No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Combination of platelet rich plasma in fractional carbon dioxide laser treatment increased clinical efficacy of for acne scar by enhancement of collagen production and modulation of laser-induced inflammation: PRP WITH FRACTIONAL CO 2 LASER FOR ACNE SCAR
Abstract
Background:
Platelet-rich plasma (PRP) which contains large amounts of growth factors has been tried to enhance therapeutic efficacy of laser treatment for acne scar with unknown underlying mechanism.
Objectives:
The present study was conducted to investigate the molecular mechanism of increased clinical efficacy of PRP when combined with fractional laser treatment for treating acne scars.
Methods:
Subjects with mild to moderate acne scars were treated with two sessions of fractional CO2 laser therapy given with and without co-administration of PRP. Skin biopsy specimens were obtained at baseline, 1, 3, 7, and 28 days for investigation of molecular profiles associated with skin changes produced by laser plus PRP treatment.
Results:
The PRP treatment increased clinical efficacy with decreased severity of adverse effects such as erythema, swelling and oozing. Productions of TGFβ1 and TGFβ3 proteins were more highly elevated on the PRP-treated side of the face compared to the control side at day 28. Furthermore, PRP-treated side showed significant increase of c-myc, TIMP, and HGF expression. Experimental fibroblast culture model was also used. PRP administration after laser irradiation increased expressions of p-Akt, TGFβ1, TGFβ3, β-catenin, collagen 1, and collagen 3 in both dose-dependent and time dependent manners in fibroblast. Moreover, we acquired clinical and histological data through randomized control clinical trial.
Conclusion:
Taken together with human study results combined with the data from cell experiments we suggest that PRP treatment increased fibrogenetic molecules induced by fractional CO2 laser, which have association with clinical effect. Lasers Surg. Med. © 2017 Wiley Periodicals, Inc.
... It has been suggested that combining PRP with laser therapy imparts synergetic effects for acne scarring [20]. The microchannels produced by the laser therapy enable PRP to penetrate deeper within the skin, allowing for enhanced efficacy and better clinical outcomes [20]. ...
... It has been suggested that combining PRP with laser therapy imparts synergetic effects for acne scarring [20]. The microchannels produced by the laser therapy enable PRP to penetrate deeper within the skin, allowing for enhanced efficacy and better clinical outcomes [20]. With more significant product penetration, the growth factors and cytokines from PRP are more optimally absorbed and therefore have more potent effects [20]. ...
... The microchannels produced by the laser therapy enable PRP to penetrate deeper within the skin, allowing for enhanced efficacy and better clinical outcomes [20]. With more significant product penetration, the growth factors and cytokines from PRP are more optimally absorbed and therefore have more potent effects [20]. The cytokines secreted by PRP may also reduce post-treatment erythema [20,21] and alleviate discomfort associated with laser treatment [22,23]. ...
Acne has a prevalence of over 90% among adolescents, and subsequently progresses to acne scarring in approximately 47% of cases. Due to the severe psychological and social ramifications acne scarring has on patients, there is a need for more effective treatments. Platelet-rich plasma (PRP), an autologous preparation enriched with growth factors, cytokines, and chemokines, has shown efficacy in promoting wound healing and tissue remodeling in dermatology. Recent evidence suggests that the efficacy of PRP may be enhanced when combined with laser therapy, which induces controlled tissue damage through photo-thermolysis thereby promoting tissue remodeling and epidermal regeneration. The microchannels created by laser treatments are thought to allow deeper penetration of PRP into the skin, potentially increasing its therapeutic effects. This review aims to analyze the combined use of PRP and laser therapy for treating acne scarring by examining randomized control trials from the past decade indexed on PubMed. Six studies met our inclusion criteria and were included in this review. The findings of this review support the hypothesis that combining PRP with laser therapy offers superior clinical results compared to monotherapy, providing a more effective approach to managing acne scarring.
... Min et al. 20 through a randomised split face study studied platelet-rich plasma-induced collagen production and modulation of laser-induced inflammation after fractional CO 2 laser sessions correlating with increased clinical efficacy in acne scars. They used fractional CO 2 laser a month apart, followed by either intradermal platelet-rich plasma or intradermal normal saline injections on the randomised halves of the face. ...
... The method of delivery of platelet-rich plasma was broadly of two types, intradermal injection or topical application. The efficacy of FCL/Frac Er:Yag + PRP injections when compared with FCL/Frac Er:Yag + normal saline injections in improvement of scars were statistically significant in studies by Lee et al., 15 Gawdat et al., 16 Shah et al., 18 Min et al. 20 and El-Taieb et al. 25 Abdel al et al. 22 and El-Hawary et al. 29 observed significant improvement in FCL + PRP group as compared to platelet-rich plasma alone. But, El-Hawary et al. 29 did not find a significant difference between FCL + PRP group as compared to the fractional CO 2 laser alone. ...
... A randomised control trial by Mahamoud et al. 27 compared FCL + PRP injections with FCL + hyaluronic acid injections and found no statistically significant difference between the two. Comparing the adverse effects of platelet-rich plasma injections as compared to normal saline controls, most studies (Lee et al., 15 Gawdat et al., 16 Shah et al., 18 Min et al., 20 Abdel Aal et al. 22 and El-Hawary et al. 29 ) reported significantly less intensity of erythema, edema, crusting, downtime and post-inflammatory hyperpigmentation. However, two studies Gawdat et al. 16 and El-Hawary et al., 29 reported significantly increased pain in the FCL + PRP group as compared to FCL + NS. ...
Background
Acne scars are one of the most common sequelae of inflammatory acne. It commonly affects adolescents and young adults and hence is associated with significant psychological morbidity. It is historically resistant to oral as well as surgical modalities. In the last two decades, ablative lasers (fractional or otherwise) have proven to be effective in management of acne scars. Some studies have proven the efficacy of platelet rich plasma in reducing the adverse effects and improving the efficacy of lasers.
Objective
Review of the studies combining platelet rich plasma with ablative laser for post acne scars.
Methods
A literature review of the MEDLINE database for studies evaluating the combination of ablative lasers with platelet rich plasma was performed. Only studies with higher levels of evidence (randomised controlled trials and comparative studies) were included in this review.
Results
Adding intradermal platelet rich plasma to fractional ablative lasers in the management of post acne scars increases clinical efficacy, reduces downtime as well as frequency and duration of ablative lasers related adverse effects. The efficacy of topical platelet rich plasma is less as compared to intradermal platelet rich plasma.
Limitations
The studies analysed are heterogeneous in nature with varied protocols and duration of follow up.
Conclusions
It is recommended to combine the ablative lasers with intradermal platelet rich plasma for better clinical response and reduce adverse effects as well as downtime.
... 14,15 Furthermore, seven randomized controlled trials (RCTs) assessed the efficacy of ablative FCO 2 laser therapy with PRP, representing 223 participants, were not included or later published after the most recent systematic reviews. [16][17][18][19][20][21][22] The primary aim of this systematic review and meta-analysis was to compare the efficacy and safety of ablative FCO 2 laser alone and in combination with PRP in the treatment of moderate to severe atrophic acne scars with respect to the clinical improvement, patient satisfaction, Goodman and Baron's qualitative acne scar grading scale, and duration of erythema and edema. ...
... Eventually, 11 RCTs were deemed eligible to be included in the quantitative synthesis and meta-analysis. [16][17][18][19][20][21][22][25][26][27][28] 3.1 | Trial characteristics Three hundred thirteen treated participants were involved in this systematic review. Of whom, 220 (70.29%) participants were included from nine randomized split-face clinical trials, [16][17][18][19]22,[25][26][27][28] and they were randomly assigned to receive either ablative FCO 2 laser sessions in one side and ablative FCO 2 laser with PRP on the other side. ...
... [16][17][18][19][20][21][22][25][26][27][28] 3.1 | Trial characteristics Three hundred thirteen treated participants were involved in this systematic review. Of whom, 220 (70.29%) participants were included from nine randomized split-face clinical trials, [16][17][18][19]22,[25][26][27][28] and they were randomly assigned to receive either ablative FCO 2 laser sessions in one side and ablative FCO 2 laser with PRP on the other side. Ninety three (29.71%) ...
Background:
Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80-90% of all acne scars. Ablative fractional carbon dioxide (FCO2) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars.
Methods:
Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review saught to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD).
Results:
11 RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR=2.56, 95% CI 1.37 to 4.78 and OR=3.38, 95% CI 1.80 to 6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD = -0.40, 95% CI -0.65 to -0.14).
Conclusion:
The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars. This article is protected by copyright. All rights reserved.
... The combination of Platelet-Rich Plasma (PRP) with FCL reduced laser side effects, erythema and edema, and added better efficiency than using each one alone (6)(7)(8)(9)(10)(11)(12)(13)(14)(15).The utilization of FCL combined with surgical methods like punch elevation (16) and subcision (17) has shown significantly better results for clinical improvement especially in deep scars(Deep Boxcar -Icepick types). No remarkable differences in clinical improvements were observed between the FCL/ SC-CM and FCL only (18). ...
... Combination therapy of FCL with PRP is more effective in reducing the appearance of scars, reducing adverse effects of laser therapy, with better patient satisfaction of the outcome compared to FCL alone. The degree of improvement with the combined treatment was higher than 65% (intradermal injection (ID) and topical PRP application) (6)(7)(8)(9)(10)(11)(12)(13)(14). The evaluation according to subtype analysis was differed between studies, in Min's study, the improvements were equal in all scar subtypes (11), whereas in Arsiwala's study, the highest improvement was in rolling scars, followed by boxcar scars. ...
... The degree of improvement with the combined treatment was higher than 65% (intradermal injection (ID) and topical PRP application) (6)(7)(8)(9)(10)(11)(12)(13)(14). The evaluation according to subtype analysis was differed between studies, in Min's study, the improvements were equal in all scar subtypes (11), whereas in Arsiwala's study, the highest improvement was in rolling scars, followed by boxcar scars. Poorer response of ice pick scars (9). ...
Fractional laser (FL) resurfacing has proved its effectiveness in acne scars treatments. To evaluate the efficacy of Fractional laser systems for treatment of acne scars as a monotherapy, and as adjunctive therapy with other treatment types. A systematic literature review was performed by searching the electronic databases PubMed, Google Scholar, and Embase. Fractional laser has proven therapeutic efficacy of over 26% in treating acne scars, with minor and transient side effects, and well-tolerant pain. The application of PRP not only accelerated recovery and reduced adverse events, but also enhanced localized collagen neogenesis and redistribution. The addition of surgical treatments to Fractional Laser Systemes (FLS) therapy delivers the best treatment results for Icepick scars. Fractional laser is an effective tool for treating acne scars. The degree of effectiveness varies according to the laser parameters, the number of treatment sessions, skin photo type, the severity and the type of scars. The application of Platelet-Rich Plasma (PRP) and Fractional Radiofrequency Microneedle (FRM) in addition to the FL treatment improves the therapeutic efficacy and reduces the appearance of Post Inflammatory Hyper-Pigmentation (PIH), and is the ideal treatment for dark-skinned patients. FL therapy along with surgical methods such as subsicion and punch techniques provided the best improvements for deep scars.
... By enhancing collagen synthesis and remodeling, PRP can help fill in depressed or pitted scars, improving their texture and volume. The regenerative effects of PRP may also lead to the formation of healthier, more uniform tissue, reducing the visibility of acne scars [14]. Furthermore, the anti-inflammatory properties of PRP can mitigate the inflammatory response associated with acne scars, potentially minimizing redness and swelling. ...
... For example, PRP may be combined with laser therapy, chemical peels, or dermal fillers. The specific combination approach depends on the individual patient's needs and the expertise of the treating dermatologist [14]. ...
... The difference in improvement in both trials was attributed to the PRP because PRP contains growth factors, cytokines, chemokines, and proteases that accelerate tissue repair. 16 Min et al. 18 showed a significant increase in growth factors and in the number of collagen fibers in their study comparing the combination group to the ablative fractional CO 2 laser group alone. ...
... Both acne scars and SG are disorders resulting from the disruption of the connective tissues in the dermis. The clinical improvement in SG with the combination of ablative fractional CO 2 laser and autologous PRP may be due to dermal remodeling and increase in collagen fibers that were also seen in the patients with acne scars.18 The histopathological results of the present study support the adjunct use of PRP in elastin and collagen production. ...
Background:
Striae gravidarum (SG) is a connective tissue disorder seen commonly in primigravidas. It is associated with impairment in the quality of life.
Objective:
To determine the efficacy of ablative fractional carbon dioxide (CO2) laser combined with autologous platelet-rich plasma (PRP) versus ablative fractional CO2 laser and placebo in the treatment of SG.
Study design:
Randomized, double-blinded, placebo-controlled trial METHODOLOGY: The study was conducted in 16 patients with SG. The assigned treatment area (abdomen) was divided into two sides and was randomly assigned to the PRP side and the control side. All patients received ablative fractional CO2 laser. Immediately after each laser procedure, the PRP side received autologous PRP, while the control side received plain normal saline solution (pNSS) as a placebo. The study was done for three sessions, at intervals of 4 weeks. An independent assessor used the photographs taken at weeks 6, 10, 14 and 16 to assess the clinical improvement. The patient satisfaction was reported at the same intervals. A quartile grading scale was used to measure both the clinical improvement and patient satisfaction. Data were analyzed using the Jonckheere-Terpstra test. Histopathology was done before treatment, and at the end of the study period.
Results:
The combination of ablative fractional CO2 laser and autologous PRP had better clinical improvement and patients' satisfaction compared to ablative fractional CO2 laser and placebo. However, both outcome measures were not statistically significant.
Conclusion:
Ablative fractional CO2 laser combined with autologous PRP appears to be an effective treatment in SG.
... 47 Application techniques included FCL to the atrophic facial scars, then either percutaneous or topical PRP; 2 to 3 treatments were performed in 3-to 4-week intervals (average of 2.3 sessions with 3.9-week intervals). Eight studies reported statistically signi cant improvements in scar appearance in the PRP group compared to control, [47][48][49][51][52][53][54][55] with seven noting diminished duration and/or severity of post-laser adverse e ects (erythema, edema, crusting, oozing). 48,49,[51][52][53][54]56 One study revealed signi cantly worse erythema and edema in the PRP-treated group a few days after therapy, though no signi cant di erence in the duration of these e ects was identi ed. ...
... Eight studies reported statistically signi cant improvements in scar appearance in the PRP group compared to control, [47][48][49][51][52][53][54][55] with seven noting diminished duration and/or severity of post-laser adverse e ects (erythema, edema, crusting, oozing). 48,49,[51][52][53][54]56 One study revealed signi cantly worse erythema and edema in the PRP-treated group a few days after therapy, though no signi cant di erence in the duration of these e ects was identi ed. 50 Gawdat et al 54 examined FCL in combination with either ID or topical PRP and found both applications signi cantly enhanced scar appearance compared to FCL alone. ...
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.
... In a split-face study by Shah et al., [5] where outcomes after FACL with and without PRP injections were assessed using G and B quantitative scale, significant reduction was observed in acne scars on the study side (mean G and B quantitative grade was 14.83 at baseline and 4.2 at 4 months) and the control side (mean G and B grade was 15.23 at baseline and 7.5 at 4 months). Min et al. [6] also concluded that combined treatment approach with FACL and PRP for acne scar management appeared to be safe and effective. There are several mechanisms that could explain the synergistic effects of PRP on overall clinical improvement. ...
... The lower incidence of dryness and edema on the study side could be explained by the effects of various growth factors present in PRP, which modifies the wound-healing properties of acne scar after FACL. A study by Min et al., [6] on the effect of PRP on collagen production and modulation of laserinduced inflammation, concluded that the PRP treatment Statistically significant difference between two sides after fourth session. Mean percentage improvement in G and B AQGS after four sessions on the study side (33.61%) was more as compared to the control side (26.94%). ...
Context:
Though many treatment options are available for treating post-acne scars, optimized treatment still does not exist. Till date, comparative split-face studies, analyzing the efficacy of combined treatment modalities for acne scars with adequate sample size and with statistically significant results, are still lacking.
Aim:
The aim of this study was to compare the effectiveness of the combined use of platelet-rich plasma (PRP) and fractional ablative CO2 laser (FACL) versus FACL in the management of acne scars and to study the safety of autologous PRP and FACL in the treatment of post-acne scars.
Settings and design:
This was a randomized split-face trial study.
Materials and methods:
This study was conducted in 30 patients having Goodman and Baron's grade 3 and 4 acne scars. The efficacy of PRP in combination with FACL was compared to FACL alone in the treatment of post-acne scars. Right half of the patient's face was taken as the study side where FACL was performed followed by PRP injections. The left half of the same patient's face was taken as the control side where FACL was performed followed by normal saline injections.
Statistical analysis:
Results were analyzed using Statistical Package for the Social Sciences (SPSS, Chicago).
Results:
At the time of enrollment, mean Goodman and Baron Acne Qualitative Grading Scale on study and control side was 3.80 with standard deviation (SD) of 0.40 at baseline. After completion of four treatment sessions, it was reduced to 2.43 (SD = 0.76) and 2.76 (SD = 0.49) on the study and control side, respectively. Improvement on both sides was statistically significant (P = 0.000).
Conclusion:
There is no single proven modality for the effective treatment of post-acne scars. Combination of FACL with newer adjuvants such as PRP has definitive role in managing post-acne scars with better safety profile than FACL alone.
... From this observation, we inferred that fractional CO 2 laser with or without PRP is an effective treatment modality for post-acne atrophic scars as confirmed by similar studies. [9][10][11] On comparison of the mean scar scores improvement at each visit between the two groups, the mean change in scar scores was higher in the fractional CO 2 with PRP group patients compared to fractional CO 2 laser alone, showing an added reduction in the scar score by addition of topical PRP. In addition, there was a better mean VAS improvement of the patient after fractional CO 2 laser ablation followed by topical PRP (4.08 ± 1.44) than that after CO 2 laser ablation alone (3.46 ± 1.05). ...
... [17] Pain and hyperpigmentation were observed lesser in patients treated with fractional CO 2 laser followed by topical PRP. As validated by numerous studies over the last 10 years, [5,[11][12][13]18] PRP following fractional CO 2 laser therapy leads to a considerable reduction in long-term adverse effects such as pain and post-laser hyperpigmentation, which are commonly observed in Fitzpatrick skin type III to V owing to its richness of growth factors responsible for reducing inflammation and hastening the wound-healing process. ...
Context:
Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit prevalent in adolescent population. Atrophic acne scarring negatively affects the quality of life. Although challenging to treat, the introduction of fractional carbon dioxide (CO2) laser and platelet-rich plasma (PRP) therapy for atrophic scars has opened up new avenues.
Aim:
The aim of this study was to evaluate and compare the efficacy of fractional CO2 laser alone and in combination with topical PRP in treating post-acne atrophic scars.
Subjects and methods:
A hospital-based prospective, double-blinded, randomized, and comparative study was conducted. A total of 33 cases with post-acne atrophic scars of moderate to severe grade were randomly allotted into Group A and Group B who were treated for three monthly sessions of fractional CO2 laser followed by topical PRP and fractional CO2 laser monotherapy, respectively. Evaluation at baseline and every visit was carried out and compared at the end of 12 weeks.
Results:
Of the 33 patients, 25 completed the study. The mean change in score was higher in subjects of Group A. The mean scar score significantly reduced in both groups. The mean visual analog scale was higher in Group A. The reduction in scar score was significantly higher in patients with rolling scars and boxcar scars and least in ice pick scars. Erythema, edema, pain, and hyperpigmentation were higher in Group B.
Conclusion:
Combination therapy with PRP is more efficacious in reducing post-acne atrophic scars and reducing adverse effects of laser therapy as compared to fractional CO2 laser monotherapy.
... Besides studying the effectiveness of different types of lasers for acne scars, these authors have also investigated the efficacy of CO 2 fractional laser combined with adipose-derived stem cell exosomes or PRP for treating acne scars. They found that the combination of exosomes or PRP increased clinical efficacy compared to using lasers alone [26,27]. Overall, these researchers continue to focus on the efficacy and safety of various types of lasers alone or in combination for acne scars. ...
Background
Acne vulgaris is a chronic inflammatory skin condition, commonly resulting in acne scars. Treating acne scars remains a significant challenge in dermatology. With advancements in laser technology, its clinical use for treating acne scars has been increasing annually. However, bibliometric analysis on laser treatment for acne scars is lacking. This study aims to use bibliometrics to comprehensively understand the development trends and research hotspots in laser treatment for acne scars.
Methods
Using “acne scar” and “laser” as search terms, literature on laser treatment of acne scars from 2014 to 2024 was retrieved from the Web of Science Core Collection (WoSCC) database. The literature data were visualized using VOSviewers, CiteSpace, and R software, generating maps of countries, research institutions, authors, journals, references, and keywords.
Results
The analysis included 536 articles from 46 countries, with the United States and China leading in publications. Publications focusing on laser treatment of acne scars exhibit a consistent growth trend annually. Key research institutions include Mahidol University in Thailand, Cairo University in Egypt, and Hallym University in South Korea. The “Journal of Cosmetic Dermatology” had the highest number of articles in this field, while “Dermatologic Surgery” was the most cited publication. These publications involved contributions from 2135 authors, with Professor Manuskiatti Woraphong from Mahidol University in Thailand being the most prolific author in this field. Research on the efficacy of laser treatment for acne scars is a major focus in this field. Among the different types of lasers, CO2 lasers are the most commonly used. Emerging research focuses include therapies such as platelet‐rich plasma, picosecond laser, trichloroacetic acid, and burn scar.
Conclusions
Treatment efficacy is the primary focus of research in the field of laser treatment for acne scars. Platelet‐rich plasma, and novel picosecond lasers, have emerged as hot topics and trends in this research field. However, it is important to note that the impact factors of journals publishing in this field are currently low. Therefore, clinicians must consider and explore strategies for publishing high‐quality clinical research in the future.
... Similarly, Min et al. [18] recruited 25 subjects with moderate-to-severe acne scars and skin types III-IV. FCL was irradiated on both sides of the face. ...
Acne scars are the unfortunate outcome of acne vulgaris. It is a common problem that faces many young adults and can cause severe distress and impair their quality of life. Different therapeutic modalities have been tried for atrophic acne scars; however, no standard treatment has been identified yet. In this review, we are focusing on fractional CO2 laser (FCL), whether used as monotherapy or combined with platelet-rich plasma (PRP), trying to highlight the efficacy and safety of such modalities in the treatment of atrophic acne scarring. PubMed, Embase, and Cochrane Library databases were used to search for relevant studies that were published in the period from January 2017 to December 2022. We used a combination of the following keywords: “acne scar,” “acne scars,” “modalities for acne scars” in addition to the names of additional therapies studied in this review, such as “laser and acne scars,” “plateletrich plasma,” “platelet-rich plasma,” “PRP,” and “platelet-rich plasma therapy and acne scars”. Twelve studies were found utilizing the use of FCL whether used as monotherapy or combined with PRP in the treatment of atrophic acne scarring. Most of the studies showed that acne scars improved with both treatment modalities, but the combination approach yielded better results with less incidence of side effects.
... PRP has been effective in several dermatologic diseases, including alopecia, melasma, scars, and vitiligo. [45][46][47] The biggest use has been on patients suffering from androgenetic alopecia (AGA). 48,49 Specifically, over the past 5 years, 21 RCTs attempted to assess the efficacy and safety of PRP for the treatment of AGA. ...
Platelet-rich plasma (PRP) is autologous plasma with a platelet concentration that is on average five times greater than baseline, and has been extensively investigated for its potential applications across various medical fields, including orthopaedics, dermatology, wound healing, maxillofacial surgery, and others. This review article aims to provide an overview of PRP’s applications and evidence over the past 5 years in randomised controlled trials. Many studies demonstrate PRP’s effectiveness in reducing pain and improving functional outcomes, while others report no significant differences compared to alternative treatments or placebo. Across various studies, several key limitations exist, such as small sample sizes, short follow-up durations, and lack of standardisation in PRP preparation methods, highlighting the need for research to further establish PRP’s effectiveness in these clinical applications. The article also discusses the different classification systems for PRP, and underscores the importance of understanding the components that influence clinical outcomes, as well as noting the growth of PRP in the marketplace. Overall, while studies exist demonstrating the clinical utility of PRP, standardised reporting is required to determine its full potential, as well as optimal preparation and administration strategies.
... 150 Carbon dioxide laser is one of the most effective treatments for acne scars. 149,151 However, this approach may result in damage to the superficial skin barrier. 147 Although there is no standard of care for post-laser surface treatment, optimizing wound healing after laser surgery is a necessity. ...
Soft tissue damage stimulates sympathetic nerves to release large amounts of catecholamine hormones which bind to β‐adrenergic receptors (β‐ARs) on the cell membrane surface. It activates the downstream effector molecules and impairs soft tissue wound healing. β‐blockers specifically inhibit β‐ARs activation in acute/chronic skin lesions and ulcerative hemangiomas. They also accelerate soft tissue wound healing by shortening the duration of inflammation, speeding keratinocyte migration and reepithelialization, promoting wound contraction and angiogenesis, and inhibiting bacterial virulence effects. In addition, β‐blockers shorten wound healing periods in patients with severe thermal damage by reducing the hypermetabolic response. While β‐blockers promote/inhibit corneal epithelial cell regeneration and restores limbal stem/progenitor cells function, it could well accelerate/delay corneal wound healing. Given these meaningful effects, a growing number of studies are focused on examining the efficacy and safety of β‐blockers in soft tissue wound repair, including acute and chronic wounds, severe thermal damage, ulcerated infantile hemangioma, corneal wounds, and other soft tissue disorders. However, an intensive investigation on their acting mechanisms is imperatively needed. The purpose of this article is to summerize the roles of β‐blockers in soft tissue wound healing and explore their clinical applications.
... To reduce the adverse effects following fractional CO 2 laser, several studies recommended its use in combination with PRP (23)(24)(25)(26). They suggested that PRP following fractional CO 2 laser therapy may lead to a considerable reduction in post-laser adverse effects particularly PIH. ...
Background:
The treatment of atrophic acne scars represents a therapeutic challenge. Recently, plasma gel has been introduced among treatment modalities.
Objective:
To compare the efficacy of platelet-rich-plasma "fluid" versus "gel" form combined with fractional CO2 laser in the treatment of atrophic acne scars.
Methods:
Twenty-seven patients with atrophic acne scars were included. Treatment with fractional CO2 laser plus plasma fluid/gel was randomly assigned to the right/left sides of the face. Clinical and Optical Coherence Tomography (OCT) assessments were scheduled at baseline, 1 month, and 3 months after the last session.
Results:
There was a significant improvement in clinical assessment scores at 3rd-month follow-up on the plasma gel- and plasma fluid-treated sides compared to those at the 1st-month follow-up (p< 0.001). Scar depth decreased significantly at 3rd-month follow-up when compared to baseline on both plasma gel- and plasma fluid-treated-sides (p< 0.001). The numerical pain score was significantly lower on the plasma fluid-treated side compared to the plasma gel-treated side (p= 0.004).
Conclusion:
The use of platelet-rich plasma in combination with fractional CO2 laser, both in fluid and gel form, produced significant results in the treatment of atrophic acne scars. Patients reported an immediate more noticeable effect with plasma gel. However, the fluid injection was less painful.
... Immunohistochemical results suggest that there was increased TGFβ1 and C-myc levels, and collagen 1 expression was significantly higher in combination treatment suggestive of the clinical efficacy of the combination therapy. 15 Similar results were reported in other studies, [16][17][18][19] Kar et al reported significant improvement on both sides of the face with combination treatment of fractional CO 2 laser treatment along with PRP and treatment with CO 2 for atrophic acne scars as assessed by Goodman and Barons quantitative global acne scar grading system, but there was no significant difference between right and left sides of the face. The authors conclude that in the PRP treatment there is a significant reduction in the downtime and the inflammation caused by laser treatment. ...
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.
... This has also been confirmed by different studies. [27][28][29] However, we have not been able to show statistically significant difference with the use of PRP in this study since redness disappeared and re-epithelization occurred in the same amount of time in both groups. The procedure proved to be patient friendly since 85% of the patients were satisfied or very satisfied with the treatment and treatment outcome. ...
Aims:
The objective of this study was to evaluate the effectiveness and safety of high-energy ablative fractional nanosecond Q-switched 1064 nm laser therapy for acne scars.
Material and methods:
Forty-six patients aged from 16 to 69 years and of Fitzpatrick skin type from 2 to 4 were included in this retrospective study. Multiple passes were delivered with a fractional 1064-nm handpiece at high energy. Results were evaluated using blinded analysis of patient before and after photographs and also by evaluating patient satisfaction.
Results:
Most patients (75%) were improved or very improved according to blinded evaluation. Patient satisfaction was high. No hypo/hyperpigmentation, scarring, or any other side effects were reported by any of the patients.
Conclusions:
The study demonstrated good clinical outcomes in facial acne scar management with a high patient satisfaction rate and no adverse side effects.
... PRP treatment also produced increased epidermal growth factor receptor (EGFR) expression and decreased keratin 16 in keratinocyte at 48 hours, strongly suggesting that PRP accelerate epithelization and decrease laser induced skin damage. Additionally, they attributed the soothing effect of PRP to the upregulation of TGFβ and hepatocyte growth factor (HGF) and associated decreased levels of C-FOS and AP-1 pathway [18]. ...
... In our study, immunohistochemical analysis for collagens I and III confirmed the increase in collagen III fibers, but no relevant modifications in collagen I count was seen. In contrast, most previous studies on the skin showed an increase in collagen I and III fibers after CO 2 laser treatment [32,33]. As far as we know, this is the first study to evaluate collagen remodeling in vaginal samples through immunohistochemistry. ...
Objective:
The aim of the study was to evaluate the clinical response and collagen remodeling in the vaginal wall after three sessions of carbon dioxide (CO2) laser application.
Methods:
Fourteen postmenopausal women with vulvovaginal atrophy, aged 45-65 years and sexually active, were evaluated with clinical questionnaires, gynecological examinations and histological techniques before and after 20 weeks of treatment (ClinicalTrials.gov NCT03939078). Treatment consisted of 3-monthly sessions of the CO2 laser. Clinical questionnaires included the Vaginal Health Index, the Female Sexual Function Index and the International Consultation on Incontinence Questionnaires Short Form. Biopsies were taken from the lateral vaginal wall at week 0 (left wall) and week 20 (right wall). Tissue samples were stained with hematoxylin and eosin, Periodic Acid-Schiff, Picrosirius Red Stain and Orcein dyes. Immunohistochemical study was used to quantify collagens I and III in the samples.
Results:
The mean age was 54.4 ± 4.5 years, and the average time of amenorrhea was 7.6 ± 5.1 years. The Female Sexual Function Index and the Vaginal Health Index Score values increased while the International Consultation on Incontinence Questionnaire Short Form score decreased after the programmed treatment. There was no significant change in vaginal pH. Histological studies showed increases in the total and superficial epithelial cell layers, and type III collagen fibers (from 10.86 ± 7.66 to 16.87 ± 3.96, p < 0.05), and immunohistochemical studies confirmed the significant increase in collagen III.
Conclusion:
Histological findings revealed epithelial atrophy reversal and collagen remodeling of the vaginal wall. Immunohistochemical analysis showed an increase in collagen type III fibers.
... 9,18,19 Several studies suggested that fractional CO 2 laser treatment combined with PRP could reduce edema and prolonged erythema after laser treatment. [20][21][22] The majority of studies available demonstrated that using PRP in combination with CO 2 for the management of atrophic acne scars could be superior to topical intradermal PRP alone. 23,24 Consistent with such findings, our study showed that with the application of PLT, the erythema and edema associated with CO 2 laser treatment were able to resolve completely within 2 days. ...
Objective
There are several clinical cases on the application of PRP (platelet-rich plasma) therapies. To improve disadvantages such as the inability to be standardized and stored long term, we proposed a novel platelet-lyophilized treatment (PLT) to enhance the wound healing rate and improve acne scarring.
Study Design
A single-blinded study at a single health care center was performed. All subjects were treated with a fractional carbon dioxide laser. On the right side of the face, 2 mL PLT solution (dissolved in normal saline) was applied, while on the left side of the face (control group), 2 mL normal saline was applied. The treatment described above was repeated every 3 to 4 weeks, and 4 treatments were performed in total. Assessments were performed prior to each treatment and at the one-month follow-up after the fourth treatment. Subjective assessments included questionnaires administered by the principal investigator and a self-assessment questionnaire completed by the subjects. Moreover, VISIA complexion analysis was used for objective data collection, and spots, wrinkles, texture, pores, UV spots, brown spots, red areas, and porphyrins were objectively analyzed.
Results
Our data indicated that the PLT side showed a more rapid recovery than the saline side; on average, the sloughing off of the crusts was noted on day 5 and day 6. The improvement rate for skin spots, texture, and pores was significantly increased on the PLT side, with the pigment and pore size both having a statistically significant improvement of p<0.001, while the texture had a significant improvement of p<0.01.
Conclusion
The results suggested that the application of PLT could be a novel method to enhance wound healing and improve acne scarring after laser skin rejuvenation.
... Kürzlich wurden positive Effekte auf das klinische Outcome und die Down- des Outcomes in der Wundheilung [21]. EGF ("epidermal growth factor") hingegen zeigte keinen eindeutigen Vorteil im Vergleich zu Vaseline [25]. ...
Treating the signs of skin ageing or acne scars by chemical peels or ablative lasers is increasingly used worldwide. Due to their reduced invasiveness, these methods are often favored over aesthetic surgical interventions. Both procedures rely on the principle of controlled damage to the skin. The subsequent regeneration may lead to the development of new epidermal (and dermal) tissue and therefore improve the skin's aesthetic appearance. At present, there are no official guidelines in Germany concerning pre- and post-interventional skin care, which is currently based on the personal experiences and evaluations of the practitioner. It is known that an appropriate treatment regime can improve the outcome and reduces downtime pre- and post-laser as well as pre- and post-peel. The aim of this article is to present the different possibilities of pre- and post-interventional care. In most cases, priming includes intense ultraviolet (UV) protection, topical retinoids as well as skin brightening agents, and occasionally oral herpes simplex prophylaxis. In order to support post-interventional wound healing, skin care should modulate inflammation and balance skin hydration. In addition to light moisturizers, broad spectrum UV protection as well as the avoidance of sports and sweating are essential.
... Levels of TGF Beta and collagen expression were also increased in PPP and PRP groups over control, again to a greater degree in the PRP group. 11 Another split-face study in which 30 patients were treated with FCL alone or with intradermal L-PRP similarly showed significant improvement in acne scar improvement in the L-PRP group as compared to control. 12 ...
Platelet preparations are autologous blood concentrates with supraphysiologic concentrations of platelets with or without leukocytes used in various clinical applications including regenerative medicine, wound healing, and facial rejuvenation. Their use harnesses the important role of platelets and their secretory products in immunoregulation, wound healing, angiogenesis, and tissue remodeling. The use of platelet preparations has been long documented in orthopaedic surgery, maxillofacial surgery, and other fields, but over the years research has increased in their application to facial plastic surgical techniques. Here we review the various formulations of platelet rich concentrates, their applications to facial skin rejuvenation, wound healing, scar reduction, and tissue fill as documented in the literature since 2018.
... Acne vulgaris is one of the most common skin disorders worldwide and is estimated to affect approximately 10% of the global population. 1,2 Acne can cause cosmetic problems as well as psychosocial distress; 3,4 thus, proper treatment is important to prevent permanent sequelae. Recent guidelines report various treatment modalities for acne according to disease severity, from topical agents to systemic medications. ...
Various evaluation methods for acne severity have been used without standardization, and the diversity of acne outcome measures is an obstacle to the integrated analysis of various acne studies. In this study, we sought to investigate physician‐based evaluation methods used in clinical studies of acne vulgaris and to determine differences according to time, region and study design. PubMed was searched for articles on acne published from January 2000 to June 2019 in five dermatology journals: Journal of the American Academy of Dermatology, JAMA Dermatology, British Journal of Dermatology, Journal of the European Academy of Dermatology and Venereology and Acta Dermato‐Venereologica. A total of 186 articles with acne evaluation methods were selected. Among the selected studies, region, study design, type of intervention and the number of subjects were identified and analyzed. Articles from 2010 to 2019 used Investigator Global Assessment (IGA; odds ratio [OR], 5.808; 95% CI, 1.894–17.811) more often and the Leeds technique (OR, 0.282; 95% CI, 0.098–0.812) less often compared with articles from 2000 to 2009. Controlled experimental studies preferred lesion counting (OR, 238.637; 95% CI, 46.795–1216.954), IGA (OR, 9.177; 95% CI, 3.053–27.586) and Leeds Revised Acne Grading System (LRAGS; OR, 10.844; 95% CI, 3.050–38.559) compared with observational studies. North American studies applied lesion counting (OR, 4.573; 95% CI, 1.173–17.836) and IGA (OR, 11.330; 95% CI, 3.487–36.818) more often and LRAGS (OR, 0.171; 95% CI, 0.039–0.758) less often compared with European studies. This study demonstrated the diversity and heterogeneity of acne outcome measures even in highly influential dermatology journals. This is due to the limitations of current methods and suggests the importance of developing a core outcome measure.
... Its growth factors stimulate stem cells along with activation of fibroblasts proliferation, differentiation, and regeneration with subsequent enhancement of extracellular matrix production mainly collagen, thus increasing its deposition, condensation, and remodeling. 25 Furthermore, PRP stimulate hyaluronic acid production which can absorb water leading to increasing skin volume and improving its turgor. [27][28][29][30] In Abbreviations: GBQS, Goodman and Baron's qualitative scar; L-GFs, lyophilized-growth factors; P 1 , P value for comparing between Fr CO2 + PRP and Fr CO2 + L-GFs; P 2 , P value for comparing between before treatment and after treatment; PRP, platelet rich plasma. ...
Lyophilized‐growth factors (L‐GFs), is a new platelet rich plasma (PRP) preparation that is standardized in growth factors concentrations. The aim of this study was to compare the therapeutic efficacy of ablative fractional CO2 laser in combination with L‐GFs vs PRP in post‐acne scars. This study was conducted on 45 patients presented with facial post‐acne scars. Each patient received three sessions of fractional CO2 laser on both sides of the face followed by topical application of L‐GFs on one side and conventional PRP on the other side. Assessment was done before and after treatment semiquantitatively by Echella d'Èvaluation Clinique des Cicatrices d'Acné (ECCA) score and qualitatively by Goodman and Baron's qualitative scar (GBQS) scale, in addition to dermoscopic evaluation. The current study reported significant clinical improvement of post‐acne scars on both sides of the face evidenced by significant reduction of both ECCA score and GBQS scale with minimal side effects. The degree of clinical improvement and patients' satisfaction were significantly higher with shorter downtime in response to fractional CO2 laser combined with L‐GFs rather than its combination with PRP. In conclusion, laser assisted delivery of L‐GFs via fractional CO2 laser could be considered a novel successful therapeutic modality for post‐acne scars.
... In the current study, combining ablative FCO 2 with PRP was associated with marked improvement of the scars and increased patients' overall satisfaction. These results were similar to that of Gawdat et al. [10] and Min et al. [23] who used PRP as an adjuvant to FCO 2 laser in the treatment of atrophic acne scars. They concluded that this combination increased clinical efficacy by enhancement of collagen production, modulation of laser-induced inflammation, and degree of improvement of the acne scars. ...
Background and Objectives
To compare the efficacy of autologous platelet‐rich plasma (PRP), ablative fractional carbon dioxide (FCO2) laser, and their combination in the treatment of atrophic acne scars, both clinically and immuno‐histopathologically.
Study Design/Materials and Methods
Sixty patients were randomly divided into three equal groups. Group 1 received intradermal PRP injection sessions. Group 2 received FCO2 laser sessions. Group 3 received FCO2 laser followed by intradermal PRP injection sessions. Each group received three sessions at monthly intervals. The final assessment took place 3 months after the last session. Skin biopsies were obtained before and 1 month after treatment sessions with pathological evaluation.
Results
Combined PRP and FCO2 laser‐treated patients had a better clinical response, fewer side effects, and shorter downtime than FCO2 laser alone. PRP‐treated patients had some improvement but significantly lower than the other two groups.
Conclusion
The current study concluded that a combination of PRP and FCO2 laser is an effective and safe modality in the treatment of atrophic acne scars with better results than PRP or FCO2 laser alone. Lasers Surg. Med. © 2020 Wiley Periodicals LLC
... Our current study might be in agreement with the results of a study by Al Taweel In consistence with our study, Min et al 25 Abbreviations: PRP, platelet-rich plasma; HA, Hyaluronic acid. ...
... Our current study might be in agreement with the results of a study by Al Taweel In consistence with our study, Min et al 25 Abbreviations: PRP, platelet-rich plasma; HA, Hyaluronic acid. ...
Background
Atrophic acne scarring is a common cosmetic problem that may affect 95% of patients with acne.
Aims
The objective is to evaluate the efficacy of the fractional CO2 laser combined with intradermal injection of PRP versus intradermal injection of noncross‐linked hyaluronic acid in the treatment of different types of atrophic postacne scars.
Methods
The study included 30 patients with postacne scars. All the patients received 3 treatments of fractional CO2 laser combined with intradermal injection of PRP at one side of the face compared with intradermal injection of noncross‐linked hyaluronic acid at the other side of the face. Efficacy of the treatment was assessed by the physician's clinical assessment using Goodman and Baron's qualitative and quantitative grading systems and histopathological evaluation from six participants.
Results
The study included 30 patients ages ranging from 25 to 44 years old. There was a statistically significant reduction in the severity of acne scars on both sides after treatment using qualitative and quantitative Goodman and Baron. Histopathological evaluation showed an increase in the collagen and elastic fiber content in both modalities with a more favorable outcome in the PRP‐treated side.
Conclusion
Both treatment modalities resulted in a significant clinical and histopathological improvement in atrophic postacne scar with insignificant difference between them.
Atrophic acne scarring is a prevalent problem that has been treated with a variety of procedures, each with various degrees of success. For better results, combined regimens of treatment are recommended. Our aim was to compare the efficacy of topical insulin against topical platelet-rich plasma (PRP) as an adjunct treatment to fractional CO2 laser for atrophic acne scars. The study comprised 30 patients with atrophic acne scars. All patients underwent four sessions of fractional CO2 laser on both sides of the face at one-month intervals, followed by topical PRP treatment on one side of the face and topical insulin on the other. Two non-treating dermatologists used the Acne Scar Assessment Scale (ASAS) to assess the outcome. At their last follow-up appointment, patients were asked to assess their improvement on each side of the face in a percentage from 0 to 100%. Prior to treatment, there was no difference in the ASAS scores between the two sides of the face. One month after the last treatment session, ASAS scores improved significantly on both sides of the face. No significant difference (p = 0.794) between both sides were detected. Both techniques helped to improve atrophic acne scars and may have a synergistic outcome regarding efficacy and safety.
Background:
Acne is a chronic inflammatory and immune-mediated disease of the pilosebaceous unit (the skin structure consisting of a hair follicle and its associated sebaceous gland). It is characterised by non-inflammatory lesions (open and closed comedones) and inflammatory lesions (papules, pustules, nodules, and cysts). Lesions may be present on the face, thorax, and back, with variable severity. Acne exhibits a global distribution and has a growing prevalence. Acne vulgaris is the most common form. Acne gives rise to complications such as scars and can seriously affect people's mental health, especially those with severe acne. Acne has a huge impact on the quality of life and self-esteem of those affected.
Objectives:
To synthesise the existing evidence on the efficacy and safety of non-systemic pharmacological interventions and non-pharmacological interventions (physical therapy and complementary therapies) in the treatment of acne vulgaris and related skin complications.
Methods:
We searched the Cochrane Database of Systematic Reviews, Epistemonikos, MEDLINE, and Embase to 2 December 2021, and checked the reference lists of included reviews. At least two authors were responsible for screening, data extraction, and critical appraisal. We excluded reviews with high risk of bias as assessed with the ROBIS tool. We evaluated the overall certainty of the evidence according to GRADE (as carried out by the authors of the included reviews or ourselves). We provide comprehensive evidence from the review data, including summary of findings tables, summary of results tables, and evidence maps.
Main results:
We retrieved and assessed a total of 733 records; however, only six reviews (five Cochrane reviews and one non-Cochrane review) with low risk of bias met the overview inclusion criteria. The six reviews involved 40,910 people with acne from 275 trials and 1316 people with acne scars from 37 trials. The age of the participants ranged from 10 to 59 years, with an average age range from 18 to 30 years. Four reviews included original trials involving only female participants and three reviews included original trials with only male participants. Main results for clinically important comparisons: Benzoyl peroxide versus placebo or no treatment: In two trials involving 1012 participants over 12 weeks, benzoyl peroxide may reduce the total (mean difference (MD) -16.14, 95% confidence interval (CI) -26.51 to -5.78), inflammatory (MD -6.12, 95% CI -11.02 to -1.22), and non-inflammatory lesion counts (MD -9.69, 95% CI -15.08 to -4.29) when compared to placebo (long-term treatment), but the evidence is very uncertain (very low-certainty evidence). Two trials including 1073 participants (time point: 10 and 12 weeks) suggested benzoyl peroxide may have little to no effect in improving participants' global self-assessment compared to placebo (long-term treatment), but the evidence is very uncertain (risk ratio (RR) 1.44, 95% CI 0.94 to 2.22; very low-certainty evidence). Very low-certainty evidence suggested that benzoyl peroxide may improve investigators' global assessment (RR 1.77, 95% CI 1.37 to 2.28; 6 trials, 4110 participants, long-term treatment (12 weeks)) compared to placebo. Thirteen trials including 4287 participants over 10 to 12 weeks suggested benzoyl peroxide may increase the risk of a less serious adverse event compared to placebo (long-term treatment), but the evidence is very uncertain (RR 1.46, 95% CI 1.01 to 2.11; very low-certainty evidence). Benzoyl peroxide versus topical retinoids: Benzoyl peroxide may increase the percentage change in total lesion count compared to adapalene (long-term treatment), but the evidence is very uncertain (MD 10.8, 95% CI 3.38 to 18.22; 1 trial, 205 participants, 12 weeks; very low-certainty evidence). When compared to adapalene, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): percentage change in inflammatory lesion counts (MD -7.7, 95% CI -16.46 to 1.06; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), percentage change in non-inflammatory lesion counts (MD -3.9, 95% CI -13.31 to 5.51; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.96, 95% CI 0.86 to 1.06; 4 trials, 1123 participants, 11 to 12 weeks; low-certainty evidence), investigators' global assessment (RR 1.16, 95% CI 0.98 to 1.37; 3 trials, 1965 participants, 12 weeks; low-certainty evidence), and incidence of a less serious adverse event (RR 0.77, 95% CI 0.48 to 1.25, 1573 participants, 5 trials, 11 to 12 weeks; very low-certainty evidence). Benzoyl peroxide versus topical antibiotics: When compared to clindamycin, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): total lesion counts (MD -3.50, 95% CI -7.54 to 0.54; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), inflammatory lesion counts (MD -1.20, 95% CI -2.99 to 0.59; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), non-inflammatory lesion counts (MD -2.4, 95% CI -5.3 to 0.5; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.95, 95% CI 0.68 to 1.34; 1 trial, 240 participants, 10 weeks; low-certainty evidence), investigator's global assessment (RR 1.10, 95% CI 0.83 to 1.45; 2 trials, 2277 participants, 12 weeks; very low-certainty evidence), and incidence of a less serious adverse event (RR 1.27, 95% CI 0.98 to 1.64; 5 trials, 2842 participants, 10 to 12 weeks; low-certainty evidence). For these clinically important comparisons, no review collected data for the following outcomes: frequency of participants experiencing at least one serious adverse event or quality of life. No review collected data for the following comparisons: topical antibiotics versus placebo or no treatment, topical retinoids versus placebo or no treatment, or topical retinoids versus topical antibiotics.
Authors' conclusions:
This overview summarises the evidence for topical therapy, phototherapy, and complementary therapy for acne and acne scars. We found no high-certainty evidence for the effects of any therapy included. Randomised controlled trials and systematic reviews related to acne and acne scars had limitations (low methodological quality). We could not summarise the evidence for topical retinoids and topical antibiotics due to insufficient high-quality systematic reviews. Future research should consider pooled analysis of data on new emerging drugs for acne treatment (e.g. clascoterone) and focus more on acne complications.
This narrative review summarizes current knowledge on the use of autologous platelet concentrates (APCs) in esthetic medicine, with the goal of providing clinicians with reliable information for clinical practice. APCs contain platelets that release various growth factors with potential applications in facial and dermatologic treatments. This review examines several facial esthetic applications of APCs, including acne scarring, skin rejuvenation, melasma, vitiligo, stretchmarks, peri‐orbital rejuvenation, peri‐oral rejuvenation, hair regeneration and the volumizing effects of APC gels. A systematic review of literature databases (PubMed/MEDLINE) was conducted up to October 2023 to identify randomized controlled trials (RCTs) in the English language on APCs for facial rejuvenation and dermatology. A total of 96 articles were selected including those on platelet rich plasma (PRP), plasma‐rich in growth factors (PRGF), and platelet‐rich fibrin (PRF). Clinical recommendations gained from the reviews are provided. In summary, the use of APCs in facial esthetics is a promising yet relatively recent treatment approach. Overall, the majority of studies have focused on the use of PRP with positive outcomes. Only few studies have compared PRP versus PRF with all demonstrating superior outcomes using PRF. The existing studies have limitations including small sample sizes and lack of standardized assessment criteria. Future research should utilize well‐designed RCTs, incorporating appropriate controls, such as split‐face comparisons, and standardized protocols for APC usage, including optimal number of sessions, interval between sessions, and objective improvement scores. Nevertheless, the most recent formulations of platelet concentrates offer clinicians an ability to improve various clinical parameters and esthetic concerns.
Introduction
Plasma‐rich plasma (PRP), exosomes, and stem cells represent promising new treatments for facial rejuvenation and to enhance other cosmetic procedures. Although these treatments are rapidly advancing, there are no universally accepted treatment protocols for their use. The goal of the following review is to describe some of the possible benefits of PRP, exosomes, and stem cells in aesthetic medicine.
Results
A review of available studies showed that potential uses of PRP include wound healing after facial surgery, facial rejuvenation, androgenetic alopecia, acne scars, striae distensae, and vitiligo. Exosomes may provide beneficial treatment for skin rejuvenation, scar reduction, hyperpigmentation, and hair growth. Stem cells show promise for androgenetic alopecia, scar improvement, and treatment of photoaged skin. These new technologies may be used alone, but are often combined with existing aesthetic treatments.
Conclusion
PRP, exosomes, and stem cells may play an important role in restoring youthful tissue structure and function. Interpretation of some study results is sometimes challenged by the lack of standardized treatment protocols, including routes of application and dosing. When combined with other devices and techniques, results are sometime unclear as to which treatment plays the greater role.
Scars are classified into 5 types: Superficial scars, hypertrophic scars, atrophic scars, depressed scars, and keloid. These types are primarily characterized by abnormal production of fibroblasts and collagen, as well as the disorderly arrangement of connective tissue. Laser treatment for scars involves the coordinated activation of various signaling pathways and cytokines. However, the exact pathological mechanism for scar formation remains unclear, leading to a lack of radical treatment. Recently, laser treatment has gained popularity as a new minimally invasive approach for scar treatment. The emergence of new theories such as fractional, picosecond laser, and laser-assisted drug delivery has led to continuous advance in laser treatment. Up to now, it has been developed numerous novel treatments, including combined with drug, physical, and other treatments, which have shown superior therapeutic effects. In order to optimize laser treatment in the future, it is crucial to combine new materials with postoperative care. This will help clinicians develop more comprehensive treatment strategies. Therefore, it is important to explore treatment options that have broader applicability.
The skin’s recognised functions may undergo physiological alterations due to ageing, manifesting as varying degrees of facial wrinkles, diminished tautness, density, and volume. Additionally, these functions can be disrupted (patho)physiologically through various physical and chemical injuries, including surgical trauma, accidents, or chronic conditions like ulcers associated with diabetes mellitus, venous insufficiency, or obesity. Advancements in therapeutic interventions that boost the skin’s innate regenerative abilities could significantly enhance patient care protocols. The application of Platelet-Rich Plasma (PRP) is widely recognized for its aesthetic and functional benefits to the skin. Yet, the endorsement of PRP’s advantages often borders on the dogmatic, with its efficacy commonly ascribed solely to the activation of fibroblasts by the factors contained within platelet granules. PRP therapy is a cornerstone of regenerative medicine which involves the autologous delivery of conditioned plasma enriched by platelets. This is achieved by centrifugation, removing erythrocytes while retaining platelets and their granules. Despite its widespread use, the precise sequences of cellular activation, the specific cellular players, and the molecular machinery that drive PRP-facilitated healing are still enigmatic. There is still a paucity of definitive and robust studies elucidating these mechanisms. In recent years, telocytes (TCs)—a unique dermal cell population—have shown promising potential for tissue regeneration in various organs, including the dermis. TCs’ participation in neo-angiogenesis, akin to that attributed to PRP, and their role in tissue remodelling and repair processes within the interstitia of several organs (including the dermis), offer intriguing insights. Their potential to contribute to, or possibly orchestrate, the skin regeneration process following PRP treatment has elicited considerable interest. Therefore, pursuing a comprehensive understanding of the cellular and molecular mechanisms at work, particularly those involving TCs, their temporal involvement in structural recovery following injury, and the interconnected biological events in skin wound healing and regeneration represents a compelling field of study.
The endogenous electric field (EF) generated by transepithelial potential difference plays a decisive role in wound re‐epithelialization. For patients with large or chronic wounds, negative pressure wound therapy (NPWT) is the most effective clinical method in inflammation control by continuously removing the necrotic tissues or infected substances, thus creating a pro‐proliferative microenvironment beneficial for wound re‐epithelialization. However, continuous negative pressure drainage causes electrolyte loss and weakens the endogenous EF, which in turn hinders wound re‐epithelialization. Here, we developed an electrogenerative dressing (EGD) by integrating triboelectric nanogenerators with NPWT. By converting the negative pressure‐induced mechanical deformation into electricity, EGD produced a stable and high‐safety EF that could trigger a robust epithelial electrotactic response and drive the macrophages toward a reparative M2 phenotype in vitro. Translational medicine studies confirmed that EGD completely reshaped the wound EF weakened by NPWT, and promoted wound closure by facilitating an earlier transition of inflammation/proliferation and guiding epithelial migration and proliferation to accelerate re‐epithelialization. Long‐term EGD therapy remarkably advanced tissue remodeling with mature epithelium, orderly extracellular matrix and less scar formation. Compared with the golden standard of NPWT, EGD orchestrated all the essential wound stages in a non‐invasive manner, presenting an excellent prospect in clinical wound therapy. This article is protected by copyright. All rights reserved
Although broad reviews on laser-assisted drug delivery (LADD) have been published in the past, an updated focused examination of its utility in the context of common, treatment-resistant, dermatologic conditions has not been published. This article reports a comprehensive scoping review of the potential benefits of LADD compared to laser or drug monotherapy for the treatment of 3 such conditions: scars, rhytids, and melasma. A PubMed (National Institutes of Health; Bethesda, MD) search was conducted for keywords including “laser-assisted drug delivery,” “scar,” “rhytid,” and “melasma.” Out-of-scope studies were excluded. To evaluate the efficacy of LADD for the treatment of scars, relevant articles were categorized by scar type: hypertrophic/keloid, atrophic, and hypopigmented. LADD, with both ablative and nonablative laser types, was studied in combination with corticosteroids, botulinum toxin-A (BTX-A), 5-fluorouracil, 5-aminolevulinic acid photodynamic therapy, stem cells, platelet-rich plasma, and prostaglandin analogs for the treatment of scars. Some randomized controlled trials demonstrated the efficacy of LADD, whereas others showed no significant differences in clinical outcomes but demonstrated reduced adverse effects. Regarding rhytids, laser treatment has been combined with various cosmeceuticals, including poly-L-lactic acid, topical retinaldehyde, and topical BTX-A. The studies reviewed supported the use of LADD with these drugs over monotherapy. Some studies showed that LADD was effective for the absorption of drugs such as poly-L-lactic acid and BTX-A which are often not effective topically. For melasma treatment, LADD with tranexamic acid and hydroquinone was superior in some studies, but not significantly different than monotherapy in other studies. LADD with certain drugs could be considered to treat scars, rhytids, and melasma.
Level of Evidence: 5
Introduction:
There is limited basic research on carbon dioxide (CO2 ) fractional laser, indicating blind spots in CO2 fractional laser treatment of certain diseases. This study aimed to organize previous literature, summarize the current research, and speculate on possible future development.
Methods:
We searched document data on fractional CO2 lasers from the Web of Science core collection database and retrieved 928 articles from 2004 to 2021. CiteSpace software was used to analyze the main institutions, authors, subject hotspots, and research frontiers in global CO2 fractional laser research.
Results:
The results revealed that 928 related papers were published in the past 18 years (2004-2021), and the number has increased annually. The publications were written by 3239 authors from 626 institutions in 60 countries/regions. The United States (US) dominates this field (312 documents), followed by Italy (289), and South Korea (88). Lasers in Surgery and Medicine is the journal with the most publications and citations, and Uebelhoer is the central author. The main research hotspots include vulvovaginal atrophy, fractional photothermolysis, keloids, drug delivery, gene expressions, facial acne scarring, resurfacing, vitiligo, and photo damage.
Conclusion:
Using CiteSpace, this paper draws a map of authors, institutions, and keywords in fractional CO2 laser from 2004 to 2021; summarizes the main authors, institutions, research hotspots, and cutting-edge topics of global fractional CO2 laser technology in recent years; and summarizes the current application status of global fractional CO2 laser in disease treatment. It also provides new ideas for the future application and research of fractional CO2 lasers.
Despite the rising trend for applying platelet‐rich plasma (PRP) in the management of various types of scars, there is no convincing evidence supporting its use. This motivated us to review the randomized clinical trials that examine the effectiveness and safety of PRP, alone or in combination with other methods, for the management of atrophic or hypertrophic/keloidal scars. The Web of Science, Scopus, Google Scholar, and Cochrane Library databases were systematically searched until September 1st, 2020. Thirteen clinical trials were enrolled in the meta‐analysis, and 10 more were reviewed for their results. The random effect meta‐analysis method was used to assess the effect size of each outcome for each treatment type, and I2 was used to calculate the statistical heterogeneity between the studies. Patients treated with PRP experienced an overall response rate of 23%, comparable to the results seen with laser or micro‐needling (22% and 23%, respectively) When used alone, moderate improvement was the most frequently observed degree of response with PRP (36%) whereas, when added to laser or micro‐needling, most patients experienced marked (33%, 43%, respectively) or excellent (32% and 23%, respectively) results. Concerning the hypertrophic/keloid scars, the only study meeting the required criteria reported a better improvement and fewer adverse effects when PRP was added to the intralesional corticosteroids. Platelet‐rich plasma appears to be a safe and effective treatment for various types of atrophic scars. In addition, when added to ablative lasers or micro‐needling, it seems to considerably add to the efficacy of treatment and reduce the side effects.
Treating the signs of skin ageing or acne scars by chemical peels or ablative lasers is increasingly used worldwide. Due to their reduced invasiveness, these methods are often favored over aesthetic surgical interventions. Both procedures rely on the principle of controlled damage to the skin. The subsequent regeneration may lead to the development of new epidermal (and dermal) tissue and therefore improve the skin’s aesthetic appearance. At present, there are no official guidelines in Germany concerning pre- and post-interventional skin care, which is currently based on the personal experiences and evaluations of the practitioner. It is known that an appropriate treatment regime can improve the outcome and reduces downtime pre- and post-laser as well as pre- and post-peel. The aim of this article is to present the different possibilities of pre- and post-interventional care. In most cases, priming includes intense ultraviolet (UV) protection, topical retinoids as well as skin brightening agents, and occasionally oral herpes simplex prophylaxis. In order to support post-interventional wound healing, skin care should modulate inflammation and balance skin hydration. In addition to light moisturizers, broad spectrum UV protection as well as the avoidance of sports and sweating are essential.
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.
Background:
Fractional carbon dioxide or erbium:yttrium-aluminum-garnet (YAG) laser combined with platelet-rich plasma has been used for postacne scars. Nevertheless, there is limited evidence on its use because of the small size of relevant studies. This study aims to evaluate the efficacy of platelet-rich plasma-assisted laser for postacne scars.
Methods:
Randomized controlled trials comparing carbon dioxide or erbium:YAG laser combined with platelet-rich plasma to laser alone were searched for using the PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar databases.
Results:
In total, 13 studies involving 672 cases were included. The overall degree of clinical improvement favored platelet-rich plasma combined with carbon dioxide laser (mean difference, 0.55; 95 percent CI, 0.40 to 0.70) or erbium:YAG laser (mean difference, 0.63; 95 percent CI, 0.31 to 0.96). Notably, the use of carbon dioxide laser combined with platelet-rich plasma was more effective in both greater than 50 percent improvement of acne scars (OR, 1.63; 95 percent CI, 1.10 to 2.42) and greater than 75 percent improvement of acne scars (OR, 2.78; 95 percent CI, 1.75 to 4.42), compared with laser alone. Erbium:YAG laser combined with platelet-rich plasma was more effective in greater than 75 percent improvement of acne scars compared with laser alone (OR, 3.45; 95 percent CI, 1.31 to 9.05). Moreover, patient satisfaction was significantly higher with platelet-rich plasma combined with carbon dioxide laser (OR, 2.98; 95 percent CI, 1.72 to 5.16) or erbium:YAG laser (OR, 2.88; 95 percent CI, 1.33 to 6.21) compared to laser alone.
Conclusion:
This meta-analysis provides reliable evidence that fractional carbon dioxide or erbium:YAG laser combined with platelet-rich plasma is an effective and safe combination therapy for postacne scars.
Clinical question/level of evidence:
Therapeutic, II.
Objectives
Treating chronic cutaneous wounds is challenging, and debridement is a central concept in treating them. Studies have shown that CO2 laser debridement can control local infection and promote the wound healing process. The present study aimed to investigate the efficacy and safety of fully ablative CO2 laser debridement compared to routine surgical debridement in the treatment of chronic wounds.
Methods
The retrospective cohort study was conducted on patients with chronic (>1 month) cutaneous wounds (≥1 cm²) between December 1, 2017, and December 1, 2020, in the Wound Healing Center at Shanghai Ruijin Hospital, China. Patients treated with CO2 laser debridement with a DEKA SmartXide2 C80 (DEKA) (the CO2 laser group) were compared with matched control patients with similar baseline characteristics who had undergone routine surgical debridement (the routine group). The primary outcome was time-to-heal (days) for chronic wounds in two groups, and secondary outcomes included the wound area and BWAT (Bates–Jensen wound assessment tool) score before treatment, and at 1, 2, 3, and 4 weeks after treatment.
Results
The study included 164 patients (82 in the CO2 laser group and 82 matched in the routine group). The time-to-heal for patients in the CO2 laser group (41.30 ± 17.11) was significantly shorter than that of the patients in the routine group (48.51 ± 24.32) (p = 0.015). At 3 and 4 weeks after treatment, the absolute wound area of the CO2 laser group was significantly smaller than that of the routine group. Also, the CO2 laser group exhibited a significantly lower relative area at 2, 3, and 4 weeks after treatment. The CO2 laser group yielded significantly lower BWAT scores at 2, 3, and 4 weeks after treatment. Additionally, the relative BWAT score was significantly lower in the CO2 laser group than the relative scores in the routine group at 2, 3, and 4 weeks after treatment. No adverse events related to the treatments were observed in either group during the study period.
Conclusions
The present study has shown that fully ablative CO2 laser debridement has several advantages over routine sharp surgical debridement. It is superior at ameliorating wound status and reducing wound area, and it also significantly reduces the time-to-heal for chronic wounds, without causing any adverse events.
Platelet-rich fibrin (PRF) is a second-generation platelet concentrate obtained from autologous blood. PRF is composed of abundant platelets, leucocytes, and a high concentration of various growth factors and fibrinogen. The composition and three-dimensional structure of PRF enable it to effectively make cells migrate and proliferate, playing an important role in tissue repair. Furthermore, the easy preparation and low cost of PRF make it a good treatment option. Numerous articles have been published about the application of PRF in clinical practice, however, the application of PRF in dermatology has not been comprehensively reviewed. The objective of this review article was to discuss various applications of PRF in dermatology, including healing chronic wounds, treating androgenic alopecia, skin rejuvenation, autologous fat transplantation, and treating vitiligo. PRF is a promising dermatologic treatment, but lacks a standardized protocol regarding its methods of attainment and use, which needs more investigations.
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 .
Wound healing is a multistep regeneration process that requires immunological and microenvironmental conditions occurring simultaneously. Since platelets and their granules play a pivotal role in wound healing, their use as medication is extensively been evaluated in several fields, spacing from chronic wounds to aesthetics. In this chapter, we focused on wound healing and specifically on the contribution exerted by platelet-rich plasma (PRP) in different wounds. We performed a comprehensive literature review, including randomized clinical trials, prospective studies, case--control, and case series, to investigate clinical long-term outcomes (>12 months) of topical PRP. Our results suggest that PRP improves healing, sustaining a faster tissue regeneration, reducing scar formation, improving neo-vascularization, and decreasing recurrences. Remarkably, patients display lower pain and discomfort resulting in an increased satisfaction. Since this effective technique is ideal to be performed in hospital as well as in private practice, authors encourage the use of PRP in all patients with wounds, both chronic and acute.
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.
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.
Background and Objectives
Skin barrier is often compromised following ablative fractional carbon dioxide laser (AFCO2) therapy for acne scarring. The resultant downtime, even of a few days' duration, can be of significant concern to patients. We evaluated the efficacy and safety of topical 0.5% timolol maleate (TM) for its role in short‐term restoration of the skin's biophysical properties after laser treatments.
Study Design/Materials and Methods
This double‐blind, placebo‐controlled trial included participants aged 18–50 years with atrophic acne scars for at least 3 months. After undergoing laser therapy, they applied 0.5% TM to one cheek and normal saline to the contralateral cheek (control) for 7 days. Corneometry, transepidermal water loss (TEWL) measurement, colorimetry, and clinical outcome parameters (erythema, edema, crusting, pruritus, and tightness scores) were evaluated at baseline and 48, 96, and 168 hours after AFCO2 treatment.
Results
Twenty‐five healthy participants completed the study. Most participants had Fitzpatrick skin phototype IV. The TM‐treated side showed statistically higher corneometry values and lower TEWL than the control side at every follow‐up visit (P < 0.001). The crusting score at 96 hours post‐AFCO2 treatment was also significantly better on the TM side. No adverse events occurred during the follow‐up period.
Conclusions
Application of topical 0.5% TM twice daily improves the skin‐barrier function and might promote re‐epithelialization after laser procedures. Lasers Surg. Med. © 2020 Wiley Periodicals LLC
Introduction : Adopting optimal breast feeding practices is fundamental right to a child’s survival, growth and development. Despite all the potential benefits, only about two fifths of infants 0-6 months of age worldwide are exclusively breastfed. Analysis of data on feeding practices among infants highlights the need for accelerated programming in this area. Present study was aimed to survey feeding practices in infants up to 6 months and observing variables for faulty feeding practices Method :Mother of infants up to 6 months coming from urban area in a tertiary care hospital were interviewed for feeding practices as per preformed questionnaires. If feeding practices were faulty all details regarding various factors leading to same were asked and analysed. Results :Total 518 mothers were interviewed. Only 37% infants were exclusively breast feed, in 29% feeding was started in 1st hour of life and in 25% some form of prelacteal feeds were given. On analysing different factors for faulty feeding practices we found that primigravida, CS delivery, (p<0.001)different myths regarding mother health, baby health, and breast feeding, lack of awareness ,faulty feeding techniques, low socioeconomic status(65%) and poor education(80%) were contributing factors leading to same. There were multiples factors in single mother for faulty feeding practices. Conclusion : Promotion, support and adherence to recommendations of breast feeding is still a gold standard to gain optimal growth and development of children. still health personnel has to do lot more to particularly in field of proper education, explanation and demonstration in field of same. Using newer media technology like mobile and TV will be helpful to spread it fast.
Objective:
The picosecond 755 nm alexandrite laser using a diffractive lens array has demonstrated consistent clinical efficacy for improving the appearance of acne scarring and wrinkles amongst other benefits. This small pilot study is to assess the difference, if any, in clinical benefit if a higher than the standard protocol for number of pulses delivered to a tissue area is used compared to the standard protocol guidelines.
Method:
Seven subjects received treatment to one side of the face with a standard protocol number of laser pulses with the other side of the face receiving higher than standard number of pulses from the same 755 nm picosecond laser using an additional diffractive lens array. Photographs at final follow up were compared to baseline by two blinded Board Certified Dermatologists and assessed for improvements to acne scarring using a 6-point grading score, for wrinkles using the Fitzpatrick Wrinkle & Elastosis 3-point grading scale and a Global Aesthetic Improvement Scale assessment. Subjects also completed a satisfaction questionnaire.
Results:
For the acne scarring subjects, the average improvement from baseline to final follow up was 4.0 +/- 1.0 for the standard treated side and 4.5 +/- 0.5 for the high pulse side. There was no statistically significant difference between the two treated sides (P > 0.05, n = 3 paired t-test). For the wrinkle subjects, the average grading of the standard pulse side improved from 2.0 +/- 0.82 to 1.75 +/- 1.0 from baseline to final follow-up. The high pulse side improved from 1.5 +/- 1.0 to 1.125 +/- 0.25 from baseline to final follow-up. There was no statistically significant difference between the improvement of the standard and high pulse treatment sides (P > 0.05, n = 4 paired t-test). The comparison of baseline to final follow-up images of each subject found both sides to be Much or Very Much improved with no statistically significant difference between the standard and high pulse sides (P > 0.05, n = 7 paired t-test). Six of the seven subjects did not note any difference between the effect on different sides of the face and four of the seven rated their overall improvement after treatment as Good, three subjects as Reasonable and one subject with Slight Improvement. All subjects found the treatment comfortable and easy to tolerate and there was no increased incidence of side effects other than the mild occurrences typically observed for this type of treatment.
Conclusion:
This is a small pilot study with limited subject numbers and further data is needed to be able to make firm conclusions of observed trends, which suggest that the use of higher than standard suggested protocol number of pulses with the diffractive lens array and the 755 nm picosecond laser does not appear to offer any additional benefit over that that can already be achieved with the standard number of pulses, but also does not increase risk of detrimental post treatment effects either. Lasers Surg. Med. © 2017 Wiley Periodicals, Inc.
Background and objectives:
Fractional treatment with a dual wavelength 1,064 and 532 nm picosecond-domain laser, delivering a 10 × 10 array of highly focused beamlets via a holographic optic, was investigated for the treatment of acne scars.
Study:
Twenty-seven of 31 subjects completed the study, 19 were treated using 1,064 nm and 8 were treated at 532 nm, all having four-monthly treatments. Blinded evaluation of digital images by three physician evaluators comparing pre- and 3-month post-treatment images measured efficacy using a 10-point scale. Subject self-assessment of treatment effects were also recorded. Safety was measured by recording subject discomfort scores and adverse effects.
Results:
Blinded reviewers correctly identified the baseline image in 61 of the 81 image sets (75%), and baseline acne scar scores were 1.8 ± 0.7 and 1.8 ± 0.5 for the 1,064 and 532 nm cohorts, and decreased to 1.1 ± 0.5 (P < 0.001) and 1.1 ± 0.0 (P < 0.005), respectively. Post-treatment erythema, mild edema, and petechiae were the only side effects noted.
Conclusion:
The 1,064 and 532 nm picosecond-domain laser incorporating a 10 × 10 holographic beam-splitting handpiece was found to be safe and effective for the treatment of facial acne scars. The treatments were well tolerated and the subjects experienced little to no downtime. Lasers Surg. Med. © 2017 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
Background and objective:
Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient.
Methods:
A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO2) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors.
Conclusion:
Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment efficacy. Lasers Surg. Med. 49:45-59, 2017. © 2016 Wiley Periodicals, Inc.
Platelet-rich plasma (PRP) containing hepatocyte growth factor (HGF) and other growth factors are widely used in orthopaedic/sports medicine to repair injured tendons. While PRP treatment is reported to decrease pain in patients with tendon injury, the mechanism of this effect is not clear. Tendon pain is often associated with tendon inflammation, and HGF is known to protect tissues from inflammatory damages. Therefore, we hypothesized that HGF in PRP causes the anti-inflammatory effects. To test this hypothesis, we performed in vitro experiments on rabbit tendon cells and in vivo experiments on a mouse Achilles tendon injury model. We found that addition of PRP or HGF decreased gene expression of COX-1, COX-2, and mPGES-1, induced by the treatment of tendon cells in vitro with IL-1β. Further, the treatment of tendon cell cultures with HGF antibodies reduced the suppressive effects of PRP or HGF on IL-1β-induced COX-1, COX-2, and mPGES-1 gene expressions. Treatment with PRP or HGF almost completely blocked the cellular production of PGE2 and the expression of COX proteins. Finally, injection of PRP or HGF into wounded mouse Achilles tendons in vivo decreased PGE2 production in the tendinous tissues. Injection of platelet-poor plasma (PPP) however, did not reduce PGE2 levels in the wounded tendons, but the injection of HGF antibody inhibited the effects of PRP and HGF. Further, injection of PRP or HGF also decreased COX-1 and COX-2 proteins. These results indicate that PRP exerts anti-inflammatory effects on injured tendons through HGF. This study provides basic scientific evidence to support the use of PRP to treat injured tendons because PRP can reduce inflammation and thereby reduce the associated pain caused by high levels of PGE2.
Autologous platelet-rich plasma (PRP) may enhance wound healing through the formation of a platelet plug that provides both hemostasis and the secretion of biologically active proteins, including growth factors such as platelet-derived growth factor, transforming growth factor (TGF)-β, TGF-β2, and epidermal growth factor. The release of these growth factors into the wound may create an environment more conducive to tissue repair and could accelerate postoperative wound healing. To our knowledge, there are no reports of combining the use of PRP with curative diabetic foot surgery. This article provides a summary of the literature regarding PRP and wound healing and presents a case of a 49-year-old man with diabetes and a three-month history of a deep, nonhealing plantar hallux wound in which PRP was combined with a first metatarsophalangeal joint arthroplasty. Through the use of the PRP and bioengineered tissue to supplement curative diabetic foot surgery, the patient healed uneventfully at seven weeks.
To establish a low-cost method to prepare platelet-rich plasma (PRP) and evaluates the potential of platelet derived factors to enhance wound healing in the surgical wounds in equine.
To obtain a PRP gel, calcium gluconate and autologous thrombin were added to platelet-rich plasma. For the tests six saddle horses were used and two surgical incisions were made in each animal. Wounds were treated with PRP gel or untreated. Sequential wound biopsies collected at Treatment 1: at days 5 and 30 and Treatment 2: at days 15 and 45 post wounding permitted comparison of differentiation markers and wound repair.
The optimal platelets enrichment over 4.0 time's baseline values was obtained using 300 g for 10 min on the first centrifugation and 640 g for 10 min on the second centrifugation.
Wounds treated with PRP gel exhibit more rapid epithelial differentiation and enhanced organization of dermal collagen compared to controls in equine.
The objective of this study was to use autologous plasma rich in growth factors (PRGF) on wound healing in the skin in New Zealand albino rabbits and to study reepithelialisation and inflammation at 7 and 28 days. A prospective study carried out on 20 adult rabbits. Two wounds were made on the in the skin on the back of each animal; one control, and the other in which PRGF was applied. The PRGF preparation was obtained from 10 ml of whole blood. The reepithelialisation and inflammation of wounds were measured at 7 and 28 days. Reepithelialisation improved in skin at 7 days (P = 0.007), with resolution of the inflammatory process (P = 0.005), having significant differences with respect to the control. Therefore, PRGF accelerates reepithelialisation and reduces inflammation at 7 days in skin.
Research into mechanisms of skin scarring identified transforming growth factor beta3 (TGFbeta3) as a potential antiscarring therapy. We assessed scar improvement with avotermin (recombinant, active, human TGFbeta3).
In three double-blind, placebo-controlled studies, intradermal avotermin (concentrations ranging from 0.25 to 500 ng/100 microL per linear cm wound margin) was administered to both margins of 1 cm, full-thickness skin incisions, before wounding and 24 h later, in healthy men and women. Treatments (avotermin and placebo or standard wound care) were randomly allocated to wound sites by a computer generated randomisation scheme, and within-participant controls compared avotermin versus placebo or standard wound care alone. Primary endpoints were visual assessment of scar formation at 6 months and 12 months after wounding in two studies, and from week 6 to month 7 after wounding in the third. Investigators, participants, and scar assessors were blinded to treatment. Efficacy analyses were intention to treat. These studies are registered with ClinicalTrials.gov, numbers NCT00847925, NCT00847795, and NCT00629811.
In two studies, avotermin 50 ng/100 microL per linear cm significantly improved median score on a 100 mm visual analogue scale (VAS) by 5 mm (range -2 to 14; p=0.001) at month 6 and 8 mm (-29 to 18; p=0.0230) at month 12. In the third, avotermin significantly improved total scar scores at all concentrations versus placebo (mean improvement: from 14.84 mm [95 % CI 5.5-24.2] at 5 ng/100 microL per linear cm to 64.25 mm [49.4-79.1] at 500 ng/100 microL per linear cm). Nine [60%] scars treated with avotermin 50 ng/100 microL per linear cm showed 25% or less abnormal orientation of collagen fibres in the reticular dermis versus five [33%] placebo scars. After only 6 weeks from wounding, avotermin 500 ng/100 microL per linear cm improved VAS score by 16.12 mm (95% CI 10.61-21.63). Adverse events at wound sites were similar for avotermin and controls. Erythema and oedema were more frequent with avotermin than with placebo, but were transient and deemed to be consistent with normal wound healing.
Avotermin has potential to provide an accelerated and permanent improvement in scarring.
Myc and transforming growth factor-beta (TGFbeta) signaling are mutually antagonistic, that is Myc suppresses the activation of TGFbeta-induced genes, whereas TGFbeta represses c-myc transcription. Here, we report a positive role for Myc in the TGFbeta response, consisting in the induction of an epithelial-to-mesenchymal transition (EMT) and the activation of the EMT-associated gene Snail. Knockdown of either Myc or the TGFbeta effectors SMAD3/4 in epithelial cells eliminated Snail induction by TGFbeta. Both Myc and SMAD complexes targeted the Snail promoter in vivo, DNA binding occurring in a mutually independent manner. Myc was bound prior to TGFbeta treatment, and was required for rapid Snail activation upon SMAD binding induced by TGFbeta. On the other hand, c-myc downregulation by TGFbeta was a slower event, occurring after Snail induction. The response of Snail to another cytokine, hepatocyte growth factor (HGF), also depended on Myc and SMAD4. Thus, contrary to their antagonistic effects on Cip1 and INK4b, Myc and SMADs cooperate in signal-dependent activation of Snail in epithelial cells. Although Myc also targeted the Snail promoter in serum-stimulated fibroblasts, it was dispensable for its activation in these conditions, further illustrating that the action of Myc in transcriptional regulation is context-dependent. Our findings suggest that Myc and TGFbeta signaling may cooperate in promoting EMT and metastasis in carcinomas.
Transforming growth factor type beta (TGF-beta), when injected subcutaneously in newborn mice, causes formation of granulation tissue (induction of angiogenesis and activation of fibroblasts to produce collagen) at the site of injection. These effects occur within 2-3 days at dose levels than 1 microgram. Parallel in vitro studies show that TGF-beta causes marked increase of either proline or leucine incorporation into collagen in either an NRK rat fibroblast cell line or early passage human dermal fibroblasts. Epidermal growth factor (EGF) and platelet-derived growth factor (PDGF) do not cause these same in vivo and in vitro effects; in both rat and human fibroblast cultures, EGF antagonizes the effects of TGF-beta on collagen formation. We have obtained further data to support a role for TGF-beta as an intrinsic mediator of collagen formation: conditioned media obtained from activated human tonsillar T lymphocytes contain greatly elevated levels of TGF-beta compared to media obtained from unactivated lymphocytes. These activated media markedly stimulate proline incorporation into collagen in NRK cells; this effect is blocked by a specific antibody to TGF-beta. The data are all compatible with the hypothesis that TGF-beta is an important mediator of tissue repair.
It has been previously shown that transforming growth factor beta (TGF beta) is capable of stimulating fibroblast collagen and fibronectin biosynthesis. The purpose of this study was to examine the mechanisms involved in TGF beta stimulation of fibroblast biosynthetic activity. Our results indicate that TGF beta causes a marked enhancement of the production of types I and III collagens and fibronectin by cultured normal human dermal fibroblasts. The rate of collagen production by fibroblasts exposed to TGF beta was 2-3-fold greater than that of control cells. These effects were associated with a 2-3-fold increase in the steady-state amounts of types I and III collagen mRNAs and a 5-8-fold increase in the amounts of fibronectin mRNAs as determined by dot-blot hybridization with specific cloned cDNA probes. In addition, the increased production of collagen and fibronectin and the increased amounts of their corresponding mRNAs remained elevated for at least 72 h after removal of TGF beta. These findings suggest that TGF beta may play a major role in the normal regulation of extracellular matrix production in vivo and may contribute to the development of pathological states of fibrosis.
Pseudarthrosis remains a significant problem in spinal fusion. The objective of our study was to investigate the effects of autologous growth factors (AGF) in instrumented transforaminal lumbar interbody spinal fusion (TLIF). A prospective review was carried out of 23 patients who underwent TLIF with application of AGF, with a minimum 2-year follow-up. Comparison with our historical cohort (without AGF application) was performed. Mean age at surgery was 44.3 years in the AGF treatment group. Twelve had a positive smoking history. Fourteen had undergone previous spinal surgeries. Thirteen received one-level fusions and ten received two-level fusions. The radiographic results showed a fusion rate of 100% in one-level fusions and 90% in two-level fusions. There was no significant difference in pseudarthrosis rates between the AGF treatment group and historical cohort. Excluding the cases with pseudarthrosis, there was faster bony healing in patients who had been treated with AGF application. This study indicates that although AGF may demonstrate faster fusions, it does not result in an overall increase in spinal fusion rates. Further studies are needed before AGF can routinely be used as an adjunct in spinal fusion.
Akt kinases control essential cellular functions, including proliferation, apoptosis, metabolism and transcription, and have been proposed as promising targets for treatment of angiogenesis-dependent pathologies, such as cancer and ischemic injury. But their precise roles in neovascularization remain elusive. Here we show that Akt1 is the predominant isoform in vascular cells and describe the unexpected consequences of Akt1 knockout on vascular integrity and pathological angiogenesis. Angiogenic responses in three distinct in vivo models were enhanced in Akt1(-/-) mice; these enhanced responses were associated with impairment of blood vessel maturation and increased vascular permeability. Although impaired vascular maturation in Akt1(-/-) mice may be attributed to reduced activation of endothelial nitric oxide synthase (eNOS), the major phenotypic changes in vascular permeability and angiogenesis were linked to reduced expression of two endogenous vascular regulators, thrombospondins 1 (TSP-1) and 2 (TSP-2). Re-expression of TSP-1 and TSP-2 in mice transplanted with wild-type bone marrow corrected the angiogenic abnormalities in Akt1(-/-) mice. These findings establish a crucial role of an Akt-thrombospondin axis in angiogenesis.
Background and objective:
Based on reports of poor wound healing and scarring, it is currently recommended that patients wait 6 months after completion of oral isotretinoin therapy before the safe initiation of laser treatment. Our aim was to evaluate the safety of non-ablative fractional laser (NAFL) treatment for acne scars within 1 month after isotretinoin therapy.
Study design/methods:
This was a randomized split-face controlled trial involving 10 patients with acne scars who had completed isotretinoin treatment. All patients received three treatments each spaced 4 weeks apart with an erbium-doped 1550 nm NAFL on one side of the face within 1 month after isotretinoin therapy. The untreated side acted as a control. Wound healing and adverse effects as well as acne scar improvement were evaluated by two blinded dermatologists.
Results:
All patients demonstrated normal wound healing post NAFL treatments, and neither hypertrophic scars nor keloids were observed. Acne scar improvement was satisfactory.
Conclusion:
NAFL treatment for acne scarring appears to be well tolerated within 1 month of completing isotretinoin treatment. Dermatologists should reevaluate the current recommendation to wait 6 months after isotretinoin treatment for acne scar revision with lasers. Other larger studies are necessary to further challenge this dogma. Lasers Surg. Med. XX:XX-XX, 2017. © 2017 Wiley Periodicals, Inc.
Background and objective:
Fractional Er:YAG minimizes the risk associated with skin ablation. Infrared diode laser and radiofrequency have suggested comparable improvements in acne scar. We compared the clinical efficacy of Er:YAG laser and bipolar radiofrequency combined with diode laser (BRDL) for the treatment of acne scars. Moreover, acute molecular changes of cytokine profile associated with wound healing have been evaluated to suggest mechanisms of improvement of acne scar.
Study design:
Twenty-four subjects with mild-to-moderate acne scars were treated in a split-face manner with Er:YAG and BRDL, with two treatment sessions, 4 weeks apart. Objective and subjective assessments were done at baseline, 1, 3, 7 days after each treatment and 4 weeks after last treatment. Skin biopsy specimens were obtained at baseline, 1, 3, 7, 28 days after one session of treatment for investigation of molecular profile of acute skin changes by laser treatment.
Results:
Investigator's Global Assessment representing the improvement degree shows 2.1 (50%) in fractional Er:YAG and 1.2 (25%) in BRDL. Er:YAG induced the later and higher peak expression of TGFβs and collagenases, whereas BRDL induced earlier and lower expression of TGFβ and collagenases, relatively. PPARγ dropped rapidly after a peak in Er:YAG-treated side, which is associated with tissue inhibitor of metalloproteinase (TIMP) expression. We observed higher expression of TIMP after Er:YAG treatment compared with BRDL by immunohistochemistry, which may be associated with the expression of upregulation of collagen fibers.
Conclusion:
The superior efficacy of Er:YAG to BRDL in the treatment of acne scars may be associated with higher expression of collagen which is associated with differential expression of TGFβs, collagenases, PPARγ, and TIMP. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.
Background and objective:
The utilization of lasers in dermatology has greatly expanded in recent decades. Acne scarring is a common indication in which lasers play an important therapeutic role.
Study design/materials and methods:
Available lasers include traditional ablative lasers, such as carbon dioxide and erbium lasers, traditional non-ablative lasers, such as neodymium, diode, alexandrite, pulsed dye lasers and intense pulse light, as well as both ablative, and non-ablative fractional laser systems.
Conclusion:
We sought to provide a framework for understanding the various types of lasers available to treat acne scars and review the primary literature pertaining to the efficacy, safety, and advantages of each laser discussed. Lasers Surg. Med. © 2015 Wiley Periodicals, Inc.
Background:
Ablative fractional laser procedures have been shown to facilitate topical drug delivery into the skin. Past studies have mainly used ex vivo models to demonstrate enhanced drug delivery and in vivo studies have investigated laser created channels over a time course of days and weeks rather than within the first few minutes and hours after exposures. We have noticed rapid in vivo fibrin plug formation within ablative fractional laser lesions impairing passage through the laser created channels.
Material and methods:
In vivo laser exposures were performed in a porcine model. A fractional CO2 laser (AcuPulse™ system, AcuScan 120™ handpiece, Lumenis, Inc., Yokneam, Israel) was programmed in quasi-continuous wave (QCW) mode, at 40W, 50 mJ per pulse, 5% coverage, nominal 120 µm spot size, 8 × 8 mm square pattern, 169 MTZs per scan. Six millimeters punch biopsies were procured at 0, 2, 5, 10, 15, 30, 60, 90 minutes after completion of each scan, then fixed in 10% formalin. 12 repeats were performed of each time point. Skin samples were processed for serial vertically cut paraffin sections (5 μm collected every 25 μm) then H&E and special immunohistochemistry staining for fibrin and platelet. Dimensions of Microscopic Treatment Zones (MTZs) and extent of fibrin plug were assessed and quantified histologically. Ex vivo laser exposures of the identical laser parameter were performed on porcine and human skin at different storage conditions.
Results:
Histology procured at various predetermined time intervals after in vivo fractional CO2 laser exposures revealed a rapidly forming fibrin plug initiating at the bottom of the MTZ lesions. At longer time intervals, the fibrin plug was extending towards the superficial sections. Within the first 5 minutes, more than 25% length of the entire laser-ablated channel was filled with a fibrin plug. With increased time intervals, the cavity was progressively filled with a fibrin plug. At 90 minutes, more than 90% length of the entire laser-ablated channel was occluded. Ex vivo exposures failed to produce any significant fibrin plug formation.
Conclusions:
The current study has demonstrated rapid fibrin plug formation after ablative fractional laser procedures. It was shown that the passage through laser created pathways is critically time dependent for in vivo exposures. In contrast, ex vivo exposures do not exhibit such time dependent passage capacity. In particular, drug, substance, and cell delivery studies for ablative fractional laser treatments should take early fibrin plug formation into consideration and further investigate the impact on transdermal delivery. Lasers Surg. Med. © 2015 Wiley Periodicals, Inc.
Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% ± 11%) than in grafts in which platelet-rich plasma was not added (55.1% ± 8%; p = 0.005).
The aim of this study was to investigate the role of transforming growth factor β1 in mechanisms of cutaneous remodeling induced by fractional carbon dioxide laser treatment. The dorsal skin of Kunming mice was exposed to a single-pass fractional CO2 laser treatment. Biopsies were taken at 1 h and at 1, 3, 7, 14, 21, 28, and 56 days after treatment. Transforming growth factor (TGF) β1 expression in skin samples was evaluated by ELISA, dermal thickness by hematoxylin-eosin staining, collagen and elastic fibers by Ponceau S and Victoria blue double staining, and types I and III collagens by ELISA. The level of TGF β1 in the laser-treated areas of skin was significantly increased compared with that in the control areas on days 1 (p < 0.05), 3 (p < 0.01), and 7 (p < 0.05) and then decreased by day 14 after treatment, at which time it had returned to the baseline level. Dermal thickness and the amount of type I collagen of the skin of the laser-treated areas had increased significantly (p < 0.05) compared with that in control areas on days 28 and 56. Fibroblast proliferation showed a positive correlation with TGF β1 expression during the early stages (r = 0.789, p < 0.01), and there was a negative correlation between the level of TGF β1 and type I collagen in the late stages, after laser treatment (r = -0.546, p < 0.05). TGF β1 appears to be an important factor in fractional laser resurfacing.
The treatment of acne scars with fractional CO(2) lasers is gaining increasing impact, but has so far not been compared side-by-side to untreated control skin.
In a randomized controlled study to examine efficacy and adverse effects of fractional CO(2) laser resurfacing for atrophic acne scars compared to no treatment.
Patients (n = 13) with atrophic acne scars in two intra-individual areas of similar sizes and appearances were randomized to (i) three monthly fractional CO(2) laser treatments (MedArt 610; 12-14 W, 48-56 mJ/pulse, 13% density) and (ii) no treatment. Blinded on-site evaluations were performed by three physicians on 10-point scales. Endpoints were change in scar texture and atrophy, adverse effects, and patient satisfaction.
Preoperatively, acne scars appeared with moderate to severe uneven texture (6.15 ± 1.23) and atrophy (5.72 ± 1.45) in both interventional and non-interventional control sites, P = 1. Postoperatively, lower scores of scar texture and atrophy were obtained at 1 month (scar texture 4.31 ± 1.33, P < 0.0001; atrophy 4.08 ± 1.38, P < 0.0001), at 3 months (scar texture 4.26 ± 1.97, P < 0.0001; atrophy 3.97 ± 2.08, P < 0.0001), and at 6 months (scar texture 3.89 ± 1.7, P < 0.0001; atrophy 3.56 ± 1.76, P < 0.0001). Patients were satisfied with treatments and evaluated scar texture to be mild or moderately improved. Adverse effects were minor.
In this single-blinded randomized controlled trial we demonstrated that moderate to severe atrophic acne scars can be safely improved by ablative fractional CO(2) laser resurfacing. The use of higher energy levels might have improved the results and possibly also induced significant adverse effects.
Acne vulgaris is a highly prevalent skin disorder characterized by hyperseborrhea, inflammation, and Propionibacterium acnes overgrowth. Only isotretinoin and hormonal therapy reduce sebum production. To identify a new drug candidate that modulates sebum, we examined the effects of EGCG, the major polyphenol in green tea, on human SEB-1 sebocytes and in patients with acne. In SEB-1 sebocytes, we found that EGCG reduced sebum by modulating the AMPK-SREBP-1 signaling pathway. EGCG also reduces inflammation by suppressing the NF-κB and AP-1 pathways. EGCG also induces cytotoxicity of SEB-1 sebocytes via apoptosis and decreases the viability of P. acnes, thus targeting almost all the pathogenic features of acne. Finally, and most importantly, EGCG significantly improved acne in an 8-week randomized, split-face, clinical trial, and was well tolerated. Our data provide a therapeutic rationale for the use of EGCG in acne.Journal of Investigative Dermatology advance online publication, 25 October 2012; doi:10.1038/jid.2012.292.
Platelet-rich plasma (PRP) is plasma that is produced from autologous blood, and its usefulness in plastic surgery and dermal wound healing has garnered attention in recent years. The aim of this study was to investigate the effects of PRP and platelet-poor plasma on the proliferation and differentiation of skin fibroblasts into myofibroblasts and on wound contraction using Western blotting, immunofluorescence staining, and collagen gels containing an embedded fibroblast model. PRP promotes proliferation of human dermal fibroblasts. PRP addition enhanced the expression of alpha-smooth muscle actin protein, a myofibroblast marker, as shown by immunofluorescence staining and Western blotting. PRP-treated groups demonstrated more marked contraction in the collagen gel model than the platelet-poor plasma and vehicle groups. PRP promotes proliferation, causes the differentiation of human dermal fibroblasts into myofibroblasts and promotes wound contraction, thus providing a potential therapeutic agent for skin wound healing.
Background and Objectives
Ablative fractional resurfacing (AFR) is a new modality for photorejuvenation and acne scars which combines carbon dioxide (CO2) laser ablation with fractional photothermolysis. The objective is to evaluate the efficacy and side effects of a new fractional CO2 ablative device (Fraxel Re:pair) for skin rejuvenation and acne scars in Asians.Materials and Methods
Nine patients underwent one full-face treatment. The energy levels ranged from 30–70 mJ with coverage between 30% and 45%. Improvement in skin texture, laxity, wrinkles, enlarged pores, overall pigmentation irregularity, and adverse effects were assessed up to 6 months post-treatment. Standardized photographs using the Canfield Visia CR system® were assessed by two independent observers. Subjective improvement was assessed by patient questionnaires.ResultsNine Chinese patients (skin types III and IV, mean age 44.8) were included. Statistically significant improvements were seen for skin texture, skin laxity, wrinkles, enlarged pores, and acne scars. The post-inflammatory hyperpigmentation rate was 55.5% and 11.1% at 1 and 6 months post-treatment, respectively. Eighty-six percent of patients were overall satisfied to very satisfied with the treatment.Conclusion
Ablative fractional CO2 laser resurfacing was overall safe and effective for skin rejuvenation and acne scars in Asians. However, in view of the high post-inflammatory rate and the statistically significant but only mild to moderate improvement after a single treatment as observed in this study, there is a need to review the current role of fractional ablative CO2 laser treatment as compared to fractional non-ablative for skin rejuvenation and acne scar treatment in Asians. Lasers Surg. Med. 42:615–623, 2010 © 2010 Wiley-Liss, Inc.
Ablative carbon dioxide (CO(2) ) fractional resurfacing is a promising therapeutic intervention for the treatment of acne scars, although this technique is associated with prolonged surgical site erythema and edema, which may affect the daily lives of patients. Autologous platelet-rich plasma (PRP) is known to enhance wound healing and has applications in many areas of medicine.
To evaluate the synergistic effects of autologous PRP with CO(2) fractional resurfacing for acne scars.
A split-face trial was conducted in 14 Korean participants with acne scars. All participants received one session of ablative CO(2) fractional resurfacing. Immediately after resurfacing, facial halves were randomly assigned to receive treatment with autologous PRP injections on one side (experimental side) and normal saline injections on the other side (control side). The participants were monitored for degree of recovery and resurfacing-associated adverse events, including prolonged erythema, edema, and other effects on days 0, 2, 4, 6, 8, 15, and 30. The intensity of erythema was objectively measured using a chromometer at the same time intervals. After one additional treatment session using the same protocol, two independent dermatologists evaluated clinical improvement using a quartile grading scale.
All participants completed the study. Erythema on the experimental side improved faster than on the control side and was significantly less at day 4 (p=.01). This difference was confirmed using a chromometer (p=.049). Total duration of erythema was an average of 10.4±2.7 days on the control side and 8.6±2.0 days on the experimental side (p=.047). Edema also improved faster on the experimental side than on the control side. The total duration of edema was an average of 7.1±1.5 days on the control side and 6.1±1.1 days on the experimental side (p=.04). Participants were also assessed for duration of post-treatment crusting, with a mean of 6.8±1.0 days on the control side and 5.9±1.1 days on the experimental side (p=.04). No other adverse effects were observed in any participant. Four months after the final treatment, overall degree of clinical improvement was significantly better on the experimental side (2.7±0.7) than on the control side (2.3±0.5) (p=.03).
Treatment with PRP after ablative CO(2) fractional resurfacing enhances recovery of laser-damaged skin and synergistically improves the clinical appearance of acne scarring.
Fractional carbon dioxide laser resurfacing (FxCR) has shown considerable efficacy in reducing wrinkles, although complications such as scarring and prolonged erythema are more common and down-time is longer than with nonablative laser treatment. Platelet-rich plasma (PRP), a high concentration of platelets in a small volume of plasma, is known to enhance tissue healing.
To evaluate the benefits of PRP in the wound healing process after FxCR.
Twenty-five subjects were treated with FxCR on the bilateral inner arms. PRP was prepared from 10 mL of whole blood and applied on a randomly allocated side, with normal saline being used as the contralateral control. Transepidermal water loss (TEWL) and skin color were measured on both sides. Skin biopsies were also taken from five subjects on day 28.
Significantly faster recovery of TEWL was seen on the PRP-treated side. The erythema index and melanin index on the PRP-treated side were lower than on the control side. Biopsy specimens from the PRP-treated side showed thicker collagen bundles than those from the control side.
Application of autologous PRP is an effective method for enhancing wound healing and reducing transient adverse effects after FxCR treatment.
Adequate laser settings in the treatment of scars using a carbon dioxide fractional laser system (CO(2) FS) have not been established.
To compare the efficacy and safety of low-fluence, high-density with high-fluence, low-density treatment with CO(2) FS on acne scars and enlarged pores.
Ten patients with mild to severe atrophic acne scars and enlarged pores were enrolled. Half of each subject's face was treated with a single session of CO(2) FS with a fluence of 70 mJ and a density of 150 spots/cm(2) ; the other half was treated with a fluence of 30 mJ and a density of 250 spots/cm(2) .
Follow-up results 3 months after a single low-fluence, high-density treatment with CO(2) FS showed that four of 10 participants had clinical improvement of 51% to 75% from baseline. After the high-fluence, low-density CO(2) FS treatment, five of 10 patients demonstrated marked clinical improvements of more than 76%.
Higher-energy, lower-density laser settings seem to be more effective than lower-energy, higher-density settings for acne scars and enlarged pores, although our results do not constitute a conclusive comparison of the two different modes of CO(2) FS.
Loss of articular cartilage through injury or disease presents major clinical challenges also because cartilage has very poor regenerative capacity, giving rise to the development of biological approaches. As autologous blood product, platelet-rich plasma (PRP) provides a promising alternative to surgery by promoting safe and natural healing. Here we tested the possibility that PRP might be effective as an anti-inflammatory agent, providing an attractive basis for regeneration of articular cartilage, and two principal observations were done. First, activated PRP in chondrocytes reduced the transactivating activity of NF-κB, critical regulator of the inflammatory process, and decreased the expression of COX-2 and CXCR4 target genes. By analyzing a panel of cytokines with different biological significance, in activated PRP we observed increases in hepatocyte growth factor (HGF), interleukin-4 and tumor necrosis factor-α (TNF-α). HGF and TNF-α, by disrupting NF-κB-transactivating activity, were important for the anti-inflammatory function of activated PRP. The key molecular mechanisms involved in PRP-inhibitory effects on NF-κB activity were for HGF the enhanced cellular IkBα expression, that contributed to NF-κB-p65 subunit retention in the cytosol and nucleo-cytoplasmic shuttling, and for TNF-α the p50/50 DNA-binding causing inhibition of target-gene expression. Second, activated PRP in U937-monocytic cells reduced chemotaxis by inhibiting chemokine transactivation and CXCR4-receptor expression, thus possibly controlling local inflammation in cartilage. In conclusion, activated PRP is a promising biological therapeutic agent, as a scaffold in micro-invasive articular cartilage regeneration, not only for its content of proliferative/differentiative growth factors, but also for the presence of anti-inflammatory agents including HGF.
Platelet concentrates enjoyed some clinical popularity in facial plastic surgery several years ago. However, interest waned due to expense, amount of blood required, equipment, space, and staff needed, and lack of clinically significant benefit. A novel, simple method of preparing an autologous platelet derivative (Selphyl; Aesthetic Factors, Princeton, NJ) allows rapid and inexpensive generation of a platelet-rich fibrin matrix (PRFM) that can be used to enhance healing after facial procedures as well as to rejuvenate the face without tissue manipulation. PRFM provides autologous, natural, but concentrated platelet growth factor release and stimulation of surrounding tissue. This article describes its use for cosmetic facial applications.
Atrophic facial acne scars is one of the most common problems in patients with inflammatory acne. Ablative laser resurfacing has unpleasant complications and a long recovery period. Nonablative therapies yield less improvement and satisfaction. The introduction of fractional photothermolysis (FP) is an alternative treatment for atrophic acne scars.
To evaluate the effectiveness and safety of a nonablative 1,550-nm erbium-doped fiber laser in the FP of atrophic facial acne scars in one treatment session.
Forty-five patients (skin type III-IV, mean age 29) with atrophic facial acne scars were enrolled in the study. Each patient received one treatment of FP. Comparative photographs were taken using specific complexion analysis to identify and quantify depressed scars and texture. Physician evaluations and patient satisfaction were graded on a 4-point scale. Side effects were recorded at each follow-up visit.
The improvement in atrophic scars and texture after a FP treatment were significant. Twenty-seven (60%) of the patients had good to excellent results after 1 month.
The FP of atrophic facial acne scars resulted in significant improvement even in a single treatment, with good satisfaction and unremarkable side effects.
A cost-effectiveness analysis compared the potential economic benefit of an autologous, platelet-rich plasma (PRP) gel to alternative therapies in treating nonhealing diabetic foot ulcers.
An economic model used peer-reviewed data to simulate clinical and cost outcomes and quality-adjusted life-years (QALYs) associated with PRP gel and other treatment modalities.
The model varies rates of healing, recurrence, infection, amputation, death, and associated costs for a hypothetical group of 200,000 patients with full-thickness, nonhealing diabetic foot ulcers for 5 years or until death.
The model simulates the clinical, cost, and QALY outcomes associated with PRP gel versus other modalities in treating nonhealing diabetic foot ulcers over a 5-year period.
The average 5-year direct wound care cost per modality and QALYs were PRP gel, 33,214 (2.70); standard of care, 32,659 (2.73); human fibroblast-derived dermal substitute, 24,374 (2.79); bilayered cellular matrix, 20,964 (2.81); and recombinant human platelet-derived growth factor BB, $47,252 (2.69).
Use of PRP gel resulted in improved quality of life and lower cost of care over a 5-year period than other treatment modalities for nonhealing diabetic foot ulcers. Although actual treatment outcomes may differ from those modeled, PRP gel represents a potentially attractive treatment alternative for insurers and health care providers to address the cost burden and health effects of nonhealing diabetic foot ulcers.
This study evaluated changes in platelet-derived growth factor (PDGF)-AB and transforming growth factor (TGF)-beta1 release from platelets by platelet-rich plasma activation, and the proliferation potential of activated platelet-rich plasma and platelet-poor plasma on human adipose-derived stem cells and human dermal fibroblasts.
Platelet-rich plasma was prepared using a double-spin method, with the number of platelets counted in each preparation stage. Platelet-rich and platelet-poor plasma were activated with autologous thrombin and calcium chloride, and levels of platelet-released PDGF-AB and TGF-beta1 were determined by enzyme-linked immunosorbent assay. Cells were cultured for 1, 4, or 7 days in serum-free Dulbecco's Modified Eagle Medium supplemented with 5% whole blood plasma, nonactivated platelet-rich plasma, nonactivated platelet-poor plasma, activated platelet-rich plasma, or activated platelet-poor plasma. In parallel, these cells were cultured for 1, 4, or 7 days in serum-free Dulbecco's Modified Eagle Medium supplemented with 1%, 5%, 10%, or 20% activated platelet-rich plasma. The cultured human adipose-derived stem cells and human dermal fibroblasts were assayed for proliferation.
Platelet-rich plasma contained approximately 7.9 times as many platelets as whole blood, and its activation was associated with the release of large amounts of PDGF-AB and TGF-beta1. Adding activated platelet-rich or platelet-poor plasma significantly promoted the proliferation of human adipose-derived stem cells and human dermal fibroblasts. Adding 5% activated platelet-rich plasma to the medium maximally promoted cell proliferation, but activated platelet-rich plasma at 20% did not promote it.
Platelet-rich plasma can enhance the proliferation of human adipose-derived stem cells and human dermal fibroblasts. These results support clinical platelet-rich plasma application for cell-based, soft-tissue engineering and wound healing.
The adult cellular response to tissue injury is characterized by acute inflammation followed eventually by fibroblast proliferation and collagen synthesis. Fetal tissue responses to injury differ markedly from those of the adult; an early acute inflammatory response is absent, few fibroblasts participate, and no collagen is deposited. The object of the present study was to analyze the effects of transforming growth factor beta (TGF-beta), an important regulatory molecule in adult healing events, on the fetal tissue response following wounding. Fetal cellular and extracellular matrix responses to injury were evaluated by placing subcutaneous wound implants containing TGF-beta (0.01 to 10 ng) in fetal rabbits at 24 days gestation (term = 31 days). Histologic responses one to seven days later were compared with fetal and adult control implants without TGF-beta. The histology of the adult implant was characterized by an early acute inflammatory response: by day 7 fibroblasts and collagen were predominant. In contrast, control implants removed from fetal rabbits had no histologic evidence of acute inflammation or fibroblast penetration and no collagen was deposited. When implants containing 1.0 ng TGF-beta were removed from fetal rabbits at seven days, a grossly fibrotic reaction was observed: histology confirmed marked fibroblast penetration with collagen deposition. Fetal implants containing 0.01 ng or 10 ng TGF-beta showed few fibroblasts but had increased numbers of inflammatory cells compared with controls. These observations demonstrate that the fetal response becomes adultlike with fibroblast proliferation and collagen accumulation when TGF-beta is added, thus documenting the responsiveness of the fetal system to adult repair signals.(ABSTRACT TRUNCATED AT 250 WORDS)
The relative contributions of deregulation versus high level expression of the c-myc gene to malignant transformation are not clear. To investigate the effects of subtle perturbations in c-myc expression on normal cellular physiology, we isolated cell lines with one c-myc gene copy disrupted by targeted homologous recombination. The heterozygous cell lines were further modified by introducing a c-myc transgene expressed 4-fold above the normal diploid level. During exponential growth, heterozygous cells expressed c-Myc mRNA at approximately 50% of the level found in diploid cells, resulting in a slower growth rate. The c-myc transgene reversed the growth defect and accelerated growth relative to diploid cells. Serum deprivation of transgene-expressing cells caused a fraction of the culture to undergo apoptosis. After an initial wave of apoptosis, the remainder of the culture successfully entered Go. Transgene mRNA continued to be constitutively expressed in quiescent cells, but c-Myc protein was not detectable. During the G0 to G1 transition, heterozygous cells induced c-myc expression with normal kinetics, but levels throughout the time course were consistently at least 50% lower than those in diploid cells. The reduction in c-myc expression was correlated with a 3-4-h delay in entry into S phase. The presence of the transgene, which was expressed constitutively throughout the G0 to G1 transition, reversed the delay but did not further accelerate entry into S phase. Our results show that even small perturbations in c-myc expression cause changes in the proliferative status of cells and thus argue that the natural regulation patterns of the gene are crucial for the maintenance of normal cellular physiology.
Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% +/- 11%) than in grafts in which platelet-rich plasma was not added (55.1% +/- 8%; p = 0.005).
Cell division is coupled to cell growth. Since some c-myc target genes are regulators of cell growth while others function in cell division pathways, c-myc is apparently poised at the interface of these processes. Cell culture systems have shown specific myc-associated growth phenotypes. Increased cell growth precedes DNA synthesis after myc activation in cells expressing myc-estrogen receptor fuson constructs and cells lacking c-myc exhibit a marked loss of protein synthesis. A number of candidate c-myc target genes regulate processes required for cell growth including rRNA transcription and processing, ribosomal protein transcription and translation, and translation initiation. These interactions all have the potential to account for the growth phenotypes in c-myc mutant cells. The ability of translation initiation factors, including eIF4E, to transform cells makes them particularly interesting targets of c-myc. Further evaluation of these target genes will provide important insights into growth control and c-myc's functions in cellular proliferation.
Autologous platelet-rich plasma is a source of platelet-derived growth factor (PDGF) and transforming growth factor beta (TGF-beta), both important in accelerating hard and soft tissue maturation. This article describes a two-step centrifugation method to sequester and concentrate platelets to a level four to eight times baseline whole blood values. The technique produces concentrations of PDGF-AB above 500% and TGF-beta1 greater than 800%. Flow cytometry measuring p-selectin expression shows that the platelets remain quiescent throughout the procedure, maintaining their integrity and viability, with no inadvertent activation.
This study analyzed the effect of the platelet count in platelet-rich plasma (PRP) on bone regeneration in vivo. Twenty male New Zealand white rabbits were used. PRP was produced using the Platelet Concentrate Collection System (PCCS) (3i, Miami, FL, USA). After inducing ketamine-xylazine anaesthesia, a self-tapping titanium screw (Branemark MK III TiUnite, 3.75 x 7 mm) was inserted in each distal femur; the femurs were randomized so that one side was treated with PRP while the other (control) was not. Intravital fluorochrome staining was performed on days 1, 7 (1.5 ml of 2% doxycycline/kg bodyweight), 14 (6% xylenol orange, 1.5 ml/kg), and 21 (1% calcein green, 5 ml/kg). Animals were euthanized on day 28 (n = 20). Specimens were prepared for histomorphological evaluation according to Donath and Breuner [J. Oral Pathol. 11 (1982) 318]. Comparing the bone regeneration (fluorochrome staining) in the 4-week implants (n = 19), the only significant difference (sign test, P = 0.004) was seen with intermediate platelet concentrations (n = 9,503,000-1,729,000 platelets/microl PRP). There were no differences in the bone/implant contact rates between the test and the control side among the three groups. The platelet concentration required for a positive PRP effect on bone regeneration seems to span a very limited range. Advantageous biological effects seem to occur when PRP with a platelet concentration of approximately 1,000,000/microl is used. At lower concentrations, the effect is suboptimal, while higher concentrations might have a paradoxically inhibitory effect. On the other hand, the effect of this type of platelet concentrate was not beneficial to accelerate the osseointegration of enosseous dental implants.
The epidermal growth factor receptor (EGFR) has been implicated in the regulation of wound healing. In order to directly evaluate the role of endogenous EGFR in cutaneous incisional wound healing, we examined EGFR null- and wild-type skin after injury. By 5 d after wounding, re-epithelialization was complete in all EGFR wild-type wounds, but in only 40% of EGFR null wounds. Delayed wound closure in EGFR null skin was accompanied by an increase in edema, longer lasting and more prominent eschar, and increased distance between apposing wound edges. EGFR altered neutrophil and mast cell infiltration, and enhanced angiogenesis. EGFR enhanced epithelial proliferation during the first 3 d following injury, although proliferation was greater in EGFR null wounds at 5 d. Although migration was decreased in EGFR null keratinocytes cultured with standard medium or in medium supplemented with transforming growth factor-alpha when compared with controls, the addition of the wound-associated motogen keratinocyte growth factor eliminated the differences between genotypes. Epithelial migration into the wound was decreased in EGFR null skin, suggesting that both EGFR-dependent and -independent mechanisms regulate migration during wound healing. These data demonstrate that EGFR regulates multiple facets of cutaneous wound healing, including inflammation, wound contraction, proliferation, migration, and angiogenesis.
Akt/PKB is a serine/threonine protein kinase that functions as a critical regulator of cell survival and proliferation. Akt/PKB family comprises three highly homologous members known as PKBalpha/Akt1, PKBbeta/Akt2 and PKBgamma/Akt3 in mammalian cells. Similar to many other protein kinases, Akt/PKB contains a conserved domain structure including a specific PH domain, a central kinase domain and a carboxyl-terminal regulatory domain that mediates the interaction between signaling molecules. Akt/PKB plays important roles in the signaling pathways in response to growth factors and other extracellular stimuli to regulate several cellular functions including nutrient metabolism, cell growth, apoptosis and survival. This review surveys recent developments in understanding the molecular mechanisms of Akt/PKB activation and its roles in cell survival in normal and cancer cells.
Acne is the most common skin disease, causing significant psychosocial problems for those afflicted. Currently available agents for acne treatment, such as oral antibiotics and isotretinoin (Accutane), have limited use. Thus, development of novel agents to treat this disease is needed. However, the pathophysiology of acne inflammation is poorly understood. Before new therapeutic strategies can be devised, knowledge regarding molecular mechanisms of acne inflammation is required. We report here that transcription factors nuclear factor-kappaB and activator protein-1 are activated in acne lesions with consequent elevated expression of their target gene products, inflammatory cytokines and matrix-degrading metalloproteinases, respectively. These elevated gene products are molecular mediators of inflammation and collagen degradation in acne lesions in vivo. This new knowledge enables a rational strategy for development of pharmacological agents that can target the inflammation and matrix remodeling that occurs in severe acne.
The therapeutic use of autologous platelet-rich plasma constitutes a relatively new biotechnology that has been a breakthrough in the stimulation and acceleration of soft-tissue and bone healing. The efficiency of this process lies in the local and continuous delivery of a wide range of growth factors and proteins, mimicking the needs of the physiological wound healing and reparative tissue processes. Consequently, the application of platelet-rich plasma has been extended to many different fields, including orthopedics, sports medicine, dentistry, cosmetic and periodontal medicine and cosmetic, plastic and maxillofacial surgery. This article highlights the use of this technology and discusses some of the obstacles and challenges that need to be addressed to maintain progress in this field.
The ECCA grading scale (échelle d'évaluation clinique des cicatrices d'acné) is a tool designed to help dermatologists to assess the severity of acne scars and to standardize the discussions about the treatments of scars.
We developed an acne scar clinical grading scale called ECCA, which consists of 6 items designed to assess easily and quickly the severity of acne scars by a global score. The interobserver reliability of the ECCA grading was statistically validated.
The statistical analysis showed the interinvestigator reliability of the ECCA grading scale among 7 dermatologists who used it on the same group of 10 acne patients.
ECCA is a new tool which will now be available for dermatologists to use in their everyday practice and for clinical trials evaluating the efficacy of treatments on acne scars.
A positive role for Myc in TGFbeta-induced snail transcription and epithelial-to-mesenchymal transition
- Smith
Akt1 regulates pathological angiogenesis, vascular maturation and permeability in vivo
- Chen
Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians
- Chan