Combined autologous platelet‐rich plasma with microneedling versus microneedling with non‐cross‐linked hyaluronic acid in the treatment of atrophic acne scars: Split‐face study

Acne scarring causes cosmetic discomfort, depression, low self‐esteem and reduced quality of life. Microneedling is an established treatment for scars. A multimodality approach to scar treatment is usually necessary to achieve the best cosmetic results. The objective of this study was to evaluate the efficacy and safety of platelet rich plasma (PRP) combined with microneedling in comparison with microneedling with non‐cross‐linked hyaluronic acid for the treatment of atrophic acne scars. Forty‐one patients of 20‐40 years of age with atrophic acne scars were included. Microneedling was performed on both halves of the face. Topical application of PRP was given on right half of the face, while the left half of the face was treated with topical application of non‐cross‐linked hyaluronic acid. Four treatment sessions were given at an interval of 1 month consecutively. Goodman's Qualitative scale and the quartile grading scale are used for the final evaluation of results. There was a statistically significant improvement in acne scars after treatment among the studied group. Right and left halves showed 85.4% and 82.9% improvement, So the difference of the improvement between the two modalities is statistically insignificant P > 0.05 We conclude that microneedling has efficacy in the management of atrophic acne scars. It can be combined with either PRP or noncross‐linked hyaluronic acid to enhance the final clinical outcomes in comparison with microneedling alone. The difference between the two modalities is insignificant.     

黄金微针射频联合自体富血小板血浆治疗面部痤疮凹陷性瘢痕的疗效评估

目的 探讨黄金微针射频联合自体富血小板血浆(PRP)治疗面部痤疮凹陷性瘢痕的疗效。方法 选择河南大学第一附属医院皮肤科门诊2019年4月—2021年4月接收且诊治的74例凹陷性痤疮瘢痕患者为对象,随机分为2组。观察组采用黄金微针射频联合PRP治疗,对照组采用滚轮微针联合PRP治疗,两组均治疗间隔4周,连续治疗3次,3次为1疗程。1个疗程结束后6个月随访,比较两组ECCA权重评分和临床疗效分析、记录治疗引起的皮肤损伤相关时间指标。结果 观察组治疗前ECCA权重评分为53.38±19.15,对照组为52.43±25.94,两组差异无统计学意义(Z=-0.64,P=0.524);治疗后观察组ECCA权重评分降低为24.46±14.38,对照组降低为36.08±20.38,观察组低于对照组(Z=-2.20,P<0.05)。观察组和对照组总体有效率分别为91.89%和72.97%,两组差异有统计学意义(χ²=4.57,P<0.05)。观察组患者的红肿持续时间、愈合时间和停工时间均短于对照组患者,差异均有统计学意义(均P<0.05)。结论 黄金微针射频联合P...     

Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin

Introduction Acne scars can cause emotional and psychosocial disturbance to the patient. Various modalities have been used for the treatment of acne scars like punch excision, subcision, peels, microdermabrasion, unfractionated and fractioned lasers. The latest in the treatment armamentarium is microneedling. Acne scars commonly coexist with postinflammatory hyperpigmentation. A combination of microneedling and glycolic acid (GA) peels was found to give excellent results in the treatment of such scars. The aim was to study the efficacy of a combination of microneedling with glycolic peel for the treatment of acne scars in pigmented skin. Method Thirty patients in the age group of 20–40 years with atrophic box type or rolling scars with postinflammatory hyperpigmentation were chosen for the study. Two groups were made. The first group comprised of 30 patients in whom only microneedling was performed once in 6 weeks for five sessions. In the second group of 30 patients, a combination of microneedling and 35% GA peels was carried out. Patients from both groups were evaluated on the basis of Echelle d’Evaluation clinique des Cicatrices d’acné classification. Results Based on the objective scoring and its statistical analysis, there was significant improvement in superficial and moderately deep scars (grade 1–3). There was also improvement in skin texture, reduction in postacne pigmentation in the second group. Conclusion Microneedling is a simple, inexpensive office procedure with no downtime. It is safe in Indian skin (skin types III–IV). The combined sequential treatment with GA peel caused a significant improvement in the acne scars without increasing morbidity.     

Treatment of acne vulgaris with fractional radiofrequency microneedling

Fractional radiofrequency microneedling is a novel radiofrequency technique that uses insulated microneedles to deliver energy to the deep dermis at the point of penetration without destruction of the epidermis. It has been used for the treatment of various dermatological conditions including wrinkles, atrophic scars and hypertrophic scars. There have been few studies evaluating the efficacy of fractional radiofrequency microneedling in the treatment of acne, and none measuring objective parameters like the number of inflammatory and non‐inflammatory acne lesions or sebum excretion levels. The safety and efficacy of fractional radiofrequency microneedling in the treatment of acne vulgaris was investigated. In a prospective clinical trial, 25 patients with moderate to severe acne were treated with fractional radiofrequency microneedling. The procedure was carried out three times at 1‐month intervals. Acne lesion count, subjective satisfaction score, sebum excretion level and adverse effects were assessed at baseline and at 4, 8 and 12 weeks after the first treatment as well as 4, 8 and 12 weeks after the last treatment. Number of acne lesions (inflammatory and non‐inflammatory) decreased. Sebum excretion and subjective satisfaction were more favorable at every time point compared with the baseline values (P < 0.05). Inflammatory lesions responded better than non‐inflammatory lesions (P < 0.05). Adverse effects such as pinpoint bleeding, pain and erythema were noted, but were transient and not severe enough to stop treatment. Fractional radiofrequency microneedling is a safe and effective treatment for acne vulgaris.     

The Treatment of Acne Scars,a 30-Year Journey

Over the past 30 years, the treatment of acne scars has undergone changes that have been significantly influenced by the concurrent development of new devices. The advent of fractional resurfacing lasers was a watershed moment for acne scarring therapy. The author recounts a career history of considerations of acne scarring treatments as well as the literature supporting the experiences causing changes in practice. Fractional ablative and nonablative lasers, sublative radiofrequency, picosecond lasers, microneedling with and without radiofrequency and fillers are the bulk of the treatments covered, along with a discussion of combination therapy. A practical algorithm for acne scarring for selection of treatment modalities is presented.

     

Energy-based devices in the treatment of acne scars in skin of color

Background

Acne scarring is disfiguring and psychologically taxing on patients. Many energy-based modalities have emerged and been studied for the treatment of acne scarring; however, there is a paucity of these studies in skin phototypes IV–VI.

Objective

To review the medical literature and discuss the most significant studies regarding safety and efficacy of energy-based devices (ablative lasers, non-ablative lasers, and radiofrequency microneedling) in the treatment of ethnic skin (skin phototypes IV–VI).

Methods

A literature search was conducted using the PubMed database and bibliographies of relevant articles.

Results

Ablative and non-ablative lasers have proven to be effective for treatment of acne scars in ethnic skin. The risk of developing adverse effects such as post-inflammatory hyperpigmentation is contingent upon several factors including skin phototype, laser device, fluence, and moreso density settings. Non-ablative fractional lasers have been considered first line for the treatment of acne scars in skin of color due to their better safety profile; however, they are less efficacious and require more treatments compared to ablative lasers. Studies regarding efficacy and safety of radiofrequency microneedling for treatment of acne scarring in skin of color are limited, but are promising.

Conclusion

Ablative lasers, non-ablative lasers, and radiofrequency microneedling are all useful treatments for acne scarring in ethnic skin when appropriate settings are used. Further head-to-head studies are needed to evaluate their efficacy and safety in darker skin phototypes V–VI.     

Pityriasis rubra pilaris in the setting of HIV infection: clinical behaviour and association with explosive cystic acne

The development of pityriasis rubra pilaris (PRP) in three patients with human immunodeficiency virus (HIV) infection is described. Two of the patients had onset of severe generalized cystic acne concomitant with their development of PRP. PRP and acne conglobata should be added to the group of cutaneous disorders that can present in a more virulent manner in the setting of HIV infection. The association of cystic acne with PRP and their response to treatment are discussed.     

A case of fractional microneedling radiofrequency induced rosacea

Fractional microneedling radiofrequency (FMR) has been reported to improve cutaneous wrinkles due to its effects of inducing neoelastogenesis and neocollagenosis. Furthermore, FMR has shown to be effective in acne scars, acne lesions, hyperhidrosis, acne-related postinflammatory erythema and recently in rosacea. FMR treatment has been suggested to improve rosacea by reducing inflammation and abnormal vessel proliferation. Here we present a 61-year-old female who developed rosacea symptoms after the treatment of FMR for cutaneous wrinkles. Since the case shows conflictory findings with the previous data, it was found worthy presentation.     

Evaluating resurfacing modalities in aesthetics

Skin resurfacing for cutaneous rejuvenation has evolved with the development of a plethora of nonsurgical and minimally invasive modalities. We have highlighted the advances in laser therapy, chemical peels, radiofrequency, microneedling, and platelet-rich plasma therapy. We have also included studies providing head-to-head comparisons between procedures and discussed relevant debates in the field. We have examined additionally combination treatments and resurfacing in acne scars, melasma, and skin of color.     

Efficacy of topical vitamin D combined with microneedling in the treatment of vitiligo: A comparative study

Background

Vitiligo is a depigmenting disorder caused by the destruction of melanocytes by various mechanisms which affect melanocyte function and survival. Different therapeutic approaches for vitiligo include nonsurgical and surgical methods but effective therapy is still challenging. There are few studies that suggest the role of vitamin D analogs in the repigmentation process with encouraging results. To our knowledge, this is the first study to evaluate the effect of topical vitamin D (cholecalciferol) combined with microneedling in the treatment of depigmented patches of vitiligo.

Aim of the Work

Evaluate the effect of microneedling alone versus microneedling with topical vitamin D in the treatment of vitiligo.

Patients and Methods

A prospective comparative clinical trial was carried out on 25 patients with stable vitiligo; every patient had at least two patches; the first patch was treated with microneedling alone. The other patch was treated with microneedling combined with topical cholecalciferol.

Results

Good-to-excellent response was detected in 52% of the patches treated with microneedling topical cholecalciferol, while only in 40% of the patches treated with microneedling alone. The improvement was higher in combined treatment with no significant difference between both groups.

Conclusion

Topical cholecalciferol is a relatively effective and safe alternative in the treatment of stable vitiligo and its combination with microneedling increases its efficacy.     

Combined subcision,autologous platelet-rich plasma,and CROSS technique in the treatment of atrophic acne scars: Prospective split face study.

Acne scars represent a therapeutic dilemma. This study aimed to evaluate the efficacy of combined subcision, autologous platelet-rich plasma (PRP), and chemical reconstruction of skin scars (CROSS) technique in the treatment of acne scars. In 20 patients with atrophic acne scars, one facial side was treated with subcision plus PRP, and the other was treated with the same combination plus CROSS technique (trichloroacetic acid 50%) for 3 sessions at 3-week intervals. Clinical evaluation, digital photography, quantitative global scarring grading system, and Lipper and Perez score were done at baseline, every session, and 1 month after the last session. Participants assessed their improvement at the end of the follow-up period using a scale (0 to 10). There was a significant reduction in quantitative global scarring grading system (P < .001) and Lipper and Perez score (P < .001) after treatment compared with baseline in both sides. No significant difference was found when the two treated sides were compared after treatment by both scores. Patients’ satisfaction was excellent (12 patients [60%]) and good (eight patients [40%]) with no significant difference between both sides. In conclusion, combined subcision and PRP is recommended for acne scars. Adding CROSS technique (trichloroacetic acid 50%) did not further ameliorate the condition.     

黄金微针射频治疗面部痤疮瘢痕的疗效评估

目的 评价黄金微针射频治疗面部痤疮瘢痕的有效性及安全性。方法 广州市皮肤病防治所2016年6月至2017年6月采用黄金微针射频治疗的42例痤疮瘢痕患者（观察组）和CO2点阵激光治疗的47例痤疮瘢痕患者（对照组）,分别用疗效四级单盲法和临床痤疮瘢痕评估量表（ECCA）权重评分对两组治疗前后照片分析统计,评估疗效。统计方法采用χ2检验,两独立样本t检验及配对资料Wilcoxon秩和检验。结果 治疗后,观察组和对照组总体有效率分别为92.9%（39例）和89.4%（42例）,两组差异无统计学意义（χ2 = 0.042,P > 0.05）。治疗前观察组ECCA权重评分为46.7 ± 16.3,对照组为45.7 ± 15.8,两组差异无统计学意义（t = 0.271,P > 0.05）。治疗后,观察组ECCA权重评分降低为29.5 ± 15.1,前后比较差异有统计学意义（Z = -5.713,P < 0.05）;对照组降低为31.3 ± 14.9,前后比较差异有统计学意义（Z = -6.086,P < 0.05）。结论 黄金微针治疗面部痤疮瘢痕疗效确切,安全性高且创伤小。     

Evaluation of autologous platelet-rich plasma plus ablative carbon dioxide fractional laser in the treatment of acne scars

Introduction: Acne scar is a common distressing complication of acne vulgaris. CO₂ laser resurfacing proved effective for the treatment of this problem, but the associated complications may limit its use. Platelet-rich plasma (PRP) may increase the chance of favorable outcome. Aim of the work: To evaluate the synergistic effects of autologous PRP with fractional CO₂ laser resurfacing in the treatment of acne scars among Egyptian patients. Patients and method: This study included 30 patients suffering from post-acne scars. CO₂ laser treatment was applied to both sides of the face followed by PRP injection for the right side. Evaluation was carried out through operating physicians, two blinded physicians as well as through patient’s satisfaction. Result: The right side of the face (PRP-treated side) achieved excellent improvement in 13.3% of the patients, while there was no excellent improvement on the left side. Conclusion: Combination of fractional CO₂ laser resurfacing and intradermal PRP was superior to CO₂ laser alone for acne scar treatment.     

Microneedling for the treatment of hair loss?

Microneedling is a minimally invasive dermatological procedure in which fine needles are rolled over the skin to puncture the stratum corneum. This therapy is used to induce collagen formation, neovascularization and growth factor production of treated areas. It has been used in a wide range of dermatologic conditions, including androgenetic alopecia (AGA) and alopecia areata, among others. While there are a limited number of studies examining this therapy in the use of hair loss, microneedling has been successfully paired with other hair growth promoting therapies, such as minoxidil, platelet‐rich plasma and topical steroids, and shown to stimulate hair follicle growth. It is thought that microneedling facilitates penetration of such first‐line medications, and this is one mechanism by which it promotes hair growth. To date, the area most studied and with the most success has been microneedling treatment of AGA. While the current evidence does not allow one to conclude superiority of microneedling over existing standard therapies for hair loss, microneedling shows some promise in improving hair growth, especially in combination with existing techniques. This review summarizes the current literature regarding microneedling in the treatment of alopecia and calls for further studies to define a standard treatment protocol.     

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.     

Spontaneous clinical improvement in HIV-associated follicular syndrome

Since 1991 infrequent reports have described a distinctive triad of nodulocystic acne, striking follicular spines and an eruption resembling pityriasis rubra pilaris (PRP) in HIV-positive patients. It has been suggested that this may represent a subtype of PRP, or alternatively that it should be viewed as a unique HIV-associated follicular occlusion triad. Clinical manifestations may be severe, and in several cases have been ultimately fatal, with death occurring due to complications of cutaneous sepsis. We describe a case demonstrating severe conglobate acne, follicular keratotic spines and histologically confirmed PRP in association with HIV infection. Clinical features and treatment modalities of previously reported cases are reviewed. Despite refusing all topical and systemic treatment our patient showed spontaneous remission of skin signs after 2 years.     

HIV-associated pityriasis rubra pilaris responsive to triple antiretroviral therapy

HIV-associated pityriasis rubra pilaris (PRP) or PRP type VI designates a new distinctive entity reported in HIV patients. It is characterized by cutaneous lesions of PRP and variable association with lesions of acne conglobata, hidradenitis suppurativa and lichen spinulosus. We report a patient with HIV-associated PRP which was treated by triple antiretroviral therapy (zidovudine, lamivudin and saquinavir) with complete response. The patient has remained free from symptoms for 20 months of follow-up. We review the clinical features, pathology, evolution, treatment and possible aetiology of this recently described entity.     

Microneedling with glutathione versus microneedling alone in treatment of facial melasma: Split-face comparative study

Background

Melasma is a distressing disfiguring acquired pigmentary disorder especially affecting females and it is of high tendency of recurrence. Up till now, treatment of melasma is a challenging problem.

Objectives

We evaluated the effectiveness of microneedling with glutathione versus microneedling alone in treatment of melasma.

Patients and Methods

In this study, 29 adult females with epidermal type of melasma (confirmed with Wood's light examination) were enrolled. The affected area was subjected to microneedling using dermapen followed by application of glutathione solution on the right side only. This session was performed every 2 weeks for 3 months (six sessions for every patient). The response to therapy was measured using modified melasma area and severity index (m MASI) that were calculated on each side of the face (Hemi- m MASI) before treatment sessions.

Results

There was statistically significant reduction in the mean of Hemi- m MASI score over the sessions on both sides of the face but the right side (microneedling with glutathione) showed more reduction and earlier response to therapy than the left side (microneedling alone). On the left side, mean of Hemi- m MASI score before and after sessions was (4.06 ± 1.91, 2.31 ± 1.450) and on the right side, it was (4.21 ± 2.08, 1.96 ± 1.30), respectively and this was statistically significant. Percentage of improvement on the left side was 46.92 ± 16.30 (%) while on the right side was 55.17 ± 15.50 (%) and this was statistically significant.

Conclusions

Microneedling is an effective promising tool in treatment of melasma and its combination with glutathione as a whitening agent, increases and accelerates its efficacy. So, combined therapy is more preferred than monotherapy in treatment of facial melasma.     

Platelet-rich plasma for facial rejuvenation: An early examination

Platelet-rich plasma (PRP) has become a popular and trendy treatment in dermatology for various skin ailments, most notably for acne scars, traumatic scars, hair regrowth, and cutaneous rejuvenation. Although PRP has been utilized in the world of orthopedics for many years, its recent entry into dermatology has been wrought with controversy, especially as some have marketed it to consumers as a type of cure-all; however, the studies behind PRP treatment, especially for cutaneous rejuvenation, are currently limited, while we await additional larger studies. Clinicians should have an understanding of the evidence behind such new trends, especially in the fast-pace world of esthetics.