Comparative study using fractional carbon dioxide laser versus glycolic acid peel in treatment of pseudo-acanthosis nigricans

Evaluating the Efficacy and Safety of Alpha-Hydroxy Acids in Dermatological Practice: A Comprehensive Clinical and Legal Review

The global market for alpha-hydroxy acids (AHAs) is undergoing significant expansion, propelled by increasing demand for skincare products that address aging and environmental damage. This review focuses on the dermatological applications of AHAs, particularly in cosmetic formulations like chemical peels. We have identified that AHAs, such as glycolic and lactic acids, enhance skin rejuvenation by promoting apoptosis in skin cells, boosting collagen and elastin synthesis, and improving skin texture and luminosity. Our comprehensive analysis reveals a nuanced understanding of AHAs' effectiveness across various skin types and conditions, demonstrating their broad utility in treating conditions like acne, hyperpigmentation, and photoaging. However, the optimal concentrations for therapeutic efficacy with minimal side effects are yet to be precisely defined, necessitating further research. Regulatory compliance is underscored as essential for the safe application of AHAs in cosmetics, with international guidelines recommending specific concentrations and pH levels to minimize potential skin irritation. In Conclusion, the review highlights the effectiveness of AHAs in cosmetic dermatology, emphasizing the necessity for continued research and rigorous regulatory adherence to maximize their safe and beneficial application worldwide.

Systematic review of topical, laser, and oral treatments in acanthosis nigricans clinical trials

Acanthosis nigricans (AN), with an estimated prevalence of 19.4% in the U.S., presents as hyperpigmented, velvety plaques in intertriginous regions. Acanthosis Nigricans negatively affects psychological well-being and particularly impacts skin of color individuals. Addressing the underlying cause of acanthosis nigricans, as current guidelines recommend, is often challenging. This highlights the importance of skin directed treatment for acanthosis nigricans. This systematic review evaluated topical, laser, and oral treatments for acanthosis nigricans and provides evidence-based recommendations for clinical use. Adhering to PRISMA guidelines, we evaluated 19 clinical trials investigating topical, oral, and laser interventions for acanthosis nigricans. Oxford Centre for Evidence-Based Medicine guidelines were used to make clinical recommendations. We strongly recommend topical tretinoin (grade A) and endorse the appropriate use of adapalene gel, urea cream, and fractional carbon dioxide laser therapy (grade B). Further research is essential to enhance our understanding of alternative treatments to determine additional evidence-based recommendations. This review aims to guide clinicians in managing acanthosis nigricans, especially when direct treatment of underlying conditions is impractical.

Review of facial acanthosis nigricans: Easy to diagnose and difficult to treat marker of hyperinsulinemia/metabolic syndrome

Facial acanthosis nigricans (FAN) is an increasingly discussed anatomical variation of acanthosis nigricans (AN). Its presentation as brown to black pigmentation with ill-defined blurred margins with varying degree of textural changes commonly over forehead, temporal, and malar regions of the face predominantly in dark-skinned individuals with a male predilection can be confused with other common facial melanoses. Its pathogenesis, clinical features, and management are in many ways similar to in the commonly described areas like neck and major flexural areas. Understanding of FAN has gained momentum in the past decade with studies highlighting its association with various metabolic abnormalities particularly insulin resistance and obesity. It is now being considered to be a cutaneous marker of metabolic syndrome. While there is uniformity in its clinical description, there appears to be scope for further in depth biochemical and histopathological studies to link the pigmentation, altered texture and microscopic changes in individuals presenting with FAN and hyperinsulinemia with or without other features of metabolic syndrome. It awaits a consensus on grading its severity and correlating it with histological features as patients often hesitate to be subjected to a biopsy of the face. This is a review of current literature pertaining to FAN. Newer clinical, dermoscopic, histopathological, and biochemical insights will help to understand this relatively new entity.

Efficacy and safety of lasers versus topical medications for acanthosis nigricans and pseudo-acanthosis nigricans treatment: a systematic review

Acanthosis nigricans (AN) is a cutaneous disorder identified by well-defined pigmented plaques mostly detected on skin folds. Timely diagnosis and treatment of AN is essential as it could be an early manifestation of an underlying condition. The treatment of choice for AN has not been determined yet. Our study aimed to compare the efficacy and safety of various lasers with topical medications, including cream and peel. PubMed, Scopus, and Web of Science databases, as well as the Google Scholar search engine, were thoroughly searched until May 1st, 2023. Study selection was restricted to clinical trials published in English language comparing lasers with topical treatments. This study followed the PRISMA guidelines for systematic reviews and meta-analyses. Out of 1748 studies, Six clinical trials met our inclusion criteria, with 133 patients. We examined laser therapies, including fractional CO2 laser, 1550-nm erbium fiber laser, and long-pulsed alexandrite laser, while the topical treatments comprised glycolic acid (GA) peel, retinoic acid peel, trichloroacetic acid (TCA) peel, and tretinoin cream. In two studies, GA peel demonstrated favorable results compared to fractional CO2 laser. Besides, fractional CO2 laser exhibited efficacy, surpassing TCA peel in AN management. Additionally, a fractional 1550-nm erbium fiber laser displayed superiority over tretinoin cream in reducing average roughness. Similarly, a long-pulsed alexandrite laser demonstrated its effectiveness in axillary AN treatment compared to the combination of tretinoin and ammonium lactate. Overall, the findings revealed that laser therapy was associated with superior results. Moreover, topical treatments are safe and efficacious in AN management.

Correlation between Acanthosis Nigricans Scoring Chart (ANSC) and narrowband reflectance spectrophotometer in assessing severity of acanthosis nigricans

INTRODUCTION

There is a lack of standardized tool to monitor treatment outcome of acanthosis nigricans. To meet this end, we developed the Acanthosis Nigricans Scoring Chart (ANSC) that evaluates skin color (score range of 1-8) and skin texture (score range of 1-6), which adds up to a total ANSC score (score range of 2-14). We aimed to determine the correlation of ANSC to narrowband reflectance spectrophotometry and to evaluate its reliability.

METHODS

A cross-sectional study was conducted in adult acanthosis nigricans patients. Two raters independently graded participants using ANSC twice, in which scores were correlated to readings from Mexameter MX18. Intra- and interrater reliability were also evaluated via intraclass correlation coefficient (ICC).

RESULTS

Participants had mean (sd) melanin and erythema indices of 615.8 (176.2) and 451.4 (53.4), respectively. Mean (sd) total ANSC score was 9.43 (2.43). The total ANSC score and skin color subdomain demonstrated strong correlations (r > 0.6) with spectrophotometric results, whereas skin texture showed a moderate correlation (r = 0.4-0.6). Total ANSC score generally had excellent intra- and interrater reliabilities (ICC > 0.85).

CONCLUSION

The total ANSC score and its subdomains strongly correlate with spectrophotometer and demonstrate excellent reliability in assessing acanthosis nigricans.

Efficacy of Fractional Carbon Dioxide (CO2) Laser versus Q-Switched Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) and Potassium-Titanyl-Phosphate (KTP) Lasers in the Treatment of Acanthosis Nigricans

Background

Acanthosis nigricans (AN) is a common chronic skin disorder clinically presents by velvety hyperpigmented lesions mainly at the flexural areas. Fractional photothermolysis has been reported to improve both pigmentary and textural changes by removing thin layers of skin with minimal thermal damage. Other options are the Q-switched (Qs) Nd:YAG (1064 nm) and Qs KTP (532 nm) lasers. Both can induce collagen remodeling by dermal photo-mechanical microdamage.

Aim of the Work

The aim of this study was to assess the clinical efficacy and the safety of fractional CO₂ laser versus Qs Nd:YAG and KTP lasers in the treatment of acanthosis nigricans.

Methods

This randomized-controlled split neck study was conducted on 23 patients suffering from AN. For each patient, one side of the neck was randomly assigned to fractional CO₂ laser and the other side to Qs Nd:YAG and KTP lasers every four weeks for four months followed by 4 monthly follow-up assessment. Acanthosis Nigricans Area and Severity Index (ANASI) score, melanin and erythema indices as well as Patient Satisfaction Scale (PSS) were used to assess improvement on each side separately.

Results

There was no statistically significant difference regarding the clinical improvement between the side treated with Fractional CO₂ laser and the side treated with Qs Nd:YAG and KTP lasers (P value >0.05). In most patients, both sides showed improvement during different sessions of therapy, as regards ANASI scores, melanin indices, patient satisfaction scores, and side effects.

Conclusion

In this study, we concluded that both fractional CO₂ and Q-switched lasers proved to be a safe and effective line of treatment of acanthosis nigricans.

Research trends and hotspot analysis of fractional carbon dioxide laser: A bibliometric and visualized analysis via Citespace

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.

Comparative study between fractional carbon dioxide laser versus retinoic acid chemical peel in the treatment of acanthosis nigricans

BACKGROUND

Acanthosis nigricans (AN) is a common dermatological issue with several therapeutic modalities to treat. Despite retinoid is the first drug of choice in the treatment, the fractional-ablative carbon dioxide (CO₂ ) laser has revealed as a promising procedure for the management of neck-AN, outstanding to its ability for superficial ablation of the skin surface, with trans-epidermal melanin elimination.

OBJECTIVES

To decide whether fractional-ablative CO₂ laser or retinoic acid (5%) peel is the more effective and safe choice for AN treatment.

METHODS

In this study, twenty Egyptian cases with neck-AN were enrolled, where each case was exposed to four sessions with 2 weeks apart of both fractional CO₂  laser on the right half of the neck and retinoic acid peel on the left half of the neck. Cases were assessed by a scoring system: Acanthosis Nigricans Area and Severity Index (ANASI) score, two blinded dermatologists, and dermoscopically before and one month after treatment.

RESULTS

We found a highly statistically significant improvement among both treated groups regarding (ANASI) score and dermatologist's assessments. Bedside, the degree of sulci cutis, cristae cutis, brown-to-dark brown dots, and milia-like cysts, dermoscopic sign improvement was evident in both treated groups. However, fractional CO₂ laser shows the superior result to retinoic acid peel in the treatment.

CONCLUSION

Fractional CO₂ laser and retinoic acid peel are considered effective modalities for neck-AN treatment. However, fractional CO₂ laser was more effective.

Acanthosis nigricans: A review

BACKGROUND

Acanthosis nigricans (AN) is a cutaneous disorder characterized by symmetric velvety hyperpigmented plaques on intertriginous areas like axilla, neck, inframammary, and groin.

AIMS

To summarize the pathophysiology and classification of AN, provide an update of diagnostic testing strategies, and describe the current therapeutic options described so far in the literature for this disease.

METHODS

A comprehensive english language literature search across multiple databases (PubMed, EMBASE, MEDLINE, and Cochrane) for keywords (alone and in combination) was performed. MeSH as well as non-MeSH terms such as "acanthosis nigricans," "classification," "pathophysiology," "diagnosis," "treatment," "topical drugs," "systemic drugs," "chemical peeling," and "lasers" were taken into consideration.

RESULTS

The pathophysiology of AN revolves around a multifactorial stimulation of proliferation of epidermal keratinocytes and dermal fibroblasts. Various types of AN include benign, obesity-associated, syndromic, malignant, acral, unilateral, medication-induced, and mixed-type. Homeostasis model assessment-insulin resistance (HOMA-IR) is a good tool for assessment of insulin resistance. Management involves general measures (weight reduction and addressing the underlying cause, if any), topical drugs (retinoids, vitamin D analogs, and keratolytics), oral drugs (retinoids and insulin sensitizers), chemical peels (trichloroacetic acid), and lasers (Long pulsed alexandrite, fractional 1550-nm erbium fiber, and CO₂ ).

CONCLUSION

Acanthosis nigricans is a treatable condition; however, complete cure and disappearance of lesions are difficult to achieve. Weight reduction is the most scientific and practical management strategy. Long-term studies and further research is warranted in the pathophysiology and treatment of this common condition.

Fractional carbon dioxide laser versus trichloroacetic acid peel in the treatment of pseudo-acanthosis nigricans

BACKGROUND

Treatment of acanthosis nigricans (AN) is challenging, and new modalities are being explored continuously to increase the therapeutic efficacy.

AIM

To evaluate the efficacy and safety of fractional CO2 laser compared to trichloroacetic acid (TCA) peel in the treatment of pseudo-acanthosis nigricans (pseudo-AN).

METHODS

The study included 40 patients with pseudo-AN on the neck and axilla allocated into two groups each containing 20 patients. Group (A) was treated with TCA 20% peel applied on the pigmented area while group (B) received fractional CO2 laser. Both treatments were performed till complete clearance or for a maximum of four treatment sessions. Patients with excellent response were further followed up for 6 months after the end of treatment.

RESULTS

Both modalities were effective in the treatment of pseudo-AN; however, the therapeutic response was significantly higher in the fractional CO2 laser group compared to the TCA peel group (p < 0.01). Marked to excellent response (51%-100% clearance of AN lesions) was achieved in 85% of the patients in the fractional laser group versus 10% of the patients in the TCA group. Adverse effects, for example, persistent erythema, post-inflammatory hyperpigmentation, and burning sensation, were also statistically higher in the TCA group compared to the laser group (p = 0.04).

CONCLUSION

Fractional CO2 laser is a promising effective and well-tolerated treatment modality for pseudo-acanthosis nigricans.