Journal of Cosmetics, Dermatological Sciences and Applications

Published by Scientific Research Publishing
Online ISSN: 2161-4105
Nine-year-old male patient with history of localized vitiligo for 1 year treated by Pimecrolimus cream. Lesions on right knee at (A) baseline visit; (B) after 3 months and (C) after 6 months.
Percent reduction at each visit for both groups.
Twenty-year-old male patient with history of localized vitiligo for 2 years treated by Pimecrolimus cream. Lesions on back at (A) baseline visit; (b) after 3 months and (C) after 6 months.
Percent reduction according to site for both groups.
Age, duration of the disease, and surface area of lesions for both groups.
Background: Calcineurin inhibitors like tacrolimus and pimecrolimus are new modality of treat- ment of localized vitiligo. Objective: To compare the effectiveness and side effects of 1% pimecro- limus cream in comparison with 0.05% clobetasol propionate cream as a treatment of localized type of vitiligo. Patients and Methods: Fifty two patients with localized vitiligo were included in this single, blind, comparative therapeutic trial. Full history and examination for each patient was done. Wood's light was used when needed to confirm the diagnosis. Thirty (57.7%) were females and 22 (42.3%) males, female to male ratio of 1.36:1. Their ages ranged between 3 - 40 (13.15 ± 7.9) years, while disease duration ranged from 6 - 84 (29.62 ± 20.56) months. Total numbers of le- sions were 114 lesions with a mean of 2.2 lesions per patient. The surface area of the lesions ranged between 1 - 31 (7.15 ± 6.98) cm². Vitiliginous patches were most commonly located on face 48 (42.1%) lesions, and lower limbs 35 (30.7%) lesions. Patients were divided in to two groups according to the type of therapeutic modality. Group A consisted of 25 patients (52 lesions) re- ceiving 1% pimecrolimus cream and Group B 27 patients (62 lesions) treated with 0.05% clobeta- sol propionate cream, both used twice daily. The amount of cream per area was applied according to rule of fingertip unit. Measuring the surface area of the lesions and calculating the reduction rate were done every month till the end of the 6 th month. Then patients were asked to stop the use of medication to be re-evaluated again after 3 months without any treatment and to record any local or systemic side effects. Results: After 6 months of treatment there was 79.67% reduction in the surface area of lesions in Group A, while in Group B there was 82.59% reduction in the surface * Corresponding author.
Professor Syed Ghulam Shabbir (1923-2002).  
Professor Syed Ghulam Shabbir (1923-2002), is one of the Pakistani well-known dermatologists. In 1986, Shabbir and his colleagues described a novel autosomal recessive syndrome, which they called laryngoonychocutaneous syndrome. They reported this condition, in 22 patients in 12 families living in Lahore, Pakistan. This syndrome is characterized by cutaneous erosions, nail dystrophy and exuberant vascular granulation tissue in certain epithelia, especially conjunc-tiva and larynx. This report sheds light on Shabbir and the syndrome that bears his name.
Background: The pathogenesis of acne vulgaris is multifactorial, and therapy can be directed at many of these factors, singly or in combination. There are different modalities of treatment of active acne vulgaris but they are often long lasting which could not be accepted by many patients. Objective: To evaluate the effectiveness, long term efficacy and safety of chemical peeling using 35% TCA solution in the treatment of active acne vulgaris. Patients and Methods:This clinical, interventional, therapeutic study was done at the Department of Dermatology—Baghdad Teaching Hospital during the period from January 2012 to March 2013. Eighteen patients with active acne vulgaris were included in this study, 10 (55.6%) females and 8 (44.4%) males. Their ages ranged from 15 to 35 (21.56 ± 5.501) years. Twelve patients were associated with acne scars. History and dermatological examination were performed for all patients regarding all demographic points related to the disease. Chemical peeling with 35% TCA used one session regarding active acne vulgaris and three sessions in patients with associated scarring. Scoring for active acne vulgaris and acne scar was done for each case before and after peeling to evaluate the severity of acne lesions and scarring. All patients were with Fitzpatrick’s skin types III and IV. Patients were followed up every two weeks for 12 weeks after starting therapy and every 4 weeks for 12 weeks after stopping the treatment to watch improvement, side effects and relapse. Results: Scoring for active acne vulgaris including papules and pustules showed highly statistically significant reduction after 2 weeks of therapy (p Conclusions: Chemical peeling by TCA 35% is a cost-effective mode of therapy for active acne vulgaris and acne scar with low down time in patients with dark complexion.
The proportion of etiological factors in the cases.
The proportion of various clinical abnormalities in the sample.
The number of patients per the place where the procedure was performed.
Background: Nowadays, the use of dermal fillers for correcting signs of aging, such as wrinkles, depressions, and folds, has become increasingly popular. However, the abuse of these products can lead to disfigurements and unpredictable consequences among users. Objective: To evaluate the clinical abnormalities related to dermal fillers abuse in Iraqi people, and identify the various factors contributing to them. Methods: A total of 35 patients with different facial abnormalities due to the abuse of dermal fillers, attending our clinic in Diwaniyah, Iraq, from September 2016 to December 2017, were enrolled. A questionnaire-based analysis was used to collect clinical and sociodemographic data from patients to determine the etiological profile behind this problem. Several disfigurements and facial defects were diagnosed on clinical base. We have treated most of the situations that require intervention and treatment. Results: A total of 35 patients aged between 25 and 54 years with a sex ratio of 0.093 were enrolled in this study. Their mean age was 42 years, and the age group between 35 and 45 years was forming 85.7% of the cases. The clinical abnormalities recorded in this study include: buffy face 8 (22.8%), facial asymmetry 3 (8.5%), Mdoka fish lips like 6 (17%), periorbital redness 1 (2.8%), filler fatigue 6 (17%), bags under eyes 4 (11.4%), sizeable bulbous nose 4 (11.4%), topographical changes 2 (5.7%), and stone-like cheeks 1 (2.8%). The leading causes of the abuse of fillers were as follows: 12 (34.28%) candidates were not compatible with the procedure, 9 (25.7%) were non-compliance with the indications of the Food and Drug Organization (FDA), 9 (25.7%) fillers were injected in the wrong place, 18 (51.4%) injections were of a larger quantity than required, and 5 (14.2%) had a frequent and long-term injection. Conclusion: The use of dermal fillers for a wrong purpose can result in disfigurements rather than beautification. The commonest disfigurements are the puffy face, enlarged lips, and bags under eyes. The clinical uses of dermal fillers in Iraq need to be monitored by the health authorities, with the assurance that these products should be sold only by a doctor’s prescription to reduce their abuse.
Tissue engineering strategies. 
Skin bioprinting for functional skin. 
Tissue engineering has been used for the treatment of several skin diseases and lesions; however, tissue engineering and regenerative medicine also have a huge potential in cosmetology. They include skin substitutes, cell therapy and wound-healing treatments based on biomaterial-based replacements and 3D systems. This review focuses on the bioprinting technology and how it can improve skin functions, restoring pigmentation or helping hair follicles to develop.
This paper reports the clinical experience of a multi-center, multiple physician trial with a novel fractional radiofrequency ablative skin resurfacing and rejuvenation device (Fractora, Invasix, Israel) deployed on both Caucasian skin types I - III and Asian skin type IV. Histological study demonstrated deep ablation and collagen restructuring in the papillary and reticular dermis. The Fractora device combines the more “cone shaped” ablation seen with CO2 and Erbium lasers with a deep non-ablative heating pattern, seen with other bipolar RF fractional needle resurfacing devices. Ablation, coagulation zones and healing dynamics are analyzed for different energy settings. Two different treatment protocols are suggested: one for light skin and then one for darker skin with a higher risk of post-inflammatory hypperpigmentation. Treatment results show improvement in skin texture, pores, wrinkles and skin dyschromia.
Fractora handpiece with 24 pin tip. 
Study participants and treatment characteristics. 
Active acne and acne scars before (A, B, C) and after (D, E, F) four Fractora treatments. 
Histological sections of skin biopsies from a representative patient before Fractora treatments. (a) Demonstrates acne scar tissue 1.5 mm deep in the dermis, devoid of hair follicles and sebaceous glands. H&E staining. (b) Demonstrates thick and disorganized collagen fibers in the acne scar tissue (circle), as opposed to normal collagen pointed by arrow. H&E staining. (c) Demonstrates acne scar tissue mostly devoid of elastic fibers (circle), as opposed to normal elastic fibers pointed by arrow. VVG and Shikata staining. 
Background: Acne vulgaris (AV) is a common disease that often results in disfiguring facial scarring that carries into adulthood. Here we report our experience with fractional radiofrequency (FRF) device in treatment of patients with acne and acne related scarring. Materials & Methods: We retrospectively reviewed the charts of all patients with acne scarring who completed a four treatment regimen in our clinic. Results: We identified eight patients who completed four treatments with median age of 20.5 years (range 17 - 41). All patients demonstrated significant improvement of acne lesions and acne scarring. Skin biopsies demonstrated reduction of scar depth and increased new collagen production, and repopulation of the scar tissue by elastic fibers and adnexal structures after the fourth treatment. Conclusion: FRF emerges as a safe and effective treatment modality for AV and acne related scars. Further randomized controlled studies are required to fully evaluate the magnitude of this positive effect and more basic science studies are needed in order to better characterize its mechanism of action on acne lesions.
Bilateral symmetrical distribution of acanthosis nigricans on the face.
Showing the correlation between ANSI score & HDL & TCH levels.
Showing the correlation between ANSI score & insulin & growth hormone levels.
Showing the correlation between ANSI score & leptin level.
Showing the correlation between ANSI score & AC & AIP levels.
Background: Acanthosis nigricans is a well known cause of facial melanosis in Iraqi males and usually it is a part of ordinary acanthosis nigricans. It is commonly associated with many metabol- ic derangements. Objectives: To evaluate cases of acanthosis nigricans of the face for all metabolic disturbances including fasting blood sugar, fasting serum insulin, total cholesterol, triglyceride, growth hormone and serum leptin. Patients and Methods: Twenty seven cases of acanthosis nigri- cans of the face were included in this case descriptive, clinical and biochemical study. This was conducted in Department of Dermatology-Baghdad Teaching Hospital and Department of Clinical Biochemistry, College of Medicine, Baghdad, Iraq during the period from November 2012-August 2014. It consisted of 26 males and one female, their ages ranged from 16 - 58 (39 ± 4.9) years. The diagnosis was established by clinical and histopathological evaluation. Sharquie's ANSI scoring of acanthosis nigricans of face was carried out for all patients, also body mass index was assessed. Biochemical evaluation was carried out for all patients including total cholesterol, triglyceride, fasting blood sugar and insulin, insulin resistance, growth hormone and leptin enzyme immu- noassay. Twenty seven healthy control non obese individuals with comparable ages and gender were assessed for all tests. Results: Biochemical results showed that fasting blood glucose, fasting serum insulin, insulin resistance, fasting serum triglyceride, total cholesterol, growth hormone and serum leptin were statistically significantly high in patients with acanthosis nigricans of the face in comparison with control individuals and all were positively correlated with the scoring of acanthosis nigricans of the face apart from high density lipoprotein was negatively correlated. Conclusion: Acanthosis nigricans of the face is a good marker for the associated metabolic diseases and these metabolic changes were statistically significantly correlated with the severity of acan- thosis nigricans. * Corresponding author.
Preservation of viable tissue is important in wound management. It is achieved by small, incremental removal of de-vitalised, necrotic and infected tissues. Maggot debridement therapy (MDT) is used in septic necrotic wounds that fail to respond to conventional modalities. MDT has relied on Lucilia sericata, which consumes only necrotic tissues, as opposed to Lucilia cuprina, which devours both flesh and necrotic tissues. Recent findings have shown that L. cuprina consumes mainly necrotic and very small amounts of viable tissues and may be used in MDT where L. sericata is very rare or absent. Here we describe wound healing in a patient from rural South Africa with cutaneous myiasis. Our find-ings agree with workers who indicated that L. cuprina could be used in MDT.
The decrease of intracellular TG level by β-CRX in hamster sebocytes. Hamster sebocytes at the 3rd passage were treated every two days for 8 days with or without β-CRX (1.1-10 μM) in the presence or absence of insulin (Ins) (10 nM). A: The harvested cell lysate was subjected to the measurement of intracellular TG level as described in the Materials and Methods. B: Isolated RNA (an equivalent of 2.5 ng of total RNA) from the cells was subjected to the analysis of DGAT-1 mRNA expression as described in the Materials and Methods. Data are shown as mean ± SD of three dishes. * and ** , significantly different from untreated cells (Cont) (p < 0.05 and 0.01, respectively). # and ## , significantly different from insulin (Ins) (10 nM)-treated cells (p < 0.05 and 0.01, respectively). 
β-CRX decreases sebum accumulation in insulindifferentiated hamster sebocytes. Hamster sebocytes treated with insulin (10 nM) and/or β-CRX (10 μM) as shown in Figure 2 were subjected to oil red O staining for the analysis of intracellular sebum accumulation as described in the Materials and Methods. A: untreated cells; B: insulin (10 nM)-treated cells; and C: cells treated with insulin (10 nM) and β-CRX (10 μM). Bars: 50 μm. 
β-CRX and 13-cisRA suppress the production of PLIN1 in insulin-differentiated hamster sebocytes. Cell lysate (50 μg protein) prepared from hamster sebocytes treated every two days for 8 days with insulin (10 nM), β-CRX (1.1-10 μM), and/or 13-cisRA (1 μM) was subjected to Western blot analysis for PLIN1 and β-actin as described in the Materials and Methods. Data are shown as mean ± SD of four independent experiments. ***, significantly different from untreated cells (p < 0.001). # and ### , significantly different from insulin (10 nM)-treated cells (p < 0.05 and 0.001, respectively). 
Suppression of PLIN1 mRNA expression by bCRX in insulin-differentiated hamster sebocytes. Isolated RNA (an equivalent of 2.5 ng of total RNA) from the cells treated with insulin (10 nM), β-CRX (1.1-10 mM), and/or 13-cisRA (1 mM) as shown in Figure 5 was subjected to the analysis of PLIN1 mRNA expression as described in the Materials and Methods. Data are shown as mean ± SD of four different experiments. *, significantly different from untreated cells (p < 0.05). # and ## , significantly different from insulin (10 nM)-treated cells (p < 0.05 and 0.01, respectively). 
Background: Acne vulgaris is characterized by the enhancement of sebaceous lipogenesis and sebum secretion, and apart from retinoids and some natural products there are few effective antiacne agents that directly suppress sebum production and accumulation in sebaceous glands. Objective: We examined the effects of β-cryptoxanthin (β-CRX), which is a carotenoid pigment most abundant in Citrus unshiu Marcovich (Satsuma mandarin orange) and plays a role as a vitamin A precursor on sebum production and accumulation in hamster sebaceous gland cells (sebocytes). Materials and methods: The regulation of sebum production was examined by the measurement of triacylglycerols (TGs), the major sebum component, and oil red O staining in insulindifferentiated hamster sebocytes. The expression of diacylglycerol acyltransferase-1 (DGAT-1), a rate-limiting enzyme of TG biosynthesis, and perilipin 1 (PLIN1), a lipid storage droplet protein, was analyzed using real-time PCR and Western blotting. Results: Hamster sebocytes constitutively produced TGs during cultivation and the production of TGs was enhanced by insulin treatment. Both constitutive and insulin-enhanced TG productions were dose- and time-dependently inhibited by β-CRX as well as 13-cis retinoic acid. In addition, the gene expression of DGAT-1 was suppressed by β-CRX in the sebocytes. Furthermore, the insulin-en- hanced sebum accumulation as lipid droplets was reduced in the β-CRX-treated cells. Moreover, β-CRX was found to suppress the gene expression and production of PLIN1 in insulin-differentiated hamster sebocytes. Conclusions: These results provide novel evidence that β-CRX is an effective candidate for acne therapy by its ability to exert dual inhibitory actions against DGAT-1-dependent TG production and PLIN1-mediated lipiddroplet formation in hamster sebocytes.
The inflammatory and fibrous responses to injuries are painful and are inhibitory to the regeneration of specialized cells. The fibrous scarring of skin injuries can also be disfiguring. Cells obtain energy not only from the metabolism of food, but also via the alternative cellular energy (ACE) pathway. The ACE pathway is reflected in a dynamic (kinetic) quality of the body’s fluids. It is postulated to result from the absorption of an environmental force called KELEA (kinetic energy limiting electrostatic attraction). The body’s ACE pathway can be enhanced by the parental administration and even the oral consumption of products comprising KELEA activated water. One of these products, termed Enercel, was originally considered a complex homeopathic remedy. Another product is water containing electrolysis-generated, copper-silver-citrate (CSC) complexes. This product was initially formulated to be bacteriocidal, especially for Gram positive bacteria. This article describes the independent successful use of each of these two products in achieving essentially painless, scar-free healing of skin injuries. The skin injuries were due to a variety of causes including: vascular insufficiency from diabetes; hot water burn; penetrating object; chronic infection; and surgical incision. It is proposed that the ACE pathway increases the resilience of cells of the innate immune system to the triggering of an inflammatory reaction by “danger signals” released from damaged tissues. KELEA activated water should be widely available for the urgent therapy of burns and other traumatic injuries to the skin. ACE pathway enhancing modalities also need to be evaluated in the repair of cellular damage occurring to the heart, brain and other internal organs of the body.
Procedure of the study performed on the skin of the left forearm of the subjects.
Background: Carnosine is a low molecular weight water soluble biological dipeptide, composed of alanine and histidine, present in a levorotatory form in mammalian tissues. Interesting activities are related to the detoxification from free radical species and byproducts of membrane lipids peroxidation. Objectives: The aim of the present study was to evaluate the photoprotective properties of carnosine and acetylated carnosine when applied to human skin. Materials and methods: Carnosine and N-acetylcarnosine at 0.5% solution in water were applied before and after UVB irradiation in twenty healthy volunteers with phototype 2 or 3. 9 patients were males and 11 females, 25 to 46 years of age. None of the patients had a positive case history for photodermatoses or had received any sun exposure. The minimal erithemal dose (MED) for UVB was determined before the study with a UVB Philips TL12 lamp with a radiance of 4 mW/cm2 and a 290 - 320 nm emission spectrum. Results: Carnosine solution obtained 3.6% reduction of erythema (compared to MED) and N-acetylcarnosine 7.3% reduction. Conclusions: An antioxidant capacity of N-acetylcarnosine and carnosine was shown, probably more significant with vehicles improving skin penetration of the substances through skin barrier. N-acetylcarnosine represents an interesting hydrophilic antioxidant for dermatological preparations.
Comparison of NANA and other skin lightening agents. 
Screening of major ingredients from EBN by LC-MS/MS. (a) Full scan of total ion chromatography of different water extracts of different grades of EBNs. Three outstanding peaks with the highest abundance were recorded along with the retention time. (b) Mass spectrums of the outstanding peaks from the full scan were obtained. From which, peak 1 were identified as protein-like molecules while peak 2 and peak 3 were identified as NANA (m/z 307.9  87.0 and m/z 307.9  170.0) and citric acid (m/z 191.0  111.0 and m/z 191.0  86.9) respectively. NANA and citric acid standards were applied for the identification. n = 4.
EBNs inhibit the activity of tyrosinase. (a) Different concentrations of L-DOPA were added to testing reagent containing mushroom tyrosinase (5000 U/mL) and incubated for 1 hour. Absorbance readings were taken at 492 nm. (b) The dopachrome formed by oxidation of 0.5 mM of L-DOPA incubated for 20 min with 0.2 mg/mL mushroom tyrosinase, served as blank control. Vitamin C (5 mM) served as a positive control. The dopachrome concentration, after treatment of different EBNs or adulterants (all at 10 mg/mL water extract), was determined. (c) Protein was depleted from the water extracts of different EBNs by precipitation using acetonitrile. The percentage of inhibition on tyrosinase activities before and after protein depletion was recorded. One mg/mL extract was added. The percentage of inhibition on tyrosinase activities was presented as Mean ± SD (n = 3). ***p < 0.001 versus reference group.
NANA inhibits tyrosinase (a) The reaction rate of mushroom and human tyrosinase was defined as 100% activity (i.e. 29.75 µM/min and 147.20 nM/min, respectively) with the substrate of 0.5 mM of L-DOPA. The inhibition effects of NANA from 0 mM to 25 mM on the mushroom and human tyrosinase activity were shown. The reaction velocity was calculated by the concentration of dopachrome, measured by spectrometer at 492 nm against time in min. Lineweaver-Burk plot of different concentrations of NANA on (b) mushroom tyrosinase and (c) human tyrosinase. Values are Mean ± SD (n = 3).
NANA and EBN inhibit melanin formation in cultured B16 and A375 cells. (a) B16 murine melanoma and (c) A375 human melanoma cells were seeded on 6-well plate and cultured in DMEM supplemented with 10% fetal bovine serum. On the following day, B16 cells were exposed to vitamin C (5 mM), as a positive control. For A375 human melanoma, 10 nM of α-MSH was applied to all samples to stimulate melanogenesis on day 2. Microscopic views of different wells were captured after 48 hours of incubation. Images were captured from intact B16 cells to observe the release of melanosomes. Scale bar = 100 µm. (b) Melanin from B16 cells and (d) A375 cells with or without the treatment of vitamin C (5 mM), or tBHQ (50 µM), or 2% kojic acid, or NANA (20 mM), or EBN extracts (1 mg/mL), were extracted and measured by spectrometer at 405 nm. Melanin concentrations were converted from the absorbance of 405 nm using melanin standard curve. The content of melanin were presented as Mean ± SD (n = 3). One-way ANOVA was performed on the data set by GraphPad 5.0. Statistical significant differences were indicated. ***P < 0.001 versus reference group.
Edible bird's nest (EBN; Yan Wo), or cubilose, is originated from the salivary secretion of Aero-dramus fuciphagus. In Asia, EBN is famous for its unproven skin lightening function. Here, we aim to reveal the active ingredients of EBN responsible for skin lightening function. Three major fractions were isolated from EBN water extract by chromatography using LC-MS/MS, bioactivities of these isolated fractions were analyzed by assays of tyrosinase, melanocytes and 3D human skin model, from which, N-acetylneuraminic acid (NANA), the second isolated fraction showed an inhibition effect on tyrosinase activity in a dose-dependent manner. The IC50 of tyrosinase originated from mushroom and human was 16.93 mM and 0.10 mM respectively. Furthermore, only EBN with higher content of NANA (e.g. White and Red EBN), but not EBN with less NANA (e.g. Grass EBN), showed promising skin lightening function. This is the first report to reveal NANA being an active ingredient of EBN on skin lightening function.
Ex-vivo UV aged skin histology at D2 in survival medium. Immunohistochemical analysis of mitotic cells in the epidermis (Ki67, ×400: 1 cm = 19 µm). Left: untreated. Right: treated with TriFractional RF pulse. Increase of mitotic cells in the zone adjacent to the fractional RF treatment area is demonstrated. 
Ex-vivo UV aged skin histology at D10 in survival medium. Histological analysis of dermal collagen stained by sirius red (×400: 1 cm = 19 µm). Left: untreated. Right: treated with TriFractional RF pulse. Increase of collagen fibers in the dermis under the fractional RF treatment zone is demonstrated. 
Introduction: The need for cosmetic facial enhancement procedures with minimal down time and low risk has led to the development of methods for non-surgical skin rejuvenation. Various ablative lasers were developed, which remove the full skin surface in a controlled manner. However, the prolonged recovery and the significant risks prompted the development of fractional lasers which ablate the skin in a fractional manner, leaving untreated areas to improve healing process. In the past few years, fractional radiofrequency (RF) systems have been introduced that enable controlled skin resurfacing accompanied with dermal collagen remodeling. The new TriFractional technology from Pollogen ® is designed to enable skin resurfacing and treatment of wrinkles using RF energy. The objective of the current research was to evaluate the safety and effectiveness of the novel TriFractional technology using the TriFractional applicator (A3F) for micro-ablative skin resurfacing and the treatment of wrinkles and acne scars. Methods: Healthy volunteers consented to undergo TriFractional treatments for various aesthetic indications. In addition, in-vivo and ex-vivo histological results showing immediate and long term effects of the TriFractional technology were obtained. A portion of the subjects underwent the complete TriLipo Med ™ Procedure which includes 2 TriFractional treatments spaced one month apart, with 2 TriLipo RF + Dynamic Muscle Activation (DMA) face treatments two weeks after each TriFractional treatment. Results: Subjects experienced an improvement of wrinkles, skin texture and acne scars along with facial contouring. No significant adverse effects were detected post-treatment. Histology findings demonstrated immediate and long term TriFractional effects on both epidermal and dermal skin layers. Conclusions: TriFractional is a promising technology for skin resurfacing, treatment of wrinkles and improvement of additional aesthetic indications such as acne scars. The TriLipo MED ™ procedure is a unique combination approach for total facial rejuvenation and contouring.
A patient with acne scars before and six months after subcision.
A patient with rolling & icepick acne scars before and six months after subcision. 
A patient with depressed acne scars before and six months after subcision.
Background: Acne vulgaris is a very common skin disease among young people which might be associated with scarring that has a great impact on the emotional, psychological and social life of the patients as it will go with them for life. Subcision is a new technique for the treatment of acne scars. Objective: To assess objectively and subjectively the efficacy and safety of subcision in the treatment of depressed acne scars. Patients and Methods: This is an open-label therapeutic trial. A total of 16 patients were enrolled in this study. Twelve were males and 4 were females. Their ages ranged from 19 - 39 with a mean of 26.64 ± 5.64. The duration of scar varied between 6 months and 10 years with a mean of 4.14 ± 2.54 years. subcision was done by introducing a sterile, hypodermic, 18-gauge needle. The needle was held by a three ml syringe for better orientation of the sharp tip of the needle. It was kept horizontal to the skin surface with the bevel up, and was introduced in a high sub dermal plane. The needle was slowly advanced parallel to the skin surface. Initially, rapid, repetitive linear back-and-forth motion of the needle makes the skin free of the underlying scar. This procedure was repeated in all directions in a fan-like manner. Results: According to Modified Sharquie’s scoring system for grading acne scars, 4 (25%) patients had severe grade, 11 (68.8%) patients had moderate grade and only 1 (6.2%) patient had mild grade. Evaluation at 6 months after treatment revealed that 8 (50%) patients had mild acne scar, 7 (43.8%) had moderate acne scar and only 1 (6.2%) patient still had severe grade. This change in the grades was statistically significant (p-value = 0.01713441). The average score before treatment was 13.13 ± 2.363; it became 9.50 ± 2.944 after 6 months. By paired t-test comparison, the difference in the score was statistically highly significant (p = 0.000044). Regarding the photographic assessment, the difference in the visual analogue scale before and after treatment was statistically significant (p-value = 0.043823). All patients were satisfied regarding subcision as treatment for their acne scars with variable degrees. In general the reported side effects were transient and vanished within 3 - 7 days apart from firm bumps which resolved within 12 weeks in all patients. Conclusion: Subcision appears to be simple, safe, minimally invasive, well-tolerated, and effective surgical procedure that provides significant long-term betterment for depressed acne scars especially for the rolling type.
Top-cited authors
Adil Noaimi
  • University of Baghdad
Khalifa E Sharquie
  • University of Baghdad
Swati Gajbhiye
  • L.A.D college
Sevgi Güngör
  • Istanbul University
Buket Aksu
  • Istanbul Altinbas University