gillis MS, Yin M, Kirsch B, Cooper M, Sluzevich JC. A Review of Oral Therapies for the Treatment of Skin Hyperpigmentation. J Cutan Med Surg 2021; 26:169-175. [PMID: 34541912 DOI: 10.1177/12034754211045391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review article examines evidence supporting the use of oral therapies in treating idiopathic, actinic, and metabolically induced skin hyperpigmentation. A thorough review of the literature regarding oral treatments for hyperpigmentation was systematically conducted through PubMed. Keywords used in the primary search include "Hyperpigmentation," "Melanosis" or "Melasma," "Lightening," "Oral," and "Therapeutics." The search was limited to the English language, and no timeframe restrictions were implemented. Numerous orally administered therapies have been proposed for the treatment of skin hyperpigmentation. There is an abundant body of literature demonstrating the efficacy of orally administered tranexamic acid, glutathione, isotretinoin, and proanthocyanidin. It is reasonable to expect that the most effective oral therapies will address known underlying causes of hyperpigmentation such as thyroid disease, diabetes, and hormonal imbalance. Improvement due to oral therapy of otherwise unresponsive skin hyperpigmentation or hyperpigmentation of unknown cause is less predictable. This review is limited by the strength of evidence contained within the available studies. Clinical studies investigating the treatments discussed within this article are limited in number, at times lack blinding in the study design, and are based on small sample sizes. Based on existing research, the most promising oral remedies for hyperpigmentation appear to be tranexamic acid, glutathione, isotretinoin, and proanthocyanidin. Additional studies to better establish safety and efficacy are necessary.
Collapse
Affiliation(s)
| | - Leila M Tolaymat
- 156400 Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | - Claire B Haga
- 156400 Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Nancy L Dawson
- 156400 Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Mindy S Gillis
- 156400 Department of Human Resources, Mayo Clinic, Jacksonville, FL, USA
| | - Mingyuan Yin
- 156400 Department of Research Administration, Mayo Clinic, Jacksonville, FL, USA
| | | | - Maria Cooper
- 156400 Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | - Jason C Sluzevich
- 156400 Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
11
|
Barone N, Safran T, Vorstenbosch J, Davison PG, Cugno S, Murphy AM. Current Advances in Hypertrophic Scar and Keloid Management. Semin Plast Surg 2021; 35:145-152. [PMID: 34526861 PMCID: PMC8432993 DOI: 10.1055/s-0041-1731461] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hypertrophic scars and keloids are caused by excessive tissue response to dermal injury due to local fibroblast proliferation and collagen overproduction. This response occurs because of pathologic wound healing due to dysregulation in the inflammatory, proliferative, and/or remodeling phase. Patients with hypertrophic scars or keloids report reduced quality of life, physical status, and psychological health. Hypertrophic scars or keloids will develop in 30 to 90% of individuals, and despite their prevalence, treatment remains a challenge. Of the treatments currently available for hypertrophic scars and keloids few have been adequately supported by studies with appropriate experimental design. Here, we aim to review the available literature to provide up-to-date information on the etiology, epidemiology, histology, pathophysiology, prevention, and management options available for the treatment of hypertrophic scars and keloids and highlight areas where further research is required.
Collapse
Affiliation(s)
- Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Tyler Safran
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Joshua Vorstenbosch
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Peter G. Davison
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Amanda M. Murphy
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
- Division of Plastic and Reconstructive Surgery, Jewish General Hospital, Montreal, Canada
| |
Collapse
|
12
|
Hu S, Laughter MR, Anderson JB, Sadeghpour M. Emerging topical therapies to treat pigmentary disorders: an evidence-based approach. J DERMATOL TREAT 2021; 33:1931-1937. [PMID: 34114938 DOI: 10.1080/09546634.2021.1940811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hyperpigmentation disorders are commonly encountered in dermatology clinics. The use of prescription-grade and over-the-counter topical lightening agents has increased in popularity, leading to a substantial growth of research over the past decade. OBJECTIVE We seek to review clinical studies evaluating the use of different Rx-grade and OTC ingredients in treating hyperpigmentation. METHODS AND MATERIALS A comprehensive search on PubMed was conducted to identify patient-based evidence on the most common ingredients used as topical lightening agents: arbutin, ascorbic acid, cysteamine, hydroquinone, kojic acid, niacinamide, retinoids, and triple-combination therapy. The topicals were classified as either prescription-grade or over-the-counter. RESULTS Varying levels of evidence support the use of topicals in treating hyperpigmentation. There were more clinical trials examining Rx-grade products than OTC products. Mild but tolerated side effects are noted in many of these agents. CONCLUSION Careful monitoring and adjustment of doses will be needed to maximize skin lightening benefits and minimize side effects.
Collapse
Affiliation(s)
- Sophia Hu
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa R Laughter
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Jaclyn B Anderson
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | |
Collapse
|
13
|
Cucu C, Butacu AI, Niculae BD, Tiplica GS. Benefits of fractional radiofrequency treatment in patients with atrophic acne scars - Literature review. J Cosmet Dermatol 2020; 20:381-385. [PMID: 33355993 DOI: 10.1111/jocd.13900] [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: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Acne scars carry a huge physical and psychological impact on people. This article aims to evaluate the role of fractional radiotherapy in treatment of atrophic acne scars. The main objective includes providing an up-to-date review of existing literature, presenting the most significant studies conducted in this field. METHODS In order to study the impact of fractional radiotherapy on the appearance of atrophic acne scars, we conducted a search on Pubmed using the keywords "fractional radiotherapy", combined with/or "acne", "atrophic acne scars" and "acne scars" and found 75 papers, from which we selected 39. RESULTS There are several therapeutic approaches for the improvement of acne scars with variable results and possible side effects. Fractional radiofrequency system has been used widely in the last years, as it turned out to be an effective treatment method, either in combination with other modalities, or alone. CONCLUSION There are no generalized clinical guidelines adopted to standardize atrophic acne scar treatment. The multiple therapeutic options available create a dilemma in choosing the proper method in order to enhance its efficacy and to minimize its risks. The accumulated experience in nonablative collagen stimulating devices like fractional radiofrequency has proven that thickening of interstitial fibers in the dermis is possible with a controlled thermal injury, without epidermal damage and development of side effects.
Collapse
Affiliation(s)
| | - Alexandra-Irina Butacu
- Department of Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - George-Sorin Tiplica
- Department of Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
14
|
Rathod D, Foroughi A, Mekokishvili L, Wollina U, Lotti T, Rajan A, Goldust M. A cross-sectional, multi-center study on treatment of facial acne scars with low-energy double-pass 1450-nm diode laser. Dermatol Ther 2020; 33:e13326. [PMID: 32208551 DOI: 10.1111/dth.13326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/15/2020] [Accepted: 03/18/2020] [Indexed: 01/30/2023]
Abstract
Acne scars are the ultimate outcome of acne vulgaris, a prevalent skin disorder affecting the pilo-sebaceous unit. Laser resurfacing has been demonstrated to be an efficient therapy option for acne scars. Hence, we adopted this concept and conducted a study to evaluate the safety and efficacy of low-energy double-pass 1450-nm diode laser on acne scars. This study was conducted on 48 patients with acne scars, treated at 4-week interval with low-energy double-pass 1450-nm diode laser. Patients were evaluated clinically and with photographs, at day 0, first month and third month post the final treatment and during follow-up visit. Five treatment sessions were completed by all patients. Approximately, 79.2% of patients showed around 30% improvement. At the end of third month follow-up, 92.9% of the patients demonstrated >30% improvement. Vesicle formation was observed in two cases, with no post-inflammatory hyperpigmentation and transient hyperpigmentation was observed in one case, which vanished within 2 months. Our study showed that 1450-nm diode laser treatment was efficient and well endured in facial acne scars when used with double-pass at low-energy.
Collapse
Affiliation(s)
- Dipali Rathod
- Consultant Dermatologist, Mumbai, Maharashtra, India
| | | | - Lali Mekokishvili
- Department of Dermatology, Caucasus International University, Faculty of Medicine, Tbilisi, Georgia
| | - Uwe Wollina
- Department of Dermatology and Allergology, StädtischesKlinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Torello Lotti
- University of Studies Guglielmo Marconi, Rome, Italy
| | - Aswath Rajan
- Department of Dermatology, Venereology and Leprology, Goa Medical College, Bambolim, Goa, India
| | - Mohamad Goldust
- University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
15
|
Bajouri A, Orouji Z, Taghiabadi E, Nazari A, Shahbazi A, Fallah N, Mohammadi P, Rezvani M, Jouyandeh Z, Vaezirad F, Khalajasadi Z, Ghasemi M, Fanni A, Haji Hosseinali S, Alizadeh A, Baharvand H, Shafieyan S, Aghdami N. Long-Term Follow-up of Autologous Fibroblast Transplantation for Facial Contour Deformities, A Non-Randomized Phase IIa Clinical Trial. CELL JOURNAL 2019; 22:75-84. [PMID: 31606970 PMCID: PMC6791067 DOI: 10.22074/cellj.2020.6340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
Abstract
Objective Recently, the promising potential of fibroblast transplantation has become a novel modality for skin
rejuvenation. We investigated the long-term safety and efficacy of autologous fibroblast transplantation for participants
with mild to severe facial contour deformities.
Materials and Methods In this open-label, single-arm phase IIa clinical trial, a total of 57 participants with wrinkles
(n=37, 132 treatment sites) or acne scars (n=20, 36 treatment sites) who had an evaluator’s assessment score of
at least 2 out 7 (based on a standard photo-guide scoring) received 3 injections of autologous cultured fibroblasts
administered at 4-6 week intervals. Efficacy evaluations were performed at 2, 6, 12, and 24 months after the final
injection based on evaluator and patient’s assessment scores.
Results Our study showed a mean improvement of 2 scores in the wrinkle and acne scar treatment sites. At sixth
months after transplantation, 90.1% of the wrinkle sites and 86.1% of the acne scar sites showed at least a one grade
improvement on evaluator assessments. We also observed at least a 2-grade improvement in 56.1% of the wrinkle
sites and 63.9% of the acne scar sites. A total of 70.5% of wrinkle sites and 72.2% of acne scar sites were scored as
good or excellent on patient assessments. The efficacy outcomes remained stable up to 24-month. We did not observe
any serious adverse events during the study.
Conclusion These results have shown that autologous fibroblast transplantation could be a promising remodeling
modality with long-term corrective ability and minimal adverse events (Registration Number: NCT01115634).
Collapse
Affiliation(s)
- Amir Bajouri
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Zahra Orouji
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Ehsan Taghiabadi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Abdoreza Nazari
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Atefeh Shahbazi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Nasrin Fallah
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Parvaneh Mohammadi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mohammad Rezvani
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Zahra Jouyandeh
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Fatemeh Vaezirad
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Zahra Khalajasadi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mahshid Ghasemi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Aslan Fanni
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Sara Haji Hosseinali
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hossein Baharvand
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Saeed Shafieyan
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran. Electronic Address:
| | - Nasser Aghdami
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran. Electronic Address:
| |
Collapse
|
16
|
Mechanical modeling of pimple growth. J Mech Behav Biomed Mater 2019; 95:191-195. [PMID: 31009903 DOI: 10.1016/j.jmbbm.2019.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/12/2019] [Accepted: 04/11/2019] [Indexed: 11/24/2022]
Abstract
Pimple is one of the most common skin diseases for humans, whose growth cause pain yet the corresponding mechanical analysis is lacking. A finite element model is developed to quantify the deformation field with the expansion of follicle, and then the mechanical stimulus is related to the sensation of pain during the development of pimple. Parametric studies show the dependence of mechanical stimulus and pain level on the pimple-surrounded structures, follicle depth and mechanical properties of the epidermis. The findings in this paper may provide useful insights on prevention or pain mitigation of pimples, as well as those related to other tissue growth and respective cosmetic concerns.
Collapse
|
17
|
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]
|
18
|
Bagatin E, de Freitas THP, Machado MCR, Ribeiro BM, Nunes S, da Rocha MAD. Adult female acne: a guide to clinical practice. An Bras Dermatol 2019; 94:62-75. [PMID: 30726466 PMCID: PMC6360964 DOI: 10.1590/abd1806-4841.20198203] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/10/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution. OBJECTIVE To develop a guide for the clinical practice of adult female acne. METHODS A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne. RESULTS The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne. CONCLUSION Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.
Collapse
Affiliation(s)
- Edileia Bagatin
- Department of Dermatology, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo (SP), Brazil
- Program of Post-Graduation in Translational Medicine, Escola
Paulista de Medicina, Universidade Federal de São Paulo, São Paulo
(SP), Brazil
| | - Thais Helena Proença de Freitas
- Dermatology Service, Hospital da Santa Casa de São Paulo,
Brazil
- Dermatology Clinic, Departamento de Clínica Médica,
Santa Casa de São Paulo, São Paulo (SP), Brazil
| | - Maria Cecilia Rivitti Machado
- Department of Dermatology, Hospital das Clínicas, Faculdade
de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil
- Discipline of Dermatology, Faculdade de Medicina, Universidade
Metropolitana de Santos, Santos (SP), Brazil
| | - Beatriz Medeiros Ribeiro
- Dermatology Service, Hospital Regional da Asa Norte, Secretaria de
Saúde do Distrito Federal, Brasília (DF), Brazil
| | | | - Marco Alexandre Dias da Rocha
- Service of Cosmiatry, Department of Dermatology, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo (SP),
Brazil
| |
Collapse
|
19
|
Xiao Y, Chen L, Jing D, Deng Y, Chen X, Su J, Shen M. Willingness-to-pay and benefit-cost analysis of chemical peels for acne treatment in China. Patient Prefer Adherence 2019; 13:363-370. [PMID: 30863024 PMCID: PMC6391120 DOI: 10.2147/ppa.s194615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There have been few studies on economic evaluation of acne treatments. Chemical peel (CP), a treatment approach primarily aimed at removing acne hyperpigmentation and scarring, is gradually accepted in the Chinese market. OBJECTIVES This study aimed to detect willingness-to-pay (WTP) and to conduct a benefit-cost analysis for CP treatment among Chinese acne patients. MATERIALS AND METHODS The costs were obtained from the patient's perspective and compared with benefits. The net benefits were approximated by WTP, using the contingent valuation method. A glycolic acid peel served as the demonstrated example. WTP and related information were inquired via an online questionnaire among the Chinese population. Factors for WTP were identified using generalized linear models. The benefit-cost ratio (BCR) was calculated. Discounting was not considered for both WTP and costs. RESULTS The response rate of the survey was 95.4% among the 476 anonymous participants. The average cost for three-time CP treatment was USD 383.4. Statistically significant differences in WTP among the cases were identified. The mean WTP for Case 1, Case 2, and Case 3 was USD 234.6, 222.0, and 401.7, respectively. A statistically significant association between WTP and self-reported acne severity was observed for all cases after adjustments for demographic characteristics (P<0.01). The Cardiff Acne Disability Index was positively associated with WTP. The BCRs were 0.61, 0.58, and 1.4 for Case 1, Case 2, and Case 3, respectively. CONCLUSION Patients with acne in China are willing to pay for acne treatment. Although the benefits of CP treatment have not generally outweighed their aggregated costs, WTP for CP treatment was positively associated with self-reported acne severity and desirable efficacy of treatment. Individualized acne treatments are recommended to target a specific population in the Chinese market.
Collapse
Affiliation(s)
- Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ;
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ;
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| | - Liping Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ;
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ;
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| | - Danrong Jing
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ;
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ;
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| | - Yuxuan Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ;
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ;
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ;
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ;
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ;
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ;
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ;
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| |
Collapse
|
20
|
The ameliorative effect of hemp seed hexane extracts on the Propionibacterium acnes-induced inflammation and lipogenesis in sebocytes. PLoS One 2018; 13:e0202933. [PMID: 30148860 PMCID: PMC6110517 DOI: 10.1371/journal.pone.0202933] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/10/2018] [Indexed: 11/21/2022] Open
Abstract
In this study, we investigated the anti-microbial, anti-inflammatory, and anti-lipogenic effects of hemp (Cannabis sativa L.) seed hexane extracts, focusing on the Propionibacterium acnes-triggered inflammation and lipogenesis. Hemp seed hexane extracts (HSHE) showed anti-microbial activity against P. acnes. The expression of iNOS, COX-2, and the subsequent production of nitric oxide and prostaglandin increased after infection of P. acnes in HaCaT cells, however, upon treating with HSHE, their expressions were reduced. P. acnes-induced expressions of IL-1β and IL-8 were also reduced. HSHE exerted anti-inflammatory effects by regulating NF-κB and MAPKs signaling and blunting the translocation of p-NF-κB to the nucleus in P. acnes-stimulated HaCaT cells. Moreover, P. acnes-induced phosphorylation of ERK and JNK, and their downstream targets c-Fos and c-Jun, was also inhibited by HSHE. In addition, the transactivation of AP-1 induced by P. acnes infection was also downregulated by HSHE. Notably, HSHE regulated inflammation and lipid biosynthesis via regulating AMPK and AKT/FoxO1 signaling in IGF-1-induced inflammation and lipogenesis of sebocytes. In addition, HSHE inhibited 5-lipoxygenase level and P. acnes-induced MMP-9 activity, and promoted collagen biosynthesis in vitro. Thus, HSHE could be utilized to treat acne vulgaris, through its anti-microbial, anti-inflammatory, anti-lipogenic, and collagen-promoting properties.
Collapse
|
21
|
Al Qarqaz F, Al-Yousef A. Skin microneedling for acne scars associated with pigmentation in patients with dark skin. J Cosmet Dermatol 2018. [DOI: 10.1111/jocd.12520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Firas Al Qarqaz
- Department of Dermatology; Jordan University of Science and Technology; Irbid Jordan
| | - Ali Al-Yousef
- Computer Department; Computer and Information Technology College; Jerash University; Jerash Jordan
| |
Collapse
|
22
|
Ng QX, Koh SSH, Shin D, De Deyn MLZQ, Ho CYX. Use of polymethylmethacrylate (PMMA) microspheres collagen to treat atrophic acne scars. Med Hypotheses 2017; 108:115-116. [PMID: 29055383 DOI: 10.1016/j.mehy.2017.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/07/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Abstract
Acne scarring is a common and persistent sequela affecting many individuals worldwide, with significant physical and long-lasting psychological effects. Currently, the treatment options available for acne scars are mostly invasive and have several side effects. This paper explores the possibility of using polymethylmethacrylate (PMMA) collagen microspheres, a relatively underexplored technique hitherto, to treat common atrophic scars. PMMA-collagen is more popularly used in injectable wrinkle fillers. Preliminary research has shown that PMMA-collagen has a beneficial effect on atrophic scars while having the added advantage of being safe, tolerable and minimally invasive as well.
Collapse
Affiliation(s)
- Qin Xiang Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
| | - Shawn Shao Hong Koh
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Dongju Shin
- Department of Chemistry, Yonsei University, 50 Yonsei-ro, Seoul 120-749, South Korea
| | | | - Collin Yih Xian Ho
- National University Hospital, National University Health System, Singapore 119074, Singapore
| |
Collapse
|
23
|
Abdel Aal AM, Ibrahim IM, Sami NA, Abdel Kareem IM. Evaluation of autologous platelet-rich plasma plus ablative carbon dioxide fractional laser in the treatment of acne scars. J COSMET LASER THER 2017; 20:106-113. [DOI: 10.1080/14764172.2017.1368667] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ahmed Mohammed Abdel Aal
- Department of Dermatology and Venerology (Laser Unit), Al-Hussein Hospital, Faculty of Medicine, Al- Azhar University, Cairo, Egypt
| | - Ibrahim Maeraj Ibrahim
- Department of Dermatology and Venerology (Laser Unit), Al-Hussein Hospital, Faculty of Medicine, Al- Azhar University, Cairo, Egypt
| | - Nevein Ahmed Sami
- National Institute of Laser Enhanced Sciences, Cairo University, Egypt
| | - Ibrahim Mohammed Abdel Kareem
- Department of Dermatology and Venerology (Laser Unit), Al-Hussein Hospital, Faculty of Medicine, Al- Azhar University, Cairo, Egypt
| |
Collapse
|
24
|
Yeo DC, Balmayor ER, Schantz JT, Xu C. Microneedle physical contact as a therapeutic for abnormal scars. Eur J Med Res 2017; 22:28. [PMID: 28807013 PMCID: PMC5557429 DOI: 10.1186/s40001-017-0269-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/04/2017] [Indexed: 12/23/2022] Open
Abstract
Background Abnormal (keloid and hypertrophic) scars are a significant affliction with no satisfactory single modality therapy to-date. Available options are often ineffective, painful, potentially hazardous, and require healthcare personnel involvement. Herein a self-administered microneedle device based on drug-free physical contact for inhibiting abnormal scars is reported. Its therapeutic activity through microneedle contact eliminates hazards associated with toxic anti-scarring drugs while self-treatment enables administration flexibility. Methods The microneedle patch was fabricated with FDA-approved liquid crystalline polymer under good manufacturing practice. It was first tested to ascertain its ability to inhibit (keloid) fibroblast proliferation. Later the microneedle patch was examined on the rabbit ear hypertrophic scar model to explore its potential in inhibiting the generation of abnormal scars post-injury. Finally, the microneedle patch was applied to the caudal region of a hypertrophic scar located on a female patient’s dorsum to verify clinical efficacy. Results On untreated control cultures, barely any non-viable fibroblasts could be seen. After 12-h treatment with the microneedle patch, the non-viable proportion increased to 83.8 ± 11.96%. In rabbit ear hypertrophic scar model, 100% of the control wounds without the presence of patches on rabbit ears generated regions of raised dermis originating from the wound site (3/3), whereas microneedle treatment prevented dermis tissue thickening in 83.33% of the wounds (15/18). In the clinical test, the microneedle patch was well tolerated by the patient. Compared to the untreated region, microneedle treatment decreased the number of infiltrated inflammatory cells, with less disrupted dermis tissue architecture and more flattened appearance. Conclusions A self-administered, drug-free microneedle patch appears highly promising in reducing abnormal scarring as observed from in vitro, in vivo and clinical experiments. Larger cohort clinical studies need to be performed to validate its efficacy on abnormal scars. Electronic supplementary material The online version of this article (doi:10.1186/s40001-017-0269-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- David C Yeo
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 70 Nanyang Drive, Singapore, 637457, Singapore
| | - Elizabeth R Balmayor
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute for Advanced Study, Technical University of Munich, Munich, Germany
| | - Jan-Thorsten Schantz
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 70 Nanyang Drive, Singapore, 637457, Singapore. .,Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Chenjie Xu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 70 Nanyang Drive, Singapore, 637457, Singapore. .,NTU-Northwestern Institute for Nanomedicine, Nanyang Technological University, Singapore, Singapore.
| |
Collapse
|
25
|
Layton AM, Whitehouse H, Eady EA, Cowdell F, Warburton KL, Fenton M. Prioritizing treatment outcomes: How people with acne vulgaris decide if their treatment is working. J Evid Based Med 2017; 10:163-170. [PMID: 28444879 DOI: 10.1111/jebm.12249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/08/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To collect information about how people with acne make day-to-day decisions concerning the effectiveness of their treatment. METHODS Between May and August 2013, an optional question was embedded in the James Lind Alliance Acne Priority Setting Partnership's online survey to collect treatment uncertainties. The question asked people with acne to "Tell us in your own words how you decide if your treatment has been effective." RESULTS A total of 742 respondents specified at least one outcome or means of assessing change (outcome measure). Fewer spots were the most commonly cited outcome, identified by 272 respondents (36.7%). Other frequently mentioned outcomes were in descending order: less redness (19.4%), reduction in spot size (12.1%), and less pain/discomfort (11.4%). Signs were much more commonly used than symptoms and surrogate outcomes such as changes in aspects of life quality were infrequently mentioned. Visual inspection of the skin was the most widely adopted outcome measure (16.3%). CONCLUSIONS Although the most frequently used methods map well onto the outcome measures adopted in the majority of acne trials, namely physician-assessed changes in lesion counts and global acne severity, people with acne often take into account several factors that cannot be assessed by a third party at a single point in time. The minimal use of changes in psychosocial wellbeing and mood may reflect that these are regarded as secondary consequences of improvements in appearance. The robustness of these findings now requires independent evaluation. If confirmed, they could form the basis of a new patient-reported outcome measure.
Collapse
Affiliation(s)
- Alison M Layton
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Heather Whitehouse
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - E Anne Eady
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | | | - Mark Fenton
- National Institute for Health and Clinical Effectiveness, City Tower, Piccadilly Plaza, Manchester, UK
| |
Collapse
|
26
|
Treatment of Acne Scars on Darker Skin Types Using a Noninsulated Smooth Motion, Electronically Controlled Radiofrequency Microneedles Treatment System. Dermatol Surg 2017; 43 Suppl 1:S64-S69. [PMID: 28009691 DOI: 10.1097/dss.0000000000000894] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Noninvasive technologies for treating acne scars use radiofrequency (RF)-emitting microneedles for both mechanical disruption of fibrotic strands and heat-mediated collagen remodeling. OBJECTIVE Efficacy and safety evaluation of electronically controlled noninsulated RF microneedling system on acne scars in patients with dark skin. METHODS Nineteen patients, 24 to 51 years old, skin types III to V, with acne scars were enrolled in the study. Each patient had 3 treatment sessions at monthly intervals using a multisource RF treatment platform with a microneedle RF applicator. Efficacy was evaluated by the Goodman and Barron's Global Qualitative Acne Scarring System. RESULTS No bleeding points occurred during treatments. Post-treatment erythema was observed immediately after the treatment and lasted up to 10 hours after the treatment. Improvement of at least 1 acne scar grade was noted in 11 of 19 patients (57.9%) after 1 month and in 9 of 9 patients (100%) after 3 months. CONCLUSION The tested noninsulated electronically controlled RF microneedles were found to be safe and efficient in the treatment of atrophic acne scars in skin types III to V with minimal pain or downtime.
Collapse
|
27
|
Dreno B, Tan J, Rivier M, Martel P, Bissonnette R. Adapalene 0.1%/benzoyl peroxide 2.5% gel reduces the risk of atrophic scar formation in moderate inflammatory acne: a split-face randomized controlled trial. J Eur Acad Dermatol Venereol 2016; 31:737-742. [DOI: 10.1111/jdv.14026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/18/2016] [Indexed: 01/12/2023]
Affiliation(s)
| | - J. Tan
- Windsor Clinical Research Inc. and Western University; Windsor ON Canada
| | - M. Rivier
- Galderma R&D; Sophia Antipolis France
| | - P. Martel
- Galderma R&D; Sophia Antipolis France
| | | |
Collapse
|
28
|
Forbat E, Al-Niaimi F. Fractional radiofrequency treatment in acne scars: Systematic review of current evidence. J COSMET LASER THER 2016; 18:442-447. [DOI: 10.1080/14764172.2016.1225964] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- E. Forbat
- King Edward VII Hospital, London, UK
| | - F. Al-Niaimi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas’ Hospital, London, UK
| |
Collapse
|
29
|
Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M. Treatment Modalities for Acne. Molecules 2016; 21:E1063. [PMID: 27529209 PMCID: PMC6273829 DOI: 10.3390/molecules21081063] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/26/2016] [Accepted: 08/08/2016] [Indexed: 01/19/2023] Open
Abstract
Acne is a common inflammatory skin disease which affects the pilosebaceous units of the skin. It can have severe psychological effects and can leave the patient with severe skin scarring. There are four well-recognized pathological factors responsible for acne which is also the target for acne therapy. In this review, different treatment options are discussed, including topical (i.e., retinoids, and antibiotics) and systemic (i.e., retinoids, antibiotics, and hormonal) treatments. Since the general public has been showing an increasing interest in more natural and generally safer treatment options, the use of complementary and alternative medicines (CAM) for treating acne was also discussed. The use of physical therapies such as comedone extraction, cryoslush therapy, cryotherapy, electrocauterization, intralesional corticosteroids and optical treatments are also mentioned. Acne has been extensively researched with regards to the disease mechanism as well as treatment options. However, due to the increasing resistance of Propionibacterium acnes towards the available antibiotics, there is a need for new treatment methods. Additionally, the lack of necessary evidence on the efficacy of CAM therapies makes it necessary for researchers to investigate these treatment options further.
Collapse
Affiliation(s)
- Lizelle Fox
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - Candice Csongradi
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - Marique Aucamp
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - Jeanetta du Plessis
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - Minja Gerber
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| |
Collapse
|
30
|
Goh CL, Noppakun N, Micali G, Azizan NZ, Boonchai W, Chan Y, Cheong WK, Chiu PC, Etnawati K, Gulmatico-Flores Z, Foong H, Kubba R, Paz-Lao P, Lee YY, Loo S, Modi F, Nguyen TH, Pham TL, Shih YH, Sitohang IB, Wong SN. Meeting the Challenges of Acne Treatment in Asian Patients: A Review of the Role of Dermocosmetics as Adjunctive Therapy. J Cutan Aesthet Surg 2016; 9:85-92. [PMID: 27398008 PMCID: PMC4924420 DOI: 10.4103/0974-2077.184043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Conventional acne treatment presents several challenges such as intolerable side effects and antibiotic resistance. Dermocosmetic products may be used to reduce these unwanted effects. Dermocosmetics include skin cleansers, topical sebum-controllers, skin antimicrobial/anti-inflammatory agents, moisturizers, sunscreens, and camouflage products. Appropriate use of these products may help augment the benefit of acne treatment, minimize side effects, and reduce the need for topical antibiotics. In Asia, there is currently limited scientific data on the application and recommendations for dermocosmetic use in acne vulgaris (AV). This article reviews the evidence on dermocosmetics for AV and provides practice recommendations as discussed during the 4th Asia-Pacific Acne Leaders' Summit held in Bangkok, Thailand, on 7 and 8 February 2015. Through a premeeting survey, a series of plenary lectures, a stepwise program of discussion sessions, and Medline article review, the Expert Panel set forth relevant recommendations on the role of dermocosmetics as adjunct for treating AV in Asian patients.
Collapse
Affiliation(s)
- Chee Leok Goh
- Department of Dermatology, National Skin Centre, Singapore
| | - Nopadon Noppakun
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Noor Zalmy Azizan
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Waranya Boonchai
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yung Chan
- Cutis Medical Group, Hong Kong, China
| | | | - Pin Chi Chiu
- International Aesthetic Medical Center, Chinese Medical University Hospital, Taichung City, Taiwan
| | - Kristiana Etnawati
- Department of Dermatology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Henry Foong
- Foong Skin Specialist Clinic, Ipoh, Perak, Malaysia
| | | | - Purita Paz-Lao
- Derma Clinic, Makati Medical Center, Makati City, Manila, Philippines
| | | | - Steven Loo
- Dermatology and Venereology, Hong Kong Adventist Hospital, Hong Kong, China
| | - Farida Modi
- Dermacare Skin Clinic and Cosmetic Centre, Mumbai, India
| | | | - Thi Lan Pham
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | - Yi Hsien Shih
- Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Irma Bernadette Sitohang
- Cosmetic Dermatology Division, Department of Dermatovenereology, Faculty of Medicine Universitas/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Su Ni Wong
- Dr SN Wong Skin, Hair, Nails and Laser Specialist Clinic, Mt Elizabeth Medical Centre, Singapore
| |
Collapse
|
31
|
Abdel Hay R, Shalaby K, Zaher H, Hafez V, Chi C, Dimitri S, Nabhan AF, Layton AM. Interventions for acne scars. Cochrane Database Syst Rev 2016; 4:CD011946. [PMID: 27038134 PMCID: PMC7069546 DOI: 10.1002/14651858.cd011946.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acne scarring is a frequent complication of acne and resulting scars may negatively impact on an affected person's psychosocial and physical well-being. Although a wide range of interventions have been proposed, there is a lack of high-quality evidence on treatments for acne scars to better inform patients and their healthcare providers about the most effective and safe methods of managing this condition. This review aimed to examine treatments for atrophic and hypertrophic acne scars, but we have concentrated on facial atrophic scarring. OBJECTIVES To assess the effects of interventions for treating acne scars. SEARCH METHODS We searched the following databases up to November 2015: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2015, Issue 10), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers, and checked the reference lists of included studies and relevant reviews for further references to randomised controlled trials. SELECTION CRITERIA We include randomised controlled trials (RCTs) which allocated participants (whether split-face or parallel arms) to any active intervention (or a combination) for treating acne scars. We excluded studies dealing only or mostly with keloid scars. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data from each of the studies included in this review and evaluated the risks of bias. We resolved disagreements by discussion and arbitration supported by a method expert as required. Our primary outcomes were participant-reported scar improvement and any adverse effects serious enough to cause participants to withdraw from the study. MAIN RESULTS We included 24 trials with 789 adult participants aged 18 years or older. Twenty trials enrolled men and women, three trials enrolled only women and one trial enrolled only men. We judged eight studies to be at low risk of bias for both sequence generation and allocation concealment. With regard to blinding we judged 17 studies to be at high risk of performance bias, because the participants and dermatologists were not blinded to the treatments administered or received; however, we judged all 24 trials to be at a low risk of detection bias for outcome assessment. We evaluated 14 comparisons of seven interventions and four combinations of interventions. Nine studies provided no usable data on our outcomes and did not contribute further to this review's results.For our outcome 'Participant-reported scar improvement' in one study fractional laser was more effective in producing scar improvement than non-fractional non-ablative laser at week 24 (risk ratio (RR) 4.00, 95% confidence interval (CI) 1.25 to 12.84; n = 64; very low-quality evidence); fractional laser showed comparable scar improvement to fractional radiofrequency in one study at week eight (RR 0.78, 95% CI 0.36 to 1.68; n = 40; very low-quality evidence) and was comparable to combined chemical peeling with skin needling in a different study at week 48 (RR 1.00, 95% CI 0.60 to 1.67; n = 26; very low-quality evidence). In a further study chemical peeling showed comparable scar improvement to combined chemical peeling with skin needling at week 32 (RR 1.24, 95% CI 0.87 to 1.75; n = 20; very low-quality evidence). Chemical peeling in one study showed comparable scar improvement to skin needling at week four (RR 1.13, 95% CI 0.69 to 1.83; n = 27; very low-quality evidence). In another study, injectable fillers provided better scar improvement compared to placebo at week 24 (RR 1.84, 95% CI 1.31 to 2.59; n = 147 moderate-quality evidence).For our outcome 'Serious adverse effects' in one study chemical peeling was not tolerable in 7/43 (16%) participants (RR 5.45, 95% CI 0.33 to 90.14; n = 58; very low-quality evidence).For our secondary outcome 'Participant-reported short-term adverse events', all participants reported pain in the following studies: in one study comparing fractional laser to non-fractional non-ablative laser (RR 1.00, 95% CI 0.94 to 1.06; n = 64; very low-quality evidence); in another study comparing fractional laser to combined peeling plus needling (RR 1.00, 95% CI 0.86 to 1.16; n = 25; very low-quality evidence); in a study comparing chemical peeling plus needling to chemical peeling (RR 1.00, 95% CI 0.83 to 1.20; n = 20; very low-quality evidence); in a study comparing chemical peeling to skin needling (RR 1.00, 95% CI 0.87 to 1.15; n = 27; very low-quality evidence); and also in a study comparing injectable filler and placebo (RR 1.03, 95% CI 0.10 to 11.10; n = 147; low-quality evidence).For our outcome 'Investigator-assessed short-term adverse events', fractional laser (6/32) was associated with a reduced risk of hyperpigmentation than non-fractional non-ablative laser (10/32) in one study (RR 0.60, 95% CI 0.25 to 1.45; n = 64; very low-quality evidence); chemical peeling was associated with increased risk of hyperpigmentation (6/12) compared to skin needling (0/15) in one study (RR 16.00, 95% CI 0.99 to 258.36; n = 27; low-quality evidence). There was no difference in the reported adverse events with injectable filler (17/97) compared to placebo (13/50) (RR 0.67, 95% CI 0.36 to 1.27; n = 147; low-quality evidence). AUTHORS' CONCLUSIONS There is a lack of high-quality evidence about the effects of different interventions for treating acne scars because of poor methodology, underpowered studies, lack of standardised improvement assessments, and different baseline variables.There is moderate-quality evidence that injectable filler might be effective for treating atrophic acne scars; however, no studies have assessed long-term effects, the longest follow-up being 48 weeks in one study only. Other studies included active comparators, but in the absence of studies that establish efficacy compared to placebo or sham interventions, it is possible that finding no evidence of difference between two active treatments could mean that neither approach works. The results of this review do not provide support for the first-line use of any intervention in the treatment of acne scars.Although our aim was to identify important gaps for further primary research, it might be that placebo and or sham trials are needed to establish whether any of the active treatments produce meaningful patient benefits over the long term.
Collapse
Affiliation(s)
- Rania Abdel Hay
- Faculty of Medicine, Cairo UniversityDepartment of Dermatology13th Abrag OthmanKournish el MaadiCairoEgypt11431
| | | | - Hesham Zaher
- Faculty of Medicine, Cairo UniversityDepartment of Dermatology13th Abrag OthmanKournish el MaadiCairoEgypt11431
| | - Vanessa Hafez
- Cairo UniversityDepartment of Dermatology, Faculty of MedicineKasr El Aini Hospital Medical School15 Nasser Street from Fatma Roshdi St.Haram, GuizaCairoEgypt
| | - Ching‐Chi Chi
- Chang Gung Memorial HospitalDepartment of Dermatology and Centre for Evidence‐Based Medicine6, Sec West, Chia‐Pu RoadPuzihChiayiTaiwan61363
- Chang Gung UniversityCollege of MedicineTaoyuanTaiwan
| | - Sandra Dimitri
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of MedicineRamsees street, AbbaseyaCairoEgypt11566
| | - Ashraf F Nabhan
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of MedicineRamsees street, AbbaseyaCairoEgypt11566
| | - Alison M Layton
- Harrogate and District NHS Foundation TrustDepartment of DermatologyHarrogateUK
| | | |
Collapse
|
32
|
Park SY, Park MY, Suh DH, Kwon HH, Min S, Lee SJ, Lee WJ, Lee MW, Ahn HH, Kang H, Lee JB, Ro YS, Ahn KJ, Kim MN, Kim KJ, Kim NI. Cross-sectional survey of awareness and behavioral pattern regarding acne and acne scar based on smartphone application. Int J Dermatol 2015; 55:645-52. [PMID: 26340516 DOI: 10.1111/ijd.12853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/06/2014] [Accepted: 09/08/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although acne scar is a permanent sequela that may be induced by improper management of active acne lesion, patient behavior patterns and awareness regarding acne are unclear. The aim of this study was to identify awareness and behavioral patterns concerning acne and acne scar of people having acne and differences between those with and without acne scars. METHODS The survey was performed via smartphone application for 900 participants in their second to fourth decade having current or previous acne lesions. They were further categorized into two groups based on the presence of acne scar (scar and scarless groups) with no statistical difference in demographic composition. RESULTS The mean age of all participants was 24.6 ± 5.3. The scar group had a longer disease duration (4.9 years) than those of the scarless group (2.2 years). Participants in the scar group thought that acne scarring affected psychosocial aspects more negatively compared with those in the scarless group. Participants in the scarless group visited dermatology clinics earlier than those in the scar group. In the scar group, 62.1% of participants have never had their acne scars treated medically. Most (88.6%) participants from both groups believed that non-dermatologic treatment caused side effects or aggravated their acne. CONCLUSIONS Participants with acne scars tended to treat their acne and acne scars improperly, which could negatively affect their daily lives. Acne scars are sequelae of acne and should be regarded as a distinct disease entity, requiring a patient's early visit to dermatologic clinics.
Collapse
Affiliation(s)
- Seon Yong Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - Mi Youn Park
- Department of Dermatology, National Medical Center, Seoul, South Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - Hyuck Hoon Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - Seonguk Min
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - Sang Joo Lee
- Yeonsei Star Skin and Laser Clinic, Seoul, South Korea
| | - Weon Ju Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyo Hyun Ahn
- Department of Dermatology, College of Medicine, Korea University, Seoul, South Korea
| | - Hoon Kang
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jee Bum Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, South Korea
| | - Kyu Joong Ahn
- Department of Dermatology, School of Medicine, Konkuk University, Seoul, South Korea
| | - Myeung Nam Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kwang Joong Kim
- Department of Dermatology, College of Medicine, Hallym University, Anyang, South Korea
| | - Nack In Kim
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, South Korea
| | | |
Collapse
|
33
|
Cheng L, Sun X, Hu C, Jin R, Sun B, Shi Y, Cui W, Zhang Y. In vivo early intervention and the therapeutic effects of 20(s)-ginsenoside rg3 on hypertrophic scar formation. PLoS One 2014; 9:e113640. [PMID: 25502572 PMCID: PMC4264739 DOI: 10.1371/journal.pone.0113640] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/27/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Intra-lesional injections of corticosteroids, interferon, and chemotherapeutic drugs are currently the most popular treatments of hypertrophic scar formation. However, these drugs can only be used after HS is formed, and not during the inflammatory phase of wound healing, which regulates the HS forming process. OBJECTIVE To investigate a new, effective, combining therapeutic and safe drug for early intervention and treatment for hypertrophic scars. METHODS Cell viability assay and flow cytometric analysis were studied in vitro. Animal studies were done to investigate the combining therapeutic effects of 20(S)-ginsenoside Rg3 (Rg3) on the inflammatory phase of wound healing and HS formation. RESULTS In vitro studies showed that Rg3 can inhibit HS fibroblasts proliferation and induce HSF apoptosis in a concentration-dependent manner. In vivo studies demonstrated that Rg3 can limit the exaggerated inflammation, and do not delay the wound healing process, which indicates that Rg3 could be used as an early intervention to reduce HS formation. Topical injection of 4 mg/mL Rg3 can reduce HS formation by 34%. Histological and molecular studies revealed that Rg3 injection inhibits fibroblasts proliferation thus reduced the accumulation of collagen fibers, and down-regulates VEGF expression in the HS tissue. CONCLUSION Rg3 can be employed as an early intervention and a combining therapeutic drug to reduce inflammation and HS formation as well.
Collapse
Affiliation(s)
- Liying Cheng
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital affiliated to Medical School of Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, People's Republic of China
| | - Xiaoming Sun
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital affiliated to Medical School of Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, People's Republic of China
| | - Changmin Hu
- Orthopedic Institute, Soochow University, 708 Renmin Road, Suzhou, Jiangsu 215006, People's Republic of China
| | - Rong Jin
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital affiliated to Medical School of Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, People's Republic of China
| | - Baoshan Sun
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital affiliated to Medical School of Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, People's Republic of China
| | - Yaoming Shi
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital affiliated to Medical School of Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, People's Republic of China
| | - Wenguo Cui
- Orthopedic Institute, Soochow University, 708 Renmin Road, Suzhou, Jiangsu 215006, People's Republic of China
- * E-mail: (YZ); (WC)
| | - Yuguang Zhang
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital affiliated to Medical School of Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, People's Republic of China
- * E-mail: (YZ); (WC)
| |
Collapse
|
34
|
Abstract
INTRODUCTION Acne is the most common skin condition in the US. The mainstay of acne therapy includes: topical retinoids, topical antibiotics, benzoyl peroxide (BP), and oral isotretinoin for severe cases. Although these treatment options are highly effective they do have certain drawbacks. Current acne treatment regimens often require patients to use multiple medications, some of which may have irritating side effects. Furthermore, Propionibacterium acnes resistance to antibiotics has become an increasing problem due to the rise in antibiotic use. AREAS COVERED New therapies that have either been released onto the market or that are being developed include: adapalene-BP combination agent, dapsone 5% gel, minocycline foam, topical nitric oxide-releasing agent, cortexolone 17 α-propionate, and CIP isotretinoin. Some of these new therapies address the challenges faced with existing treatment options. For instance, the relatively new combination therapy, adapalene-BP, limits antibiotic resistance and also helps simplify treatment regimens. The newly developed topical nitric oxide-releasing agent also holds potential in limiting antibiotic resistance. EXPERT OPINION Many of the new therapies discussed in this paper are still in early stages of testing so it is difficult to predict their outlook; however, based on preliminary findings, these therapies seem to be promising.
Collapse
Affiliation(s)
- Imran Aslam
- Wake Forest School of Medicine, Center for Dermatology Research, Department of Dermatology, Medical Center Boulevard , Winston-Salem, NC 27157-1071 , USA
| | | | | |
Collapse
|
35
|
Hexsel D, Soirefmann M, Porto MD, Schilling-Souza J, Siega C, Dal'Forno T. Superficial Dermabrasion Versus Topical Tretinoin on Early Striae Distensae: A Randomized, Pilot Study. Dermatol Surg 2014; 40:537-44. [DOI: 10.1111/dsu.12460] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Kerwin LY, El Tal AK, Stiff MA, Fakhouri TM. Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches. Int J Dermatol 2014; 53:922-36. [DOI: 10.1111/ijd.12436] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Abdel Kader El Tal
- Department of Dermatology; Wayne State University; Dearborn MI USA
- Department of Dermatology; American University of Beirut; New York NY USA
| | - Mark A. Stiff
- Department of Dermatology; Wayne State School of Medicine; Southfield MI USA
| | | |
Collapse
|