Article

-Microneedling combined with PRP or TCA Peeling for Management of Acne Scarring: A Split-Face Clinical and Histologic Comparison.

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Background: Minimally invasive procedures provide effective, safe, relatively long-lasting, and natural results without large damage to the skin. A combination treatment is considered an approach that includes at least 2 different and unrelated modalities. Objectives: This study aims to evaluate the use and effectiveness of some combined minimally invasive procedures for management of acne scarring. Patients/methods: Twenty-four volunteers with postacne atrophic scars were randomly divided into 3 equal groups according to performed procedure on each side of the face (microneedling by dermaroller alone or combined with platelet-rich plasma [PRP] or trichloroacetic acid [TCA] 15% peeling) and received 6 bi-weekly sessions of treatment. Photography and punch biopsies were taken before and after 3 months of treatment for clinical, histological, and histometrical evaluation. Results: Combined treatment of dermaroller and PRP or dermaroller and TCA 15% showed significant improvement when compared with dermaroller alone (P = .015 and .011 respectively). Epidermal thickness showed statistically significant increase in studied groups, mainly after dermaroller and TCA 15%. Moreover, the 3 studied groups showed more organized collagen bundles and newly formed collagen formation and markedly decreased abnormal elastic fibers. Conclusions: Based on the clinical, histometrical, and histochemical assessment, inspite that most volunteers showed significant improvement after treatment, however, the combined use of dermaroller and TCA 15% was more effective in postacne atrophic scars than the use of dermaroller and PRP or dermaroller only.

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... 62 This technique was first developed in the early 21st century and many histometric studies since have reported increased epidermal thickness, upregulated elastin fiber and collagen lattice formation, and release of various regenerative growth factors in days and weeks following treatment. 60,[63][64][65] Due to the relative simplicity, low downtime, and minor complication rates of PCI, microneedling has been touted as a practical and efficacious modality of treatment for acne scarring. ...
... Numerous RCTs, however, have reported mixed results regarding this combination therapy, with some reporting a significant increase in efficacy with the addition of PRP 77,78 and more recent studies reporting no significant difference at all. 64,74,79 It is important to note that all these studies have some variation in the frequency, application, and duration of combined therapy. ...
... 80 Amniotic fluid topical application also improved patient outcomes according to objective physician measures and histometric analysis noting an increase in epidermal thickness and neocollagenesis. 81 Finally, various studies have shown that combining microneedling with chemical peels, including TCA and glycolic acid, have improved patient outcomes, 64,72,82 while one study noted that Jessner's solution did not enhance the effects of microneedling. 70 specifically, El-Domyati et al noted that increased epidermal thickness was especially apparent for skin treated with TCA and microneedling while PRP seemed to better augment collagen and elastin production. ...
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Curtis Tam,1 Jeffrey Khong,1 Kevin Tam,1 Ruslan Vasilev,1 Wesley Wu,2 Salar Hazany1 1Salar Hazany M.D. Inc, Beverly Hills, CA, USA; 2Department of Dermatology, Veterans Affairs Medical Center, Seattle, WA, USACorrespondence: Curtis Tam, Salar Hazany M.D. Inc, Beverly Hills, CA, USA, Tel +1 310 571 8435, Fax +1 855 569 5698, Email drsalar@hazanyderm.comAbstract: Scarring is a dire consequence of acne vulgaris. Particularly, atrophic acne scarring is highly prevalent among young adults, and its physical and psychological effects can persist throughout their lives if left untreated. This literature review will analyze various non-energy-based approaches to treating atrophic acne scarring, emphasizing recent advances within the last 5 to 10 years. To accomplish this, we performed a PubMed search for various acne scar treatments such as chemical peels, dermabrasion, microdermabrasion, subcision, microneedling, punch techniques, dermal fillers, and thread lifting. Our findings and analysis show that there is no panacean solution to treating atrophic acne scars, which explains the evolving trend towards developing unique combinatorial treatments. Although a fair comparison of each treatment approach is difficult to achieve due to the studies’ varying sample sizes, strength of evidence, treatment execution, etc, there still remains a level of consensus on what treatments are well suited for particular scar types.Keywords: TCA, subcision, microdermabrasion, microneedling, fillers, excision
... [10] The infraorbital area, nasolabial folds, and crow's feet areas were the most commonly injected; other areas of treatment included the forehead/malar region, the preauricular region, and the jaw region. All studies Alam et al. [9] Double-blind, split-face RCT 19 20 ml 3 ml Nil Acid citrate dextrose Smart PREP2 APC (Harvest technologies) Zenker [10] Case series 418 from Germany, Japan, UK, Israel 10 ml 4 ml Nil NA Single centrifugation PRP in combination with laser resurfacing Hui et al. [11] Single-blind split-face RCT 13 30 ml 2.2 ml CaG Heparin calcium Double spin 1) 1200 rpm for 10 min 2) 3500 rpm for 5 min Shin et al. [12] Randomized controlled study, single-blind 2) 3700 rpm for 10 min Nofal et al. [15] Randomized controlled trial 45 10 ml 2 ml CaCI2 NA Double spin 1) 175 g for 10 min ...
... [44] A randomized split-face trial evaluated micro needling alone or in combination with either topical PRP or trichloroacetic acid (TCA) 15% peels. [45] Both combination treatments showed significant cosmetic improvement in acne scars compared to micro needling alone. Assessment was done by blinded dermatologists and independent observers. ...
... All groups showed more organized and dense collagen bundles following treatment, but this was more pronounced in the topical PRP group. [45] 2) Intradermal PRP in combination micro needling Micro needling along with PRP has a synergistic action. This combination would intensify the natural wound healing cascade because of high concentration of patients own growth factors induced by skin needling and PRP. ...
Article
Platelet-rich plasma (PRP) is being used as a treatment modality for skin rejuvenation since the last decade. There has been a lot of ambiguity regarding the ideal protocol to be followed and the specific indications where its use should be promoted. The use of PRP as monotherapy for skin rejuvenation, acne scars, periorbital rejuvenation, lipofilling and in combination with fractional CO2 and other resurfacing modalities is increasing rapidly. In this article, we have reviewed the current scientific evidence available and the IADVL national task force for PRP has come up with standard recommendations for use of PRP in esthetics along with the grade of evidence and strength of recommendation for each indication. The aim of this review is to provide a standard protocol for use of PRP in esthetics, for clinicians and academicians, leading to excellent results with this promising treatment modality.
... el-Domyati et al. [21] 2018 Split-face rCt. 24 twenty-four volunteers with post-acne atrophic scars were randomly divided into three equal groups. ...
... participants received six bi-weekly sessions of treatment. The combination of dermaroller and 15% tCA was found to be more effective in the treatment of post-acne atrophic scars than the use of dermaroller and prp or dermaroller alone [21]. ...
Article
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Background: Acne vulgaris is a condition that most often appears during adolescence and can last from a few to over a dozen years. Unpleasant remnants of acne include post-inflammatory hyperpigmentation and acne scars, which often result in a reduced quality of life and can interfere with sufferers’ ability to function in society. Aim of the study: Assess the effectiveness of trichloroacetic acid (TCA) in reducing skin sebum levels (oiling) and smoothing acne scars. Case report: A 35-year-old female reported excessive oiliness of the skin and acne scars on both cheeks. Before and after TCA treatment, sebum levels were measured on the surface of the skin using a Sebumeter®. In addition, the cheek scars were graded using the Goodman and Baron scale. Conclusion: After a series of five treatments with TCA, there was a large reduction in sebum on the epidermal surface, and acne scars were reduced on both cheeks.
... El-Domyati et al. showed that combined treatment of a dermaroller and PRP or dermaroller and 15% TCA resulted in a better improvement when compared to a dermaroller. In addition, in the combined groups, the collagen bundles were better organized [80]. This study shows that combined treatments are much better than treatments conducted alone. ...
... It should be remembered that each therapy should be selected individually for each patient. The best results in scar reduction are achieved with treatments using lasers, radiofrequency, MN, and PRP [24,32,47,55,78,80]. ...
Article
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Acne vulgaris is a chronic skin disease that, depending on its course, is characterized by the occurrence of various skin eruptions such as open and closed comedones, pustules, papules, and cysts. Incorrectly selected treatment or the presence of severe acne vulgaris can lead to the formation of atrophic scars. In this review, we summarize current knowledge on acne scars and methods for their improvement. There are three types of atrophic scars: icepick, rolling, and boxcar. They are of different depths and widths and have different cross-sections. Scars can combine to form clusters. If acne scars are located on the face, they can reduce the patient’s quality of life, leading to isolation and depression. There are multiple effective modalities to treat acne scars. Ablative lasers, radiofrequency, micro-needling, and pilings with trichloroacetic acid have very good treatment results. Contemporary dermatology and cosmetology use treatments that cause minimal side effects, so the patient can return to daily functioning shortly after treatment. Proper dermatological treatment and skincare, as well as the rapid implementation of cosmetological treatments, will certainly achieve satisfactory results in reducing atrophic scars.
... These factors not only aid in clotting but also drive angiogenesis and promote tissue repair and regeneration [10]. Multiple authors have shown that topical application or intradermal injection of PRP and its growth factors produce favorable cutaneous changes: clinical (restores its vitality, increases its thickness, recovers its elastic consistency, improves blood circulation, increases its smoothness, decreases its wrinkles and improves their appearance) [2,10,11] histopathological (increases the number of fibroblasts, collagen fibers and blood vessel basement membranes) [2,10,12] immunohistochemical (improves collagen expression type I, III and IV) [13][14][15] and the genetic material (through the polymerase chain reaction expression of three target genes, such as: collagen IA, matrix metalloproteinase gene 1 and protein rich in proline of keratinocytes) [13,14]. PRP has been used as an adjunct to multiple skin rejuvenation treatments (lipotransference, laser, peeling, lifting). ...
... In all the studies reviewed these treatments expected a higher response when combined than alone [12,[16][17][18], PRP has also been used to reduce the intensity and duration of adverse events in these modalities. In a study by Kim H. and Gallo J, they were able to objectively reduce erythema and edema after treatment with fractional carbon dioxide laser by administering intradermal PRP (P = 0.02), associated with fewer subjective symptoms reported by patients (itching, burning and pain) [18]. ...
... Tissue biopsies have successfully been extracted in a number of acne scar studies in order to perform histological analyses of skin treated with microneedling. 12,[15][16][17] This analysis provides a more objective evaluation of skin structure and function beyond the top layers of the epidermis. 18 High-resolution photography equipped with filters and polarized light can be used to evaluate wrinkles, pigmentation, texture, pore size, and the presence of bacteria. ...
... Blood flow also significantly changed from baseline at the follow-up visits, particularly between 300 µm and 500 µm below the skin surface as shown in Figure 9. Beginning at Day 60, mean blood flow was statistically lower than at baseline between these depths in both the face and neck and continued to decrease through the end of the study (Figures 9A and B). In the face, average blood flow at 300µm decreased from baseline, 17 ...
Article
Background: While ablative techniques have been standard of care for the treatment of fine lines and wrinkles, microneedling is a minimally invasive alternative. Objectives: The purpose of this study was to assess the efficacy of microneedling on facial and neck fine lines and wrinkles. Methods: 35 subjects between 44 and 65 years old with Fitzpatrick skin types I-IV received four monthly microneedling treatments over the face and neck. Subjects returned one and three months post-treatment. At every visit, high-resolution ultrasonography, optical coherence tomography, transepidermal water loss and BTC-2000 were performed. 0.33mm microbiopsies were collected pre-treatment, before the fourth treatment and three months post-treatment. Results: 32 subjects (93.75% female, 6.25% male) completed all seven visits. Facial dermal and epidermal density increased 101.86% and 19.28%, respectively from baseline at three months post-treatment. Facial elasticity increased 28.2% from baseline three months post-treatment. Facial attenuation coefficient increased 15.65% and 17.33% one and three months post-treatment. At study completion, blood flow 300µm deep decreased 25.8% in the face and 42.3% in the neck. Relative collagen type III and elastin gene expression was statistically higher three months post-treatment. However, total elastin protein levels unchanged compared to baseline. 58% of biopsies extracted three months post-treatment showed dermal muscle formation, compared to baseline 15.3%. Conclusions: The results illustrate the effects of microneedling treatments. Non-invasive measurements and biopsy data showed changes in skin architecture and collagen/elastin gene expression suggesting skin rejuvenation, with new extracellular matrix production and muscle formation.
... 30 Another randomized split-face trial evaluated microneedling alone or in combination with either topical PRP or trichloroacetic acid (TCA) 15% peels. 31 Both combination treatments demonstrated significant cosmetic improvement in acne scars compared to microneedling alone according to assessments by blinded dermatologists and independent observers. No significant difference was observed between the combination treatments. ...
... All groups showed more organized and dense collagen bundles following treatment, but this was more pronounced in the topical PRP group. 31 Regarding combination of laser treatment and topical PRP, a split-face study was conducted in 30 patients with severe acne scars to evaluate the effects of AFR with and without topical PRP. 23 Although both treatment arms offered improvement, the addition of topical PRP did not have significant added benefit to scar appearance. ...
Article
Full-text available
In recent years, platelet-rich plasma (PRP), collagen peptides, and stem cells have become popular treatments for cutaneous rejuvenation. Mass marketing to consumers via the internet and social media has attracted the attention of the aesthetics industry to these treatments. However, the studies behind these treatment modalities have not supported the often exaggerated claims of effectiveness that have targeted consumers. It is important for clinicians to understand the evidence behind any new trends, especially in the fast-paced world of aesthetics, where treatments often outpace current medical understanding. Here, we summarize and evaluate the current prominent literature on these popular aesthetic treatments.
... In terms of atrophic acne scars, there are many types of treatments including medical, surgical procedural management, tissue augmentation, and various ablative and non-ablative laser and light energies [29]. Treatment has to be tailored to the patient's needs, tolerance, and goals along with the skin type, and physician's assessment and expectations [20]. In our study, three trials used a fractional carbon dioxide laser as the main treatment, three trials used microneedling, and one trial used subcision (subcutaneous incision-less surgery). ...
... As to the primary outcomes, the degree of improvement and mean improvement score were analyzed with both results yielding significant improvements. These results were compatible with the histochemical findings of an increased epidermal thickness, denser and more-organized collagen fibers, and finer elastic fibers [20]. Another pathway that explains the effect of PRP in the treatment of acne scars could be through the accelerating effect it has on the generation of hyaluronic acid, which is known to draw water into the hyaluronic acid matrix, causing it to swell, which creates volume and skin turgor and lubricates tissues. ...
Article
Background A number of studies have investigated the role of platelet-rich plasma (PRP) as an assisted therapy for atrophic acne scars. However, the results are diverse, and no up-to-date meta-analysis was found that exclusively examined atrophic acne scar treatment. Objectives To perform a meta-analysis to assess improvements in the side effects of PRP and the effect of assisted therapy for atrophic acne scars. Methods This study followed PRISMA guidelines. A comprehensive search of the literature was carried out in September 2018 using the electronic databases of PubMed, EMBASE, MEDLINE, and the Cochrane Library. Results Seven articles were included in this review. All of the studies published utilized PRP as additive therapy. The major therapies included fractional carbon laser therapy and microneedling. Five studies (249 participants) reported four degrees of improvement on an improvement scale (degrees 3 and 4 were considered improvement in this analysis). Four studies (200 participants) reported mean improvement scores. A significantly higher degree of improvement was shown in the PRP group compared to the control group (OR = 8.19; 95% CI 4.32–15.52; p < 0.00001), as well as better mean improvement score (WMD = 23.73; 95% CI 18.60–28.87; p < 0.00001). Substantial heterogeneity was seen in the degree of improvement (I² = 54% p = 0.07) and the mean improvement score (I² = 75%; p = 0.008). There were overall fewer monitored side effects, including erythema and edema (in days), in the PRP groups; however, no significance was found. Conclusions This review shows that PRP is a useful assisted therapy for atrophic acne scars, which can achieve better improvement. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... [38] The evidence in support of microneedling and PRP combination is however scarce. Although some studies have reported improved results with a combination, [39][40][41] others have shown no added benefits. [42,43] It is notable that patients subjectively report higher satisfaction rates with a combination of PRP and microneedling owing to the reduction in post-procedure erythema and edema. ...
Article
Full-text available
Regenerative medicine refers to the restoration of the form and function of damaged and diseased tissues by upregulation of natural regenerative processes present in the human body. Applications of regenerative medicine in dermatology are numerous, ranging from the acceleration of wound healing, hair restoration, mesenchymal stem cell augmented fat transfer, skin rejuvenation, enhancing results, and reducing downtime postprocedure and postlaser, etc. In modern aesthetic practice, the most prominent among current regenerative treatments are platelet-rich plasma (PRP), stem cells, growth factors, and most recently, exosomes. Most of the modalities available at present lack high-quality evidence supporting their use and good quality clinical trials are required for the optimization of cellular source, dose, and administration intervals before these modalities are deemed acceptable for use at a wider scale.
... Besides, plateletrich plasma (PRP), which contains various growth factors and bioactive cytokines, has also been applied as adjuvant therapy for acne scars (14,15). Some small-scale clinical studies have observed the role of combined treatment with microneedling and PRP for patients with atrophic acne scars (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). However, the efficacy and safety of microneedling treatment combined with PRP in patients with atrophic acne scars have rarely been comprehensively evaluated. ...
Article
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Background Microneedling is a promising method for the treatment of acne scars, while the effect of microneedling combined with platelet-rich plasma (PRP) remains unknown. We performed a meta-analysis of controlled studies to compare the efficacy and safety of microneedling treatment with and without additional PRP in patients with acne scars. Methods Randomized and non-randomized controlled studies were identified by search of Medline, Embase, and Cochrane's Library databases. Results were pooled with a random-effects model, incorporating the possible heterogeneity. Results Four randomized and 10 split-face non-randomized controlled studies with 472 patients were included. Compared to microneedling therapy without PRP, combined treatment with microneedling and PRP was associated with increased odds of clinical improvement of >50% in Goodman's qualitative scale [GQS: odds ratio (OR): 2.97, 95% confidence interval (CI): 1.96–4.51, p < 0.001; I ² = 0%], and a significantly improved mean GQS score (mean difference: −0.32, 95% CI: −0.44 to −0.20, p < 0.001; I ² = 0%). Combined treatment was associated with a higher patient satisfying rate (OR: 4.15, 95% CI: 2.13 to 8.09, p < 0.001; I ² = 53%), while the incidence of severe adverse events such as severe erythema (OR: 1.59, 95% CI:.73 to 3.46, P = 0.24; I ² = 0%) and severe edema (OR: 1.14, 95% CI: 0.47 to 2.76, P = 0.77; I ² = 0%) were not significantly different. Conclusions Combined treatment with microneedling with PRP is more effective than microneedling without PRP for patients with acne scars.
... Eight studies evaluated the combination of PRP with microneedling, encompassing one RCT 57 and seven comparative studies. 21,22,[58][59][60][61][62] One study performed percutaneous PRP and microneedling treatments on alternating visits, 58 and the rest completed the combination treatments at the same visit, performing three to six sessions with two-to four-week intervals (average of 3.9 sessions with 3.3-week intervals). All three studies on percutaneous PRP combined with microneedling showed signi cant clinical improvement and patient satisfaction with combined PRP and microneedling compared to controls. ...
Article
Platelet-rich plasma (PRP) has been integrated into numerous treatment regimens for medical and aesthetic dermatology. While some of these approaches are well-established, many uses are underreported in the literature. We sought to identify and summarize the emerging dermatologic applications for PRP by conducting a comprehensive PubMed search of studies published between 2000 and 2020. These studies were reviewed to synthesize collection methods, treatment schedule, adverse effects, and the impact of therapy for new and emerging uses for PRP. In general, we identified positive treatment outcomes for skin rejuvenation, scar revision, alopecia, pigmentary disorders, lichen sclerosus, leprosy-induced peripheral neuropathy, plaque psoriasis, and nail disorders. Widely, therapy was well-tolerated and suitable for all reported phototypes. The variations in collection and application sequences make concrete recommendations difficult to discern, underscoring the need for a standardized approach to preparation and treatment methods. We hope this review serves as an outline for new and interesting uses for PRP and will help readers familiarize themselves with this exciting technology for comfortable integration into their practices.
... Although both the combination techniques were efficacious, micro-needling with TCA was preferred by the subjects over micro-needling with PRP for acne scars. 11 A similar study of combination techniques for photoaging and facial wrinkles showed a significant increase in evaluation scores of PRP and micro-needling compared with micro-needling and TCA. Additionally, histological results also revealed improvement of dermal structures in microneedling and PRP combination compared with microneedling and TCA. 10 In a recent randomized trial, Alam et al showed that PRP therapy improved the visual appearance in individuals with photoaged skin, the results showed that both fine and coarse texture improved significantly more with a single treatment of PRP than the individuals treated with normal saline. ...
Article
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Purpose: Platelet-rich plasma (PRP) is a promising noninvasive technique for facial rejuvenation. This systematic literature review aims to appraise the nature and quality of published evidence evaluating the effectiveness and safety of PRP in facial rejuvenation. Patients and methods: A systematic literature review was conducted with the search string "Platelet-rich plasma AND Facial rejuvenation" in PubMed and Embase. Clinical studies evaluating the outcomes after PRP-based facial rejuvenation either as monotherapy or in combination with other treatment modalities were included. Studies evaluating wound-healing properties of PRP were excluded. The outcomes included both patient-reported and physician-assessed outcomes. Nonstatistical synthesis of evidence was performed by qualitative assessment. The results are reported by the Synthesis Without Meta-analysis (SWiM) reporting standard. Results: A total of 36 studies that included a total of 3172 patients were considered for the evidence synthesis. The number of patients in the included studies ranging from 11 to 2005 with a median of 27.5 patients that reflects the challenges in clinically assessing the aesthetic outcomes after PRP-based facial rejuvenation. Among the 36 studies, 17 were observational studies and 18 were interventional studies with 1 being case report PRP was evaluated either alone or in combination with hyaluronic acid, lipofilling, micro-needling technique, and laser-based interventions. Among the studies, 1 study reported the enhanced platelet concentrate in a fibrin matrix to be relatively safe and effective with a maximum benefit observed at 12 weeks suggesting the platelet-rich fibrin matrix may provide desired aesthetic outcomes and it requires further studies to substantiate. Conclusion: The results suggest very limited clinical evidence, and further clinical studies are warranted to establish the effectiveness of PRP in facial rejuvenation. Furthermore, a consensus for end points used for establishing clinical utility in patients requiring facial rejuvenation is warranted.
... Combined MN-Peeling protocols have already been proposed in the past [34,35]; combined treatments of micro-needling with platelet rich plasma or TCA 15% have shown significant improvements when compared with micro-needling alone. However, the studies proposing the use of combined MN-peeling protocols did not examine the simultaneous use of both. ...
Article
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Background: The interest in maintaining a young and attractive appearance in an era with increasingly hectic rhythms has generated a pressing demand for effective aesthetic procedures with the shortest possible recovery period, stimulating the search for non-invasive, yet successful, solutions. The aim of this study was to evaluate the effectiveness of the combined soft peeling and MN technique on the various imperfections typical of facial aging. Methods: This multicentric uncontrolled experimental study recruited a population of healthy subjects of both sexes with advanced signs of photo- and chrono-aging. These subjects were provided with a single session of microneedling and peeling at the same time. Recruited subjects were re-evaluated 30 (±4) and 60 (±4) days after treatment by photographic comparison before and after treatment. The physicians evaluated the improvement of facial wrinkles according to the Wrinkle Assessment Scale of Lemperle. Forty-nine subjects completed the study and showed a significant improvement in wrinkles in all areas of the face. Results: There were no significant differences in the different subpopulations compared: males–females, Glogau 3–Glogau 4, smokers–non-smokers, phototypes 1–4, and check up at 30 days–control at 60 days. The adverse events manifested were localized edema in four cases (8.2%) lasting an average of 3–4 days, very fine crustiness in four cases (8.2%), transient post inflammatory dyschromia in two cases (4.1%) lasting 2–3 weeks, and herpetic reactivation in one case (2.0%). Conclusions: The study demonstrates the therapeutic efficacy of the combined needling-peeling treatment in different types of wrinkles.
... Ibrahim et al. [13] concluded that the treatment of acne scars was satisfactory, whether using combined microneedling and PRP or microneedling alone. However, El-Domyati et al. [14], Porwal et al. [15], and Simran [16] found that outcome treatment of acne scars with the combination of "dermaroller and PRP" produced better results than "dermaroller alone. Similarly, our study showed that the combined therapy of microneedling RP and PRP gave satisfactory responses. ...
Article
Full-text available
Background: Acne Vulgaris is a self-limiting, chronic skin lesion, which may heal with squally of different types of scars (ice pitted, boxcar, rolling, and keloid). Different options used to deal with scars such as laser dermabrasion, surgical excision, and chemical peeling. This study aims to assess the safety and effectiveness of using a combination of radiofrequency (RF) microneedling and platelet-rich plasma (PRP) in managing the atrophic acne scars among a sample of Iraqi patients. Method: An interventional study conducted from January 2017 to December 2018 at a private dermatological clinic in Kalar City, Al-Sulaymmania Province, Iraq. Patients with the atrophic scar and willing to participate are adequately assessed and treated by RF and PRP. A different number of sessions of therapy used, and patients followed for three months after the last meeting. Results: Thirty-one patients were involved in the study. The majority of them (27, 87.0%) were females with a mean age of 26.41±8 years. Twenty patients (64.5%) had opened mouth (boxcar and rolling) scars, and eleven (35.5%) had ice pitted scars. Ten patients (32.25%) showed an excellent response to RF and PRP therapy with two grades improvement, fifteen patients (48.38%) showed good response with one-grade improvement and six patients (19.6%) showed poor response without improvement in grades, (all of them of ice pitted scars). There was a direct relationship between the number of sessions and the response to therapy. Three patients developed folliculitis at sits of puncturing with the isolation of staphylococcus auras bacteria, which cleared by topical and systemic antibiotics. Conclusions: Although ice pitted scars showed an inadequate response to therapy, however, the reaction of the boxcar and rolling scars to RF and PRP was excellent, indicating that combination procedure is a safe, efficient and satisfactory option for the treatment of atrophic acne scars.
... A combination of PRP and microneedling showed significantly greater mean improvement (64.87%) compared to microneedling alone (27.87%). [84] A similar trend was observed by Porwal et al., [85] with 58.58% improvement in the combination group compared to 43.03% in only microneedling patients. In another study, improvement in boxcar and ice pick scars was greater than with rolling scars. ...
Article
Acne scars are the reason for significant morbidity among dermatology outpatients. With more modalities being introduced every year, it is important to choose the best one suited for a particular type of scar for each patient to obtain an optimum result. Guidelines on acne scar management in the skin of color are not available where the therapeutic effect and side effect profile of the modalities can vary significantly. This narrative review looked at critical evaluation of the available modalities to find the level of evidence and therapeutic ladder of management of different types of acne scars. Treatment options for different types of scars have been described. Evidence level for each type of modality for the individual type of scar was calculated using the Strength of Recommendation Taxonomy (SORT) developed by editors of the US family medicine and primary care journals. In addition, various newer and emerging treatment options, such as dermal cell suspension, jet volumetric remodeling, and radiofrequency subcision, have been discussed. The highest level of evidence is available for microneedling, fractional radiofrequency, fractional CO 2 , and erbium:yttrium aluminum garnet laser for mild to moderate grade scars. Trichloroacetic acid chemical reconstruction of skin scars showed efficacy in ice pick scars. Grade 4 scars improve poorly with resurfacing procedures, where punch excision and punch elevation can be tried. Platelet-rich plasma therapy was effective in combination with lasers and microneedling. Overall there is lack of high-quality data in the management of post acne scars. Combination treatment has shown better efficacy compared to single modalities.
... Новые биологические методы лечения, такие как PRP-терапия (плазмолифтинг), применяются для коррекции атрофических рубцов постакне [39]. Аутологичная обогащенная тромбоцитами плазма в качестве метода биологической стимуляции факторами роста и цитокинами может обеспечивать быстрый и продолжительный эффект при западающих рубцах постакне за счет стимуляции регенераторных процессов [40]. Однако авторы отмечают, что методики PRP-терапии для лечения атрофических рубцов постакне требуют дальнейших исследований [41]. ...
... Despite a large number of studies devoted to PRP effect on intestinal anastomosis regeneration, still, the impact of autoplasma on adhesion and different methods of PRP application is not well established (5,9). as a rule, soaking the intestinal walls with prp precedes the anastomosis formation (13,14), although injected PRP, which proved to be highly effective in other areas of medicine (17,18,19,20), has not been applied to the intestinal anastomosis. ...
... Ibrahim et al. [13] concluded that the treatment of acne scars was satisfactory, whether using combined microneedling and PRP or microneedling alone. However, El-Domyati et al. [14], Porwal et al. [15], and Simran [16] found that outcome treatment of acne scars with the combination of "dermaroller and PRP" produced better results than "dermaroller alone. Similarly, our study showed that the combined therapy of microneedling RP and PRP gave satisfactory responses. ...
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Acne Vulgaris is a self-limiting, chronic skin lesion, which may heal with squally of different types of scars (ice pitted, boxcar, rolling, and keloid). Different options used to deal with scars such as laser dermabrasion, surgical excision, and chemical peeling. This study aims to assess the safety and effectiveness of using a combination of radiofrequency (RF) microneedling and platelet-rich plasma (PRP) in managing the atrophic acne scars among a sample of Iraqi patients. Methods: An interventional study conducted from January 2017 to December 2018 at a private dermatological clinic in Kalar City, Al-Sulaymmania Province, Iraq. Patients with the atrophic scar and willing to participate are adequately assessed and treated by RF and PRP. A different number of sessions of therapy used, and patients followed for three months after the last meeting. Results: Thirty-one patients were involved in the study. The majority of them (27, 87.0%) were females with a mean age of 26.41±8 years. Twenty patients (64.5%) had opened mouth (boxcar and rolling) scars, and eleven (35.5%) had ice pitted scars. Ten patients (32.25%) showed an excellent response to RF and PRP therapy with two grade improvement, fifteen patients (48.38%) showed good response with one-grade improvement and six patients (19.6%) of ice pitted scars showed poor response without improvement in grades. There was a direct relationship between the number of sessions and the response to therapy. Three patients developed folliculitis at sits of puncturing with the isolation of staphylococcus auras bacteria, which cleared by topical and systemic antibiotics. Conclusion: Although ice pitted scars showed an inadequate response to therapy, however, the reaction of the boxcar and rolling scars to RF and PRP was excellent, indicating that combination procedure is a safe, efficient and satisfactory option for the treatment of atrophic acne scars.
... Ibrahim et al. [13] concluded that the treatment of acne scars was satisfactory, whether using combined microneedling and PRP or microneedling alone. However, El-Domyati et al. [14], Porwal et al. [15], and Simran [16] found that outcome treatment of acne scars with the combination of "dermaroller and PRP" produced better results than "dermaroller alone. Similarly, our study showed that the combined therapy of microneedling RP and PRP gave satisfactory responses. ...
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Background: Acne vulgaris is a common skin disease that frequently results in scarring. Scars secondary to acne can lead to physical disfigurements and a profound psychological impact. Early and effective treatment is the best means to minimize and prevent acne scarring. In patients with darker skin tones, current acne scar treatments pose complications, including dyspigmentation, further scarring, and overall unsatisfactory clinical outcomes. Objective: We sought to compare the efficacy of microneedling versus 35% glycolic acid chemical peels for the treatment of acne scars. Methods: Sixty patients with Fitzpatrick Skin Phototype IV to VI with atrophic acne scars were randomized into two groups: Group A underwent microneedling every two weeks for a total of 12 weeks and Group B received chemical peels every two weeks for a total of 12 weeks. Acne scar treatment efficacy was represented by an improvement greater than one grade from baseline according to the Goodman and Baron Scarring Grading System, measured two weeks after the completion of the last treatment session. Results: Group A demonstrated more improved outcomes in acne scar treatment compared to Group B; 73.33% (n=22) of patients in Group A achieved treatment efficacy while 33.33% (n=10) in Group B did the same. Additionally, 26.67% (n=8) in Group A showed no efficacy after treatment compared to 66.67% (n=20) in Group B. Conclusion: Microneedling provided better treatment outcomes compared to 35% glycolic acid peels for acne scar treatment in our patient population with Fitzpatrick Skin Phototypes IV to VI.
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The goal of facial rejuvenation is to reverse age-related skin changes. Over time, both intrinsic and extrinsic processes act to thin the epidermis and reduce the natural volume of collagen and subcutaneous fat. Recently, platelet-rich plasma has gained popularity as an adjunct in minimally invasive facial rejuvenation procedures. This chapter will discuss its use as an injectable, in conjunction with lasers, microneedling, and fat grafting.KeywordsFacial rejuvenationMicroneedlingLaser resurfacing
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In this study, the authors chose to assess the prognostic capabilities of the laser Doppler flowmetry method for postoperative complications in patients with advanced peritonitis. A retrospective randomized controlled trial (evidence level IIB) was performed. The study involved 54 patients who were operated on for secondary widespread fibrinous-purulent peritonitis. The patients were divided into two groups with 27 patients in each: the main group — with developed postoperative complications and a comparison group — without complications. The research was carried out by the analyzer "Lazma MC-1" (Russia). Scanning of the parietal and visceral peritoneum, small and large intestines, as well as the edges of the laparotomic wound was performed. A total of 504 scans were performed. The relationship of indicators was determined using the Spearman's rank correlation coefficient. Microcirculation indices in both groups were characterized by pronounced disorders of pre- and postcapillary resistance and disorders of tissue perfusion. The following indicators turned out to be statistically significant: percentage of microcirculation (r= 0.77 at p≤0.05), standard deviation (r = 0.67 at p≤0.05), coefficient of variation (r = 0.59 at p≤0, 05) and shunting percentage. In patients of the main group, the changes were expressed in an increase in pre- and postcapillary resistance, progressive arterio-venular shunting. All this ultimately led to disturbances in the perfusion of the intestinal wall, peritoneum and laparotomic wound, which led to postoperative complications. The technique of abdominal laser Doppler flowmetry can be a prognostic method that allows predicting the development of early postoperative complications after primary surgery and making appropriate adjustments to the treatment.
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The purpose of the study was to analyze the characteristics of the course and outcome in patients with diffuse peritonitis, depending on the methods of repeated sanitation and drainage of the abdominal cavity and ultrasound monitoring. The authors carried out a retro-spective analysis of the results of treatment of 102 patients. All patients were divided into 2 groups depending on the method of treatment, with randomization by extent and phase of peritonitis. In the group 1, a semi-open method of treatment was used: sanitation and drainage of the abdominal cavity with continuous peritoneal lavage, and staged relaparotomy according to indications. In the group 2, video laparoscopic sanitation and drainage of the abdominal cavity on demand were applied. In this group, with the Mannheim Peritonitis Index below 15 points, drainage was not performed. With the Mannheim index below 20 points, 1–2 drains were installed, when above 25 points — 3–4 drains. Postoperative complications in patients of the group 1 were found in 40.9%. In the group 2, there were fewer complications compared the group 1. This was due not only to fewer local complications, but also intra-abdominal complications, which were almost 2 times fewer. Thus, video laparoscopic sanitation is the method of choice for planned repeated sanitation of the abdominal cavity. Relaparotomy should be performed only with strict indications in the event of intra-abdominal complications and if video laparoscopic sanitation cannot be performed. Ultrasound monitoring in the post-operative period makes it possible to timely identify postoperative complications, differentiate their nature and exact localization.
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Objective: To investigate the effect and safety of PRP and Yifu combined with ultrapulsed CO2 lattice laser in patients with sunken acne scar. Methods: 700 subjects were selected from the group of patients with sunken acne scar treated in our hospital from November 2010 to December 2020. They were divided into control group (n = 350) and study group (n = 350). The grouping was mainly based on the random number table method. Patients in the control group were treated with ultrapulse CO2 lattice laser, while those in the study group were treated with ultrapulse CO2 lattice laser combined with PRP and Yifu. The clinical effect, scar improvement and quality of life before and after treatment, and adverse events during treatment were compared between the two groups. The clinical effect was categorized into cure after treatment, significant effect, effective, and ineffective. The total effective rate = 1 - ineffective rate. Results: After treatment, the total effective rate of the study group (81.43%) was higher than that of the control group (70.00%). After treatment, ECCA, VSS scores, daily activities, symptoms and feelings, work and study, leisure and entertainment, interpersonal relationship, treatment status, and total scores were all lower in both groups than before treatment, and the study group was lower than the control group. During the treatment, the incidence of adverse events in the study group (17.33%) was lower than that in the control group (28.57%), P < 0.05. Conclusion: PRP and Yifu combined with ultrapulse CO2 lattice laser in the treatment of sunken acne scar can effectively improve the scar, reduce the incidence of adverse events, and the treatment effect is obvious, which can improve the quality of life of the patients.
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Background: Platelet-rich plasma is a useful adjuvant therapy in the treatment of acne scars. Fat is as ideal soft tissue filler. Aims: To compare the efficacy and safety of subcision with autologous fat grafting versus subcision with intradermal Platelet-rich plasma for the treatment of acne scars. Methods: Twenty-four patients were divided into two groups with 12 patients each. One group subjected to single session of subcision with autologous fat grafting. Second group treated with subcision followed by intradermal Platelet-rich plasma monthly once for 3 months. High resolution digital photographs taken before and after every session. Single blinded physician assessment was also done. Results: In quantitative acne scar assessment scoring, both group of patients showed significant percentage of improvement in acne scars, 61.23 ± 9.48% in patients treated with subcision followed by autologous fat grafting and 44.16 ± 7.28% in patients treated with subcision followed by intradermal PRP. At the time of enrolment, 33.3% (n = 8) of patients had Grade A (milder) scarring, 50% (n = 12) had Grade B (moderate) scarring while 16.7% (n = 4) had Grade C (severe) scarring. After the completion of the treatment, it was found that 75% (n = 18) of patients were in Grade A while 20.8% (n = 5) of patients were in Grade B (p < 0.05; significant). Conclusion: Both the treatment modalities, i.e., autologous fat grafting and intradermal PRP were effective and safe for the treatment of acne scars and results in each group was significant (p < 0.001). But there were no statistically significant differences between the two treatment groups (p = 0.23).
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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.
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The review presents data from foreign and domestic clinical studies on the efficacy and safety of microneedling application in the treatment of post-acne symptom complex. An analysis of the database of systematic reviews of Russian, European, American researchers, comparative studies on the effectiveness of the microneedling therapy in patients with different skin types for the treatment of postacne symptom complex is presented. Possibilities of microneedling monotherapy and variants of combined treatment, in particular the combinations of microneedling with PRP-therapy, acid peels, non-ablative lasers, injection gels (PMMA-collagen, hyaluronic acid, sodium succinate) are shown.
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Background Platelet-Rich Plasma (PRP) is a medical material with numerous applications. It produces particularly spectacular effects when applied in cosmetic dermatology. The aim of the paper was to illustrate the origin of the treatment. Conclusion The therapy originates from transfusiology, where it is applied as a concentrate of platelets to treat trombocytopenia. PRP treatment is 70 years old and has an increasing number of applications. PRP holds particular promise for cosmetic dermatology.
Chapter
The use of PRP is well described as a healing booster but not so well as a rejuvenation tool. The protocols vary a lot and the efficacy is not really well proven. In this chapter we review the literature and present our experience in the use of PRP/PRF in aesthetic field for skin rejuvenation .
Chapter
Combined aesthetic interventions have become the new normal in aesthetic and medical dermatology as no single agent or approach can simultaneously target all tissue layers while applying complementary mechanisms of action for synergistic results. Particularly in the field of skin rejuvenation and cellular remodeling, a combination approach is needed for natural results as the pathophysiology driving conditions such as aging, hair loss, and scarring are multifaceted and require addressing changes that occur as a results of the interplay in the musculoskeletal, ligament, adipose tissue, and skin layer. Among the new treatment modalities introduced in the field of aesthetic dermatology, platelet-rich plasma (PRP) is emerging as an ideal adjunct that enhances clinical outcomes after interventions for skin rejuvenation, scarring, and hair loss, to name a few. In this chapter we describe the most common combination treatments using PRP in the field of aesthetic/medical dermatology.
Chapter
Autologous platelet-rich plasma (PRP) preparations are increasingly used as adjuncts to medical and cosmetic dermatologic applications. Their benefits stem from their ability to deliver high concentrated potent growth factors to target tissue and stimulate matrix remodeling, angiogenesis, and resolution of inflammation, to name a few of their functions. Recently the use of PRP has been evaluated for improving the appearance of challenging conditions such as scarring and striae distensae. While the improvement of scars/striae has been documented with strategies such as lasers, microneedling, topicals, and subcision, they are associated with incomplete resolution and long recovery times. In this respect, PRP offers an appealing treatment strategy that can work synergistically with other strategies to accelerate wound healing and maximize matrix remodeling. In this chapter we describe the challenges associated the current landscape of scar/striae treatment and illuminate the role PRP has been documented to have in this field. Review of the literature reveals that PRP can improve the quality of atrophic acne scars in particular and surgical scars but not keloid scars. Moreover, used in similar fashion as that for treating scars, it can be beneficial in the management of striae distensae. Overall, PRP is a promising adjunct in scar management, but in the authors opinion further research with long-term follow-up is needed to delineate the value of this modality in different subtypes of scars.
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Background: The use of platelet-rich plasma has emerged as one of the most desired nonsurgical treatments for facial rejuvenation and hair restoration. It has grown to encompass a wide variety of applications within the field of plastic surgery, including its use in combination with microneedling, laser, and fat-grafting procedures. Methods: In this article, the authors aim to (1) describe the preparation process of platelet-rich plasma; (2) discuss the proposed science behind platelet-rich plasma with regard to its evolving role in hair restoration and facial rejuvenation; and (3) highlight the recent literature examining its widespread use. Results: Based on the available literature, there is a therapeutic advantage to the use of platelet-rich plasma as a single treatment modality for alopecia and skin rejuvenation and in combination with laser skin treatment and fat grafting. There is, however, a considerable amount of variability in the processing, preparation, and treatment modalities. Conclusions: Despite a lack of standardized protocols for platelet-rich plasma preparation and a scarcity of large-scale studies with long-term follow-up, there is convincing evidence with objective measurement modalities that display positive outcomes after treatment for skin rejuvenation, hair regrowth, wound healing, and fat graft take.
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Background: Microneedling (MN) is used for the treatment of scars, amongst other indications. Although used in Asia and the Middle East for decades, related to the supposed lack of post-procedure pigmentary alterations even in darker skin types, MN only recently gained attention in the United States as an effective, well-tolerated aesthetic treatment. Materials and methods: A systematic review of the Medline database was completed using search terms "microneedle" or "microneedling" or "micro needle" or "micro needling" and "scar". Included articles were written in English and discussed the use of MN for the treatment of scars in human subjects. Results: Fifty-eight studies were included for review, with a total of 1845 patients treated for acne scarring, hypertrophic or keloid scars, and those resulting from surgery, trauma, varicella or smallpox. MN and its counterpart fractional radiofrequency MN (FRF-MN) were used as monotherapy or in combination with topical, surgical or systemic modalities. MN and FRF-MN treatment resulted in clinical improvement of scar appearance from baseline. No serious adverse events occurred. Conclusion: MN is a well-tolerated, minimally invasive procedure that can be used for the treatment of scars with a high level of patient satisfaction. Further clinical studies are needed to develop standardized treatment protocols.
Article
Background: Scarring is common complication of acne. Microneedling is well accepted modality of treatment for atrophic acne scar. Platelet rich plasma (PRP) is newer option in acne scar management. Aim: To compare efficacy of combined microneedling and PRP with microneedling atrophic acne scar. Materials and Method: A total of 34 patients of atrophic acne scar were included in study. Right side of face was treated with combined microneedling and PRP and left side of face treated with microneedling alone. Total three sitting of treatment given at monthly interval. Final assessment was done using physician satisfaction score and Goodman and Baron acne scar grading one month after last sitting. Result: A total of 34 patients enrolled out of which 2 were dropped out 32 patients had included in final analysis. The baseline mean Goodman and Baron Score of both side of face was 2.72±0.45 which was reduced to 2.2 ±0.4 and 2.37 ±0.5 on right side and left side of face respectively. The mean physician satisfaction score was 2.16±0.79 and 1.91±0.8 on right side and left side of face respectively. Conclusion: Combined approach using microneedling with PRP is a better option than microneedling alone in acne scar management clinically.
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Background Anatomy of the periorbital region is very complex. Malar oedema/mounds/festoons often remain unaddressed. There are various treatments proposed for this pathologic entity as well as non‐standardized nomenclature. Implementation of technology in aesthetic medicine and surgery resulted in novel treatments for this entity. Aims The aim of this case presentation was to show the combination of fractional microneedle bipolar radiofrequency with medium depth 15%TCA peel as a great tool in treating malar bags with no complication and excellent result. Patients/Methods We report a case of 44‐year‐old women with malar mound and festoon. The treatment consisted of rejuvenation of whole periorbital region‐ upper and lower blepharoplasty and novel treatment combination‐fractional microneedle bipolar radiofrequency with medium depth 15%TCA peel in 2 sittings. Results After 6 weeks, excellent results can be observed with malar mound and festoon completely resolved. No complications were observed. Conclusion Fractional microneedle bipolar radiofrequency with medium depth 15%TCA peel is a safe and effective treatment option for malar bags.
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Sendo o microagulhamento uma técnica bastante difundida na área da dermatologia, este trabalho busca como a eficácia do microagulhamento no tratamento da acne vem sendo avaliada na literatura. Trata-se de uma revisão integrativa do tipo qualitativa. Buscou-se nas bases de dados Pubmed, Sciencedirect e Scopus os termos “acne and microneedling” e “acne and percutaneous induction of collagen” e seus correspondentes em português. Como critérios de inclusão, considerou-se: a) serem pesquisas clínicas b) estarem disponíveis em texto completo c) publicadas entre 2015 e 2019 d) estarem em português, inglês ou espanhol. Excluiu-se os textos que não tinham relação com a temática e as duplicatas. Assim, dos 108 artigos apresentados pela busca nas bases de dados, 23 foram selecionados por afinidade à temática de busca, sendo 38 artigos excluídos por duplicação e 47 por não serem relacionados com o assunto. O tratamento de acne com microagulhamento mostrou-se efetivo e seguro, pouco invasivo e de rápida recuperação. Apesar disso, salienta-se a necessidade de pesquisas futuras mais específicas, avaliando a sua combinação com outros tratamentos, a quantidade de sessões necessárias e o resultado nos diferentes graus de cicatrizes.
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Background Skin needling, also called “collagen induction therapy”, is a novel non‐pharmacological treatment modality that has been increasingly utilized for the treatment of acne scars. Aims To review the medical literature and to select the most significative and recent studies regarding skin needling as a treatment for acne scarring, used alone or combined with other treatments. Methods A literature search was performed using the PubMed, Medline, and Embase databases, in addition to reviewing the bibliographies of relevant articles. Results Almost all the articles evaluated showed improvement of acne scars severity after microneedling treatment. When combined with other treatments such as autologous platelet‐rich plasma (PRP), chemical peels, filler injections or laser treatment, a greater improvement was reported. Needling technique is well‐tolerated with erythema and dryness representing the most frequent adverse events. Conclusions Microneedling is a useful treatment for ance scarring. Further studies are needed to evaluate its efficacy and safety and to create a standardized protocol to adopt for each patient according to the severity of acne scars.
Article
This is a brief history of the beginnings of skin needling (collagen induction therapy) and Part 1 covers the original clinical work which was then validated by research primarily by Matthias Aust and team at Hanover Medical School, Germany. Skin needling became the very first medical procedure that induces regeneration instead of scar formation because it employs transforming growth factor‐β3 (TGF‐β3) and interleukin‐10 (IL‐10). We essay into methods to optimise the effects of skin needling. First by the depth of penetration into the skin which will depend on the condition treated. Wrinkles stretch marks, and so on only require 1.0 mm whereas burns scars acne scars, and so on require deeper penetration, that is, approximately 3.0 mm. In Part 2, we need to consider the use of topicals both before and after skin needling. Vitamins A and C are scientifically proven to almost quadruple the effects of needling. Selected peptides seem to further enhance results. Hyaluronic acid is best induced naturally but may be used topically for comfort. Finally, we examine the rationale of the intervals between needling. The best clinical results seem to come from treatments at 4 to 10 days intervals to take advantage of raised titres of TGF‐β3 and IL‐10. Other modalities such as red and infrared LED, platelet‐rich plasma and mild peeling are gaining appeal to give better results. Skin needling is the safest and most effective method to treat photoaging, lax skin, stretch marks, acne scars, and burn scars.
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Background: The use of platelet-rich plasma (PRP) combined with noninvasive, nonenergy procedures for atrophic acne scars has shown promise. To date, there has not been a systematic review or meta-analysis of the effectiveness of this therapy. Aims: To use meta-analysis to compare Goodman and Baron qualitative scores, patient satisfaction outcomes, and adverse effects in patients undergoing combination procedures with PRP, combination procedures without PRP, and noninvasive monotherapy without PRP in the treatment of patients with atrophic acne scars. Patients/methods: The Pubmed and Cochrane library databases were searched for relevant studies published before May 1, 2019. PRISMA guidelines were utilized. Studies that compared the use of PRP in combination with a noninvasive procedure and therapies without PRP for the treatment of atrophic acne scars were included. Cochrane's handbook was utilized to assess the individual biases of the included studies. Publication bias was assessed. Results: A total of 311 participants (153 whole-face participants and 158 split-face participants) were reviewed across eight included studies. Quantitative analysis of 241 participants across six included studies showed a statistically significant reduction in scar severity scores in favor of microneedling or subcision with PRP (P < .001). Combination therapy with intradermal or topical PRP was significantly more effective than monotherapy alone and combination therapy with an adjunct other than PRP (P < .001 and .001, respectively). Conclusion: This systematic review and meta-analysis demonstrated that microneedling or subcision with PRP produced statistically significant improvement in validated outcomes over microneedling or subcision alone.
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Introduction. Wound regeneration is an important process in surgical interventions. Failure of an intestinal anastomosis is an important intestinal surgery problem. The objective of the study. To evaluate the effect of platelet-rich plasma (PRP) and compare the effectiveness of various application methods in intestinal anastomosis regeneration in rabbits. Methods. Platelet-rich auto-plasma was obtained from 81 rabbits, which was used to study two methods of applying PRP (injection into the muscle layer / soaking in the intestinal wall) in comparison with the control group, on the end-to-end small-intestinal anastomosis. Results. The analysis of the histological and morphometric data showed that the regeneration between the samples of intestinal anastomosis treated with PRP soaking and injections into the intestinal wall is more favorable in comparison with the control group, which, in turn, was determined by the quantitative ratio of inflammatory infiltrate, fibroblast proliferation, neo-angiogenesis, and collagen deposition. PRP soaking in the intestinal wall significantly increased the number of adhesions battles. The analysis of the deformation and strength characteristics of the formed anastomoses also showed significantly high values of the rupture strength of the anastomoses treated with PRP, in contrast with the control group. Conclusion. PRP injection into the muscular layer of the intestinal wall significantly reduces the development of adhesions in comparison with the PRP-saturated group of intestinal anastomoses. Further research is needed to clarify the optimal method of PRP application, which will improve the regeneration of the intestinal anastomosis.
Article
Background: Platelet-rich plasma (PRP) is an increasingly popular treatment modality for various dermatologic conditions, but there are limitations in both the published literature and clinician knowledge. Objective: To create a high-yield, in-depth analysis of PRP in procedural dermatology by reviewing available data on its role in hair restoration, soft-tissue remodeling, resurfacing, and rejuvenation; identifying practice gaps and controversies; and making suggestions for future research that will establish dermatologists as pioneers of regenerative medicine. Materials and methods: A two-part systematic review and expert analysis of publications before October 2018. Results and conclusion: Most studies on PRP report favorable outcomes with the strongest level of evidence existing for androgenetic alopecia followed by postprocedure wound healing, scar revision, striae, rejuvenation, and dermal filling. There is a dearth of large randomized controlled trials, considerable heterogeneity in the variables studied, and lack of specificity in the preparatory protocols, which may influence clinical outcomes. Future investigations should use consistent nomenclature, find ideal solution parameters for each cutaneous indication, determine significant outcome metrics, and follow double-blinded, randomized, controlled methodologies. Addressing these deficiencies will take sound scientific inquiry but ultimately has the potential to benefit the authors' specialty greatly.
Article
Background: Platelet-rich plasma (PRP) is an increasingly popular treatment modality for various dermatologic conditions, but there are limitations in both the published literature and clinician knowledge. Objective: To create a high-yield, in-depth analysis of PRP in procedural dermatology by reviewing available data on its role in hair restoration, soft-tissue remodeling, resurfacing, and rejuvenation; identifying practice gaps and controversies; and making suggestions for future research that will establish dermatologists as pioneers of regenerative medicine. Materials and methods: A 2-part systematic review and expert analysis of publications before October 2018. Results and conclusion: Most studies on PRP report favorable outcomes with the strongest level of evidence existing for androgenetic alopecia followed by postprocedure wound healing, scar revision, striae, rejuvenation, and dermal filling. There is a dearth of large randomized controlled trials, considerable heterogeneity in the variables studied, and lack of specificity in the preparatory protocols, which may influence clinical outcomes. Future investigations should use consistent nomenclature, find ideal solution parameters for each cutaneous indication, determine significant outcome metrics, and follow double-blinded, randomized, controlled methodologies. Addressing these deficiencies will take sound scientific inquiry but ultimately has the potential to benefit the authors' specialty greatly.
Article
Platelet-rich plasma (PRP) has gained popularity in facial plastic surgery because of its role in wound healing. PRP, having a higher concentration of platelets, allows for greater release of growth factors and biologically active proteins, which in turn activates the wound-healing cascade stimulating neoangiogenesis and collagen production. One of the most popular uses for PRP is for facial skin rejuvenation in the form of dermal injections and topical application during microneedling. The promising nature of PRP makes using it for injection and/or in conjunction with microneedling a good addition to any practice that deals with skin rejuvenation.
Article
Background: Microneedling is a popular, minimally invasive skin rejuvenation modality for acne scarring. Recent reports have evaluated the efficacy and safety of microneedling monotherapy and combination treatment for scarring. Objective: This review aims to systematically analyze the current literature on microneedling techniques used for acne scarring. Methods: A PubMed search (2009-current) was used to identify literature on microneedling treatment for acne. All randomized and nonrandomized clinical trials, case cohorts, case reports, and case series were included with the exception of 2 studies, which were excluded due to unavailability. Results: All 33 articles evaluated showed improvement of acne scar appearance after microneedling treatment. Evidence was inconsistent when comparing microneedling monotherapy to dual therapy or to fractional laser treatment. Conclusion: Microneedling improves acne scarring, and further studies are needed to compare microneedling with other minimally invasive treatments.
Article
Introduction: Novel topical products formulated using tri- and hexapeptide technology (TriHex Technology® ; Alastin Skincare® , Inc) are used to clear the extracellular matrix, stimulate neocollagenesis and elastogenesis, decrease inflammation, and accelerate the epidermal healing process. Aims: This study assessed the efficacy of two topical tri- and hexapeptide-containing products pre- and post-treatment with radiofrequency (RF) microneedling of the photoaged neck with respect to healing and aesthetic outcomes. Subjects/methods: In this open-label, nonrandomized study, eligible subjects underwent one screening visit, one RF microneedling procedure and follow-up visits on post-treatment Days 3, 7, 30, and 90. Subjects were instructed to apply one product to the neck for 2 weeks prior to treatment and 7 days post-treatment. On post-treatment Day 7, subjects switched to the other product until the end of the study. At each visit, subject and investigator questionnaires were completed and standardized digital images were obtained. Results: Female subjects (N = 10) with a mean age of 51.3 years (range, 44-59 years) completed the study. All subjects achieved statistically significant improvements in Investigator Global Assessment scales at post-treatment Day 90 and reported improvement in all Skin Quality Assessments. Among Subjective Tolerability Assessments, all post-treatment reports of tingling and burning resolved by Day 3. 90% of stinging resolved by Day 3 with 100% resolving by Day 7. 40% of subjects had minimal itching on Day 3 which resolved by Day 7. Among the Investigator Post-treatment Tolerability Assessments, edema resolved in all subjects by Day 3 and erythema settled between Day 3 and Day 7. Conclusion: Pre- and post-treatment use of topical products formulated with tri- and hexapeptide technology appears to hasten healing and complement aesthetic outcomes associated with RF microneedling of the neck.
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Objective: Treatment of acne scarring is always a challenge. Microneedling therapy or percutaneous collagen induction is a new addition to the treatment modalities for such scars and has been reported to be simple and effective in atrophic acne scar treatment. The aim of this study is to evaluate the clinical effect and objectively quantify the histological changes of acne scarring in response to skin microneedling. Design: A prospective clinical study. Participants: Ten patients with different types of atrophic acne scars were subjected to three months of skin microneedling treatment (six sessions at two-week intervals). Measurements: Patients were photographed, and skin biopsies were obtained at baseline as well as one and three months from the start of treatment. Histometry for epidermal thickness and quantitative evaluation of total elastin; newly synthesized tropoelastin; collagen types I, III, and VII; and newly synthesized collagen were performed for all biopsies. Results: Compared to the baseline, patients' evaluations revealed noticeable clinical improvement in atrophic post-acne scars in response to skin microneedling. There was a statistically significant increase (p<0.05) in the mean of collagen types I, III, and VII and newly synthesized collagen, while total elastin was significantly decreased (p<0.05) after the end of treatment. Conclusions: Multiple minimally invasive sessions of skin microneedling are an effective treatment for post-acne atrophic scars as it stimulates the repair processes with the advantage of being a relatively risk-free, in-office procedure with minimal patient recovery time.
Article
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Atrophic acne scars are difficult to treat. The demand for less invasive but highly effective treatment for scars is growing. To assess the efficacy of combination therapy using subcision, microneedling and 15% trichloroacetic acid (TCA) peel in the management of atrophic scars. Fifty patients with atrophic acne scars were graded using Goodman and Baron Qualitative grading. After subcision, dermaroller and 15% TCA peel were performed alternatively at 2-weeks interval for a total of 6 sessions of each. Grading of acne scar photographs was done pretreatment and 1 month after last procedure. Patients own evaluation of improvement was assessed. Out of 16 patients with Grade 4 scars, 10 (62.5%) patients improved to Grade 2 and 6 (37.5%) patients improved to Grade 3 scars. Out of 22 patients with Grade 3 scars, 5 (22.7%) patients were left with no scars, 2 (9.1%) patients improved to Grade 1and 15 (68.2%) patients improved to Grade 2. All 11 (100%) patients with Grade 2 scars were left with no scars. There was high level of patient satisfaction. This combination has shown good results in treating not only Grade 2 but also severe Grade 4 and 3 scars.
Article
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The treatment of acne scars is challenging due to the variety in morphology of acne scars and the limitations of the available treatment modalities in their ability to improve scars. Multiple treatment options exist, and each has a unique place in the armamentarium of the acne scar surgeon. In order to optimally treat a patient’s scars, a tailored treatment plan must be created in which the patient’s specific types of scars are treated with the procedures that are most likely to improve those types of scars. The definition of and the rationale for combination therapy is discussed in detail. The indications for specific procedures are reviewed, highlighting ways that procedures can be combined to most optimally treat patients with certain combinations of scars.
Article
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Facial rejuvenation is a significant process involved in restoring youthfulness. The introduction of less invasive procedures has increased acceptance of such procedures. Often a combination of different techniques allows individualized treatment with optimal outcomes. Furthermore, this leads to a natural look without a significant downtime. We report herein the use of such a combined approach in middle-aged women with particular emphasis on botulinum toxin type A, dermal fillers, and chemical peels.
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A cross-sectional, community-based study was performed to determine the prevalence and severity of acne vulgaris in adolescents and of factors influencing the acne severity risk. The presence of acne was clinically determined and the secondary outcome measures of family acne history and the relation of acne to nutrition habits, emotional stress, menstruation, and smoking were recorded in a questionnaire. A representative sample of 1,002 pupils aged 16+/-0.9 years was enrolled. The overall acne prevalence was 93.3, 94.4% for boys and 92.0% for girls. Moderate to severe acne was observed in 14%. The prevalence of moderate to severe acne was 19.9% in pupils with and 9.8% in those without a family history of acne (P<0.0005; OR: 2.3). Acne severity risk increased with the number of family members with acne history. A mother with acne history influenced the severity of acne the most. Increasing pubertal age, seborrhea, the premenstrual phase, mental stress, and sweet and oily foods were recognized as risk factors for moderate to severe acne. In contrast, gender, spicy foods, and smoking were not associated with acne severity. In conclusion, acne is a common disorder in Iranian adolescents, with a low rate of moderate to severe acne. A genetic background is suggested, with mother's acne history being the most important prognostic factor. Skin quality and certain nutrition habits may affect acne severity.
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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
BACKGROUND: Chronic solar irradiation results in both morphologic and functional changes in affected skin. α-hydroxy acids, such as glycolic acid, have been shown to improve photodamaged skin. OBJECTIVE: To investigate alterations in collagen gene induction and epidermal and dermal hyaluronic acid production as a result of administered glycolic acid. METHODS: In this study we compared collagen gene expression from skin biopsy specimens, and epidermal and dermal hyaluronic acid immunohistochemical staining between glycolic acid-treated and vehicle-treated skin. Forearm skin was treated with 20% glycolic acid lotion or a lotion vehicle control twice a day for 3 months. RESULTS: Epidermal and dermal hyaluronic acid and collagen gene expression were all increased in glycolic acid-treated skin as compared to vehicle-treated controls. CONCLUSION: Our data suggest that epidermal and dermal remodeling of the extracellular matrix results from glycolic acid treatment. Longer treatment intervals may result in collagen deposition as suggested by the measured increase in mRNA.
Article
Cosmetic-driven research currently yields an avalanche of products and treatments for all dermatological sub-segments. Many treatments aimed at rejuvenating skin have been developed. Although chemical peels have now been used for more than a century-and despite the availability of new technologies- the treatment is still widely known and employed due to its practicality, low cost, and excellent results. The present study offers a review of all types of peelings recognized by the scientific literature - from the most superficial to the deepest - compiling the practical experience of the authors and detailed descriptions of the application technique, results, and complications.
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Platelet-rich plasma (PRP) contains autologous growth factors, which could act synergistically with growth factors induced by skin needling in order to enhance the wound-healing response. The combination of treatments, carried out by using skin needling and PRP application, should enhance both efficacy of skin needling and PRP application. The objective of this study is to establish the effectiveness of the combined use of skin needling and PRP application in acne scarring treatment. Twelve patients affected with rolling acne scars were enrolled. Each patient underwent 2 sessions of treatments, each consisting of skin needling followed by PRP application on the right side of the face and skin needling alone on the left side of the face. Digital photographs of all patients were taken. Photographic data were analyzed by using the Sign Test (α<.05). The study showed that the scars severity grade in all patients was greatly reduced on all of the face, but the improvement was more efficient on the side treated with both skin needling and PRP. Our study showed that the combined use of skin needling and PRP is more effective than skin needling alone in improving acne scars.
Article
The face is the focus of human interactions, and facial appearance profoundly affects self-esteem. Facial appearance is not only a compilation of the dimensions of the primary morphologic features but is also a direct result of the emotional expressions exhibited on the face. Facial expressions are central in the communication of emotions, as well as in signaling characteristics such as age. The repeated expression of emotions produces hyperfunctional facial lines, and the presence of these lines when the face is at repose may give an erroneous impression of emotions or personality characteristics. These lines are also perceived as a sign of aging. Treatment of hyperfunctional facial lines is beneficial for patients who believe that their faces are not communicating their emotions properly, who want to delay the outward appearance of aging, or who simply want to look their best.
Article
Treatment of acne scarring is always a challenge. Microneedling therapy or percutaneous collagen induction is a new addition to the treatment modalities for such scars and has been reported to be simple and effective in atrophic acne scar treatment. The aim of this study is to evaluate the clinical effect and objectively quantify the histological changes of acne scarring in response to skin microneedling. A prospective clinical study. Ten patients with different types of atrophic acne scars were subjected to three months of skin microneedling treatment (six sessions at two-week intervals). Patients were photographed, and skin biopsies were obtained at baseline as well as one and three months from the start of treatment. Histometry for epidermal thickness and quantitative evaluation of total elastin; newly synthesized tropoelastin; collagen types I, III, and VII; and newly synthesized collagen were performed for all biopsies. Compared to the baseline, patients' evaluations revealed noticeable clinical improvement in atrophic post-acne scars in response to skin microneedling. There was a statistically significant increase (p<0.05) in the mean of collagen types I, III, and VII and newly synthesized collagen, while total elastin was significantly decreased (p<0.05) after the end of treatment. Multiple minimally invasive sessions of skin microneedling are an effective treatment for post-acne atrophic scars as it stimulates the repair processes with the advantage of being a relatively risk-free, in-office procedure with minimal patient recovery time.
Article
Dermal stimulation and augmentation represent the main facial treatments in aesthetic medicine. Their use continues to increase. Treatments primarily use a bioresorbable substance, such as hyaluronic acid. There are also numerous exogenous fillers that may also be used to obtain a fibrotic response, at the dermal level, resulting in volume augmentation. As biodegradable substances, these exogenous injectables can have distinct disadvantages. They may cause transient effects, such as persistent erythema, swelling and encapsulation, granuloma formation and sometimes, even chronic or delayed infections. Consequently, the physicians and aesthetic dermatologists have sought an autologous source for soft tissue augmentation. As a result, human growth factors have been widely studied and today there are clinical applications of several individual growth factors. Examples are a keratinocyte growth factor (Kepivance®, Sweden) for oral mucositis and platelet derived growth factor (Regranex, UK) for non-healing diabetic wounds. However, these exogenous growth factors, when applied outside their normal environment, may have unwanted side effects. In 2008, the U.S. FDA identified the use of Becaplermin as a possible cause of increased cancer mortality. Similarly, the safe use of Palifermin has not been established. In contrast, autologous platelets are an excellent source of growth factors due to their biological properties and their endogenous origin. They are now the main source of growth factors used to facilitate wound healing. It has been shown that the application of a Platelet Rich Plasma (PRP) enhances early wound healing (6, 7, 15), and improves healing in diabetic ulcers (3). Since the 1990s, the application of platelet preparations for wound healing has outpaced that of isolated, exogenous growth factors. Apart from the wide use of PRP to accelerate wound healing, there is substantial clinical evidence regarding its use in other medical fields. For example, cross-linked PRP forms a gel which is widely used in orthopedics (11, 12), as well as in maxillofacial surgery (9).
Article
Microneedling or percutaneous collagen induction is a new modality used for skin rejuvenation, tightening, and scar remodeling. It offers a simple and effective treatment for photoaged skin with minimal disruption of the epidermis, thus limiting adverse effects and minimizing downtime. To evaluate the efficacy, coupled with quantitative assessment, of the histological changes in response to multiple sessions of skin microneedling in the treatment of aging skin. Ten patients with Fitzpatrick skin type III and IV and Glogau class II to III wrinkles were subjected to six skin microneedling sessions at 2-week intervals. Standard photographs and skin biopsy specimens were obtained at baseline and at one and three months after the start of treatment. Histometry for epidermal thickness and quantitative evaluation of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin were performed for all skin biopsies. Skin microneedling produced noticeable clinical improvement of photoaged skin, with corresponding histological enhancement. Compared to the baseline, collagen types I, III, and VII, as well as newly synthesized collagen, together with tropoelastin showed a statistically significant increase (P < 0.05) in response to treatment, while the mean level of total elastin was significantly decreased (P < 0.05) after treatment. Skin microneedling is a promising minimally invasive treatment option with the advantage of increased collagen production. However, multiple sessions are usually needed to maintain the improvement achieved. © 2015 The International Society of Dermatology.
Article
A proposal has recently been made regarding the potential adjuvant use of platelet-rich plasma (PRP) with fractional carbon dioxide laser (FCL) for the correction of acne scars. To compare the efficacy and safety of two administration modes of autologous PRP (intradermal injection (ID) and topical application) after FCL with that of FCL alone in the treatment of atrophic acne scars. Thirty patients were randomly divided into two groups. Both underwent split-face therapy. Group 1 was administered FCL followed by ID PRP on one side and FCL followed by ID saline on the other. In group 2, one cheek was treated with FCL followed by ID PRP, and the other received FCL followed by topical PRP. Each patient received 3 monthly sessions. The final assessment took place at 6 months. Combined PRP- and FCL-treated areas had a significantly better response (p = .03), fewer side effects, and shorter downtime (p = .02) than FCL-treated areas, but there were no significant differences in ID- and topical PRP-treated areas in degree of response and downtime (p = .10); topically treated areas had significantly lower pain scores. The current study introduces the combination of topical PRP and FCL as an effective, safe modality in the treatment of atrophic acne scars with shorter downtime than FCL alone and better tolerability than FCL combined with ID PRP.
Article
Aging of the skin is a multifactorial phenomenon in which ongoing intrinsic changes combine the cumulative effects of chronic exposure to the elements, primarily UV radiation, in a synergistic fashion, causing the skin to lose its thickness and elasticity and develop wrinkles. There is now an increased interest in a wide range of non-ablative treatments for skin aging, which are used to rejuvenate skin with minimal downtime and complications. As the demand for minimally invasive rejuvenation is increasing, different modalities have been designed to produce favorable alterations in the dermis with no epidermal damage via photomodulation, selective photothermolysis, fractional photothermolysis, radio waves, electro-optical synergy, injectable fillers, neurotoxins, skin needling and biorejuvenation to stimulate collagen synthesis and rejuvenate the aged skin while preserving the integrity of the epidermis.
Article
Background: Chronic solar irradiation results in both morphologic and functional changes in affected skin. alpha-hydroxy acids, such as glycolic acid, have been shown to improve photodamaged skin. Objective: To investigate alterations in collagen gene induction and epidermal and dermal hyaluronic acid production as a result of administered glycolic acid. Methods: In this study we compared collagen gene expression from skin biopsy specimens, and epidermal and dermal hyaluronic acid immunohistochemical staining between glycolic acid-treated and vehicle-treated skin. Forearm skin was treated with 20% glycolic acid lotion or a lotion vehicle control twice a day for 3 months. Results: Epidermal and dermal hyaluronic acid and collagen gene expression were all increased in glycolic acid-treated skin as compared to vehicle-treated controls. Conclusion: Our data suggest that epidermal and dermal remodeling of the extracellular matrix results from glycolic acid treatment. Longer treatment intervals may result in collagen deposition as suggested by the measured increase in mRNA.
Article
  Acne scars can cause emotional and psychosocial disturbance to the patient. Various modalities have been used for the treatment of acne scars like punch excision, subcision, peels, microdermabrasion, unfractionated and fractioned lasers. The latest in the treatment armamentarium is microneedling. Acne scars commonly coexist with postinflammatory hyperpigmentation. A combination of microneedling and glycolic acid (GA) peels was found to give excellent results in the treatment of such scars. The aim was to study the efficacy of a combination of microneedling with glycolic peel for the treatment of acne scars in pigmented skin.   Thirty patients in the age group of 20-40 years with atrophic box type or rolling scars with postinflammatory hyperpigmentation were chosen for the study. Two groups were made. The first group comprised of 30 patients in whom only microneedling was performed once in 6 weeks for five sessions. In the second group of 30 patients, a combination of microneedling and 35% GA peels was carried out. Patients from both groups were evaluated on the basis of Echelle d'Evaluation clinique des Cicatrices d'acné classification.   Based on the objective scoring and its statistical analysis, there was significant improvement in superficial and moderately deep scars (grade 1-3). There was also improvement in skin texture, reduction in postacne pigmentation in the second group.   Microneedling is a simple, inexpensive office procedure with no downtime. It is safe in Indian skin (skin types III-IV). The combined sequential treatment with GA peel caused a significant improvement in the acne scars without increasing morbidity.
Article
Chemical peeling is a popular, relatively inexpensive, and generally safe method for treatment of some skin disorders and to refresh and rejuvenate skin. This article focuses on chemical peels and their use in routine clinical practice. Chemical peels are classified by the depth of action into superficial, medium, and deep peels. The depth of the peel is correlated with clinical changes, with the greatest change achieved by deep peels. However, the depth is also associated with longer healing times and the potential for complications. A wide variety of peels are available, utilizing various topical agents and concentrations, including a recent salicylic acid derivative, beta-lipohydroxy acid, which has properties that may expand the clinical use of peels. Superficial peels, penetrating only the epidermis, can be used to enhance treatment for a variety of conditions, including acne, melasma, dyschromias, photodamage, and actinic keratoses. Medium-depth peels, penetrating to the papillary dermis, may be used for dyschromia, multiple solar keratoses, superficial scars, and pigmentary disorders. Deep peels, affecting reticular dermis, may be used for severe photoaging, deep wrinkles, or scars. Peels can be combined with other in-office facial resurfacing techniques to optimize outcomes and enhance patient satisfaction and allow clinicians to tailor the treatment to individual patient needs. Successful outcomes are based on a careful patient selection as well as appropriate use of specific peeling agents. Used properly, the chemical peel has the potential to fill an important therapeutic need in the dermatologist's and plastic surgeon's armamentarium.
Article
Postadolescent acne is usually described as an inflammatory, mild-to-moderate dermatosis, frequently involving the lower third of the face, the jawline, and the neck. However, we have also frequently observed a clinical form predominantly characterized by retention lesions (microcomedones and macrocomedones), with few inflammatory lesions (comedonal postadolescent acne [CPAA]), which appears significantly correlated with cigarette smoking. We sought to investigate the clinical features of postadolescent acne in a group of female patients affected by acne and its relationship with cigarette smoking. A total of 226 women with acne (25-50 years) attending our department were examined by a team of 3 dermatologists, to assess the age of onset of the disease, and the number, type, and distribution of acne lesions. In all, 192 of 226 patients (85.0%) were classified as having CPAA and 34 as having papulopustular postadolescent acne. A smoking habit was confirmed in 150 of 226 (66.3%). Remarkably, 72.9% of patients with CPAA were smokers as compared with only 29.4% of those with papulopustular postadolescent acne (P < .0001). Possible limitations are related to geographic area or to the prevalence of darker skin types (III and IV) (data about skin types have not been collected). Other possible aggravating factors (ie, stress and diet) have not been investigated. According to our results, CPAA appears as the most frequent clinical form of postadolescent acne and seems to be strictly correlated with cigarette smoking.
Article
Atrophic facial scars are always a challenge to treat, especially the ones that are deep-seated and/or involve much of the face. Microneedling or dermaroller therapy is a new addition to the treatment armamentarium for such scars that offers a simple and reportedly effective management of these scars. The aim of the present study was to perform an objective evaluation of the efficacy of dermaroller treatment in atrophic facial scars of varying etiology. Thirty-seven patients of atrophic facial scarring were offered multiple sittings of microneedling (dermaroller) treatment and their scars were evaluated and graded clinically and by serial photography at the start as well as at two months after the conclusion of the treatment protocol. Any change in the grading of scars after the end of treatment and follow-up period was noted down. The patients were also asked to evaluate the effectiveness of the treatment received on a 1-10 point scale. The efficacy of dermaroller treatment was thus assessed both subjectively by the patients as well as objectively by a single observer. Overall 36 out of the total of 37 patients completed the treatment schedule and were evaluated for its efficacy. Out of these 36 patients, 34 achieved a reduction in the severity of their scarring by one or two grades. More than 80% of patients assessed their treatment as 'excellent' on a 10-point scale. No significant adverse effects were noted in any patient. Microneedling therapy seems to be a simple and effective treatment option for the management of atrophic facial scars.
Article
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.
Article
Acne is a prevalent condition in society and often results in secondary damage in the form of scarring. Of course, prevention is the optimal method to avoid having to correct the physically or emotionally troublesome scars. However, even with the best efforts, scars will certainly arise. This article attempts to give a broad overview of multiple management options, whether medically, surgically, or procedurally based. The hope is that a general knowledge of the current available alternatives will be of value to the physician when confronted with the difficult task of developing a treatment plan for acne-scarred individuals, even in challenging cases.
Article
The elastic fibers present in various connective tissues of the body are responsible for physiologic elasticity of the organs. These fibers consist of 2 distinct components, elastin and the elastic fiber microfibrils. Controlled synthesis and balanced interaction of these 2 components are essential for normal fibrillogenesis. The intracellular biosynthesis of elastin by connective tissue cells, such as smooth muscle cells, involves assembly of the polypeptide chains on the membrane-bound ribosomes, hydroxylation of some prolyl residues to hydroxyproline, and secretion of the polypeptides packaged in Golgi vacuoles. In the extracellular space the elastin molecules assemble into fiber structures which are stabilized by the synthesis of complex covalent cross-links, desmosines. Recently, aberrations in the structure or metabolism of elastin have been detected in a variety of heritable and acquired diseases affecting skin and other connective tissues. These conditions include pseudoxanthoma elasticum, cutis laxa, and elastosis perforans serpiginosa, as well as arteriosclerosis and other degenerative changes of the vascular connective tissues.
Article
Elastic fibres in histological sections have only a slightly higher affinity (than chromatin or cartilage matrix) for unpurified Orcein in acidified 70% ethanol, but the staining of elastic fibres is more exothermic (the heat of staining being in good agreement with publishedin vitro measurements), has a considerably higher activation energy, and is probably accompanied by a greater decrease in entropy. Experiments with purified dye fractions, and unpurified dye in 10% ethanol, were inconclusive, as it was not possible to prove unequivocally that equilibrium between dyebath and substrate had been achieved under these conditions. The results are consistent with the selectivity of orcein for elastic fibres under practical conditions being due to (a) the presence in elastic fibres of a relatively large number of dye-binding sites per unit volume, which probably bind by some non-ionic mechanism, (b) the relatively non-polar nature of elastic fibres, which repel cationic dye particles less than do tissue components that at low pH carry a positive charge, and (c) the low permeability of elastic fibres, so that dyeing, once achieved, is relatively resistant to alcoholic extraction. An alcoholic solvent for the dye enables strong solutions, and hence short staining times, to be used.
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
This paper discusses the results recently seen by practitioners who use platelet-rich plasma, as well as the practical considerations that they must make when considering whether to adapt their practice for its use. In this study, an average of a 358% increase in platelet concentration was achieved.
Article
Trichloroacetic acid (TCA) chemical peel and dermabrasion are beneficial methods for treatment of photoaged skin. In this study, we evaluated the changes induced by these therapies on various structures of facial skin of nine dark-skinned patients (Fitzpatrick types IV-V; TCA, five patients; dermabrasion, four patients) demonstrating different degrees of photodamage. Routine histopathology coupled with histometric computer-assisted image analysis was used to assess epidermal changes. Alcian blue stain was used to evaluate changes in glycosaminoglycans. Immunoperoxidase techniques with antibodies against types I and III collagen and elastin were used to evaluate quantitatively changes in collagen and elastic fibers, and their ultrastructure was examined by transmission electron microscopy. Similar histologic, immunohistochemical, as well as ultrastructural changes were observed in the two groups, including epidermal and dermal rejuvenation with new collagen deposition and normalization of the elastic tissue. However, these changes were more prominent in patients treated with dermabrasion than those treated with TCA. The results of this study suggest that beneficial effects of such modalities on facial skin were accomplished primarily by increasing the amounts of collagen I and collagen III and improving the morphologic appearance of collagen and elastic fibers.
Article
A detailed evaluation of the use of the Masson's trichrome stain in the light microscopic study of glomerular alterations indicates this to be an excellent, inexpensive method to obtain maximum information. Most aspects of glomerular pathology may be appreciated. In properly prepared tissue and with high magnification, proteinaceous deposits of rather small size, axial mesangial abnormalities, and mesangial cell interposition may be detected. There is generally excellent correlation with electron-microscopic and immunofluorescent studies. While this method cannot replace the more sophisticated ultrastructural and fluorescent technics, it can offer considerably more information than is presently appreciated.
Article
Acne is traditionally regarded as a skin disorder of the teenage years. However, recent epidemiologic studies have shown that a significant number of female patients aged >25 years experience acne. One recent community-based UK study estimated the prevalence of facial acne in adult women aged between 26 and 44 years to be 14%. It is not clear whether there is a true increase in acne in this age group or whether these patients are less tolerant of their acne and/or better informed of available therapies and so seek advice. The reasons for persistent acne are not fully understood. External factors such as use of certain cosmetics, ingestion of drugs, and endocrine abnormalities should all be considered when managing these patients. Post-adolescent acne in females can be divided into ‘persistent acne’, which represents a continuation of acne from adolescence into adult life, and ‘late-onset’ acne, which describes significant acne occurring sometimes for the first time after the age of 25 years. The clinical picture of each of these forms of acne in adult females can differ slightly from conventional adolescent disease. The course of each form is more indolent. Because of these variations, the approach to investigation and management of these cases may have subtle differences when compared with that for teenage disease. Acne treatment should aim to reduce sebum, comedogenesis, propionibacteria population, and inflammation. Treatment selection will depend on the acne grade and site as well as the patient‘s preference and ability to comply with therapy. Maintenance therapy plays an important role in managing this group of patients. As the response to treatment is inevitably slow, patients must be encouraged to adhere to the chosen treatment regimen. This article reviews the literature on persistent acne in women in terms of clinical presentation and possible etiologic factors, and outlines principles of therapy related to managing these cases.
Article
Nonablative facial resurfacing is a noninvasive approach to tissue remodeling and skin rejuvenation. These procedures are considered an alternative to the more traditional laser resurfacing with less dramatic effects, but also with significantly less downtime. Results vary based on the lasers and light sources used. In general, the infrared lasers improve texture, visible light lasers somewhat improve texture but greatly reduce redness and telangiectasias, and intense pulsed light devices improve both red targets and brown discoloration, as well as skin texture. Lastly, low-energy devices may improve redness and texture modestly. Patient selection, as well as device selection, is based on the outcome desired. Side effects are uncommon and preventable.
Social implications of hyperdynamic lines
  • Finn
Chemical peels: review and practical applications
  • Vania Marta
  • Tania Maria
  • H B Chinobu
  • C Paula
Vania Marta FY, Tania Maria HB, Chinobu C, Paula HB. Chemical peels: review and practical applications. Surg Cosmet Dermatol. 2013;5:58-68.