An objective assessment of microneedling therapy in atrophic facial acne scars

CONTEXT

Microneedling therapy is one of the recent advances in treating acne facial scars.

AIM

To evaluate the efficacy of microneedling therapy in the treatment of atrophic acne facial scars.

SETTINGS AND DESIGN

A total number of 10 patients between the age group of 20 and 40 years (8 women and 2 men) who complained of acne scars from November 2012 to August 2014 were selected for the study.

SUBJECTS AND METHODS

Microneedling therapy was performed following the application of the Eutectic Mixture of Local Anesthetics in an interval of 2 months. All patients underwent three sessions. A follow-up of 2 months after the last sitting was carried out.

STATISTICAL ANALYSIS

Cochran's Q-paired test, Kendall's W-test, and Pearson's correlation were used for statistical analysis.

RESULTS

Patients in our study had three forms of acne scars: box-scar, icepick form, and rolling scars. Patients were told to rate the outcome of the treatment at the end of the follow-up. Three observers randomly selected were shown the pre- and postoperative photographs of the patients to rate the treatment outcome. Statistically there was no interobserver bias. Ninety percent reduction in number of scars and depth of scars was noted at the end of three sittings. The improvement in pigmentation was insignificant. Seventy percent improvement in the skin texture was noted. Nine patients suffered from transient postinflammatory erythema and six patients had postoperative swelling.

CONCLUSION

Microneedling therapy is a safe and effective method of treating acne scars.

Facial rejuvenation using stem cell conditioned media combined with skin needling: A split-face comparative study

BACKGROUND

The use of stem cells derived growth factors is representing a novel treatment modality in facial rejuvenation. Nowadays, skin needling is considered a very famous treatment of skin aging. However, the addition of such derived products, augments its therapeutic efficacy in the management and delay of skin aging.

OBJECTIVE

Comparing the effect of amniotic fluid mesenchymal stem cell derived conditioned media (AF-MSC-CM) combined with skin needling versus the needling alone in the management of facial aging.

METHODS

Both sides of the face of ten volunteers, suffering from facial aging, were treated with five sessions of skin needling, 2 weeks apart. After skin microneedling, AF-MSC-CM was added topically to the right side only. Clinical, histological, and morphometrical assessment of the treated skin was done at 1 month after the last session.

RESULTS

The percentage of improvement of aged skin increased significantly on the combined treated side (AF-MSC-CM and dermaroller [DR]), when compared with the other side (DR only) (P < .001). Remodeling of the dermal structures was observed mainly on the combined side. Meanwhile, histometry of the epidermis revealed a significant increase in the epidermal thickness on both treated sides.

CONCLUSION

AF-MSC-CM combined with skin needling was more efficient in managing facial aging than skin needling alone.

Effects of different therapeutic modalities for postacne scars on circulating collagen III

BACKGROUND

Therapies for postacne scarring act through modulation of elastin and collagen, and collagen III might therefore represent a biomarker of treatment effectiveness.

PATIENTS AND METHODS

Patients (n = 70) with postacne scars and individuals without scars (n = 56) were included in this case-control study. Patients were treated with Dermaroller microneedling, trichloroacetic acid chemical reconstruction, punch excision, or scar subcision. Scar severity was graded immediately before and after treatment with a photographic quartile scale and the ECCA scale. Serum levels of collagen III were measured in control individuals and in patients, before treatment, 1 month after the first treatment session, and 4 months after the final session.

RESULTS

Circulating levels of collagen III were significantly higher in patients with postacne scarring (24.1 ± 12.5) before treatment than in control individuals (2.6 ± 0.8). Circulating levels of collagen in patients were significantly lower 4 months posttreatment (14.3 ± 8.1) than at baseline. The mean percentage change in serum collagen III was positively correlated with both the mean percentage improvement by photographic evaluation (r = .530, P < .000) and the mean percentage change in the ECCA scale (r = .632, P < .000).

CONCLUSION

Circulating collagen III is a biomarker for improvement of postacne scarring following different therapies.

Efficacy of microneedling with topical vitamin C in the treatment of melasma

BACKGROUND

Despite the wide therapeutic options available for the treatment of melasma, including many active topical medications, technologies with lights and peelings, clinical control of this disorder is extremely challenging.

OBJECTIVES

To evaluate the effect of microneedling with topical vitamin C in the treatment of melasma.

METHODS

Thirty female patients with melasma received six sessions of microneedling with addition of topical vitamin C every two weeks. At each session, photos were taken and Melasma Area and Severity Index (MASI) score was calculated to assess the clinical improvement.

RESULTS

Mean age of the eligible patients was 33.2 ± 5.77 years. About 50% of cases were of Fitzpatrick skin type III. All patients showed improvement at the end of the sessions. Mean MASI score in the first session was 8.61 ± 4.45 and there was a gradual decline in its value till it reached a mean of 5.75 ± 4.16 in the last session (P < 0.0001).

CONCLUSION

Microneedling with topical vitamin C is an effective and safe treatment option for epidermal melasma especially in Fitzpatrick skin phototypes I-III.

Amniotic fluid-derived mesenchymal stem cell products combined with microneedling for acne scars: A split-face clinical, histological, and histometric study

BACKGROUND

Postacne scars are still a challenge in its management. Microneedling is a popular minimally invasive technique in treatment of such scars. However, the addition of topical stem cell products after microneedling is considered a new treatment regimen for these scars.

OBJECTIVE

To compare efficacy of amniotic fluid-derived mesenchymal stem cell-conditioned media (AF-MSC-CM) and microneedling vs microneedling alone in management of atrophic acne scars.

METHODS

Ten cases with atrophic postacne scars received five sessions of microneedling, with 2-week interval on both sides of the face. Then, AF-MSC-CM was topically applied to right side of the face after microneedling. Clinical examination with histopathological and computerized histometric analysis was done 1 month after the sessions.

RESULTS

There was significant increase in the improvement percentage of acne scars on right side (dermaroller and AF-MSC-CM) vs left side of face (dermaroller; P < 0.001). Histologically, improvement of character of collagen and elastic fibers was noticed, especially on right side. Meanwhile, significant increase in epidermal thickness on both sides of face was detected.

CONCLUSION

Amniotic fluid-derived mesenchymal stem cell-conditioned media combined with microneedling is more effective in management of atrophic postacne scars than microneedling alone.

Efficacy of fractional carbon dioxide laser versus microneedling in the treatment of striae distensae

Background: Fractional photothermolysis is creation of microscopic thermal zones of controlled depth, width and density. Microneedling is a simple treatment modality to reduce striae distensae. Objective: Evaluate and compare the efficacy of fractional carbon dioxide laser and microneedling as a treatment of striae distensae. Methods: Individuals with striae distensae received three split-body treatments at four-week intervals. The right side of the body was treated with fractional CO₂ laser, while the other side with microneedling. Assessment was done by comparing photographs before and after treatments by two blinded physicians using a quartile grading scale. Evaluation also included patient satisfaction score and histopathological examination. Results: In total 33 subjects were enrolled and 30 completed the study. By quartile grading score, we recorded 55% moderate-excellent improvement of striae in the dermaroller-treated side but with fractional CO₂ laser-treated side, we recorded 76% of patients had moderate-excellent improvement. Patients were more satisfied with fractional CO₂ laser than the microneedling. Post-inflammatory hyperpigmentation, as a complication of fractional CO₂ laser, appeared in 11 patients. Conclusion: Fractional CO₂ laser is more effective in treating striae with acceptable side effects but still microneedling can be afforded as an effective, safe and cheap method.

A Comparative Study of Combined Dermaroller and Platelet-Rich Plasma Versus Dermaroller Alone in Acne Scars and Assessment of Quality of Life Before and After Treatment

Background:

Scarring due to acne is a frequently encountered problem in dermatological outpatient department. Microneedling has been a well-accepted modality for the treatment of atrophic acne scars. Platelet-rich plasma (PRP) is a newer option to investigate.

Aims:

The aims of this study were (1) to compare the efficacy of combined dermaroller and PRP therapy with dermaroller alone in facial acne scars and (2) to assess the psychosocial impact due to acne scars and its treatment.

Methods:

A total of 55 patients were included in the study and randomly divided into two groups, Group A: 28 and Group B: 27. Proper counseling was done, and detailed clinical findings were recorded. Patients in Group A were treated with dermaroller alone while Group B patients underwent treatment with a combination of dermaroller and intradermal PRP injections. A total of three sitting were done at monthly interval. Final response was assessed at 1 month after the last sitting. Criteria of evaluation included Goodman and Baron's quantitative scale, visual analog score, and dermatology life quality index scores. Side effects were noted. Results were analyzed using Chi-square test and t-test.

Results:

Significant percentage improvement was noted in both the groups. However, Group B treated with both modalities had better results when compared with that in the Group A.

Conclusion:

A combination approach using dermaroller and PRP was a safe and better option than using dermaroller alone in atrophic acne scars for clinical improvement as well as for improvement in dermatology life quality index score.

Split Face Comparative Study of Microneedling with PRP Versus Microneedling with Vitamin C in Treating Atrophic Post Acne Scars

Introduction:

Acne scars are largely preventable complications of acne. 95% of the scars occur over the face thus impacting the quality of life. Correction of scars is the priority for acne patients.

Materials and Methods:

Thirty patients with post acne atrophic facial scars attending the OPD during the period from April to October 2013 were offered four sittings of microneedling with PRP on one side and microneedling with vitamin C on other side of the face at an interval of 1 month.

Results:

Twenty-seven out of the total 30 patients completed the treatment schedule. Two patients were lost to follow up and one dropped out of the study due to severe PIH. Mean age of the patients was 27.5 years. Out of 30 patients, 23 achieved reduction in scarring by one or two grades. Excellent response was seen in five (18.5%) patients with platelet-rich plasma (PRP) as compared to two (7%) patients who received treatment with vitamin C according to physician's assessment. As far as up gradation by 1 score is considered, i.e., good response, it was similar in both cases. Vitamin C did not prove to be as efficacious as PRP since 10 (37%) patients had poor response in vitamin C-treated area compared to only 6 (22.2%) patients who underwent PRP therapy, but vitamin C proved to be efficacious in dealing with post inflammatory hyper-pigmentation secondary to acne. Patients were more satisfied with PRP as compared to vitamin C. The results were evaluated and statistical analysis was done using SPSS 16.0.2.

Conclusions:

Overall results were better with microneedling and PRP. Vitamin C combined with microneedling also showed improvement with respect to firmness and smoothness of skin; as well as post inflammatory hyper-pigmentation. Microneedling combined with PRP proved to be good in treating boxcar and rolling scars but had limited efficacy in dealing with ice pick scars.

A split-face comparative study to evaluate efficacy of combined subcision and dermaroller against combined subcision and cryoroller in treatment of acne scars

BACKGROUND

Acne scars occur consequent to abnormal wound healing following sebaceous follicular inflammation in acne. Various types of acne scars are icepick, rolling, boxcar, hypertrophic, and keloidal. Different modalities of treatment include subcision, dermaroller, cryoroller, punch excision, chemical peeling, and lasers.

OBJECTIVES

To compare the efficacy of combined subcision and dermaroller vs. combined subcision and cryoroller in acne scar treatment.

METHODS

Thirty patients (19 males and 11 females) with grade 2, 3, and 4 postacne scarring (Goodman and Baron qualitative grading system) were enrolled in the study. Three sittings each at 1-month interval were carried out of subcision under nerve block on the entire face followed by derma roller (2.5 mm) and cryoroller on one half of the face. Standardized digital photography was performed preprocedure and at 6 months. Grading of acne scar photographs using the Goodman and Baron qualitative and quantitative grading scale was carried out by a blinded observer pre- and postprocedure at 6 months. Patients' own evaluation based on patient scar severity perception scale of 1-10 was also taken into account.

RESULTS

Assessment using the quantitative grading scale showed a 57% improvement using combined subcision and cryoroller against 40% improvement with combined subcision and dermaroller. Average improvement perceived by the subjects was 61% with combined subcision and cryoroller against 45% with combined subcision and dermaroller. The data were analyzed using Wilcoxon signed rank test and found statistically significant. Postinflammatory hyperpigmentation on the cryoroller side and erythema, edema, and hematoma formation due to subcision was transient.

CONCLUSION

Combined subcision and cryoroller is more effective than combined subcision and dermaroller for treatment of acne scars.

A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study

Introduction:

Dermal papilla (DP) is the site of expression of various hair growth related genes. Various researches have demonstrated the underlying importance of Wnt proteins and wound growth factors in stimulating DP associated stem cells. Microneedling works by stimulation of stem cells and inducing activation of growth factors.

Materials and Methods:

Hundred cases of mild to moderate (III vertex or IV) androgenetic alopecia (AGA) were recruited into 2 groups. After randomization one group was offered weekly microneedling treatment with twice daily 5% minoxidil lotion (Microneedling group); other group was given only 5% minoxidil lotion. After baseline global photographs, the scalp were shaved off to ensure equal length of hair shaft in all. Hair count was done in 1 cm² targeted fixed area (marked with tattoo) at baseline and at end of therapy (week 12). The 3 primary efficacy parameters assessed were: Change from baseline hair count at 12 weeks, patient assessment of hair growth at 12 weeks, and investigator assessment of hair growth at 12 weeks. A blinded investigators evaluated global photographic response. The response was assessed by 7- point scale.

Results:

(1) Hair counts – The mean change in hair count at week 12 was significantly greater for the Microneedling group compared to the Minoxidil group (91.4 vs 22.2 respectively). (2) Investigator evaluation – Forty patients in Microneedling group had +2 to +3 response on 7-point visual analogue scale, while none showed the same response in the Minoxidil group. (3) Patient evaluation – In the Microneedling group, 41 (82%) patients reported more than 50% improvement versus only 2 (4.5%) patients in the Minoxidil group. Unsatisfied patients to conventional therapy for AGA got good response with Microneedling treatment.

Conclusion:

Dermaroller along with Minoxidil treated group was statistically superior to Minoxidil treated group in promoting hair growth in men with AGA for all 3 primary efficacy measures of hair growth. Microneedling is a safe and a promising tool in hair stimulation and also is useful to treat hair loss refractory to Minoxidil therapy.