Prevalence and risk factors of acne scars in patients with acne vulgaris

Advancements in Acne Scar Treatment: Exploring Novel Therapies

BACKGROUND

Acne-induced scarring remains a formidable challenge, compelling patients to explore surgical interventions. This study aims to delve into and showcase recent strides in acne scar treatment, with a specific focus on innovative therapies.

METHODS

Conducting a narrative review spanning studies from 2013 to 2023, this paper provides a general overview of interventions. The review included English-language studies with full-text availability. Rigorous data screening and extraction by two independent authors covered diverse facets, including study particulars, participant profiles, measurement tools, intervention durations, outcomes, and key findings. The initial search was performed within PubMed, Scopus, Google Scholar, and the gray literature.

RESULTS

Ultimately, 26 studies meeting inclusion criteria were included and reviewed for final analysis.

CONCLUSION

Recognizing the varied nature of acne scars, this narrative review underscores the need for personalized treatment strategies, considering scar type and severity. The study also emphasizes the potential necessity of combining treatments for optimal results. Despite substantial progress, ongoing research and more extensive studies are imperative to continually refine acne scar treatment outcomes, ultimately enhancing the well-being of those affected by this condition.

Recommendations to Improve Outcomes in Acne and Acne Sequelae: A Focus on Trifarotene and Other Retinoids

Acne vulgaris affects nearly 50 million people in the USA, ranking as the eighth most prevalent disease globally. This chronic inflammatory skin condition often results in sequelae, including atrophic acne scars, acne-induced macular erythema and acne-induced hyperpigmentation, impacting patients' quality of life. This commentary article reviews the use of topical retinoids, with a particular emphasis on trifarotene cream 0.005%, for managing both acne and acne sequelae. Topical retinoids are considered central to improving treatment outcomes because of their established efficacy, safety and tolerability. Adapalene, tretinoin and tazarotene have demonstrated efficacy in reducing acne and acne sequelae in several studies. Trifarotene has been extensively studied in Phase 3 trials, demonstrating notable success in treating mild-to-moderate acne. Recently, two large-scale, randomized, blinded, Phase 4 clinical trials investigated trifarotene cream 0.005% in patients with atrophic acne scarring and acne-induced hyperpigmentation across all Fitzpatrick phototypes. The START study found that there was a greater reduction in total atrophic acne scar count in the trifarotene group compared with the vehicle group at Week 24 (55.2% vs 29.9%) with statistical significance established as early as Week 2 (P = 0.001). Based on this evidence, we recommend that topical retinoids should be introduced as first-line therapy for the treatment of acne and acne sequelae. Retinoids should be implemented into a treatment routine as early as possible, especially for patients with darker Fitzpatrick phototypes or patients at risk of atrophic acne scarring. Furthermore, retinoids should be incorporated within a comprehensive skincare regimen that includes adequate photoprotection when treating patients with darker Fitzpatrick phototypes. Finally, management of acne and acne sequelae should include maintenance therapy with topical retinoids. This article supports the American Academy of Dermatology's call for acne sequelae treatment guidance and emphasizes the need for continued research to optimize patient care.

Research Situation, Hotspots, and Global Trends in Laser Treatment of Acne Scars: A Bibliometric Analysis of Related Research From 2014 to 2024

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.

Multi-modal approach with dye laser and CO2 laser for the resolution of vascularized acne scars: a case series

Background

As a prevalent condition of the pilosebaceous unit, acne vulgaris affects approximately 85% of people between the ages of 12 and 25 years. Among the patients, 47% report having acne scars. Considering the characteristics of the dye laser, we believe that this device can be a feasible solution for treating these facial skin imperfections. Specifically, in this study, we suggest the combination of the 595 nm wavelength with a fractional CO2 laser to ensure skin resurfacing and the best possible result.

Case Description

For this study, 31 patients presenting vascularized acne scars were considered. They ranged between 20 and 35 years old. The therapeutical approach usually started with two dye laser treatments and two CO2 laser sessions. In this study, the dye laser was mainly used for the resolution of skin inflammation and vascularization while CO2 was used for skin remodelling. To guarantee the best and safest outcome, a skin contact sensor was included with the device. Using a 4-point Global Aesthetic Improvement Scale (GAIS) (none: 0, slight: 1, mild: 2, excellent: 3) to assess the treatment outcomes, 77% of patients claimed it was "excellent", 16% "mild" and 7% "slight".

Conclusions

The combination of different laser devices can be a promising therapeutic alternative for acne resolution. Remodelling the skin with the CO2 laser wavelength and reducing the inflammation and vascularization with the dye laser could be particularly helpful, especially for patients who do not respond to or cannot tolerate other therapies.

The Predictive Factors of Acne Scarring and Post-Inflammatory Hyperpigmentation: A Retrospective Cohort Study

Introduction

Acne vulgaris, a prevalent dermatological condition, often results in long-term complications such as scarring and hyperpigmentation. While extensive research has focused on treatment modalities, there is a notable gap in understanding the factors contributing to the development of acne scarring and post-inflammatory hyperpigmentation (PIH).

Purpose

This study was conducted to identify the factors contributing to the development of acne scarring and post-inflammatory hyperpigmentation (PIH).

Patients and Methods

This retrospective cohort study, conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, analyzed data from patients with acne vulgaris between 2016 and 2023 using the hospital's health information system, BESTCare. Statistical analysis was performed using RStudio (R version 4.3.1). We constructed a multivariable, multinomial logistic regression model to assess the independent predictors of four acne complication groups; no scarring/PIH, scarring alone, PIH alone, and acne scarring with PIH.

Results

Among 417 analyzed participants, 95 participants had acne scarring (22.8%), 93 participants had PIH alone (22.3%), and 151 participants had both acne scarring with PIH (36.2%), and only 78 participants did not develop scarring or PIH (18.7%). Isotretinoin use and papules acne were associated with increased risk of acne complications. While adapalene gel was protective against acne scarring only.

Conclusion

This retrospective study sheds light on factors influencing acne scarring and PIH among Acne Vulgaris patients. Our findings provide valuable insights for tailoring interventions and advancing our understanding of acne vulgaris complications in the future.

Risk Factors Associated With Facial Acne Scarring in Thai Patients With Acne: A Cross-Sectional Study

BACKGROUND

One of the worst long-term effects of acne is scarring, which leads to significant physical, psychological, and economic burdens. Limited studies have specifically studied the risk factors for acne scarring. This study aims to explore risk factors associated with facial acne scarring in Thai patients with acne.

METHODS

Exploratory cross-sectional risk factor research was conducted using an online questionnaire on Thai patients aged ≥ 18 years who were diagnosed with acne between September and December 2023. The primary objective was to identify significant determinants of acne scars in patients with acne, including sociodemographic factors, clinical factors of acne, lifestyle factors, dietary habits factors, and treatment factors. Univariable and multivariable logistic regression were used to identify significant risk determinants.

RESULTS

Of 225 patients with 61.33% prevalence of acne scarring, acne scarring was found to be independently associated with the following variables: moderate acne (mOR 3.51, 95% CI 1.31-9.40, p = 0.012) or severe-to-very severe acne (mOR 8.98, 95% CI 2.71-29.73, p < 0.001), sometimes squeezing and picking behaviors (mOR 2.69, 95% CI 2.71-29.73, p = 0.033), and postacne erythema (PAE) (mOR 4.46, 95% CI 1.96-10.14, p < 0.001).

CONCLUSION

The risk factors associated with acne scarring in individuals include the severity of acne, squeezing and picking behaviors, and experiencing PAE. One of this study's essential findings confirms that PAE is a notable component that could contribute to the development of acne scars. Early treatment of individuals at risk is crucial to reduce scar formation.

Synthetic Dermal Fillers in Treating Acne Scars: A Comparative Systematic Review

BACKGROUND

Acne is a common condition observed in adolescents and in most severe acne the scars develop. There are numerous treatment options for acne scars. However, no standardized guidelines have been established to guide physicians in the optimal treatment of acne scars.

AIMS

The objective of this systematic review is to evaluate the existing evidence on various fillers used for the treatment of acne scars and to compare their effectiveness with one another.

METHODS

The study was designed following PRISMA guidelines, and the information was retrieved in May 2024 using the PubMed database and ClinicalTrials.gov registry. The inclusion criteria were that studies involving patients of any age or gender with acne scars of any type treated with synthetic dermal fillers, and studies published in English. The exclusion criteria were studies with less than 10 participants and studies that did not use synthetic dermal fillers. To assess the risk of bias in the included studies, the Cochrane Collaboration's Risk of Bias tool was used for randomized controlled trials, and in observational studies, the Newcastle-Ottawa Scale was used.

RESULTS

Twenty-six studies were included with a total of 1121 participants. Fourteen studies evaluated HA on 372 subjects, five studies focused on PMMA on 305 subjects, four on CaHA on 392 subjects, two on PLLA on 42 subjects, and one on PCL on 10 subjects.

CONCLUSIONS

Most of the studies included in this review were of low quality, as indicated by their scores on quality assessments, lack of high-quality RCTs, and small sample sizes. Future research should focus on conducting randomized, controlled, split-face studies with an adequate number of participants and a detailed examination of different scar subtypes.

Platelet-rich plasma as an adjuvant therapy to fractional ablative carbon dioxide lasers for cutaneous repair: a complementary treatment for atrophic acne scarring

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.

Role of Trifarotene in the Management of Acne in Indian Patients: Insights From an Indian Dermatology Experts' Meeting

Acne vulgaris, a prevalent inflammatory skin condition, significantly impacts individuals worldwide, particularly adolescents and adults. Its chronic nature, associated sequelae, and psychosocial impact underscore the substantial burden it poses. Current treatment guidelines primarily address facial acne, with limited guidance on managing truncal acne. Personalized approaches are increasingly recognized as essential for tailoring treatments to individual patient needs. This review integrates insights from an Indian Dermatology Experts' Meeting, featuring perspectives from nine leading dermatologists. Discussions centered on analyzing acne's burden, its effects on quality of life (QoL), unmet needs in management, trifarotene's role in Indian therapy, anticipated challenges, and the importance of ancillary care. The experts highlighted acne's profound impact on patients' QoL and identified gaps in current management guidelines, especially concerning truncal acne. Trifarotene, a fourth-generation topical retinoid approved by the FDA and Drug Controller General of India (DCGI) for facial and truncal acne, demonstrated safety and efficacy across age groups. This synthesis of expert perspectives underscores the need for personalized acne management. Trifarotene emerges as a promising therapeutic option but challenges remain, particularly in optimizing ancillary care to minimize treatment-related adverse effects. Addressing these issues will enhance treatment outcomes and patient satisfaction in acne management, emphasizing the importance of tailored approaches in clinical practice.

Evaluation and comparison of the efficacy and safety of the combination of topical phenytoin and microneedling with microneedling alone in the treatment of atrophic acne scars: A controlled blinded randomized clinical trial

INTRODUCTION

Severe acne breakouts often lead to atrophic acne scars, which affect millions of people worldwide and can significantly affect a person's self-confidence and self-image. Given the difficulty in treating atrophic acne scars, this study aims to investigate the efficacy of topical phenytoin in the treatment of atrophic acne scars.

METHOD

This split face clinical trial on 25 patients between the ages of 18 and 40 involved the application of microneedling on one side of the face, with three sessions taking place over the course of a month. On the other side, a 1% phenytoin cream was administered three times daily for 1 week following the microneedling procedure. Baseline information was collected for all patients, and follow-up assessments were conducted during the treatment sessions and 2 months after the last session. The assessments included evaluating the number and area of pores and spots, determining scar severity, assessing patient satisfaction, and recording any potential complications.

RESULTS

Among patients, 20 individuals (80%) were females, and the average age of the participants was 35.96 ± 9.23. In terms of the fine pore area, despite the fine pore count, both groups showed improvement over time (p: 0.03 vs. 0.06). Also, regarding large pore count and area, and the count and area of spots, both groups showed improvement over time (p: 0.001). However, there were no significant differences between the two groups (p > 0.05). On the other hand, when it comes to acne scar grade and patients' satisfaction, the phenytoin group outperformed the control group in all follow-up sessions and this difference was found to be significant (p: 0.001). It is worth noting that no complications were observed among any of the patients.

CONCLUSION

It appears that combining phenytoin cream with microneedling has a more effective therapeutic outcome in enhancing atrophic acne scars, when compared to microneedling alone, and this method can be regarded as a viable alternative in treating these types of scars.

Ethosomes: a potential nanovesicular carrier to enhancing the drug delivery against skin barriers

Ethosomes, which are liposomes like structures, mainly composed primarily of ethanol, have attracted considerable attention due to their potential to enhance the drug permeation via skin. The article discusses the formulation and preparation methods of ethosomes, offering insights into the various factors that influence their size, shape, and stability. Moreover, it explores the techniques used to assess the physicochemical properties of ethosomes and their impact on drug delivery effectiveness. The article also elucidates the mechanism by which ethosomes enhance skin permeation, emphasising their ability to modify the lipid structure and fluidity of the stratum corneum. Additionally, the review investigates the applications of ethosomes in diverse drug delivery scenarios, including the delivery of small molecules, peptides, and phytoconstituents. It highlights the potential of ethosomes to improve drug bioavailability, extend drug release, and achieve targeted delivery to specific skin layers or underlying tissues.

Impact of Lifestyle and Dietary Habits on the Prevalence of Acne Vulgaris: A Cross-Sectional Study From Saudi Arabia

Background Acne vulgaris is a prevalent dermatological condition worldwide, with its impact significantly influenced by various genetic, environmental, and lifestyle factors. Despite its global prevalence, data on acne's prevalence and risk factors in Saudi Arabia remain sparse. This study aims to fill this gap by examining the prevalence of acne vulgaris and identifying associated lifestyle and environmental risk factors within the Saudi population. Methodology Employing a cross-sectional survey-based design, this study collected data from a representative sample of the Saudi population aged 18 years and older. Participants were selected through stratified random sampling and completed a self-administered online questionnaire covering demographic information, lifestyle factors, and acne history. Statistical analyses, including descriptive statistics, chi-square tests, and multivariable logistic regression, were utilized to identify significant risk factors associated with acne vulgaris. Results The survey, completed by 1,983 participants, revealed a diverse age distribution with a slight predominance of the 21-25-year age group (32.5%). Gender distribution was nearly balanced (52% female, 48% male), and the majority were single (67.3%). Lifestyle assessments indicated varied water intake, with a significant portion consuming less than 1-2 L per day. Sleep duration for most fell within the 5-7 hours range. Fast food consumption was frequent among 24% of respondents, and physical activity levels showed 40% of participants exercised minimally. Notably, 72% reported a history of acne, predominantly beginning between ages 16 and 20. Acne was mainly mild to moderate in severity and primarily affected the face. Treatment was sought by 60%, with a preference for topical solutions. Awareness around acne causes was moderate, with a high consensus on the impact of stress and diet on acne development. Conclusions Acne vulgaris in Saudi Arabia is significantly associated with various modifiable lifestyle factors, suggesting that interventions focusing on lifestyle modifications may be effective in managing and preventing acne. This study advocates for the integration of lifestyle counseling into acne treatment protocols, offering a holistic approach to managing this pervasive condition.

Modern techniques in addressing facial acne scars: A thorough analysis

BACKGROUND

Facial acne scars are a prevalent concern, leading to the development of various treatment modalities.

OBJECTIVES

This review aims to explore the latest advancements in the treatment of facial acne scars, focusing on both surgical and non-surgical methods.

METHODS

The non-surgical treatments reviewed include topical medications (such as retinoids and alpha hydroxy acids) and non-invasive procedures (like microdermabrasion and chemical peels). Surgical options discussed are punch excision, subcision, and fractional laser treatments.

RESULTS

Combination therapy, integrating both surgical and non-surgical approaches, is frequently utilized to achieve optimal results in scar improvement.

CONCLUSION

Recent advancements in the treatment of facial acne scars provide promising options for individuals seeking improvement. However, these treatments have associated risks and potential adverse effects, highlighting the importance of consulting a dermatologist before beginning any treatment regimen.

An innovative microcoring technology: A novel approach to acne scar treatment

BACKGROUND

Acne scars present a complex challenge in dermatology and cosmetics, despite advancements in technological interventions such as fractional lasers, microneedling, and surgical procedures. Effective treatment remains elusive for many individuals.

OBJECTIVE

This study aims to evaluate the efficacy of rotational fractional resection using 1 mm diameter rotating scalpels as a primary treatment for icepick and boxcar scars on the cheeks and glabella region.

METHODS

Three patients with acne scars underwent a single treatment session of rotational fractional resection. Evaluation occurred at the 2-month post-treatment mark to assess improvements in scar appearance and potential skin-related side effects.

RESULTS

Following the treatment, significant improvements were observed in the targeted acne scars. Notable enhancements were noted without major skin-related adverse effects, except for minor suture marks.

CONCLUSION

The outcomes of this study underscore the potential of rotational fractional resection as an innovative and effective approach in treating acne scars. This single-session cosmetic procedure shows promise in yielding lasting and quantifiable results, offering a hopeful solution for individuals seeking comprehensive acne scar treatment.

Evaluation and comparison of the efficacy and safety of cross-linked and non-cross-linked hyaluronic acid in combination with botulinum toxin type A in the treatment of atrophic acne scars: A double-blind randomized clinical trial

INTRODUCTION

Acne vulgaris is a common skin condition that affects a significant percentage of adolescents, with scarring being one of its permanent complications. This study aims to compare the efficacy and safety of using botulinum toxin type A (BTA) in combination with cross-linked and non-cross-linked hyaluronic acid (HA) for the treatment of atrophic acne scars.

METHOD

Our study is a randomized, double-blind clinical trial conducted on 16 patients with atrophic acne scars. The patients were randomly assigned to one of two groups: one group received a single session of BTA and crossed link HA combination, while the other group received two sessions of BTA and non-crossed link HA, 1 month apart. The patients were followed up at 3 and 6 months after baseline to evaluate the number and area of fine and large pores and spots, scar grading, patient satisfaction, and complications.

RESULTS

The mean age of individuals in both the cross-linked HA and non-cross-linked HA groups was 32.75 ± 4.26 and 31.50 ± 8.48 years, respectively (p = 0.71). In terms of gender, three (37.5%) and seven (87.5%) individuals in the cross-linked and non-cross-linked HA groups were female, respectively (p = 0.11). There were no significant differences in the count and area of fine and large pores and spots between the two groups at baseline and the first follow-up session. However, in the second follow-up session, the non-cross-linked HA group had significantly better results than the cross-linked HA group in terms of large pores count and area (p = 0.01). In terms of changes over time, the non-cross-linked HA group showed significantly better improvements in the count and area of large pores compared to the cross-linked HA group (p = 0.03). Additionally, both groups experienced a significant decrease in the count and area of fine pores over time (p = 0.001), but the amount of changes was not statistically significant between the two groups (p = 0.06). Concerning acne grade, initially, 62.5% and 12.5% of cases in the cross-linked HA and non-cross-linked HA groups, respectively, had severe grades. However, in the last session, these percentages significantly decreased to 0% for both groups (p = 0.002 and 0.005, respectively). In terms of treatment complications, none of the patients experienced any adverse effects.

CONCLUSION

The study demonstrated that both cross-linked HA and non-cross-linked HA were effective in reducing acne severity and improving the appearance of pores and spots. The treatments had similar effects on fine pores, spots, and overall acne severity. However, non-cross-linked HA appeared to have a better result on large pores compared to cross-linked HA.