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Abstract

Acne is a common condition seen in up to 80% of people between 11 and 30 years of age and in up to 5% of older adults. In some patients, it can result in permanent scars that are surprisingly difficult to treat. A relatively new treatment, termed skin needling (needle dermabrasion), seems to be appropriate for the treatment of rolling scars in acne. To confirm the usefulness of skin needling in acne scarring treatment. The present study was conducted from September 2007 to March 2008 at the Department of Systemic Pathology, University of Naples Federico II and the UOC Dermatology Unit, University of Rome La Sapienza. In total, 32 patients (20 female, 12 male patients; age range 17-45) with acne rolling scars were enrolled. Each patient was treated with a specific tool in two sessions. Using digital cameras, photos of all patients were taken to evaluate scar depth and, in five patients, silicone rubber was used to make a microrelief impression of the scars. The photographic data were analysed by using the sign test statistic (alpha < 0.05) and the data from the cutaneous casts were analysed by fast Fourier transformation (FFT). Analysis of the patient photographs, supported by the sign test and of the degree of irregularity of the surface microrelief, supported by FFT, showed that, after only two sessions, the severity grade of rolling scars in all patients was greatly reduced and there was an overall aesthetic improvement. No patient showed any visible signs of the procedure or hyperpigmentation. The present study confirms that skin needling has an immediate effect in improving acne rolling scars and has advantages over other procedures.

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... Дисхромии, возрастные изменения кожи и постакне рубцы являются основными клиническими показаниями к химическому пилингу лица [31]. Наилучшие результаты достигаются при поствоспалительных гиперпигментациях. ...
... Наилучшие результаты достигаются при поствоспалительных гиперпигментациях. Сколотые (V-образные) рубцы по типу ледоруба и закругленные рубцы полностью устранить проблематично, ведение такого рода пациентов предполагает последовательные пилинги, использование топических ретиноидов и гидроксикислот [31]. Ожидаемый уровень улучшения сильно различается у пациентов с разными особенностями кожи. ...
... Микронидлинг можно безопасно выполнять для всех цветов и типов кожи: риск поствоспалительной гиперпигментации ниже, чем при других процедурах, таких как дермабразия, химический пилинг и лазерная шлифовка. Микронидлинг противопоказан пациентам, получающим антикоагулянты непрямого действия, при активных кожных инфекциях, инъекциях коллагена и других филлеров за шесть месяцев до предполагаемой процедуры микронидлинга, а также при гипертрофических и келоидных рубцах в анамнезе [19,31]. ...
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Postacne-persistent skin changes that appear as a result of long-term acne, inadequate therapy and manipulations performed in the management of this group of patients. The post-acne symptom complex is stable skin changes that appear as a result of long-term acne inadequate therapy and manipulations performed during the management of this group of patients. The pathogenetic mechanisms underlying the launch of acne currently look as follows: androgens cause hyperseborrhea, sebum lipids activate innate immunity; pathological keratinization due to the production of IL-1 inflammatory mediator and androgen hyperproduction; Cutibacterium acnes activate innate immune responses through toll-like receptors and metalloproteinases, stimulate the production of antimicrobial peptides and sebum production. The subsequent rupture of the follicles activates the wound healing process. Depending on the genetically determined features of the course of the inflammatory process, various individual postacne changes of the skin will prevail in different patients. The article highlights the main factors influencing the formation of post-acne, pathogenetic mechanisms underlying the formation of these changes, systematizes modern data on the classification, morphological and pathohistological characteristics of scars. Quantitative and qualitative scales of assessment of post-acne scars for determining the severity of the pathological process are presented, differentiated approaches to modern methods of therapy are discussed in detail, including the advantages and disadvantages of the most common methods of treating patients based on the principles of evidence-based medicine using a number of personalized methods.
... [11] It is thought that needles break collagen bundles in the superficial layer of the dermis that are responsible for scars with subsequent induction of more collagen immediately under the epidermis. [12] Platelet-rich plasma (PRP) is an autologous concentration of human platelets contained in a small volume of plasma. [13] Various growth factors, including platelet-derived growth factor, transforming growth factor, vascular endothelial growth factor, and insulin-like growth factor, are secreted from the alpha granules of concentrated platelets activated by aggregation inducers. ...
... In some patients, the severe inflammatory response results in permanent scars. [12] Because of the prevalence of acne scarring and the strong negative emotions it causes in affected patients, dermatologists are frequently presented with the challenge of evaluating and providing treatment recommendations to patients with acne scars. ...
... Our results were in agree with previously published study by Fabbrocini et al., 2009 using skin needling only showed that the grade of severity of the acne scars in all patients was greatly reduced after only two sessions, with 8 weeks interval and the statistical analysis of the results highlighted that the reduction in severity grade of acne scars, before and after collagen induction therapy (CIT) is considered significant. [12] Also El-Domyati et al., 2015 conducted a study on using microneedling therapy only for atrophic acne scars over 6 sessions at 2-week intervals, that study showed that after one month of treatment, patients showed mild improvement (15-20%) in post-acne scars appearance (p=0.02) and skin texture (20-25%) (p= 0.02) and moderate overall satisfaction (30-40%) (p=0.01) and three months after starting treatment, significant differences were noticed among patients as they showed (51-60%) good improvement in the appearance of postacne scars (p=0.01), (40-50%) moderate improvement in skin texture (p=0.01). ...
... É um procedimento terapêutico relativamente seguro usado para corrigir distúrbios pigmentares bem como para promover o rejuvenescimento da pele, redução rítides e remodelação da cicatrizes5,20 . Fabbocini et al (2009)21 demonstraram em exame histológico pós-MA, o aumento das papilas dérmicas, da espessura da pele e significativa deposição de colágeno e elastina. ...
... Vale ressaltar de que o MA é procedimento técnico-dependente, e a familiarização com o aparelho usado e o domínio da técnica são fatores que influenciam diretamente o resultado final 21 . ...
Article
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relatar um caso clínico mostrando os benefícios da associação da técnica de microagulhamento com o uso de nutracêuticos na atenuação das rugas e manchas faciais. Descrição do Caso: paciente com 49 anos com queixa de rugas profundas na glabela e manchas por toda a face, que se agravaram pós-procedimento de microagulhamento anterior. Várias opções de tratamento foram oferecidas, mas a paciente optou pelo microagulhamento exclusivamente. Foi prescrito nutracêuticos para serem ingeridos 15 dias antes e após do procedimento, para preparo da derme. A técnica de microagulhamento foi realizada com dermapen e o drug delivery com ativo clareador Smart Hexyl Pro monodose (Smart GR). Toda face foi microagulhada com profundidades de agulhas distintas, respeitando a espessura da pele em diferentes regiões, até obtenção de hiperemia superficial. Informações sobre o procedimento e sobre os cuidados pós-operatório foram passadas à paciente. O home care foi individualizado e ajustado para maximizar os resultados. Novas sessões de microagulhamento foram realizadas da mesma forma, respeitando o intervalo de 30 dias entre estas. Conclusão: a técnica de microagulhamento associada com nutracêuticos foi efetiva para atenuar as rugas e as manchas faciais presentes, já visíveis após a primeira sessão. Mesmo sem ação de outros procedimentos associados, como a toxina botulínica, os benefícios puderam ser constatados.
... In addition, gingival improvement may be related to both the regenerative effect of MN and the antioxidant of coconut and sesame oils, where the MN technique affects the healing cascade by releasing various growth factors, such as platelet-derived growth factor, transforming growth factor-α and -β, connective tissue activating protein, connective tissue growth factor, and fibroblast growth factor (Falabella & Falanga, 2001). Besides, neovascularization and neocollagenesis are introduced by the migration and proliferation of fibroblasts and the laying down of the intercellular matrix, which gives the tightening look of the mucosa (Fabbrocini et al., 2009;Majid et al., 2014). Furthermore, Mostafa and Alotaibi (2022) reported that MN with ascorbic acid was effective in gingival depigmentation, resulting in the healthy pink apperance of the gingiva. ...
Article
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Objectives: In our research, we evaluated the effect of coconut and sesame oils using the microneedling technique on gingival inflammation and plaque accumulation among patients with gingivitis by creating microholes in the gingiva to facilitate the concentration and entrance of the oils through gingival tissues. Materials and methods: Twenty-four patients with clinically diagnosed plaque-induced gingivitis were selected from Vision dental hospital, Riyadh, KSA, and assigned to one of three groups randomly; group A consisted of eight participants who were treated with dermapen and topical coconut oil, group B had eight participants who were treated with dermapen and topical sesame oil, and group C involved eight patients who received periodontal mechanical treatment only. Postintervention gingival status and plaque status for all participants were assessed using a modified average gingival index and a plaque index at Weeks 1, 2, and 4. Results: Groups A and B experienced highly significant reductions in gingival indices, while group C showed reduced scores but was not significantly notable. On the contrary, the three studied groups exhibited no significant difference in the reduction of plaque indices when compared altogether. Conclusion: Our study demonstrated an effective novel technique that revealed a noticeable improvement in gingival status and a reduction in the average gingival index and plaque index.
... In ascending order, intradermic needle insertion, PSW and LS injection all increase local blood flow [40,41]. Furthermore, microneedling, which consists in needle insertion in scar or tendon, has been shown effective in diminishing acne scar and in treatment of Achilles tendinitis and lateral epicondyloses [42,43]. This technique creates micro-wounds, restarts normal healing process and stimulates collagen and elastin production, which are important components of skin structure. ...
Article
Full-text available
Background: An intractable plantar keratoma (IPK) is a conical thickening of the epidermis' stratum corneum and a common cause of foot pain which can have a significant, detrimental impact on the mobility, quality of life and independence of individuals. Conservative treatments are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms. The purpose of this study was the evaluation of the feasibility, safety and effectiveness of innovative treatments for intractable plantar keratoma (IPK). Methods: A randomized single blind trial with 40 patients divided with block randomization in four parallel groups was conducted to compare treatment combinations: conservative sharp debridement only or sharp debridement with needle insertion, physiological water injection or lidocaine injection. All patients obtained the same treatment four times at a four-week interval. At each visit, visual analog scale (VAS), Foot Function Index (FFI) and IPK size were evaluated. VAS and FFI were also completed at a six and twelve-month follow-up. Results: Our findings in regards to feasibility demonstrated recruitment challenges because of the anticipated pain that would be provoked by needle insertion may not be worth the potential pain relief compared to debridement alone from the patient's perspective. This was also the principal cause of drop out. Our preliminary results show no main effect of group for any of the clinical outcomes: pain felt on VAS, FFI score, IPK's size (p > 0.05). However, the analysis revealed a statistically significant effect of time on VAS (p < 0.001), FFI score (p < 0.001) and IPK's size (width and depth (p < 0.001); length (p = 0.001)), but no group x time interaction was found (p > 0.05). Conclusions: This study demonstrates that IPK treatment consisting of sharp debridement with needle insertion, physiological saline water injection or lidocaine injection is feasible and safe. There was a non-statistically significant trend toward diminishing pain intensity compared to scalpel debridement alone. The pain provoked by needle insertion and injection treatments must be addressed with a scientifically proven protocol to make it more comfortable for patients before these treatments could be considered in further studies. Trial registration: ClinicalTrials.gov, NCT04777227 . 2 March, 2021 - Retrospectively registered (All participants were recruited prior to registration).
... The studied dermapen© microneedling technique had satisfactory results in atrophic acne scars. Similar results for the microneedling technique were obtained by other associates (8,9,16). Other methods of treatments were used for acne scars such as fractional carbon dioxide (CO2) laser resurfacing unites (17), and radiofrequency microneedling (10). ...
Article
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Abstract Objectives: To find the effect of microneedling dermapen© on dark skin individuals and severe form of atrophic acne scar. Patients and methods: The study was conducted as open clinical trial in dermatology clinic at Ibn-Sina Teaching Hospital in Mosul, Iraq. Twenty-five patients were included in the study. The severity of acne scars was determined by using Goodman and Baron global quantitative acne scar grading system (GBGQASGS). Patients with grade 3 and 4 were eligible for the study. All patients underwent 4sessions of dermapen microneedling treatment at six-week intervals. Results: The studied individuals consisted of 15 (60%) patients with Grade 3, and 10 (40%) patients with Grade 4 acne scars. The results revealed that 12% of the patients had minimal improvement, 48% had a moderate improvement, 40% had good improvement and no patients showed excellent improvement according to GBGQASGS. The mean ± SD of GBGQASGS was reduced from 16.39±3.43 to 7.78±2.79 at the end of sessions (p-value <0.0001). The results showed an inverse relationship between the baseline severity score and the degree of improvement of acne scars. The effect of dermapen© on acne scars showed the largest effect on the depth of scar (Cohen d =1.53), then on number of scar (Cohen d =1.37), and lastly on size of the scar (Cohen d =1.26). No serious post treatment complications were reported. Conclusion: Dermapen© microneedling therapy can be used for the treatment of atrophic acne scars, but it is not the treatment of choice in severe form of acne scars.
... Another similar study was done by Fabbocini, which involved 32 participants with acne scars [21]. These patients were treated with microneedling procedures for four months. ...
Article
Objective To evaluate the outcomes of microneedling in patients with atrophic post-acne scars. Methodology A retrospective cross-sectional study was conducted at the Department of Dermatology, Patel Hospital for a duration of six months. Patients who were diagnosed with moderate to severe-grade atrophic acne scars were enrolled in the study. Patients with a history of photosensitivity, systemic lupus erythematosus, and xeroderma pigmentosum were excluded from the study. Goodman and Baron's acne scar-grading system was used to evaluate the degree of atrophic scarring. A total of three sessions divided into four weekly intervals were conducted. The scar-grading was done before the procedure and after three treatment sessions using Goodman and Baron's acne scar grading system. Results A total of 50 patients were included in this study; 36 (72%) were females and 14 (28%) were males, with a mean age of 30.92±6.19 years. A decrease in the acne scar-grade was noted from grade III to grade II after three sessions of treatment. A significantly higher number of patients were in grade II after three-month sessions compared with before treatment (p=0.009), and a significantly lesser number of patients were in grade III (p=0.045). A significantly higher proportion of patients with moderate acne scars, as compared to severe, were in grade II (77.3% vs. 22.7%; p<0.001). Conclusion In this study, we found an improvement in the scar grade after microneedling sessions. However, as the study was retrospective, we suggest prospective randomized controlled trials in our set-up to better uncover the role of microneedling in reducing acne scars.
... A number of studies have shown an improvement of acne scars with only occasional transient side effects, including mild erythema and edema lasting for a few hours. [69][70][71][72] A study found that rolling scars benefitted the most from MN. 73 A recent study with 12-month followup reported improvements in facial and non-facial atrophic scars in various skin types with minimal risk of adverse events. 74 MN can be synergistically combined with other modalities in the treatment of acne scars and melasma as discussed in the sections below. ...
Article
Skin resurfacing for cutaneous rejuvenation has evolved with the development of a plethora of nonsurgical and minimally invasive modalities. We have highlighted the advances in laser therapy, chemical peels, radiofrequency, microneedling, and platelet-rich plasma therapy. We have also included studies providing head-to-head comparisons between procedures and discussed relevant debates in the field. We have examined additionally combination treatments and resurfacing in acne scars, melasma, and skin of color.
... In the same time, those internal cell division possibility increments dramatically on -120 Also more mv. This possibility distinction strengths fibroblast on move keeping to the point from claiming damage and At last powers them will proliferate [6]. ...
... -Dermaroller, dermapen ve dermastamp gibi aletler kullanılarak dermise 1,5-2 mm penetre olan iğnelerle dermiste multipl çok küçük kanama odakları oluşturulur 17 ...
... The derma roller is a cylindrical shaped tool that consists of a number of fine and sharp stainless steel needles with a length of 1-3 mm. This device is applied by rolling over the skin's surface to create uniform bleeding spots [9] [10]. Currently, there is a more modern automated microneedling device than the dermaroller, with a needle speed and length that can be adjusted according to which part of the face is being treated. ...
... Transdermal administration is considered noninvasive of course, can be selfpracticed, avoids first-pass metabolism, so in these papers is highly indicated to administer even high molecular weight molecules. 14,[15][16][17][18][19][20][21][22] The strength of our work lies in the simplicity of the mixture preparation and in the minimally invasive route of administration, that avoids needle use, more accepted by the patients and free from undesirable effects, while its weakness is represented by the small number of patients enrolled so far and by the shortness of follow-up to demonstrate the permanence of the results achieved.Therefore, the study should be considered as an initial pilot study to test the method, the efficacy and the safety of the mixture. ...
Article
Introduction: Platelet Rich Plasma (PRP) and Hyaluronic acid (HA) have been proven to be effective in skin rejuvenation. The aim of this single Centre pilot study was to demonstrate the effectiveness and the safety of a new mixture of PRP and HA applied topically after microneedling to rejuvenate chrono- and photo-damaged facial skin. Methods: ten patients aged 43.3+7.7years, Glogau>II were enrolled in the study and underwent three treatments each. After preparation, PRP was mixed with non-cross-linked HA and administered topically after microneedling of the facial skin. The Wrinkle Severity Rating Scale (WSRS) and the Global Aesthetic Improvement Scale (GAIS) were used respectively by a Plastic Surgeon and by the patients to assess effectiveness of the technique. Results: No early and/or late complications were observed after the treatments. Both WSRS and GAIS score improved with statistical significance before and after the procedures and comparing the first and second, second and third and, most of all, first and third topical application. No significant differences were found comparing subgroups of patients based on age (<49 or >50), smoking habits (smokers and non-smokers), patients who practised sports or not, patients taking drugs for pre-existing disease or not, summer sun-exposed patients or not. Conclusion: This new mixture of PRP-HA with the minimally invasive method of application (topical after microneedling) has proven to be effective and free of side effects in our series. Further studies with a greater number of enrolled patients are needed in order to confirm our results.
... 5 It is thought that needles break collagen bundles in the superficial layer of the dermis that are responsible for scars with subsequent induction of more collagen immediately under the epidermis. 6 Microneedling primarily targets superficial boxcar scars. Subcision (subcutaneous incisionless surgery) is another safe technique in which a needle is inserted percutaneously adjacent to the scar to manipulate and release fibrous tissue, which pulls the scar down. ...
Article
Full-text available
Background: Acne vulgaris is a common condition with a prevalence of over 90% among adolescents and post- acne scarring is a well known sequelae. Different types of scars (ice pick, boxcar, and rolling scars) warrant a customized approach of treatment for each type. We propose a novel treatment of atrophic acne scars using combination of subcision and microneedling. Methods: Ten consecutive patients of skin types III - IV with moderate and severe facial acne scarring received three sequential subcision and microneedling treatments after informed consent over a period of three months with an interval of 4 weeks between each session. Goodman and Baron’s qualitative and quantitative acne scar grading systems along with side by side comparison of pre operative and post operative photographs were used for assessment at the end of three sessions of the combination procedure. Results: Estimation of improvement with Goodman and Baron’s Global qualitative acne scarring system , we found good results in patients with Grades 3 and 4 acne scars. Out of 7 patients with grade 4 scars, 29% showed improvement by 2 grades and 71% showed improvement by 1 grade and all the 3 patients with grade 3 scars showed improvement by 1 grade. Quantitative assessment showed 30% patients had minimal improvement, 50% had moderate improvement and 20% had good improvement in scars. Adverse effects were transient pain, erythema and oedema. Conclusion: Subcision and microneedling are simple and inexpensive office procedures which in combination are well tolerated and are efficacious in treatment of moderate and severe acne scars.
... 5 It is thought that needles break collagen bundles in the superficial layer of the dermis that are responsible for scars with subsequent induction of more collagen immediately under the epidermis. 6 Microneedling primarily targets superficial boxcar scars. Subcision (subcutaneous incisionless surgery) is another safe technique in which a needle is inserted percutaneously adjacent to the scar to manipulate and release fibrous tissue, which pulls the scar down. ...
Article
Full-text available
Background: Acne vulgaris is a common condition with a prevalence of over 90% among adolescents and post-acne scarring is a well known sequelae. Different types of scars (ice pick, boxcar, and rolling scars) warrant a customized approach of treatment for each type. We propose a novel treatment of atrophic acne scars using combination of subcision and microneedling.
... Acne vulgaris may be associated with residual pigmentation and scar formation, leading to anxiety, stress and depression. There are various treatment modalities available for acne scars, including chemical peeling, chemical reconstruction using TCA CROSS, dermabrasion, laser treatments, punch techniques, subcision and dermal fillers [5]. Different types of ablative and non-ablative lasers can be used for scar treatment. ...
Article
Full-text available
Background: Both salicylic acid (SA) and trichloroacetic acid (TCA) have proven efficacy with good safety profiles in the treatment of acne vulgaris. Objectives: This study compared the clinical efficacy and safety of 25% TCA and 30% SA peels in the treatment of mild and moderate acne vulgaris. Methods: Patients with mild or moderate acne vulgaris were randomized into 2 groups of 25 persons each, and treated with either the TCA peel or the SA peel at 2-week intervals for 12 weeks. Evaluation of active acne was done by individual lesion counts (comedones, papules and pustules) and calculation of the Michaelsson acne score (MAS). Results: Both peels led to significant decrease in individual lesion counts and MAS compared to baseline values, without significant differences between the treatment groups. Thus, the peels had equivalent efficacy against acne vulgaris. The TCA peel was better in treating non-inflammatory lesions, while the SA peel was better for inflammatory lesions, but the differences were not significant. No serious adverse effects were recorded, but more patients in the TCA peel group experienced burning and stinging sensations. Conclusion: The efficacy of 25% TCA is comparable to that of 30% SA in mild-to-moderate acne vulgaris, but safety and tolerability were better with the SA peel than TCA peel.
... MNs with small length (usually less than 1000 µm [180,181]) penetrate the stratum corneum and open windows for the ISF biosensing or form transient microchannels for drug delivery while preventing the nerves and blood vessels from stimulation and impairment. Currently, MNs have been utilized for applications in the following areas: ISF sampling [180,182], disease diagnostics [153,183,184], drug delivery [179,185,186], cosmetics [181,[187][188][189], etc. ...
Article
Full-text available
Recent advances in lab-on-a-chip technology establish solid foundations for wearable biosensors. These newly emerging wearable biosensors are capable of non-invasive, continuous monitoring by miniaturization of electronics, and integration with microfluidics. The advent of flexible electronics, biochemical sensors, soft microfluidics, and pain-free microneedles have created new generations of wearable biosensors that explore brand-new avenues to interface with the human epidermis for monitoring physiological status. However, these devices are relatively underexplored for sports monitoring and analytics, which may be largely facilitated by the recent emergence of wearable biosensors characterized by real-time, non-invasive, and non-irritating sensing capacities. Here, we present a systematic review of wearable biosensing technologies with a focus on materials and fabrication strategies, sampling modalities, sensing modalities, as well as key analytes and wearable biosensing platforms for healthcare and sports monitoring with an emphasis on sweat and interstitial fluid biosensing . This review concludes with a summary of unresolved challenges and opportunities for future researchers interested in these technologies. With an in-depth understanding of the state-of-the-art wearable biosensing technologies, wearable biosensors for sports analytics would have a significant impact on the rapidly growing field—microfluidics for biosensing. This article is part of a Special Issue entitled ‘Microfluidics for Biosensing’.
... One hypothesis suggested that multiple microchannels created in the scar tissue can physically break compact collagen bundles in the dermis, which can stimulate the spontaneous formation of collagen and elastin under the scar region. 44,45 Creating multiple micro-wounds on the skin surface can stimulate the release of growth factors that directly affect the synthesis of collagen and elastin and their deposition in the skin. 46 Further cellular-molecular studies are required for a more specific and accurate description of the mechanism of the effect of microneedling. ...
Article
Full-text available
Microneedling can accelerate skin repair through numerous complex processes triggered by micro-injuries it produces on the skin surface with very thin needles. The current growth in the application of microneedling in the treatment of cutaneous diseases can be explained by its numerous effects on the skin as reported in the literature. Despite the numerous studies conducted on the application of microneedling in the treatment of skin lesions, its effects on pigmented skin lesions have remained relatively unexplored. The present review comprises an examination of the evidence for the application of microneedling in skin diseases in general and a comprehensive review of the applications of microneedling in pigmentation disorders. The review involved a search of all clinical studies, including trials, case reports, and case series, in the databases MEDLINE/PubMed and Google Scholar using the following keywords: “microneedling”, “dermal needling”, “percutaneous collagen induction”, “skin needling”, “dermaroller”, and “dermatology disorder”. Pertinent data were extracted from all relevant articles published from 1990 to April 2021, and focused on the application of microneedling in the treatment of pigmented skin lesions. Despite the limited number of available studies, evidence suggests the effectiveness and safety of microneedling in treating vitiligo, melasma, and periorbitalhypermelanosis. It is noteworthy that the combination of any type of non-aggressive needing technique with other effective therapies (especially topical agents and mesotherapy) yields more promising therapeutic results than single therapy for melasma, dark cycles and vitiligo as the prototype of pigmentary disorders. However, single needling therapy is significantly effective, too. This article is protected by copyright. All rights reserved.
... This helps in treating scars, stretch marks, wrinkles, laxity in the skin, and for facial rejuvenation. [47][48][49] The 'poke with patch' approach, the solid microneedles is punctured into the membrane surface forming micro holes. Then the microneedle is detached and the drug is applied on the membrane in the form of a ointment. ...
Article
Microneedle plays an efficient role in delivering drugs as a modernized technique. The research on microneedle is still a challenging role as it involves various factors like design, material, drug nature, drug delivery approach, and other environmental facts. Proportional with design, testing of microneedle also involves various methods like experimental, analytical, and numerical methods. The available testing methods for predicting the microneedle behavior under compression loading are discussed. In this review, the categorization of microneedle based on the fabrication, types, geometrical shape, drug delivery approach, and material so far used is elaborated. The drive of this paper is to deliver a detailed outline of polymer materials on microneedle. It is observed that in recent years polymer microneedle can endure the applied force and avoid a catastrophe during the puncture process for delivering drugs.
... There are many reports available which have studied the effects of each of these techniques individually. The percentage improvement seen in group A, which underwent microneedling using dermaroller for 4 sessions which is 93%, is comparable to that of the study done by Imran et al. (6) The downtime observed for erythema and edema to subside after the dermaroller procedure was 2-3 days which was similar to that of the study by Fabroccini et al. (7) The lesser downtime was also reported as an advantage in the study by Fernandes and Signorini et al, (8) in which they reported that the absence of epidermal damage when compared to dermabrasion. ...
Article
Full-text available
Introduction: Acne is a self-limiting disease of pilosebaceous unit seen predominantly in adolescence, clinically characterized by papules, pustules, comedones, nodules and cysts and may result in scarring. Aim and Objectives of the study: To compare the effectiveness of percutaneous collagen induction therapy versus dermabrasion in acne scars, and for monitoring the adverse effects during and after the procedure Materials and Method: Thirty patients with acne scars divided in to two groups A and B Group A underwent microneedling with dermaroller of 1.5mm dm, with the principle of percutaneous collagen induction. Group B underwent dermabrasion with motor assisted dermabrader using a diamond fraize. The percentage of improvement was graded with paired t test. Results: Among the 30 patients Group A 11 patients (73%) and 8 patients in group B (53%) showed significant reduction in acne scar grades. Rolling and boxcar type of scars responded well to both. In group B 3 patients had post inflammatory hyperpigmentation. Conclusion To conclude both percutaneous collagen induction therapy and dermabrasion were effective in treating acne scars but results was better with microneedling and is easy to perform and have minimal adverse effects.
... Microneedling causes morphological changes in the skin tissues by inducing direct mechanical traumas. Standard ablation approaches damage soft tissues past the epidermal-dermal junction, efficiently interfering with the basement membrane and initiating fibroblast collagen deposition in a parallel fashion inherent in visible scars [27][28][29][30] . Percutaneous collagen induction (PCI) is thought to cause more regenerative effects by inducing the normal wound-healing cascade of inflammation, proliferation, and remodeling within normal skin architecture [31][32][33] . ...
Article
Full-text available
Aim: The aim of this literature review is to evaluate the efficacy of microneedling treatment with injectable platelet-rich fibrin (i-PRF) for facial skin rejuvenation applications, using an objective skin analysis system and validated patient-reported outcome measures. Methods: The search approach involved the exploration of electronic databases. An advanced search option was applied to filter our search line, i.e., from February 2011 to April 2021. We performed a search on Medline, Scopus, Embase, and Web of Science, while improving the accessed articles via Ovid interface. Our keywords were chiefly aligned with a combination of MeSH terms and text words. All retrieved articles were written in English. Results: The search yielded 73 studies. After reviewing their title and summary, nine of them were found to meet the inclusion criteria and, next, the full-text articles were reviewed. Of these, three studies were excluded from systematic research, as they would no longer meet the inclusion criteria. In total, six studies were considered for review. Conclusion: Microneedling treatments combined with blood concentrates are increasingly being utilized as autologous products for aesthetic purposes. Few works can be found on i-PRF in facial rejuvenation, and even fewer on i-PRF along with microneedling. Combined applications seem to be promising and minimally invasive. Further research on PRP and PRF is warranted to better elucidate their functional roles in medical cosmetic rejuvenation.
... Furthermore, the micro-needling may induce minor bleeding which triggers the platelet to release an important growth factor known as PDGF (Platelet Derived Growth Factor) which enhances the process of cellular proliferation and collagen production. Besides, this bleeding along with the induced micro-injury triggers the local nerve endings to signal to the brain for the enhancement of the healing process [1] and [2]. Micro-needling results in release of numerous growth elements, such as, Platelet Derived Growth Factor (PDGF), Connective Tissue Activating Protein (CTAP) and Tissue Growth Factors (TGF) Connective Tissue Growth Factor (CTGF). ...
Research
Micro-needling is a novel, safe and cost effective surgical technique used extensively during the last two decades in vaccine, dermatology and medical cosmetic procedures. It is based on creation of micro-punctures using fine cone needles (microneedles). To remove acne and wounds induced scars. The micropunctures induce a cascade of inflammatory healing reactions which enhance collagen output and scars removal. This review highlights the history of microneedles, their types and modes as well as the required treatment duration to achieve the best outcomes. Furthermore, it highlights the its benefits as compared to other types of Keywords: Micropuncture, Microneedles, healing, inflammatory and collagen.
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The use of needles for cosmetic interventions is increasingly gaining ground and consolidating within the dermatologist’s therapeutic arsenal. Orentreich and Orentreich were the first to report the use of needles with the objective of stimulating the production of collagen in the treatment of depressed scars and wrinkles, a technique widespread under the name of Subcision™. Their studies were confirmed by other authors, who were based on the same precept: rupture and removal of the damaged subepidermal collagen, followed by substitution by new collagen and elastin fibers. The change in color, texture, elasticity, and uniformity of the skin surface in the presence of scars is secondary to inflammatory changes affecting the epidermis, dermis, and hypodermis en bloc or alone, and these sites are targeted by techniques that use needles. Needles with particular characteristics have been used by different authors in their procedures, among them 19 G, 20 G, 21 G, and 18 G 1.5 Nokor, presenting particular technical advantages in their experiments. Dermal tunneling (DT) proposes the release of fibrotic beams in the dermis into depressed scars, with the use of a new instrument and guided by an easy to perform methodology.
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The use of needles in order to stimulate the production of good quality collagen in the treatment of scars was initially described by Orentreich and Orentreich in 1995, who successfully reported the use of the Subcision™ technique. Shortly after, Camirand and Doucet (Aesthetic Plast Surg 21(1):48–51, 1997) reported cases of scar improvement after performing scar scarification using the needles of a tattoo machine. It is already well established that the perforation caused by needles triggers the cascade of wound healing, and in this process, through the release of growth factors, collagen production occurs. The origin of the instruments used is also important with respect to the quality of the needles. Different materials used in the manufacture of the needles interfere with the resistance, the characteristic of the injury caused, and, consequently, the results. The needles are diagonally arranged in some instruments, seeking optimization of results. The scanning microscopy shows the difference in length of the needles, which directly interferes in the intensity of the lesion caused in the skin. The microneedles attached to the device are made of stainless steel and generally pre-sterilized with gamma radiation. The rollers used for medical treatment are for single use. They should not be re-sterilized, as they lose their cut and buckle the needles, compromising the result and the safety of the procedure (Aust MC. Plast Reconstr Surg. 121(4):1421–9, 2008; Bal SM et al. Eur J Pharm Sci. 35(3):193–202, 2008; Brody HJ. Plast Reconstr Surg. 2(2):127–8, 1995).
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During treatment, needles pierce the stratum corneum and create the microchannels without damaging the epidermis, making it possible to create an accessible means of transporting macromolecules and other hydrophilic substances to the skin. The microchannels facilitate drug delivery efficiently and can increase the absorption of larger molecules by up to 80%. The application of drugs by the transdermal drug delivery system has been used as an alternative to the oral or parenteral administration of various substances. Transdermal patches can, for example, be useful for the application of vaccines and medications that require slow and controlled release into the skin. However, the transdermal route of drug absorption faces a major challenge, which is the barrier function of the skin, mainly exercised by the stratum corneum, which limits the absorption of many actives. PCI is a simple, safe method with low incidence of side effects. The association with drug delivery has the advantage of being a safe, low cost, and effective procedure that enhances the results of dermatological treatments.
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The modification of the skin after burn accident, established by the destruction of sebaceous and sweat glands, hair follicles, nerves, and vessels, results in impairment of its homeostasis, with dramatic alteration of physiological functions. Complaints, such as neuropathic pain, itching, eczema, and exulcerations, are frequent over areas of late scarring and always translate into a therapeutic challenge before the modest arsenal of possibilities available. Compared to the “light needles” of fractionated lasers, microneedles act by producing micropunctures and hematic columns at epidermal-dermal depth, causing the rupture of collagen and elastic fibers altered by burning, which favors their replacement by a new tissue. This technique can act in the different formats of scars, in any area of the body, in any type of skin, and at all ages. Even in areas with decreased concentration of sebaceous glands, the percutaneous induction of collagen with needles (PCI) is a possibility of treatment. PCI in post-burn scars produces changes in color, texture, depth, relief, and flexibility.
Chapter
The use of needles for cosmetic interventions is increasingly gaining ground and consolidating within the dermatologist’s therapeutic arsenal. Orentreich and Orentreich were the first to report the use of needles with the objective of stimulating the production of collagen in the treatment of depressed scars and wrinkles, a technique widespread under the name of Subcision™, followed by other authors who presented adaptations to the technique, with needle variation and approach. As already mentioned in previous chapters, dermal tunneling (DT) was inspired by this detachment technique and guided by its principles of fibrotic beam rupture and collagen production stimulus. For this, the methodology and instruments themselves required the DT denomination to characterize this new approach. Post-acne inflammatory scars are a frequent complaint, which presents itself as a great challenge, even in the face of all the therapeutic options offered by qualified dermatologists. The technique offers its own methodology to be followed, seeking standardization, with the objective of presenting results, as far as possible, predictable. It is indicated for facial lipodystrophy, often observed in patients after cystic acne. The typical flaccidity of the genian region and the wrinkles resulting from this excess skin are improved by the technique.
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Several treatments have been proposed that offer better results in reddish striations when compared to alba striations. Topical tretinoin in cream in high concentrations, applied as home therapy, improves the appearance of these lesions; however, it may not be well tolerated by the patient, considering climatic conditions and maintenance of her average activities. Interventions such as chemical peelings, microdermabrasion, fractionated lasers, and intense pulsed light, alone or in association, are some of the therapeutic options used by dermatology for the management of these lesions. However, there is no treatment considered ideal, and the results many times modest signal its challenge. PCI, regarding treatments with microneedles that induce collagen production, offers a stimulus in the production of this protein, without causing the deepithelialization observed in ablative techniques. The epidermis and dermis are perforated but not removed. Thus, the penetration of its needles in the skin causes micropunctures in the stretch marks, modifying their surface, destructuring the abnormal collagen and favoring neovascularization and neoangiogenesis. Both violent and white stretch marks respond to PCI, but the former commonly present satisfactory results with a smaller number of sessions, while the former need a longer time to achieve such results.
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Percutaneous collagen induction proposes a stimulus to the production of collagen by perforating the epidermis, reaching the dermis without causing deepithelialization. Thus, the author’s practice and the reports of scientific articles that offer the experience of specialists from around the world point to greater safety, less risk of adverse effects, and shorter recovery time when comparing the use of needles with ablative procedures. The preservation of this noble layer structure is the basis for the prevention of adverse effects, giving PCI ample advantage over other procedures. It is known that mechanical or chemical removal of the epidermis favors the release of cytokines and migration of inflammatory cells, culminating in the replacement of damaged tissue by a scar. Treatments with medium and deep chemical peelings, as well as mechanical abrasion, require long recovery of the skin and result in a more light-sensitive tissue, subject to post-inflammatory hyperpigmentation (IPH) and photosensitivity, adding to the risk of complications such as hypertrophic scarring, persistent erythema, and dyschromias. These conditions are likely to occur because it is a replacement of the epidermis and its basal membrane removed by a scar tissue with rectification of the dermal papillae. In these processes, the inflammatory response triggered by the destruction of the epidermis causes the production of parallel oriented thick bundles of collagen, differently from the interlacing network of collagen found in normal skin.
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An electrosurgery device is composed of a current generating unit and two electrodes: one active and one dispersive. By using an electrode consisting of a series of eight needles 0.1 mm thick and 2.0 mm long, we will equally divide by eight the energy selected for contact. With the proper configuration of the device, we can realize eight columns of 0.1 mm per shot, with a depth of 2.0 mm. Thus it is plausible the epidermal restitution is in an integral form and mechanical and thermal dermal stimulus, producing tissue retraction and synthesis of collagen. The multi-needle radiofrequency (MNR) technique has its applicability on periorbital skin excess and flaccidity, periorbital hyperpigmentation, static facial wrinkles, acne scars, superficial skin flaccidity, xanthelasma, syringoma, surgical scars, and stretch marks, among others. The use of high-frequency randomized fractional energy triggered on the skin results in dermal regeneration at the papillary-reticular interface through the stimulation of fibroblasts with consequent synthesis of collagen and elastic fibers, as well as epidermal regeneration produced by the migration of keratinocytes.
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Scleroderma is a connective tissue disease of unknown etiology, characterized essentially by progressive fibrosis of the skin. An inflammatory response triggered by the destruction of the epidermis causes the production of parallel oriented thick bundles of collagen, unlike the interlacing network of collagen found in normal skin. Studies have shown that TGF-COPY3 plays a significant role: TGF-COPY16 and TGF-COPY2 promote the formation of scar tissue collagen, while TGF-COPY4 promotes wound regeneration and healing at the expense of collagen closer to physiological. When a parallel is made with the pathogenesis of scleroderma, it is observed that the GFR-β1 and the TGF-β2 are considered the main regulatory factors of both physiological fibrogenesis and pathological fibrosis with pleiotropic activities on several cell types. Thus, it was possible to suggest that the action of PCI on this sclerotic collagen, due to the modification of the inflammatory cascade triggered mostly by TGF-α1 and TGF-α3, would result in skin that looks closer to the physiological.
Article
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Background After dermatitis, acne is the second skin disease most contributing to the burden of skin diseases worldwide. Recently, seven core outcome domains have been identified that together form an Acne Core Outcome Set (ACORN project). One of these was satisfaction with acne treatment. Objective Our aim was to identify studies that described the development of patient‐reported outcome measures (PROMS), evaluated one or more measurement properties of a PROM, or evaluated the interpretability of a PROM in patients with acne regarding treatment satisfaction. Methods The COSMIN search strategy for identifying PROMS on acne treatment satisfaction was used. We searched Pubmed, MEDLINE, Embase, LILACS, Web of Science, Cochrane Library, Emcare, PsychINFO and Academic Search premier (June 2020). Study selection, data extraction, and assessment of methodological quality according to COSMIN guidance were carried out independently by two authors. Results Only one study could be included, describing the development of a treatment satisfaction measure in patients with acne. The development was assessed as inadequate, and data on measurement properties were lacking. Additionally, we found 188 studies reporting treatment satisfaction solely as an outcome, using a wide variety of methods, none of them standardised nor validated. Conclusions We could not find a PROM on treatment satisfaction to recommend for a core outcome set in acne. There is an unmet need for a PROM measuring treatment satisfaction in acne that is robustly developed, designed and validated.
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Accidents that result in unaesthetic scars happen more and more frequently in our environment; they are a relatively common cause of visits to specialist offices. The sources and causes that cause these scars are diverse; for this reason there is almost always an injurious polymorphism that can be distinguished from normotrophic to hypertrophic and atrophic injuries, with variation in color and shape, which often requires the association of techniques aiming at the best therapeutic gain. Besides cosmetic improvement, functional correction of the area should be considered. With a certain frequency there is impairment of the elasticity of the affected region, with function deficit. Techniques using needles described in this work have the advantage of addressing scars without excision and synthesis, which could favor situations such as enlargement or dystrophy in the postoperative period. These are techniques that perforate, without cutting, cause punctures without deepithelialization of the area, and, therefore, offer more safety regarding the cosmetic results and reduction of complications. Whether isolated or in association, the proposals presented here have shown, in author’s experience, good options in the approach to scars after accidents and can be included in the therapeutic arsenal of challenging injuries.
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Scarring lesions can result from inflammatory processes, accidents, surgeries, and present varied characteristics, which contemplate both changes in color and change in skin texture, as well as compromising the revelation and distortion by retraction. Multineedle radiofrequency (MNR) proposes a neocollagenesis with preservation of this noble structure. Even the widest and deepest scars will respond to microneedles, considering that the more superficial and narrower they are, the better the therapeutic result obtained. MNR is a promising therapeutic proposal for the treatment of various forms of scarring. A thorough knowledge of these lesions is essential so that the indication alone or in association with the technique offers good cosmetic results. In the author’s conception, the results achieved can be reproduced using the methodology and the electrodes presented here with precision. The procedure requires training and is technical-dependent. The operator must be properly enabled and have all the basic knowledge necessary to guarantee the excellence of the results.
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The keloids initiated in the reticular dermis project to the skin and do not regress spontaneously. They are erythematous-violaceous, skin-colored, or hyperchromic and are distinguished from elevated scars by exceeding the limits of initial injury. It is believed that there are no spontaneous keloids. Lesions without apparent causes were probably the result of a mild injury, not perceived by the patient. Techniques for keloid management have been used with variable responses, such as intralesional injections with bleomycin and corticosteroids alone or in association, cryosurgery, use of silicone plates, lasers, intense pulsed light, in addition to topical assets such as 5-fluorouracil, interferone, retinoids, 5% imiquimode, tacrolimus, verapamil. Botulinum toxin has shown good results in specific cases. Corticosteroids present side effects such as risk of secondary infection, atrophy, telangiectasis, and hypopigmentation. Cryosurgery, when performed by not very experienced professionals, can lead to atrophy and hypochromia, and bleomycin can trigger hyperpigmentation. PCI proposes to destructure fibrosis and abnormal collagen, creating hematic columns with production of a new collagen, without causing the deepithelialization observed in ablative techniques.
Chapter
Microneedling is a minimally invasive procedure that uses fine needles to puncture the epidermis. Microneedling, or percutaneous collagen induction therapy, was introduced in the 1990s for the treatment of scars, striae, and laxity. The mechanism of action is thought to be a disruption of the epidermis and dermis. Micropunctures are created using microneedles, which produce a controlled skin injury without damaging the epidermis. Modern microneedling devices consist of rollers, stamps, and pens. Physicians and providers need to consider important factors like needle length, needle material, and clinical indications in selecting which device to utilize. DermaFrac treatment is a newer modification of microneedling combining microdermabrasion, microneedling, simultaneous deep tissue serum infusion, and light emitting diode therapy. Microneedling is an effective modality of treatment, especially in patients with Fitzpatrick's IV and V skin types because it overcomes the side effects of scarring and hyperpigmentation resulting from other procedures in which the epidermis is compromised.
Article
A 10‐year‐old boy was referred to our outpatient clinic with a 2‐year history of vitiligo minimally responsive to topical corticosteroids and phototherapy. Low dose oral corticosteroids were prescribed in combination with sessions of microneedling and 5‐fluourouracil 5% cream applied immediately after needling on a monthly basis. Repigmentation was initially noted after the first cycle at week 4. After 3 sessions of treatment (week 16), the patient showed a complete repigmentation of the knees.
Article
Facial erythema from rosacea and acne is one of the most common problems encountered in dermatologic clinics. Effective therapeutic interventions for persistent erythema, which can cause patients frustration and psychological distress, are needed. The aim of this study was to evaluate the efficacy and safety of an invasive short pulsed-type bipolar radiofrequency device (IPBRF) for the treatment of intractable facial erythema. Thirty-one patients who had been diagnosed with rosacea or acne vulgaris and combined erythema underwent at least two IPBRF treatment sessions (maximum: 5) at 2-week intervals. Treatment outcomes were evaluated by investigator global assessment (IGA) based on clinical photographs, patient global assessment (PGA) score, and skin biophysical parameters including erythema index (EI), melanin index (MI), and transepidermal water loss (TEWL). Most patients showed significant clinical improvement. IGA scores for erythema, pores and smoothness improved after treatment. PGA also showed a trend toward improvement. Mean EI was significantly improved after the second treatment compared to baseline, which maintained until the study period. MI and TEWL showed a tendency toward improvement. There were no serious adverse events reported during the study. IPBRF led to rapid clinical improvement in facial erythema associated with rosacea and acne vulgaris and could be an effective and safe treatment option.
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In recent years, microneedling has been combined with platelet‐rich plasma (PRP) with the aim of augmenting cosmetic outcomes. This chapter discusses PRP and its use in combination therapies with microneedling. PRP is an autologous high concentration of platelets derived from blood plasma. Microneedling provides accelerated neocollagenesis. Collagen induction therapy, in combination with the additional growth factors and cytokines from PRP, may act synergistically with the microneedling cascade to provide enhanced collagen remodeling and patient outcomes. PRP has been utilized for many years in dentistry, orthopedics, endodentistry, and other surgical fields. PRP as monotherapy has demonstrated significant improvements in hair growth when treating androgenic alopecia. PRP and microneedling continue to evolve as therapeutic tools in dermatology and aesthetic medicine. Top evidence‐based dermatologic indications for microneedling and PRP include hair restoration and skin rejuvenation, as well as improvements in acne scars.
Article
Objective The investigation and practice of physical therapy in flap surgery are still scare. The purpose of this study is to evaluate the impact of different microneedling interventions on survival of random pattern flaps in rats, attempting to determine the optimal microneedling protocols for improvement of flap survival. Methods 80 male Sprague-Dawley rats were randomly divided into 4 groups, with 20 in each group (group A, B, C and D). A 3cm × 9 cm rectangular random flap as the McFarlane flap was adopted in each group. In group A and B, microneedling treatment was performed before and after surgery, respectively. While animals in group C were received both preoperative and postoperative microneedling treatment. Group D was used as a control group, which was only exposed to surgery. Flap survival, flap blood flow, number of capillary formations, the expressions of CD31, CD34, HIF-1αand VEGF were detected in each group and compared. Results On the 7th day postoperatively, significant improvements with microneedling treatment were found in flap survival rate (p = 0.007), blood flow (p = 0.024), the expression levels of CD34 (p = 0.005), and the VEGF (p < 0.01). Furthermore, the VEGF expression level was significantly higher in group B when compared with the other three groups (all p < 0.01). However, there was no significant difference in the number of new blood vessels and other immunohistochemical indicators among the four groups (all p > 0.05). Conclusion Microneedling treatment especially postoperative intervention can significantly improve the survival of random flaps in rats.
Article
Context: There are several modalities of treating acne scars. The combination of microneedling and platelet-rich plasma (PRP) is a synergistic approach to treat acne scars. Aims: The aim was to compare the efficacy of microneedling alone versus microneedling with PRP in acne scars. Materials and methods: This was a split face study conducted on 36 patients with acne scars who underwent four sessions of microneedling with PRP on right side and microneedling alone on left side at monthly interval. The total scars with subtypes and Ecchelle D'Evaluation Cliniques des Cicatrices D'Acne (ECCA) score were assessed at baseline and second, fourth, and sixth visits. Visual analog score (VAS) was evaluated by both physicians and patients. Statistical analysis: The statistical analysis was carried out using Statistical Package for Social Sciences. Paired-t test and Wilcoxon signed rank test were used to compare the results. Results: Mean age was 23.7±3.2 years with 17 male and 19 female patients. The mean total scars on right and left sides declined from 42.14±21.15 to 25.08±14.14 and 43.28+23.08 to 27.17±15.68, respectively, with insignificant differences (P-value = 0.094). ECCA score on right and left sides declined from 88.31±32.78 to 62.92±23.68 and 89.58±32.43 to 66.25±23.89, respectively (P-value = 0.058). VAS evaluated by patient and physician showed maximum improvement at second and third visits, respectively. Conclusions: This study showed no added advantage of topical application of PRP over microneedling in acne scars.
Article
Context: Skin conditions contribute substantial burden toward global morbidity and mortality. Acne vulgaris, with its rising prevalence, has become a cause of concern among researchers as well as dermatologists due to scarring. Aims: The aim of this study was to compare the efficacy of microneedling alone versus microneedling combined with platelet-rich plasma (PRP) in post-acne scars using a split-face method. Materials and methods: Thirty patients with atrophic post-acne facial scars were offered four sittings of treatment monthly once. As a standard protocol, the right side of the face was subjected to microneedling with PRP (Group A) and the left side of the face with microneedling alone (Group B). Objective evaluation of improvement was performed by the physician recording the acne scar assessment score at baseline and thereafter at every visit using Goodman and Baron scale. Alongside patients also graded the improvement in acne scars at the end of the study. Statistical analysis used: The collected information was entered in MS Excel (Bellevue, WA, USA) and analyzed using appropriate statistical methods with Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY). The significance of the outcomes of the study was assessed by calculating the P value and the value of P < 0.05 was considered statistically significant. Results: The mean age of patients was 25 years. Thirteen (43%) patients in Group A had an excellent response as compared to 6 (20%) patients in Group B according to physician assessment. Patient's satisfaction was more in Group A as compared to Group B as 11 (36%) patients had more than 75% improvement in Group A as compared to 1 (3%) patient in Group B. Conclusion: The study showed a decrease in scar severity grade in all the patients enrolled for treatment. However, the combined use of microneedling and PRP was found to be more effective than a single method used for treatment of acne scars.
Article
Full-text available
Engineered nano–bio interfaces – driven by vertical micro-/nanoneedles, nanoparticles, organ-on-chip devices, and a diversity of nano-substrates for mass spectroscopy imaging – are spurring scientific and technological progress, from fundamental to transnational biomedical research. Each class has its own characteristic features, which is critical for their translational uptake; but they broadly share the same range of functionality and applicability at the forefront of modern research and medicine. The review provides insights into unique attributes of microneedle technology and its ability for efficient transdermal transport of therapeutic compounds. We highlight the use of nanoneedle technology in precise manipulation of increasingly complex cellular processes at the cell–material interface, and their potential for major improvements for many fundamental research applications and ex vivo cell-based therapies. We provide a snapshot in the use of FDA-approved nanoparticle therapeutics and their applications in nanomedicine. We cover achievements in organ-on-chip technology, particularly at the pre-clinical stage, and its potential to efficiently screen diverse types of therapeutics. The final section is dedicated to the use of nanomaterial-enhanced mass spectrometry in drug discovery and imaging. Overall, with this review we aim to highlight those main rules in the design of bio-nano interfaces that have successfully achieved translation into the market. This article is protected by copyright. All rights reserved.
Chapter
Microneedle (MN) arrays are a minimally invasive method of bypassing the stratum corneum barrier via piercing of the epidermis, creating reversible microscopic channels into the microcirculation. The concept of MN technology has developed significantly since its conception in 1976 and has been used to enhance topical and transdermal drug delivery, detect endogenous markers for patient monitoring and diagnosis, and improve the appearance of skin. Advantages of microneedles over a traditional hypodermic needle include a painless application, minimal skin trauma and bleeding, avoidance of needle phobia, potential for self-application, and a reduced risk of skin infection. The advancement of MN technology has seen the fabrication of arrays from a range of materials and the development of several types of needles, most notably solid, hollow, coated, dissolving, and hydrogel microneedles. Each type is associated with its own advantages and has been utilized for delivery of specific compounds. For example, dissolving microneedles have been explored in the realm of vaccine delivery, as there results in no sharp disposal waste following application, and the ability to self-administer needles could result in widespread vaccine coverage in low resource settings, where there may be shortages of medical personnel. This chapter focuses on the use of MN arrays for drug delivery and patient monitoring, illustrating the wide ranging capabilities of this technology.
Article
Platelet-rich plasma (PRP) has expanded its therapeutic applications into the field of aesthetic medicine. PRP is an autologous blood-derived product with an increased concentration of platelets to plasma relative to that of whole blood, which supports its therapeutic effects. Frequently promoted and marketed directly to consumers and patients, clinicians are often questioned on the efficacy and safety of PRP as a therapeutic modality. Given the rise in popularity of PRP, multiple clinical trials have been conducted to assess its application within the field of aesthetic medicine, particularly for hair loss conditions, skin rejuvenation, scarring, and conditions of dyspigmentation. We have reviewed the relevant research about the utility of PRP and associated evidence-based practices and discuss the direction for future research.
Chapter
Microneedling, a minimally invasive technique utilized to induce neocollagenesis, is frequently combined with platelet-rich plasma (PRP) to enhance results for a variety of medical and cosmetic dermatological conditions. It is generally well-tolerated and effective with preliminary data demonstrating improved outcomes for the treatment of acne scarring, striae distensae, melasma, and photoaging.
Article
Background Microneedling is a relatively novel therapeutic modality introduced in the 1990s where small, fine needles are used to create micro punctures in the skin. It is a minimally invasive procedure used for various dermatological conditions, including androgenetic alopecia (AGA). Objective and Methods We comprehensively summarize the literature regarding microneedling in dermatology. We performed linear multivariable regressions to synthesize evidence from the clinical trials that investigated the efficacy of microneedling for AGA. Studies eligible for quantitative analyses were assessed for evidence quality. Results The exact mechanism of microneedling action is yet to be determined, with theories that include the wound-healing cascade. Microneedling monotherapy significantly increased total hair count more than topical minoxidil 5% (β = 12.29; p < 0.001). The combination treatment of microneedling with topical 5% minoxidil increased total hair count significantly compared to monotherapy with microneedling (β = 7.63, p < 0.05). Increasing the overall treatment duration of microneedling and reducing the frequency of microneedling sessions may positively influence an increase in total hair count. Conclusion There are limited studies that investigate microneedling as a monotherapy for hair loss since majority of the trials combine it with other therapies such as topical minoxidil or platelet-rich plasma. While preliminary results look promising, further investigation of microneedling as a monotherapy in larger, randomized controlled trials will help determine its safety and efficacy, and place in treating AGA.
Article
Acne scars are a frequent complication with major social and psychological implications for the individual, to which attention must be paid. aiming at the timely and aggressive management of severe forms of acne, thus avoiding, as far as possible, its appearance. However, some of these patients will present this complication even with early intervention, this is due to impaired healing and the severity and duration of the inflammatory phenomenon. At a time when there are still no indisputable treatments in this area, it is necessary to seek a consensus that allows patients to provide physical and psychological relief for an irreversible sequel, even more so when it is secondary to a high incidence pathology such as acne. The main objective of this article is to review the existing valid evidence on the different treatment options and the association of these therapies to attenuate the scars caused by acne vulgaris. Literature review was used as a research methodology. In conclusion, the programming of the various parameters of the different types of therapies seems to play a definitive role in the final success of the treatment.
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Current interventions seek to promote fractional skin damage, which allows the integrity of the microregion adjacent to the trauma to be maintained intact, favoring a shorter recovery time and reduced risk of complications. The fractionated CO2 laser is an example of this proposal, as is the PCI. It is important to note that, even when the patient is submitted to surgeries that remove skin leftovers, attenuating flaccidity and wrinkles, the resulting skin must offer a good quality. This is the PCI proposal, offering a good quality of skin based on neocollagenosis and neoangiogenesis. The needles, initially idealized for the treatment of scars, also demonstrated valuable therapeutic response in aged skin. The studies of Orentreich and Orentreich (Dermatol Surg 21(6):543–549, 1995) were the first to report their use with the objective of stimulating the production of collagen in depressed scars and wrinkles, a technique widespread under the name of Subcision™. Other authors confirmed the rupture and removal of the damaged subepidermal collagen followed by the substitution of new collagen and elastin fibers by the intervention of needles. More recently, it has been proposed the use of a system of microneedles applied to the skin in order to generate multiple micropunctures, long enough to reach the dermis and trigger, with bleeding, inflammatory stimulus and activation of an inflammatory cascade that would result in the production of collagen and, subsequently, its maturation.
Article
Full-text available
PCI is a simple technique and, with the right tool, can thoroughly puncture any skin easily and quickly. Although a single treatment may not give the smoothing that is seen with laser resurfacing, the epidermis remains virtually normal. When the result is not sufficient, treatment can be repeated. The technique can be used on areas that are not suitable for peeling or laser resurfacing.
Article
A wide variety of developing systems drive substantial steady ionic currents through themselves. These currents are driven by a certain separation of ion leaks from ion pumps along the membranes of developing cells. Moreover, they seem to be more than epiphenomena. In part they may act back, via self-electrophoresis and/or specific ion gradients, to further segregate the membrane components that drive them; in part they may act to segregate and locally modify other components and thus act as prime agents of differentiation. Among the systems in which evidence for such action has been reported are: 1)Fucoid eggs. There is evidence that early calcium ion currents through these eggs are self-amplifying and induce local growth at the locus of calcium ion entry. 2)Cecropia (insect) follicles. There is evidence that large transfollicular currents maintain enough of a voltage drop between nurse and oocyte cells to help drive macromolecules into the oocytes. 3)Amputated amphibian limbs. There is evidence that large natural stump currents somehow initiate regeneration. 4)Frog embryos. The growth of isolated, embryonic Xenopus neuroblasts and myoblasts can be directed by voltage gradients so small (down to 10 to 30 mV/mm) that they may well exist within the embryo. 5)Wounded mammalian skin. Natural currents through incisions in guinea pig skin establish voltage gradients within the adjoining epidermis that are so large (100 to 200 mV/mm) they may direct wound closure.
Article
A new method of subcuticular underming for the treatment of depressed cutaneous scars and wrinkles is introduced. To define the newly coined term "Subcision" and to describe this minor surgical procedure for treating depressed scars and wrinkles. A tri-beveled hypodermic needle is inserted through a puncture in the skin surface (hence, "incisionless" surgery), and its sharp edges are maneuvered under the defect to make subcuticular cuts or "-cisions." The depression is lifted by the releasing action of the procedure, as well as from connective tissue that forms in the course of normal wound healing. This technique is useful in treating a variety of cutaneous depressions, including scars and wrinkles.
Article
In this article we describe a technique of needle dermabrasion (tattoo without pigment) used to improve achromic, hypertrophic, and unsightly scars. It is simple, safe (no complications), and it gives us consistently good results.
Article
Acne is a common condition experienced by up to 80% of people between 11 and 30 years of age and by up to 5% of older adults. In some patients, the severe inflammatory response to Propionibacterium acnes results in permanent, disfiguring scars. Over the past several decades, numerous descriptive terms and surgical techniques have been used to diagnose the types, and improve the appearance, of scarring in those persons with acne. We propose a descriptive, simple, universally applicable acne scar classification system that includes 3 scar types: icepick, rolling, and boxcar. We also have developed an effective treatment algorithm for reconstructing and improving the appearance of acne scars including punch excision, punch elevation, subcutaneous incision (Subcision), and laser skin resurfacing. This new classification system for acne scars enables the physician to more precisely identify scar subtypes. Once the scar type has been defined, appropriate and effective treatment protocols can be developed.
Article
Skin laxity, rhytides, and photoaging are generally treated by ablative procedures that injure or destroy the epidermis and its basement membrane, at least in the beginning, and subsequently lead to fibrosis of the papillary dermis. The ideal treatment would be to preserve the epidermis and promote normal collagen and elastin formation in the dermis. Percutaneous collagen induction takes us closer to this ideal. The authors performed a retrospective analysis of 480 patients in South Africa and Germany with fine wrinkles, lax skin, scarring, and stretch marks treated with percutaneous collagen induction using the Medical Roll-CIT to produce tighter, smoother skin. Most patients had only one treatment, but some have had as many as four treatments. Patients were prepared with topical vitamin A and C cosmetic creams for a minimum of 4 weeks preoperatively. On average, patients in Germany rated their improvement between 60 and 80 percent better than before the treatment. Histologic examination was carried out in 20 patients and showed a considerable increase in collagen and elastin deposition at 6 months postoperatively. The epidermis demonstrated 40 percent thickening of stratum spinosum and normal rete ridges at 1 year postoperatively. Percutaneous collagen induction was started in 1997 and has proved to be a simple and fast method for safely treating wrinkles and scars. As opposed to ablative laser treatments, the epidermis remains intact and is not damaged. For this reason, the procedure can be repeated safely and is also suited to regions where laser treatments and deep peels cannot be performed.
Article
Medical clinicians are used to being consulted by patients who want to restore their youthful appearance. Although structural changes to the face and body may be achieved with surgery, for example, face lifts, the impression of youth also relies heavily on young-looking skin. It is desirable to have thicker and tighter skin to properly fulfill the desire for youth. Percutaneous collagen induction offers an antiaging effect to improve the appearance of old skin. It allows us to improve our patients' skin from the inside outward as well as from the surface. Experience has shown that percutaneous collagen induction works optimally when combined with a scientific skin care program to restore a youthful appearance. In addition, the same technique has proven to be very effective in minimizing acne scars and burn scars by removing scar collagen and replacing it with normal collagen. Consequently, scar contractures and depressed scars are improved. With the introduction of percutaneous collagen induction therapy in 1997, a simple and fast method was developed with regard to safely treating wrinkles and scars and producing lasting smoothness. As opposed to ablative laser treatments, the epidermis remains intact and is not damaged. For this reason, the operation can be safely repeated if needed, and it can be also applicable to regions where laser treatments or deep peelings cannot be done.
Abstract reflections about collagen-induction-therapy (CIT). A hypothesis for the mechanism of action of collagen induction therapy (CIT) using micro-needles
  • H Liebl
Liebl H. Abstract reflections about collagen-induction-therapy (CIT). A hypothesis for the mechanism of action of collagen induction therapy (CIT) using micro-needles.
Wound Healing. Biochemical and Clinical Aspects
  • Ki Cohen
  • Rf Diegelmann
  • Wj Lindbland
Cohen KI, Diegelmann RF, Lindbland WJ. Wound Healing. Biochemical and Clinical Aspects. Philadelphia, WB Saunders Co; 1992.
A hypothesis for the mechanism of action of collagen induction therapy (CIT) using micro-needles
  • H Liebl