凹陷性痤疮瘢痕的治疗进展

寻常痤疮是常见的慢性炎症性毛囊皮脂腺疾病,其遗留的凹陷性瘢痕作为一种损容性皮肤病,严重降低了患者的生活质量。该文从组织填充、化学剥脱、激光治疗等多个方面阐述了治疗凹陷性痤疮瘢痕的近况,并提出了对凹陷性痤疮瘢痕未来治疗的展望。     

痤疮后凹陷性瘢痕的分类及治疗方法

凹陷性瘢痕是最常见的痤疮后遗症,严重时可对面部容貌造成不良影响。凹陷性瘢痕有多种类型,按照其大小、深度、质地可以分为冰锥样瘢痕、厢车样瘢痕、碾压样瘢痕等,且痤疮瘢痕还可有不同的颜色改变。不同类型的瘢痕需要选择不同类型的治疗方法,目前凹陷性痤疮瘢痕的治疗手段飞速发展,疗效显著提高,主要包括药物疗法、化学剥脱、皮肤磨削、微针治疗、组织填充术、外科疗法、激光和强脉冲光、射频治疗、等离子体疗法等。     

2940 nm 铒激光治疗凹陷性痤疮瘢痕的疗效与安全性观察

目的：观察2940 nm铒玻璃激光治疗痤疮凹陷性瘢痕的疗效与安全性。方法：选取25例诊断为凹陷性痤疮瘢痕的患者,使用2940 nm铒激光治疗,每4周1次,共3次。治疗前后拍照并使用EC-CA权重评分、VISIA皮肤图像分析仪评估疗效,使用CK皮肤检测仪评估皮肤屏障功能。结果：治疗结束后,所有病例均有改善,临床有效率为28％。痤疮凹陷性瘢痕ECCA权重评分明显下降,与治疗前比较,差异有统计学意义（P＜0.05）,毛孔、紫质显著减少（P＜0.05）;治疗后1周与治疗前相比,经皮水分丢失量、油脂增多（P＜0.05）,含水量减少（P＜0.05）,治疗前与治疗1月后相比,经皮水分丢失量、含水量、油脂无明显差异（P值均＞0.05）。结论：2940 nm铒激光治疗痤疮凹陷性瘢痕有效,术后1月后皮肤屏障功能恢复。     

CO2点阵激光联合果酸治疗痤疮后凹陷性瘢痕的疗效分析

目的 观察痤疮后凹陷性瘢痕患者合用CO2点阵激光技术与果酸治疗的临床价值.方法 选取2018年10月至2020年3月某医院收治的的痤疮后凹陷性瘢痕患者100例,并以随机数表模式进行设组研究,对照组50例仅接受CO2点阵激光技术治疗,观察组50例在对照组基础上配合果酸涂抹,对比两组的疗效与安全性.结果 观察组总有效率(9...     

2940nm铒激光治疗凹陷性痤疮瘢痕的疗效与安全性观察

目的:观察2 940 nm铒玻璃激光治疗痤疮凹陷性瘢痕的疗效与安全性。方法:选取25例诊断为凹陷性痤疮瘢痕的患者,使用2 940 nm铒激光治疗,每4周1次,共3次。治疗前后拍照并使用ECCA权重评分、VISIA皮肤图像分析仪评估疗效,使用CK皮肤检测仪评估皮肤屏障功能。结果:治疗结束后,所有病例均有改善,临床有效率为28%。痤疮凹陷性瘢痕ECCA权重评分明显下降,与治疗前比较,差异有统计学意义(P<0.05),毛孔、紫质显著减少(P<0.05);治疗后1周与治疗前相比,经皮水分丢失量、油脂增多(P<0.05),含水量减少(P<0.05),治疗前与治疗1月后相比,经皮水分丢失量、含水量、油脂无明显差异(P值均>0.05)。结论:2 940 nm铒激光治疗痤疮凹陷性瘢痕有效,术后1月后皮肤屏障功能恢复。     

点阵CO2激光治疗痤疮凹陷性瘢痕的临床疗效观察

目的:为点阵CO2激光治疗痤疮凹陷性瘢痕寻找更佳的参数设置及治疗操作方法.方法:选取42例痤疮凹陷性瘢痕患者,面部两侧随机分为实验组、对照组,实验组采用点阵CO2激光"局部加强模式+大面积平扫模式";对照组采用单纯"大面积平扫模式",治疗间隔时间为2个月,共治疗2次,治疗前及每次治疗后2个月予痤疮瘢痕权重评分(ECCA...     

微晶磨削治疗痤疮凹陷性瘢痕疗效观察

目的观察微晶磨削治疗痤疮凹陷性瘢痕的疗效。方法使用微晶磨面机通过机内压力将微晶粒喷打瘢痕皮肤，造成蜂窝状损伤。结果本组82例，显效45例，有效37例；患者自评，满意22例，比较满意34例。结论微晶磨削治疗痤疮凹陷性瘢痕疗效确切。     

铒激光联合E光治疗痤疮凹陷性瘢痕的临床效果评价

目的：评价铒激光联合E光治疗痤疮凹陷性瘢痕的临床疗效和安全性。方法：将大连市皮肤病医院美容皮肤科2013年1月至2016年6月就诊患者采用双色球方法随机分成治疗组和对照组,治疗组为铒激光联合E光治疗组;对照组为铒激光治疗组,每个月治疗一次,共3次。对照组与治疗组均于疗程结束1个月后比较两组患者治疗前后皮肤红斑、色沉,瘢痕,皱纹,粗糙度,光滑度的变化。结果：共就诊62例痤疮凹陷性瘢痕患者,治疗组31例,对照组31例,治疗组与对照组患者皮损治疗前光滑度、瘢痕、皱纹、粗糙度、色沉、红斑比较,差异无统计学意义(P＞0.05)。治疗后,治疗组,患者皮肤的光滑度,瘢痕,皱纹,粗糙度,红斑,色沉评分分别为73.32±0.236、2.21±0.152、168.6±0.177、63±0.128、8.63±0.122、5.20±0.232,对照组分别为70.45±0.354、3.28±0.138、180.6±0.412、66±0.422、13.62±0.121、11.22±0.121,两组比较差异有统计学意义(均P<0.05)。所有患者未见严重不良反应。结论：铒激光联合E光治疗痤疮凹陷性瘢痕较单独应用铒激光治疗组疗效明显提升。     

微晶磨削与胶原蛋白膜联合治疗痤疮后凹陷性瘢痕40例临床观察

痤疮是临床上常见的皮肤病,好发于颜面、胸背部,痊愈后常不可避免的留有皮肤粗糙,毛孔粗大和凹陷性瘢痕。以往针对皮肤粗糙,毛孔粗大和凹陷性瘢痕尚无有效的治疗手段。我院采用微晶磨削与胶原蛋白膜联合治疗痤疮后凹陷性瘢痕40例,其疗效明显,现总结如下。     

点阵CO2激光联合皮下分离术治疗痤疮凹陷性瘢痕的疗效观察

目的分析点阵CO_2激光联合皮下分离技术治疗痤疮凹陷性瘢痕的应用价值。方法选取2018年6月到2020年10月某医院收治的痤疮凹陷性瘢痕患者82例,随机分为研究组(n=41)和对照组(n=41),对照组予以点阵CO_2激光治疗,研究组予以点阵CO_2激光联合皮下分离治疗。对比两组术前、术后6个月临床痤疮瘢痕评估量表(ECCA)权重评分、瘢痕面积、色素沉着面积变化和凹陷边缘直径减少50%所用时间变化。结果术后6个月,研究组ECCA权重评分明显低于对照组;术后6个月,研究组瘢痕面积、色素沉着面积明显小于对照组;研究组凹陷边缘直径减少50%所用时间明显短于对照短,且上述差异均有统计学意义(P 0.05)。结论点阵CO_2激光联合皮下分离技术治疗痤疮凹陷性瘢痕可促进瘢痕恢复,减少瘢痕面积和色素沉着面积。     

萎缩性痤疮瘢痕治疗进展

萎缩性痤疮瘢痕治疗方法较多,主要包括激光治疗、非激光治疗及联合治疗,其中以现代激光和射频等新技术的研究进展较多。该文就现有方法对萎缩性痤疮瘢痕的治疗进展进行综述。     

Pixel 2940nm激光对痤疮瘢痕治疗作用的定量评价

目的应用VISIA皮肤图像分析仪和SOFT5.5皮肤性质测试仪对Pixel 2940nm激光治疗痤疮瘢痕患者临床效果进行定量评价。方法随机选取45例痤疮瘢痕患者,应用Pixel 2940nm激光进行治疗,每月治疗一次,分别在治疗后1周,1月和3月用VISIA皮肤图像分析仪和SOFT5.5皮肤性质测试仪对患者皮肤性质进行定量分析和评价。结果治疗后3个月与治疗后1周相比,治疗后1周患者皮肤pH值下降(P<0.05),水分降低(P<0.05),油脂增高(P<0.05),pH值与油脂有明显负相关(P<0.01),弹性无明显变化(P>0.05);治疗前后比较变化最明显的是紫质(P<0.05),治疗后1周与治疗前相比,皱纹、纹理有明显差异(P<0.05),治疗后1月与治疗前相比紫外线色素斑减少(P<0.05),治疗后3月与治疗前相比毛孔和棕色斑减少(P<0.05),色素斑和红色区无明显改变(P>0.05)。结论 Pixel 2940nm激光对痤疮瘢痕患者皮肤性质改变主要在治疗后1周,表现为皮肤水分减少、油脂增高、紫质减少和毛孔肤质改善,临床应用VISIA皮肤图像分析仪和SOFT5.5皮肤性质测试仪对痤疮瘢痕患者治疗前后皮肤性质进行定量分析,可作为Pixel 2940nm激光治疗痤疮瘢痕的一个定量衡量标准,在诊断,指导治疗和疗效评估上具有一定意义。     

Subcision in acne scar with and without subdermal implant: a clinical trial

Background Subcision is a procedure that has been reported to be beneficial in treatment of acne scars. Objective This stady aims to assess the efficacy of subcision in the treatment of rolling acne scars and evaluate a novel subdermal filler ‘absorbable plain catgut suture’ with subcision. Methods Twenty‐two patients with rolling acne scars underwent subcision, 20 of whom completed treatment and follow‐up period. One side of the face underwent subcision and another side subcision with subdermal implant. The patients and investigators’ assessment of improvement were both recorded. Results Subcision showed mild improvement in about 60% of patient and moderate improvement in about 40% of them. The rate of response showed no significant difference with the use of subdermal implant. The side‐effects of local oedema, bruising and infection were all transient. Conclusions Subcision seems to be a safe method to correct the rolling acne scars with long‐term improvement. However, the subdermal implant led to no significant superior results.     

富血小板血浆联合CO2点阵激光治疗萎缩性痤疮瘢痕疗效和安全性Meta分析

目的：系统评价富血小板血浆联合CO₂点阵激光治疗面部萎缩性痤疮瘢痕的有效性及安全性。方法：检索从建库到2019年7月Cochrane Library、Embase、Medline、中国知网、万方数据库及维普数据库中富血小板血浆联合CO₂点阵激光治疗面部萎缩性痤疮瘢痕的随机对照试验,筛选符合要求的文献并根据Cochrane偏倚风险评估方法评价纳入文献质量, 采用Revman5.3软件进行Meta分析。结果：最终纳入5个RCTs和Meta分析,结果显示：①联合疗法的总有效率和治愈率均高于单用激光组（P=0.008,0.0002）;②联合疗法和单用激光组的红斑、水肿持续时间及疼痛评分无统计学差异（P=0.21,0.35,0.50）。结论：富血小板血浆联合CO₂点阵激光治疗萎缩性痤疮瘢痕的疗效优于单独使用CO₂点阵激光,不良反应无明显差异。     

Efficacy and safety of innovative acne scar serum in Indian patients (ESTEEM India study)

Background

Scarring is a common and undesirable outcome of acne vulgaris. There are limited effective topical formulations for acne scar treatment. The investigational product, acne scar serum (HEXILAK® Acne Scar Serum) is latest topical formulation developed for treatment of acne scar with unique ingredients, Kollaren and Exo-T.

Objective

Evaluate safety and efficacy of latest acne scar serum on the reduction of acne scars in Indian population.

Materials and Methods

Subjects, diagnosed clinically with acne scars with or without hyperpigmentation, of either gender in the age group of 15 to 45 years were enrolled in the study. The investigational acne scar serum was applied twice daily for 3 months with monthly follow for outcome evaluation.

Results

Out of 72 subjects enrolled, 67 completed the study. Most of the subjects, 79.1% showed improvement in acne scar at Day 90. Significant reduction of mean total post-acne hyperpigmentation index (PAHI) was seen at all follow up visits compared with baseline. Significant improvement in mean acne scar depth, mean acne scar volume, and mean L value using 3D imaging were observed at all visits compared with baseline. All side effects reported were mild and overall, it was well tolerated by all subjects.

Conclusion

We found that there was a significant reduction in acne scar and post-acne pigmentation with new acne scar serum as a monotherapy, this needs further confirmation in larger randomized controlled studies. Therefore, topical acne scar serum with unique ingredients Kollaren and Exo-T can be a safe, effective, and new option in the armamentarium of acne scar management.     

Subcision in acne scarring: A review of clinical trials

Post-acne scarring is the most common permanent consequence of acne vulgaris. Subcision is an intervention in which a needle or blunt cannula is inserted under the scar and moved back and forth to cut fibrotic strands and form new connective tissue, thereby elevating the atrophic scars. In this study, we reviewed the efficacy and adverse effects of different subcision techniques alone or in combination with other modalities to manage acne scars. The terms (subcision), (subcision AND acne scar), and (subcision AND scar) were searched in PubMed and Google Scholar. We included all available reports on clinical trials written in English and published before June 2022. A total of 16 relevant articles were identified after reviewing the abstracts and full texts. Four articles compared blunt cannula-based subcision as a modified technique with needle-based subcision as a conventional method, while the others investigated the combination of subcision with other modalities. According to our findings, subcision is a safe and effective method for treating atrophic acne scars. Needle-based subcision and cannula-based subcision offer comparable efficacy, with the latter causing fewer side effects and inducing greater patient satisfaction. Combining subcision with the application of autologous tissues (platelet gel) or artificial materials (hyaluronic acid gels and threads) as fillers can improve outcomes and prevent the re-depressing of scars, as can its combination with frequent suctioning. Combinations with microneedling or fractionated microneedle radiofrequency have also been safe and effective. We conclude that modifications of the subcision procedure lessen its side effects, and combination therapies improve its efficacy.     

Subcision‐suction method: a new successful combination therapy in treatment of atrophic acne scars and other depressed scars

Background Among therapeutic modalities of acne scars, subcision is a simple, safe procedure with a different and basic mechanism for correcting atrophic and depressed scars. Subcision releases scar surfaces from underlying attachments and induces connective tissue formation beneath the scar directly, without injury to the skin surface. Therefore, subcision is a valuable method, but due to high recurrence rate, its efficacy is mild to moderate. Objectives To increase the efficacy of subcision, a new complementary treatment of repeated suction sessions was added at the recurrence period of subcised scars. Methods In this before and after trail, 58 patients with mild to severe acne scars of various types (rolling, superficial and deep boxcar, pitted), chicken pox, traumatic and surgical depressed scars were treated by superficial dermal undermining, with mainly 23‐guage needles. The protocol for suctioning was: start of suction on third day after subcision for flat and depressing subcised scars and its continuation at least every other day for 2 weeks. Results Forty‐six patients followed the protocol completely, had 60–90% improvement in depth and size of scars (significant improvement) with mean: 71.73%. 28.2% of them had ‘80% improvement or more’ (excellent improvement). Twelve patients started suction late and/or had long interval suction‐sessions, had 30–60% improvement (moderate improvement) with mean: 43.75%. Conclusion Frequent suctioning at the recurrence period of subcision increases subcision efficacy remarkably and causes significant and persistent improvement in short time, without considerable complication, in depressed scars of the face. Therefore, subcision‐suction method is introduced as a new effective treatment.