Atrophic Acne Scarring: A Review of Treatment Options

Background: Scarring is an unfortunate and frequent complication of acne, resulting in significant psychological distress for patients. Fortunately, numerous treatment options exist for acne scarring. Objectives: To extensively review the literature on treatment options for atrophic acne scarring. Materials and methods: A comprehensive literature search was conducted on the following topics: dermabrasion, subcision, punch techniques, chemical peels, tissue augmentation, and lasers. Results: The literature supports the use of various treatment modalities; superior results may be achieved when multiple modalities are combined for a multi-step approach to scarring. Conclusion: The safety and efficacy of various treatment devices for acne scarring is well established, but there is a paucity of split-face trials comparing modalities.Acne vulgaris is a common skin disease, affecting nearly all adolescents and 12 to 51 percent of adults aged 20 to 49.1-3 Scarring is a common sequela, estimated to occur in up to 95 percent of acne patients4 and resulting in significant psychological distress for many individuals. Given its impact on self-esteem, social interactions, and even the ability to obtain employment,5 early and effective treatment of acne scarring is paramount.Acne scarring may be either atrophic or hypertrophic. Atrophic acne scars are further subdivided morphologically into boxcar, icepick, or rolling, with the choice of treatment modality often based on scar type. Over the past few decades, a wide variety of therapeutic interventions have been developed to treat acne scars, including dermabrasion, subcision, punch techniques, chemical peels, tissue augmentation, and laser. Herein, the authors review the various treatments available for atrophic acne scarring.     

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Reproducibility and Comparability of Short- and Long-Term Heart Rate Variability Measures in Healthy Young Men

Background: In heart rate variability (HRV) studies, the duration of the electrocardiographic recordings may vary between 20 seconds and 24 hours. Little is known about the reproducibility or comparability of HRV measures calculated over observation periods of different duration. Methods: To assess the reproducibility and comparability of HRV measures computed from short recordings under standardized conditions and from ambulatory 24-hour recordings, 15 healthy young males were studied on three occasions. Results: The reliability coefficient (between subject variation divided by summed between and within subject variation) for 20-second intervals was low for all measures. For 5-minute intervals in supine position, but not standing position, the reliability coefficients of the standard deviation, root of mean squared successive differences, proportion of successive differences > 50 ms, and the proportion low frequency power were about 70%. The reliability coefficients of the 24-hour HRV measures were > 80% for all measures. Short- and long-term measures of heart rate and HRV appeared to be correlated, implying that these measures result in similar ranking of subjects. Conclusions: The results indicate that HRV measures based on 24-hour monitoring during regular activities are better reproducible than short-term measures under standardized conditions. A single 5-minute recording may suffice to characterize a group of persons in a population study, but, because of considerable day-to-day variation, it is not adequate for individual characterization.     

Effect of iron on polymorphonuclear granulocyte phagocytic capacity: role of oxidation state and effect of ascorbic acid

It has been shown that iron (III) impairs the function of polymorphonuclear granulocytes (PMN). We have studied the effect of iron (II), on the membrane function of PMN, by assessing the uptake of radiolabelled Staphylococcus aureus by these cells. Iron (II), significantly impaired PMN phagocytic function. Addition of ascorbic acid reduced uptake further. Ferrous ascorbate, molar ratio 1:20, impaired phagocytic capacity of PMN significantly at iron concentrations as low as 1-10 microM. The toxic effect of iron (II) was not observed when desferrioxamine or transferrin was present in the incubation medium. The oxygen-free radical scavengers thiourea, mannitol and catalase prevented toxicity mediated by ferrous ammoniumsulphate but not by ferrous ascorbate (molar ratio of 1:20). Although high concentrations of ascorbic acid inhibited the generation of .OH and also the formation of the DMPO-.OH adduct by zymosan stimulated PMN, toxicity of iron increased. Iron (II) impaired the uptake of S. aureus by PMN of a patient with chronic granulomatous disease while iron (III) did not. Iron mediated impairment of PMN function is not only a result of the generation of toxic oxygen metabolites but also of direct interaction of iron (II) or an iron (II)-oxygen intermediate with molecules of the cell membrane.     

Medicinal use of potato-derived products: conclusions of a rapid versus full systematic review

Vlachojannis et al reported a systematic review on the medicinal use of potato-derived products. The authors identified five trials for inclusion in the review, including one study on the treatment of burns. Based on this RCT the review authors concluded that potato peel is not recommended for burns. As the authors of a rapid review on the use of potato peels for burns, we read this systematic review with great interest. Although the concept of rapid review is rising, accelerating the review process might introduce bias and its conclusions may be subject to change once a systematic review is available. Since this rapid and systematic review were done at similar times, we explored if the results were consistent. We identified three trials on the use of potato peels. Two of these trials were not mentioned in the systematic review. The evidence indicates that sterile potato peel dressings are better than gauze alone during the healing phase.While there is no evidence of an antibacterial effect, we concluded that potato peels promote healing. Potato peel dressings might be the best available dressing in resource poor countries. Because systematic reviews have a major impact it is crucial that systematic reviews meet specified quality criteria. Therefore we draw attention to adherance to the PRISMA statement.     

Continuous event recorders did not affect anxiety or quality of life in patients with palpitations

OBJECTIVES: Palpitations can generate feelings of anxiety and decrease quality of life (QoL) due to fear of a cardiac abnormality. Continuous event recorders (CERs) have proven to be successful in diagnosing causes of palpitations but may affect patient QoL and anxiety. The aim is to determine anxiety and health-related (HR)-QoL and evaluate the burden of carrying a CER in general practice populations. STUDY DESIGN AND SETTING: Patients (n=244) participated in a randomized trial. One group (n=127) carried a CER during 4 weeks. One hundred and seventeen patients formed the usual care (UC) group. State-Trait Anxiety Inventory (STAI) and the Short Form-36 (SF-36) were administered at study inclusion, after 1, 6 months. RESULTS: At baseline, patients reported greater anxiety and lower QoL than healthy populations. The CER group had three times more cardiac diagnoses than the UC group. No differences were found between CER group and UC group at 6 weeks. At 6 months, the UC group showed QoL improvement and less anxiety compared to the CER group. Type of diagnosis had influence, but did not fully explain these differences. CONCLUSION: A CER does not negatively influence anxiety or QoL. Better outcomes in the UC group might be attributed to less cardiac diagnosis and more emphasis on psychological well-being.