Laser resurfacing of the skin for the improvement of facial acne scarring: a systematic review of the evidence

Efficacy evaluation of Endolift-based Subcision on acne scar treatment

BACKGROUND

People with acne scar suffer from destruction to the surface of the skin. Treating acne scars is a challenge that might need several methods.

AIMS

Subsection is a method that has been informed to be a useful method in treating rolling acne scars. While Subcision is a valued procedure, its effect is mild to moderate due to its high reappearance rate, and patients' dissatisfaction with some of the side effects such as inflammation after procedure.

PATIENTS/METHODS

In this pilot study, 9 rolling acne scar patients underwent Subcision with the Endolift (200-nm fiber) and followed up for 3 months. Outcomes were evaluated by 3 dermatologists (Blind). Also, the patients' satisfaction was assessed to compare with dermatologist's opinions.

RESULTS

Our results indicated that Subcision with the Endolift displayed good and very good improvement in about 90% of patient with a good and very good satisfaction in the patients. Photographic data evaluation indicated 100% improvement in scar depth, topography, and total acne scar appearance. The average numbers of lesions before the treatment were 25.5 ± 12.1, and after treatment, it was reduced to 11.4 ± 2.1 (P < .05).

CONCLUSION

Subcision with the Endolift seems to be a safe and effective method for acne scar treatment. It is done with a single perforation on each side (instead of several perforations), which reduces the pain and scar risk in the patients. Also, Endolift-based Subcision needs fewer surgical sessions and less recovery time with less inflammation and erythema.

Identifying and appraising patient-reported outcome measures on treatment satisfaction in acne: a systematic review

BACKGROUND

After dermatitis, acne is the next skin disease to contribute most to the burden of skin diseases worldwide. Recently, seven core outcome domains have been identified, which together form an Acne Core Outcome Set (ACORN). One of these was satisfaction with acne treatment.

OBJECTIVES

To identify studies that described the development of patient-reported outcome measures (PROMS), evaluated one or more measurement properties of a PROM, or evaluated the interpretability of a PROM in patients with acne regarding treatment satisfaction.

METHODS

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy for identifying PROMS on acne treatment satisfaction was used. We searched PubMed, MEDLINE, Embase, LILACS, Web of Science, Cochrane Library, Emcare, PsycINFO and Academic Search premier (June 2020). Study selection, data extraction and assessment of methodological quality according to COSMIN guidance were carried out independently by two authors.

RESULTS

Only one study could be included, describing the development of a treatment satisfaction measure in patients with acne. The development was assessed as inadequate and data on measurement properties were lacking. Additionally, we found 188 studies reporting treatment satisfaction solely as an outcome, using a wide variety of methods, none of them standardized or validated.

CONCLUSIONS

We could not find a PROM on treatment satisfaction to recommend for a core outcome set in acne. There is an unmet need for a PROM on treatment satisfaction in acne that is robustly developed, designed and validated.

Comparison of a 1064-nm neodymium-doped yttrium aluminum garnet picosecond laser using a diffractive optical element vs. a nonablative 1550-nm erbium-glass laser for the treatment of facial acne scarring in Asian patients: a 17-week prospective, randomized, split-face, controlled trial

BACKGROUND

Novel picosecond lasers using a diffractive optical element (P-DOE) have been available for skin resurfacing with distinct mechanisms. However, there are limited data directly comparing P-DOE and conventional fractional lasers for the treatment of atrophic acne scarring.

OBJECTIVES

We sought to compare the efficacy and safety of a 1064-nm neodymium-doped yttrium aluminium garnet P-DOE and a non-ablative fractional laser (NAFL) in the treatment of acne scarring.

METHODS

A prospective, randomized, split-face, controlled trial was performed. One randomly assigned half-side of each patient's face (n = 25) was treated with four consecutive sessions of P-DOE at 3-week intervals and the other side with NAFL, with subsequent follow-up for 8 weeks after the final sessions. The efficacy and safety of the two lasers were determined by the Echelle d'Evaluation Clinique des Cicatrices d'acné (Scale of Clinical Evaluation of Acne Scars; ECCA) grading scale, Investigator's Global Assessment (IGA) score and patients' reports at the final visit. Histologic analysis was also performed.

RESULTS

The P-DOE-treated side achieved a significantly better improvement in acne appearance (ECCA per cent reduction: 55% vs. 42%) with less severe pain (4.3 vs. 5.6) (P < 0.05). The IGA score and subjective satisfaction were consistent with ECCA score results. Occurrences of treatment-related side-effects were also lower in the group treated with P-DOE (P < 0.05). Histologic analysis revealed elongation and increased density of neocollagen fibres, elastic fibres and mucin throughout the dermis from both sides.

CONCLUSIONS

Compared with NAFL, P-DOE afforded better clinical outcomes and fewer side-effects in the treatment of acne scarring in Asian patients.

Comparing cannula-based subcision with the common needle method: A clinical trial

OF TRIAL DESIGN

Treatment of depressed acne scars requires multiple modalities. Although needle subcision is a valuable method, it exhibits mild to moderate efficacy in treatment of deep acne scars owing to the high recurrence rate and other side effects. A total of 100 patients with rolling acne scars were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision in two parallel groups, and the effect of cannula subcision instead of needle subcision was evaluated in the treatment of rolling acne scars.

METHODS

A total of 100 patients were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision. The outcomes of these procedures were assessed by three blinded dermatologists and by patients' satisfaction.

RESULTS

Subcision using the cannula showed good and very good improvement in about 83% of patients (n = 50, P < .05) based on dermatologists investigation and almost no side effects were observed in compared with needle subcision. The response rate was significantly different while using cannula subcision.

CONCLUSION

Cannula subcision appears to be a safe and practical technique that can enhance the efficacy of subcision without considerable complications.

Fractional Carbon Dioxide Laser: Optimizing Treatment Outcomes for Pigmented Atrophic Acne Scars in Skin of Color

Dark skin type has high propensity to acne scarring and is often complicated by persistent erythema or pigmentation at the base. Fractional lasers are available for the longest period and are able to improve most atrophic acne scars. Often pigmented scar bases and dark skin types limit the use of aggressive laser parameters. Long pulse mode is preferred over short pulse to prevent epidermal damage; low fluence is chosen versus high fluence and low density versus high density. Repeated treatments are needed to minimize complications and optimize results; all these must be achieved through a controlled stage of inflammation. Interventional priming with chemical peels and laser toning before ablative fractional carbon dioxide laser helps to reduce photodamage, recent tan, and pigment at scar base, thus minimizing the risk of post-inflammatory hyperpigmentation. Multiple recent literature evidence validates the combinations to optimize outcomes in atrophic acne scars as discussed in this review article.

Treatment of atrophic acne scarring with fractional micro-plasma radio-frequency in Chinese patients: A prospective study

BACKGROUND

Acne scarring is a common disfiguring sequela of acne vulgaris which can lead to serious psychosocial problems and have a negative effect on patients' quality of life. Although a variety of approaches can be used to treat atrophic acne scars, disadvantages such as long-healing time, dyspigmentation, infections, and prolonged erythema make these treatments unsatisfactory especially for Asians. Fractional micro-plasma radio-frequency is a novel technology that produces minor ablation to the epidermis to promote rapid re-epithelialization, while the radio-frequency evoked thermal effect can stimulate regeneration and remodeling of dermal fibroblasts.

OBJECTIVE

To evaluate the clinical effectiveness and safety of micro-plasma radio-frequency for the treatment of facial acne scars in Chinese patients.

MATERIALS AND METHODS

A total of 95 patients with facial atrophic acne scars were treated by micro-plasma radio-frequency using three sessions at 2-month intervals. Patients were seen 1 week after each treatment and 1, 3, 6 months after the final treatment. Improvement was assessed by three independent dermatologists who compared photographs taken before the first treatment and 6 months after the last treatment. Adverse effects were evaluated by a dermatologist who did not participated in the study. Patients also provided self-evaluation of satisfaction levels at the last follow-up visit.

RESULTS

A total of 86 patients with atrophic acne scars completed the entire study. There was a significant improvement in acne scars after three treatments. The mean score of ECCA grading scale (Echelle d'Evaluation Clinique des Cicatrices d'Acné) was reduced from 107.21 to 42.27 (P < 0.05). A total of 15 of 86 patients showed more than 75% improvement, 57 patients showed 50-75% improvement, and 14 patients showed 25-50%. After three treatments, all subjects showed improvements in spots, large pores, texture, UV damage, red areas, and porphyrin fluorescence. Pain, erythema, edema, effusion, and scab formation were observed in all patients. The average pain score on a visual analog scale was 6.14 ± 1.12 and all patients tolerated the treatments. The average duration of erythema was 6.26 ± 0.92 days. Hyperpigmentation, hypopigmentation, infections, and worsening of scarring were not seen. All patients were either "very satisfied" or "satisfied" with the treatment outcomes.

CONCLUSIONS

Fractional micro-plasma radio-frequency is an effective and safe treatment for acne scars, and might be a good choice for patients with darker skin. Lasers Surg. Med. 50:844-850, 2018. © 2018 Wiley Periodicals, Inc.

Can Subcision with the Cannula be an Acceptable Alternative Method in Treatment of Acne Scars?

BACKGROUND AND OBJECTIVES

Most people who experience the acne suffer from damage under the surface of their skin which causes saucer-like depressions or pits on their skin. Sometimes the skin loses its underlying support and develops fibrous bands of tissue between the skin and subcutaneous layer, which pull on the epidermis and cause a wavy texture called as rolling scar. Treatment of acne scars is a therapeutic challenge that may require multiple modalities. Subcision is a procedure that has been reported as a beneficial method in the treatment of rolling acne scars. Although Subcision is a valuable method, its efficacy is mild to moderate because of the high recurrence rate and patients dissatisfaction due to some side effects include post procedure inflammation.

MATERIALS AND METHODS

This pilot study is a clinical trial. The 8 patients suffered from mild to severe rolling acne scars on their face with symmetrical distribution of lesions, underwent Subcision with the Cannula No 18 and 21 and followed-up for 3 months. Outcomes of Subcision procedures were assessed by 3 board certified dermatologists (blind) after 2 session of treatment. The patients' satisfaction was considered to compare with dermatologist's opinions. The degree of improvement and satisfaction of the treatment estimated with these points: poor: 0, fine: 1-3, good: 4-6, and very good: 7-9. The data were finally analyzed with SPSS-18 software.

RESULTS

Subcision with the Cannula showed good and very good improvement in about 88% of patient with a satisfaction good and very good improvement in all of patients (100%). Assessment of photographic data showed 100% improvement in scar depth, topography and overall appearance of acne scars. The average numbers of lesions before the treatment were 24.8 ± 12.1 and after treatment it was reduced to 12.8 ± 2.1 (p<0.05).

CONCLUSION

Subcision with the Cannula appears to be a safe method with high efficacy in the treatment and high satisfaction in patients as we observed an interesting cure rate (more than 50% after 2 sessions). It demonstrates to be a safe procedure because it performed by single perforation in each side instead of multiple perforations that helps to reduce the patients' pain and risk of scars. In other hand Cannula-based Subcision needs considerable fewer sessions of surgery and also less recovery time.

Evaluation of microneedling fractional radiofrequency device for treatment of acne scars

Background:

Various treatment modalities including non-invasive methods such as chemical peels, topical retinoids, microdermabrasion, minimally invasive techniques such as microneedling, fractional lasers, microneedling radiofrequency devices and invasive procedures such as acne scar surgeries and ablative lasers are used for acne scars, each with its own unique advantages and disadvantages. This study is a retrospective assessment of efficacy and safety of microneedling fractional radiofrequency in the treatment of acne scars.

Methods:

Thirty one patients of skin types III-V with moderate and severe facial acne scarring received four sequential fractional radiofrequency treatments over a period of 6 months with an interval of 6 weeks between each session. Goodman & Baron's acne scar grading system was used for assessment by a side by side comparison of preoperative and post- operative photographs taken at their first visit and at the end of 3 months after the last session.

Results:

Estimation of improvement with Goodman and Baron's Global Acne Scarring System showed that by qualitative assessment of 31 patients with grade 3 and grade 4 acne scars, 80.64% showed improvement by 2 grades and 19.35% showed improvement by 1 grade. Quantitative assessment showed that 58% of the patients had moderate, 29% had minimal, 9% had good and 3% showed very good improvement. Adverse effects were limited to transient pain, erythema, edema and hyperpigmentation.

Conclusion:

Microneedling fractional radiofrequency is efficacious for the treatment of moderate and severe acne scars.

Management of acne scarring, part II: a comparative review of non-laser-based, minimally invasive approaches

Acne scarring is a commonly encountered yet extremely challenging problem to treat for the dermatologist. As acne scarring can lead to significant psychological distress and low self-esteem, it is of utmost importance to have effective and satisfying treatments in the physician's armamentarium. However, many treatments are unsatisfying, leading to patient disappointment and frustration. Although early treatment of acne lesions and inflammation with isotretinoin is beneficial in preventing acne scarring, many patients still present with troubling noticeable scars. Despite the advances in pharmacology and technology, scar treatment still remains suboptimal and is tainted with several adverse effects. However, some treatments can provide benefits. This review article exhaustively discusses and analyzes the various minimally invasive approaches to the treatment of acne scarring with an emphasis on pharmacologic agents, such as isotretinoin for atrophic acne scars and corticosteroids and chemotherapeutic drugs for hypertrophic scars. Intralesional injections of corticosteroids are efficacious in reducing keloid scar formation in addition to preventing recurrence following surgical excision. In-office and minimally invasive procedural management, including chemical peels, dermabrasion, tissue augmentation, and punch excision is also discussed. Superficial chemical peels are efficacious in treating atrophic scars with relatively few adverse effects and complications. Although dermabrasion is used less often with the advent of laser resurfacing, this technique remains as a viable option for those with atrophic scars. Post-inflammatory hyperpigmentation can be managed successfully with topical agents such as azelaic acid and hydroquinone. The efficacy of various treatment modalities is highlighted with a focus on choosing the correct modalities for specific scar types.

Evaluation of combined fractional radiofrequency and fractional laser treatment for acne scars in Asians

BACKGROUND AND OBJECTIVES

Fractionated radiofrequency (RF) induces deep dermal heating and leaves the epidermis less affected. We studied the efficacy and safety of bipolar RF and fractional diode laser followed by fractional RF in Asians with acne scars.

MATERIALS AND METHODS

Twenty-four patients (skin types III and IV) with acne scars received up to five treatments of combined fractional 915-nm laser and bipolar RF using a Matrix IR applicator (Syneron Medical Ltd, Yokneam, Israel) with fluence ranging from 50 to 70 J/cm(2) , RF at 70-100 J/cm(3) , double passes followed by full-face bipolar fractional RF treatment using Matrix RF at energy ranging from 50 to 62 mJ/pin, at 4-week intervals. Changes in acne scars, skin texture, pore size, pigmentation irregularity, and complications were assessed up to 3 months post-treatment by standardized photographs obtained with Canfield Visia-CR system®. Subjective improvement and patient satisfaction were assessed by questionnaire.

RESULTS

Twenty patients (age 27.7 ± 8.4 years) completed the study. Modest but statistically significant improvement was noted in acne scars, with the mean grade decreased by 29% (P < 0.001), and 52% were rated with at least moderate objective global improvement at 3 months. Mean pain score was 2.6 on a scale of 0-4. There were also objective improvements in all secondary endpoints. Post-inflammatory hyperpigmentation (PIH) occurred mainly over bony areas in 6.5% of all treatments. Subjective improvement was moderate to significant for 36.8% of patients, and 63% reported being satisfied with the treatment results at 3 months despite considerable pain level.

CONCLUSION

Use of fractional laser with RF followed by fractional RF was shown to be safe and effective for acne scars with modest improvement and low PIH rate comparable to other resurfacing techniques in this Asian case series. Adequate pain control and recduced energy level when treating areas in close proximity to bone are advised. Lasers Surg. Med. 44: 622-630, 2012. © 2012 Wiley Periodicals, Inc.

The effect of fractional carbon dioxide lasers on idiopathic guttate hypomelanosis: a preliminary study

BACKGROUND

Idiopathic guttate hypomelanosis (IGH) is a commonly acquired leucoderma that is characterized by discrete, round or oval porcelain-white macules ∼2-5 mm in diameter that increases in number with age. A variety of therapies with variable success rates, including cryotherapy, superficial abrasion and topical retinoids are currently being used.

OBJECTIVES

The effects of fractional CO(2) laser therapy on IGH were investigated in this pilot study.

PATIENTS AND METHODS

A total of 40 patients with IGH were enrolled. The hypopigmented lesions were treated using a 10 600-nm carbon dioxide fractional laser (CO(2) FL). Two months after a single treatment, physicians' clinical assessments were performed and the patients' overall satisfaction was evaluated.

RESULTS

The mean age of enrolled patients was 57.5 ± 10.9 years and the gender ratio was 7 : 33. The face was the most commonly treated area, although the extremities are epidemiologically the most frequently affected areas. Two months after treatment, objective assessments performed by two independent dermatologists indicated more than 50% improvement in 36 patients (90%), compared with baseline. In addition, 33 patients (82.5%) were very satisfied or satisfied with just one session of CO(2) FL treatment. Although a few patients complained of long-standing erythema and postinflammatory hyperpigmentation, these problems spontaneously resolved within 2 months after the assessments. No other noticeable side effects were observed.

CONCLUSION

CO(2) FL might be a very convenient and effective modality for treating IGH without significant side effects.

Prevention and management of hypertrophic scars and keloids after burns in children

Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.

Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures

OBJECTIVE

To survey the existing literature to identify, summarize, and evaluate procedure- and condition-specific outcome measures for use in facial plastic and reconstructive surgery.

METHODS

A review of the English-language literature was performed to identify outcomes instruments specific for targeted facial plastic surgery interventions and conditions. A search was performed using MEDLINE (1950 to September 2007), CINAHL (Cumulative Index to Nursing & Allied Health) (1982 to September 2007), and PsychINFO (1806 to September 2007). Outcomes instruments were categorized as patient-reported or clinical efficacy measures (observer-reported or objective measures). Instruments were then categorized to include relevant details on the intervention, degree of validation, and subsequent use.

RESULTS

Sixty-eight distinct instruments were identified (23 patient-reported, 35 observer-reported, and 10 objective measures), with some overlap among categories. Most patient-reported measures (76%) and half observer-reported instruments (51%) were developed in the past 10 years. The rigor of validation varied widely among measures, with formal validation being most common among the patient-reported outcome measures.

CONCLUSIONS

Validated outcomes measures are present for many common facial plastic surgery conditions and have become more prevalent during the past decade, especially for patient-reported outcomes. Challenges remain in harmonizing patient-reported, observer-based, and other objective measures to produce standardized clinically meaningful outcome measures.

Subcision for acne scarring: technique and outcomes in 40 patients

BACKGROUND

Treatment of acne scars is a therapeutic challenge that may require multiple modalities. Subcision is a technique that has been anecdotally reported to be of value in treating so-called "rolling scars."

OBJECTIVES

To assess the efficacy of subcision in the treatment of "rolling" acne scars.

METHODS

A standard technique was developed for subcision. This was then applied to the treatment of rolling scars in patients, 40 of whom completed treatment and the prescribed follow-up. Six-month follow-up data were obtained from both patients and investigators.

RESULTS

Subcision is associated with patient and investigator reports of approximately 50% improvement. Ninety percent of treated patients reported that subcision improved their appearance. The side effects of swelling, bruising, and pain are transient, but patients may have persistent firm bumps at the treatment site.

CONCLUSIONS

Subcision appears to be a safe technique that may provide significant long-term improvement in the "rolling scars" of selected patients. When complete resolution of such scars does not occur, combining subcision with other scar revision procedures or repeat subcision may be beneficial.

Acne: treatment of scars

Acne is a common disease affecting a significant proportion of the population.(1-3) It causes considerable morbidity through soreness, disfigurement, and social handicap due to inflammatory lesions.(4,5) Modern therapy ensures that a considerable proportion of all patients can be offered effective treatment of their disease, but the morbidity is not restricted solely to the inflammatory lesions of acne.(6,7) Despite appropriate and effective primary prevention of scarring, scarring occurs in some degree in 95% of all patients irrespective of the severity of inflammatory acne (although severe acne causes more scarring than the milder forms). The scarring causes long-term morbidity that requires specific therapy.(7)

Novel Opportunities in the Treatment and Prevention of Scarring

Numerous treatments have been described for the treatment and prevention of scars, but the optimal management strategy is yet to be defined. In this article we present and evaluate new opportunities for the treatment and prevention of hypertrophic scars, keloids, and atrophic scars. Clinical, animal, and in vitro studies reporting novel techniques for the treatment and prevention of scarring were identified primarily from the MEDLINE/PubMed database. We found that a variety of new treatments exist with potential effectiveness for the treatment of hypertrophic scars and keloids, including interferon, imiquimod 5% cream, tacrolimus, botulinum toxin, 5-fluorouracil, bleomycin, and verapamil. For atrophic scars, different types of lasers represent modern treatment modalities with satisfactory results. Several agents have been reported to be effective in reducing scarring in vitro and in animal studies, representing potential opportunities for scarring management. We conclude that several novel modalities may be potential therapies for scarring.

Acne vulgaris

Acne vulgaris is a common inflammatory skin condition that presents management difficulties to cosmetic surgeons. Acute management and treatment focuses on early diagnosis as well as treatment with topical agents, oral antibiotics, hormonal therapy,and nonablative chemical peel and laser applications. The treatment of postinflammatory scarring must be individualized to address potential macular dyschromia, cystic lesions,epithelial bridges, or deep pitted scars. A review of interventional options is presented to apply to the spectrum of acne scarring as well as a review of the literature to address objectively published reports on efficacy.

Surgical treatment of facial acne scars based on morphologic classification: a Brazilian experience

BACKGROUND

Acne scar treatment remains a challenge in the medical literature. It is very difficult to compare the efficacy of different therapeutic approaches because of the lack of consensus regarding acne scar description and classification.

OBJECTIVE

To establish a morphologic classification of acne scars and to assess the efficacy of different therapeutic options based on scar type.

METHODS

During an 8-year period, 228 patients were prospectively studied. Their acne scars were morphologically classified and customized, staged rehabilitation programs were established for each patient. The assessment of treatment efficacy was conducted 18 months after the end of treatment and was based on patients' and physicians' opinions ranked on a semiquantitative basis as percentage of improvement from baseline.

RESULTS

Among the 168 patients who finished the study, 26 completed three stages of the treatment plan, and 142 were submitted to one or two therapeutic stages, depending on lesion types. Eighty-six percent of the patients considered the results excellent or good compared with 76% by the authors and 78% by three independent dermatologic surgeons.

CONCLUSION

The classification and the staged therapeutic plan for acne scarred patients facilitated treatment and improved outcomes and may allow development of protocols by comparing results among different authors.

Nonablative radiofrequency for active acne vulgaris: the use of deep dermal heat in the treatment of moderate to severe active acne vulgaris (thermotherapy): a report of 22 patients

BACKGROUND

Acne vulgaris is an exceedingly common condition in adolescence and may extend into adult life in some individuals. Even though this condition is at times minimized, it has been found to have a profound impact in the quality of life of many affected individuals. Acne scarring can be even more of a source of psychological and social problems than active acne is, and when inadequately treated, the latter can lead to the former. Moderate and severe acne vulgaris usually require a regimen of systemic and/or topical medications, which are given for several months or even years and frequently require multiple visits to the physician office, the laboratory, etc. This results in loss of time at school and considerable expense. Side effects from medications and the frequent need to use alternative drugs when there is no response to medical treatment are possible.

OBJECTIVE

To evaluate the role of a novel medical device that uses radiofrequency as a source of energy to produce volumetric tissue heating, while sparing the epidermis, allowing for a procedure with no down time and no postoperative care required.

METHODS

Twenty-two patients, 10 women and 12 men, ranging in age from 16 to 28, with moderate to severe, scarring, cystic, active, acne vulgaris participated. Only nine of these patients were on concomitant medical treatment such as oral antibiotics or topical agents. All 22 patients were treated with a new nonablative radiofrequency unit, which delivers a concomitant spray of cryogen for epidermal sparing. One session was done in 20 patients and two sessions in 2 patients. The average fluence per energy delivery was 72 J/cm2. Follow-up ranged from 1 to 8 months. Patient questionnaires and active acne lesion counts were used to evaluate the response to treatment.

RESULTS

Excellent response was seen in 82% (n=18). Modest response was seen in 9% (n=2), and no response was seen in 9% (n=2); t-test on active lesion counts before treatment and after treatment was less than 0.009004. No side effects were identified on any of these patients. No down time from the procedure was seen. Only topical anesthesia, ELA-Max 5% (Ferndale Labs, Ferndale, MI) was used; 59% of patients were on no acne medication before, during, or after the procedure.

CONCLUSIONS

Nonablative radiofrequency appears to be a new safe and effective treatment alternative for moderate to severe acne vulgaris. Further research is in progress to evaluate this treatment modality in a larger number of patients.

Quantitative evaluation of nonablative laser technology

A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, new noninvasive, objective instruments were used to accurately assess the outcome of these procedures. This study measures and objectively quantifies facial skin by using 2 novel, noninvasive measuring systems after 3 to 5 treatment sessions with the 1,064 nm QS Nd:YAG laser in patients with photodamage and acne scarring. One system measures the skin surface topography and the other characterizes the biomechanical properties of the skin. Patients undergoing facial rejuvenation procedures were analyzed before and after therapy with a 32 x 32 mm in vivo three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin with a Digital Micromirror Device (DMD; Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at 3 and 6 month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to in vivo acquisition. Skin stiffness and compliance were measured with the BTC-2000 (BTC 2000, S.R.L.I. Inc. Nashville, TN). This instrument measures the response of the skin during dynamic stress created by suction. An infrared targeting laser measures the vertical displacement of the skin during the cycle. Pressure and deformation are graphically displayed on the monitor and embedded biomechanical algorithms determine the aforementioned parameters based on the average of 3 repetitive cycles. Four sites on the face were analyzed and compared including the right and left cheek and the right and left forehead. Measurements were taken at baseline and then at 1-, 3- and 6-month follow-up visits. Skin roughness decreased 11% from baseline in the patient with photodamaged skin, while the patients with acne scarring showed a 33% improvement from baseline after 3 treatment sessions. Six-months after the fifth treatment session, a 26% improvement in skin smoothness was documented in the patients with photodamaged skin, while a 61% improvement was recorded in the subject with acne scarring. Biomechanical analysis of the skin showed a 23% decrease in skin stiffness and a 30% increase in skin compliance at the 6-month follow-up in the patients with photodamage. Alternatively, the patient with acne scarring showed a 50% increase in skin stiffness, and a 30% decrease in skin compliance at the 6-month follow-up. Three-dimensional in vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines after multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. Biomechanical analysis provided technical understanding of structural changes in photodamaged skin and acne scarring following nonablative laser treatment. Future applications of these devices may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists.

3D in-vivo optical skin imaging for topographical quantitative assessment of non-ablative laser technology

BACKGROUND

A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, a new noninvasive objective assessment is required to accurately assess the outcomes of these procedures.

OBJECTIVE

The purpose of this study was to measure and objectively quantify facial skin using a novel, noninvasive, In-vivo method for assessing three-dimensional topography. This device was used to quantify the efficacy of five treatment sessions with the 1064 nm QS Nd:YAG laser for rhytides and acne scarring, for up to six months following laser treatment.

METHODS

Two subjects undergoing facial rejuvenation procedures were analyzed before and after therapy using a 30-mm, three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin using a Digital Micromirror Device (DMD Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at three and six-month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to In-vivo acquisition.

RESULTS

Skin roughness decreased by 11% from baseline after three treatment sessions in the wrinkles subject, while a 26% improvement of skin roughness was recorded by 3D In-vivo assessment six months following the fifth treatment session. The subject with acne scarring demonstrated a 33% decrease in roughness analysis after three treatment sessions by 3D In-vivo assessment. A 61% improvement in surface topography was recorded 3-months following the fifth treatment session, which was maintained at the 6-month follow-up.

CONCLUSION

Three-dimensional In-vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines following multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. This imaging technique provided objective verification and technical understanding of nonablative laser technology. Wrinkle depth and skin roughness decreased at the three and six-month follow-up evaluations by 3D In-vivo assessment, indicating ongoing dermal collagen remodeling after the laser treatment protocol. Future applications may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists.

Resurfacing of pitted facial acne scars with a long-pulsed Er:YAG laser

BACKGROUND

Conventional short-pulsed Er:YAG lasers show less effective hemostasis and weak photothermal damage on papillary dermis. Recently, newer long-pulsed Er:YAG laser systems has been developed.

OBJECTIVE

To evaluate the clinical and histologic effects of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars.

METHODS

Thirty-five patients with pitted facial acne scars were treated with a long-pulsed Er:YAG laser. All patients had Fitzpatrick skin phototypes III-V. A pulsed Er:YAG laser with a 5 mm handpiece at a setting of 7.0-7.5 J/cm2 with a 10-msec pulse duration was used. The laser was fired at 5 Hz, with four to five passes. In 28 patients, the results of laser treatment were evaluated for the degree of clinical improvement, duration of erythema, pigmentary change, and any adverse events at 2 weeks, 1 month, and 3 months. In seven patients, skin biopsy specimens were obtained at the following intervals: immediately, 1 week, 2 weeks, 4 weeks, and 8 weeks postoperatively for histologic examination.

RESULTS

The results of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars were excellent in 10 patients (36%), good in 16 patients (57%), and fair in 2 patients (7%). Erythema occurred in all patients after laser treatment and lasted longer than 3 months in 15 patients (54%). Postinflammatory hyperpigmentation occurred in 8 patients (29%). But the pigmentation faded or disappeared within 3 months. One patient (4%) experienced mild hypopigmentation. Pruritic symptoms that required medical intervention occurred in 16 patients (57%). Mild to moderate postoperative acne flare-up occurred in 8 patients (29%). No other adverse effects such as scarring, bacterial infection, or contact dermatitis were observed.

CONCLUSION

In conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and very effective treatment modality for pitted facial acne scars.

Acne vulgaris: yesterday, today and tomorrow

Acne vulgaris is one of the commonest diseases known to humanity, affecting up to 98% of all adolescents. This review examines important aspects of its epidemiology, aetiology and management in Australia in the year 2000, in comparison with a symposium in the inaugural volume of the Australian Journal of Dermatology in 1951.