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ABSTRACT Background Methods Results Conclusion 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.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.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).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. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusion Subcision is a surgical technique frequently used in the management of atrophic acne scars. The advent of new instruments, which includes sharp, blunt and energy assisted, have increased the efficacy of the procedure. The aim of this article was to review the safety of subcision in view of the new development in technology.To review the safety of subcision procedure for acne scarring and to provide clinicians with both evidence‐based and practical information regarding the complications that can be associated with this procedure.A search through MEDLINE and Google Scholar was conducted for articles from January 2000 to January 2023 that involves subcision as a monotherapy for the treatment of acne scarring.Ten articles involving subcision monotherapy were identified. The main complications of subcision were pain/tenderness, bruising, infection, formation of subcutaneous lumps, and dyspigmentation. Recommendations on how to minimize the complications from subcision have also been provided based on the clinical experience of the authors.Subcision is a safe treatment for acne scarring and clinicians need to be aware of the associated complication which occurs more with sharp instrumentation. [ABSTRACT FROM AUTHOR]

Awadh Alamri,1– 3 Dhaii Alzahrani,1,2 Ghadi Alharbi,1,2 Rami Jan,1,2 Lulu Abdullah Alsubaie,1,2 Amjad Alghamdi,1,2 Amal H Abualola,1,2 Abdulhadi Jfri1– 3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 3Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi ArabiaCorrespondence: Rami Jan, College of Medicine – Jeddah, King Saud bin Abdulaziz University for Health Sciences, P.O.Box.9515, Jeddah, 21423, Saudi Arabia, Email ramiqj@gmail.comIntroduction: 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.Keywords: acne vulgaris, acne scarring, post-inflammatory hyperpigmentation, predictive factors, retrospective cohort study

Ghassan Niaz,1 Yara Ajeebi,2 Hussein M Alshamrani,3 Murad Khalmurad,4 Kachiu Lee5,6 1Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 2Faculty of Medicine, Jazan University, Jazan, Saudi Arabia; 3Department of Dermatology, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Biological Sciences, Fairleigh Dickinson University, Teaneck, NJ, USA; 5Department of Dermatology, Temple University, Philadelphia, PA, USA; 6Main Line Center for Laser Surgery, Ardmore, PA, USACorrespondence: Ghassan Niaz, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Ar Rawdah, 2572, Jeddah, 23433, Saudi Arabia, Email ghassanabniaz@gmail.comAbstract: Fractional radiofrequency microneedling (FRM) is a popular, minimally invasive skin rejuvenation modality for treating acne scarring. In this study, we aimed to systematically evaluate the current literature on the efficacy and safety of FRM as a monotherapy to treat different types of facial acne scarring. We systematically reviewed all available literature on FRM techniques used for acne scarring by searching the PubMed and EBSCO databases up to July 2024. 16 studies involving 481 patients, comprising six prospective studies, six randomized clinical trials, three retrospective studies, and one comparative trial, were included. FRM is likely an effective treatment for acne scarring when used as a monotherapy. Further randomized controlled trials are needed to establish appropriate treatment parameters.Keywords: fractional radiofrequency microneedling, monotherapy treatment, acne scarring

Papular acne scars are a special type of acne scar, and the prevalence and treatment of this disease have rarely been reported in the literature; moreover, the prevalence of this disease is often neglected, and treatment is difficult. Our study revealed a high prevalence of this type of acne scar in the clinic and explored an effective and safe method. This retrospective study aimed to analyse the prevalence of papular acne scarring among patients attending our Dermatology Laser Clinic and evaluate the clinical efficacy of fractional CO2 lasers. We retrieved the data of 370 patients with acne scarring who visited our hospital between April 2021 and November 2022 and analysed the prevalence of papillary acne scarring among them. Among these patients, 35 underwent CO2 laser treatment using an artificial grid pattern. A total of three treatments were administered, with a two-month interval between each session. Scar assessment was conducted using the Global Scar Scale (GSS) and the Acne Scar Clinical Assessment (ECCA) scale, along with physician visual evaluation and patient satisfaction surveys, both before the first treatment and one month after the final treatment. Adverse reactions were recorded during follow-up visits after each treatment. Among the 370 patients with acne scarring, 128 exhibited papular acne scarring, resulting in a prevalence rate of 34.6%. Among them, 37.5% were male and 32.6% were female. A total of 90.6% of patients had combined other types of acne scarring, while 9.4% had papular acne scarring exclusively. Following CO2 laser grid treatment, there was a significant reduction in GSS scores and ECCA values, accompanied by a noticeable improvement in physician visual evaluation and patient satisfaction scores. Papular acne scarring has a relatively high incidence rate, and there is no significant sex difference. It often coexists with other types of acne scarring. CO2 laser treatment using an artificial grid pattern effectively improved papular acne scarring with a good safety profile. [ABSTRACT FROM AUTHOR]

Objective: This retrospective analysis aimed to estimate the efficiency of laser therapy in the management of acne scarring, assessing changes in scar severity, patient satisfaction, and adverse events. Methods: A cohort of 150 subjects with clinically diagnosed acne scarring who underwent laser therapy. Data were extracted from electronic medical records, and baseline characteristics, scar types, and management parameters were analyzed. Outcome measures included changes in scar severity scores, patient-reported satisfaction, and documentation of adverse events. Statistical analyses were conducted using appropriate methods, with sub-group analyses based on scar type and laser modality. Results: Following laser therapy, a statistically significant decrease in scar severity scores was seen across all scar types (P < 0.05). Patient satisfaction was high, with 75% reporting significant improvement. Adverse events were mild and transient, including erythema and post-inflammatory hyperpigmentation. Sub-group analyses did not reveal significant differences in management outcomes based on scar type or laser modality. Conclusion: Laser therapy demonstrates effectiveness in reducing acne scarring with a favorable safety profile. The research supports its role as a versatile management modality for diverse scar presentations, emphasizing the need for further research to optimize protocols and explore combination therapies.

Background: Scarring is one of the most prevalent long‐term complications of acne vulgaris and has cosmetic, psychological, and social burdens. Contemporary management programs integrate multiple modalities to best address the multiple factors underlying their development and persistence. This work assessed the impact of sequential multimodal laser therapy on acne scar geometrics and texture. Methods: Adult patients (n = 16) with Fitzpatrick skin type II–IV and presenting with facial acne scars, underwent three combination ablative (CO2), and nonablative (1570 nm) laser treatment sessions at two‐month intervals. Treatment was delivered using a ProScan Hybrid applicator, with each regimen including illumination with both ablative and a nonablative lasers applied in a grid mode sequence. Scar microtopography was assessed at baseline and 6 months after the last treatment session. Results: At baseline, all patients had both box and rolling scars, while only three had icepick scars. Six months following treatment, mean scar volume improved from 5.7 ± 5.2 mm3 at baseline to 3.1 ± 3.0 mm3 and mean affected area improved from 165.6 ± 134.0 mm2 94.0 ± 80.1 mm2, translating to 47.0 ± 7.9% and 43.2 ± 8.6% reductions from baseline, respectively. Patients were highly satisfied with treatment outcomes, and no serious adverse reactions were documented during the course of treatment or follow‐up. Conclusion: Multimodal CO2 and 1570‐nm laser treatment improved the surface profilometry of patients with atrophic facial acne scars. Customization of both treatment intervals and laser settings to cosmetic regions, scar profiles and skin phototypes may further enhance treatment outcomes and expand its applicability to additional skin deformities. [ABSTRACT FROM AUTHOR]

Traditional acne management with topical therapy, systemic antibiotics, hormonal agents, or oral isotretinoin requires compliance and may produce significant side effects. However, alternative treatments with lasers had failed to demonstrate durable clearance. To assess the tolerability and therapeutic outcomes of a novel 1726 nm laser treatment of moderate-to-severe acne across skin types. A prospective, open-label, single-arm, Investigational Device Exemption-approved, institutional review board-approved study of 104 subjects with moderate-to-severe facial acne and Fitzpatrick Skin Types ranging from II-to-VI was conducted. Subjects received 3 laser treatments at 3 (-1/+2)-week intervals. Following final treatment, ≥50% reduction in active acne inflammatory lesions was 32.6% at 4-weeks follow-up, increasing further to 79.8% and 87.3% at 12 and 26-weeks, respectively. The percentage of subjects clear or almost clear increased from 0% at baseline to 9%, 36.0%, and 41.8% at 4-, 12-, and 26-weeks follow-up. No serious adverse events were observed related to device or protocol; treatments were well tolerated, requiring no anesthetic. Therapeutic outcomes and discomfort were similar across all skin types. Lack of control group. The study findings demonstrate the novel 1726 nm laser is well tolerated with durable progressive posttreatment improvement to at least 26 weeks for moderate-to-severe acne across skin types. [ABSTRACT FROM AUTHOR]

Although cosmetic and dermatological in nature, scarring from acne vulgaris can have a huge psychosocial impact on patients and merits its own treatment and management strategy. There is a plethora of modalities for the treatment of acne scarring, each with their own unique benefits and adverse effects; as such, it is critical to have an overview of the available options when consulting with patients to enable appropriate and effective person-centred treatment. Here, Francesca Ramadan discusses a selection of treatment modalities, providing evidence of their efficacy and reviewing their suitability for a range of scar presentations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Most people with acne are at risk of developing acne scars, but the impact of these scars on patients' quality of life is poorly researched. Objective: To assess the perspective of patients with acne scars and the impact of these scars on their emotional well-being and social functioning. Methods: A 60-minute interview of 30 adults with acne scars informed and contextualized the development of a cross-sectional survey of 723 adults with atrophic acne scars. Results: The main themes identified in the qualitative interviews included acceptability to self and others, social functioning, and emotional well-being. In the cross-sectional survey, 31.6%, 49.6%, and 18.8% of the participants had mild, moderate, and severe/very severe acne scarring. The survey revealed that 25.7% of the participants felt less attractive, 27.5% were embarrassed or self-conscious because of their scars, 8.3% reported being verbally and/or physically abused because of their scars on a regular basis, and 15.9% felt that they were unfairly dismissed from work. In addition, 37.5% of the participants believed that their scars affected people's perceptions about them, and 19.7% of the participants were very bothered about hiding their scars daily. Moreover, 35.5% of the participants avoided public appearances, and 43.2% felt that their scars had negatively impacted their relationships. Limitations: The temporal evaluation of the impact was not estimated. Conclusion: Even mild atrophic acne scarring can evoke substantial emotional, social, and functional concerns.

Background: The physical sequelae of acne include erythema, hyperpigmentation, and scarring, which are highly burdensome for patients. Early, effective treatment can potentially limit and prevent sequelae development, but there is a need for guidance for and evidence of prevention-oriented management to improve patient outcomes. Objective: To identify unmet needs of acne sequelae and generate expert recommendations to address gaps in clinical guidance. Methods: The Personalizing Acne: Consensus of Experts panel of 13 dermatologists used a modified Delphi approach to achieve a consensus on the clinical aspects of acne sequelae. A consensus was defined as ≥75% of the dermatologists voting “agree” or “strongly agree.” All voting was electronic and blinded. Results: The panel identified gaps in current guidance and made recommendations related to acne sequelae. These included identification and classification of sequelae, pertinent points to consider for patient consultations, and management aimed at reducing the development of sequelae. Limitations: The recommendations are based on expert opinion and made in the absence of high-quality evidence. Conclusions: The identified gaps should help inform future research and guideline development for acne sequelae. The consensus-based recommendations should also support the process of consultations throughout the patient journey, helping to reduce the development and burden of acne sequelae through improved risk factor recognition, early discussion, and appropriate management.

Background: Acne is a chronic disease with a varying presentation that requires long-term management. Despite this, the clinical guidelines for acne offer limited guidance to facilitate personalized or longitudinal management of patients. Objectives: To generate recommendations to support comprehensive, personalized, long-term patient management that address all presentations of acne and its current and potential future burden. Methods: The Personalising Acne: Consensus of Experts panel consisted of 13 dermatologists who used a modified Delphi approach to reach consensus on statements related to longitudinal acne management. The consensus was defined as ≥75% voting “agree” or “strongly agree.” All voting was electronic and blinded. Results: Key management domains, consisting of distinct considerations, points to discuss with patients, and “pivot points” were identified and incorporated into the Personalised Acne Care Pathway. Long-term treatment goals and expectations and risk of (or fears about) sequelae are highlighted as particularly important to discuss frequently with patients. Limitations: Recommendations are based on expert opinion, which could potentially differ from patients' perspectives. Regional variations in health care systems may not have been captured. Conclusions: The Personalised Acne Care Pathway provides practical recommendations to facilitate the longitudinal management of acne, which can be used by health care professionals to optimize and personalize care throughout the patient journey.

Background: Acne vulgaris is a common chronic inflammatory cutaneous disorder that has a higher prevalence in adolescents and young adults. Previous studies have indicated that both genetic and environmental factors contribute to its risk. The protein encoded by the TIMP2 gene is a natural inhibitor of matrix metalloproteinases (MMPs). Changes in TIMP2 expression are speculated to disrupt the TIMP/MMP balance and result in acne scarring. Aims: Our study aimed to comprehensively explore the potential genetic susceptibility of TIMP2 to acne scarring based on a case‐control study. Patients and Methods: In total, 1060 patients with acne scarring (cases) and 2162 patients without acne scarring (controls) were enrolled in the present study. Seventeen tag single‐nucleotide polymorphisms (SNPs) in the TIMP2 gene were selected for genotyping. Genetic association analyses were conducted at both the single marker and haplotypic levels. Single marker‐based association analyses were performed in the genotypic model and allelic model. The distributions of clinical variables in different genotype groups of targeted SNPs in patients with acne scarring were also examined. Results: SNP rs4789932 was identified to be significantly associated with the risk of acne scarring in both the genotypic model (p = 0.001) and allelic model (p = 0.0002). The C allele of SNP rs4789932 was significantly associated with an increased risk of acne scarring (OR [95% CI] = 1.23 [1.10–1.37]). Significant differences were identified between the SNP rs4789932 genotypes and the clinical severity of acne scarring (p < 2.2 × 10−16). The C allele of SNP rs4789932 was associated with severe clinical features of acne scarring. Conclusions: A significant genetic marker of the promoter region in TIMP2 was identified to contribute to the risk of acne scarring in the Chinese Han population and was significantly associated with the clinical severity of acne scarring in patients. [ABSTRACT FROM AUTHOR]

Objectives: Many treatment modalities are available for post acne scarring. However, the response to the treatment is extremely variable among patients. Aim: The aim of this study was to compare the efficacy and safety of Q‐switched Nd: YAG (1064 nm) and fractional CO2 (10,600 nm) lasers in the treatment of atrophic post acne scars. Methods: This study included 20 patients with atrophic facial post acne scars graded according to Sharquie's score. All subjects received four sessions of laser treatment with a 4‐week interval between the sessions. The study was designed as a double‐blinded, comparative, split‐face study applying Q‐switched 1064‐nm Nd:YAG laser to the right side of the face and fractional CO2 laser to the left side. Results: Q‐switched 1064‐nm Nd: YAG laser achieved significantly higher improvement percentage when compared to fractional CO2 lasers (33.33% versus 17.37% Sharquie's score reduction, respectively). There was a significant negative correlation between the percentages of improvement and the patients' age on both sides and a significant positive correlation with the baseline Sharquie scores on both sides. Conclusion: Q‐Switched 1064‐nm Nd: YAG laser could be a promising safe option for the management of atrophic post acne scars. [ABSTRACT FROM AUTHOR]

Background: Hyaluronic acid fillers have been studied extensively for facial wrinkles; however, their efficacy for atrophic facial scars has yet to be analyzed in a prospective placebo‐controlled study. Objective: To analyze the efficacy and safety of a hyaluronic acid filler for atrophic facial scars. Methods & Materials: Fifteen subjects were randomized to receive up to 1 ml of VYC‐17.5 L on one cheek and up to 1 ml of saline on the other side, with an optional touch‐up treatment. Subjects were graded by a live blind evaluator using the Quantitative Global Scarring Grading System (QGSGS) (J Cosmet Dermatol. 2006;5:48), the Global Aesthetic Improvement Scale (GAIS), and Canfield photo‐analysis. Results: According to the blind evaluator, there was a significant reduction 90 days after the last treatment on the QGSGS for VYC‐17.5L compared with saline (−6.6 VYC‐17.5L vs −1.7 saline [t(28) = −4.3196, p = 0.008]). There was a smaller, but still significant reduction on the QGSGS for saline alone (10.4 to 8.6 [t(14) = −3.453, p = 0.004]). In addition, 93% (13/14) of subjects chose VYC‐17.5L over saline treatment and reported an improvement on the GAIS. There were no serious side effects and all minor side effects resolved by Day 30. Conclusion: VYC‐17.5L achieved significant improvements in rolling atrophic scars as compared to saline, though saline also had modest improvements. [ABSTRACT FROM AUTHOR]

Abstract Background Acne vulgaris, a highly prevalent multifactorial inflammatory skin disease, can be categorised into different severity and scarring grades based on the type, number, and severity of lesions. While many epidemiology studies have investigated the risk factors for acne presentation, fewer studies have specifically studied the risk factors for acne severity and scarring. Therefore, this study investigated the prevalence of acne, acne severity and scarring grades, and their associated non-modifiable and modifiable epidemiological risk factors among Malaysian Chinese. Methods A total of 1840 subjects (1117 cases/723 controls) completed an investigator-administered questionnaire as part of a cross-sectional study, which include socio-demographics, familial history, lifestyle factors, dietary habits, and acne history. Acne cases were further evaluated for their severity (n = 1051) and scarring (n = 1052) grades by a trained personnel. Results Majority of the acne cases (up to 69%) had mild acne or Grade 1/2 scarring, while 21.6% had moderate/severe acne and 5.5% had Grade 3/4 scarring. Males had significantly higher risk of presenting with higher grades of acne scarring. Those who had acne, regardless of severity and scarring grades, had strong positive familial history (either in parents and/or sibling). Frequent consumption (most or all days) of foods that are commonly consumed during breakfast (butter, probiotic drinks, cereals and milk) decreased the risk for acne presentation and higher acne scarring, while periodic consumption (once/twice per week) of nuts and burgers/fast food decreased the risk for higher acne severity. Alcohol drinking was significantly associated with increased risk for acne presentation, while paternal, parental and household smoking were associated with reduced risk of more severe acne. Conclusions In conclusion, positive familial history is a strong predisposing factor in influencing acne presentation, severity and scarring. Frequent consumption of foods that are commonly consumed during breakfast is protective against acne presentation.

Objective: Acne vulgaris is a multifactorial disease of the pilosebaceous unit. As the most common skin disease, it may affect approximately 85% of the young population. Survivin, a member of the inhibitors of the apoptosis (IAP) gene family, can inhibit apoptosis and regulate cell division and proliferation. In the study, we aimed to investigate the potential role of serum survivin in acne vulgaris. Methods: Forty individuals who were diagnosed with acne vulgaris and forty healthy subjects as the control group were enrolled in the study. Venous blood samples were collected from each participant, and the serum levels of survivin were measured by enzyme‐linked immunosorbent assay (ELISA). Statistical analysis was performed using SPSS software version 25. Results: The serum survivin levels were statistically significant between the groups, and the levels of survivin were measured as acne vulgaris patients group 153.44 and control group 104.17 pg/ml, respectively (p < 0.018). When the serum survivin levels were compared according to gender, females had higher levels of survivin than the males (168.16 versus 50.45 pg/mL, p = 0.001). A significant correlation was found between acne severity (p = 0.017) and Scale for Acne Scar severity (SCAR‐S) score (p = 0.001) according to the survivin levels. In terms of age, no significant relationship was found between age and survivin (p = 0.4048). Conclusion: Elevated serum levels of survivin were determined in acne vulgaris. Moreover, there was a significant correlation between acne stage and SCAR‐S score according to survivin levels. [ABSTRACT FROM AUTHOR]

Aim and objectives: Evaluation of the cumulative effect of Radiofrequency Microneedling and fractional Erbium: Glass 1565 laser in moderate to severe acne scars in skin of color. Material and Methods: This retrospective study was conducted on 20 patients of skin types III –V having moderate to severe atrophic acne scars. The study was carried out over 1 year from March 2019 to March 2020. Procedure: All patients underwent 4 sessions of non‐ablative Fractional Erbium: Glass 1565 laser to alternate with 4 sessions of Fractional Radiofrequency Microneedling once a month over 8 months. Results: Of the 20 patients enrolled, 18 completed treatment protocol. Two patients were withdrawn from the study because they were unable to attend follow‐up treatment sessions. The subjective evaluation was performed using photographs at baseline, 8 months, and 12 months. A photographic evaluation was performed using the following numeric responses: <25%, 25–50%, 51–75%, and 76–100% difference in severity. None of the patients had worsening of their scars. The improvement in scars was statistically significant. Conclusion: The combination of Fractional Erbium: Glass 1565 laser and Fractional Radiofrequency Microneedling can be used in the treatment of acne scars in skin of color. Our protocols helped achieve significant improvement of scars. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris is classified based on the severity of skin lesions and post-healing scar types of these lesions. Numerous epidemiology studies have investigated the risk factors associated with acne presentation and severity, but studies for acne scarring are lacking. Objective: To investigate the prevalence of acne, severity, and scarring grades and their associated risk factors among Singapore Chinese. Methods: A total of 3,888 subjects (2,090 cases/1,798 controls; median age = 21 ± 4.589; range 17–71) completed an investigator-administered questionnaire as part of a cross-sectional study, which included sociodemographics, familial medical history, lifestyle factors, dietary habits, and acne history. Acne cases were further evaluated for their severity (n = 991) and scarring (n = 988) grades by a trained personnel. Results: The majority of the acne cases had mild acne/grade 1 scarring, while less than 1% had severe acne/grade 4 scarring. Parental acne was significantly associated with acne presentation and moderate/severe acne, while sibling acne was significantly associated with grade 3/4 scarring. Gender and age affected acne severity and scarring but not acne presentation, while tertiary maternal education level and the possession of ≥3 siblings were particularly associated with acne scarring. Underweight BMI was protective against acne presentation, while atopic diseases (asthma, allergic rhinitis, eczema) were its predisposing factors. Of the evaluated lifestyle factors, computer/TV usage had significant association with acne presentation, while alcohol consumption was significantly associated with acne severity. Frequent milk consumption was associated with a protective effect for moderate-severe acne, while frequent butter consumption had a detrimental effect on acne scarring extent. Conclusion: Positive familial history is a strong predisposing factor in determining acne presentation, severity, and scarring. Demographic factors (gender, age) and sedentary lifestyle (increased computer/TV usage) influence acne presentation, while dietary habits (milk and butter consumption) influence acne severity and scarring. The predisposing factors revealed in this study could help us to gain insights into acne pathophysiology and hence develop interventions especially targeting modifiable risk factors. [ABSTRACT FROM AUTHOR]

Background: Atrophic post‐acne scarring is considered to be a therapeutic challenge. Objectives: The aim was to compare the safety and efficacy of (A) FCL combined with intradermal injection of plasma gel, (B) FCL combined with topical application of plasma gel, and (C) FCL monotherapy in the treatment of atrophic post‐acne scars. Methods: Thirty patients with facial atrophic post‐acne scars were enrolled in this study and randomly assigned into one of three groups. All of them underwent four treatment sessions at 4‐weeks intervals. They were assessed objectively by the quantitative global scarring grading system (GSGS). This system was applied at baseline, and after 1‐ and 6‐month follow‐up (FU). Subjective assessments were performed through the global esthetic improvement scale (GAIS) and level of patient satisfaction. The DLQI questionnaire was employed at the baseline and 6‐month FU. Results: According to the quantitative GSGS scores, the reductions in group A (68.4%) and group B (63%) scores were comparable, and both were significantly higher than that in group C (41.2%) in all steps of evaluation. At 6‐month FU, both groups A and B showed further significant improvement, while group C did not. Based on the GAIS and patients' satisfaction, there were no significant differences between all groups. The reductions in DLQI scores in groups A and B were comparable; however, both were significantly higher than group C (P <.001). Conclusions: The combination of plasma gel and FCL resurfacing was noticeably outstanding in their efficacy and impact on the patients' quality of life. [ABSTRACT FROM AUTHOR]

Background: Numerous techniques have been introduced to correct acne scarring, such as acid and laser peeling and mechanical and CO2 dermabrasion. Objective: The aim was to find a new, simple, and cheap technique for improving and correcting acne scarring. Patients and methods: This interventional therapeutic study started in 2013 and lasted until 2020. A total of 250 patients with acne scarring were included, with the age ranging from 20 to 45 years. Most scar severity ranged from moderate to severe. The common types of scars were boxcar, icepick, and mixed. After local xylocaine anesthesia, direct heated needle diathermy was applied to the whole skin that included the scars and two passing were done superficial and deep, followed by a TCA peel. These patients were given topical antiseptic washing agents with oral antibiotics and 10 mg prednisolone once a day to be seen again after two weeks. Scoring was done to assess the reduction rate in the scars during follow-up periods. Results: Reduction rate scores after four months were as follows: a moderate score in 10 (4%) patients, a marked score in 140 (56%) patients, and an excellent score in 100 (40%) patients. No important complications were observed apart from temporary hyperpigmentation. Patients with active acne lesions also had a full remission following the dermabrasion. Full satisfaction was expressed by 225 (90%) patients, while partial by 25 (10%). Conclusion: This simple, easy, clean, and cheap innovative technique for dermabrasion was conducted on an outpatient basis with two-week downtime, showing marked (56%) to excellent (40%) reduction rates in acne scars within one session. [ABSTRACT FROM AUTHOR]

Acne scarring is one of the most common facial skin disorders. The appropriate treatments for acne scars in patients with rosacea have not been studied. This study was designed to evaluate the efficacy and safety of non-ablative fractional 1440-nm laser (1440-nm NAFL) therapy for treatment of atrophic acne scars in patients with rosacea. In this prospective, interventional study, 32 patients with rosacea and acne scars underwent three sessions of 1440-nm NAFL therapy. Therapy efficacy, epidermal barrier function, and side effects were evaluated. Thirty patients completed and the median acne scar scores significantly reduced from 45 (30, 50) to 15 (15, 30) after three treatments (P < 0.001). The improvement score of acne scars was 2.7 ± 0.7; 22 (73.3%) were satisfied or highly satisfied. The rosacea erythema scores changed from 2.1 ± 0.4 to 1.9 ± 0.5 (P = 0.326), and flushing, burning, and stinging were not worse. The oil content after treatments was significantly reduced (P < 0.001), while there was no significant difference in other indicators of skin barrier function. The quality-of-life score decreased from 17.5 ± 3.8 to 14.1 ± 3.0 (P < 0.001). No serious side effects were observed. The 1440-nm NAFL therapy is effective in the treatment of acne scaring in patients with rosacea with little damage to the skin barrier. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris, a highly prevalent multifactorial inflammatory skin disease, can be categorised into different severity and scarring grades based on the type, number, and severity of lesions. While many epidemiology studies have investigated the risk factors for acne presentation, fewer studies have specifically studied the risk factors for acne severity and scarring. Therefore, this study investigated the prevalence of acne, acne severity and scarring grades, and their associated non-modifiable and modifiable epidemiological risk factors among Malaysian Chinese.Methods: A total of 1840 subjects (1117 cases/723 controls) completed an investigator-administered questionnaire as part of a cross-sectional study, which include socio-demographics, familial history, lifestyle factors, dietary habits, and acne history. Acne cases were further evaluated for their severity (n = 1051) and scarring (n = 1052) grades by a trained personnel.Results: Majority of the acne cases (up to 69%) had mild acne or Grade 1/2 scarring, while 21.6% had moderate/severe acne and 5.5% had Grade 3/4 scarring. Males had significantly higher risk of presenting with higher grades of acne scarring. Those who had acne, regardless of severity and scarring grades, had strong positive familial history (either in parents and/or sibling). Frequent consumption (most or all days) of foods that are commonly consumed during breakfast (butter, probiotic drinks, cereals and milk) decreased the risk for acne presentation and higher acne scarring, while periodic consumption (once/twice per week) of nuts and burgers/fast food decreased the risk for higher acne severity. Alcohol drinking was significantly associated with increased risk for acne presentation, while paternal, parental and household smoking were associated with reduced risk of more severe acne.Conclusions: In conclusion, positive familial history is a strong predisposing factor in influencing acne presentation, severity and scarring. Frequent consumption of foods that are commonly consumed during breakfast is protective against acne presentation. [ABSTRACT FROM AUTHOR]

The efficacy of the long-acting drug of hyaluronidase (bovhyaluronidase azoximer, BHA) in acne and postacne patients has been studied. The main criteria for the efficacy of acne and post-acne therapy in the assessment by confocal laser scanning microscopy and laser Doppler flowmetry are proposed.Materials and methods. Randomized, double-blind, placebo-controlled study, comparative in parallel groups. 90 patients aged 18 to 35 years (23.76 ± 4.59 years) with medium and severe acne and postacne were divided into 2 groups of 45 each by randomization (the first group received BHA 3000ME, the second — a placebo). There were two methods of administration of drug or placebo: intramuscular injection or ultraphoonophoresis. Evaluation of the skin was performed by confocal laser scanning microscopy (CLSM) in vivo (VivaScope®, NY, USA), microcirculation — by the laser Doppler flowmetry (LDF) with the laser capillary blood flow analyzer (LAKK-01, Russia). The effectiveness was evaluated by the Qualitative scaring grading system and Goodman’s quantitative global acne scarring system.Results and conclusions: With the use of BHA 80 % of patients had an improvement, 8.89 % — a significant improvement, postoperative index was reduced from 14.27 ± 5.61 to 10.18 ± 4.63 points (p < 0.05). In the placebo group the reduction of indices is insignificant. The effectiveness of the use of BHA by the ultraphonophoresis was lower than by intramuscular injection. A significant change in the microcirculation index (flux) was established from 20.09 ± 1.74 PU (Perfusion Units) up to 15.2 ± 2,1 PU (p = 0,01). The normalization of the microcirculation was noted. According to the results of CLSM, among BHA patients were observed a significant decrease of severe fibrosis and inflammatory infiltration, the number of dilated vessels. In the placebo group signs persisted. Clinical and morphological monitoring showed the expediency, high efficiency and safety of BHA in the therapy of patients with medium and severe acne vulgaris and postacne.

Background/Objective: Papular scars are a recently described clinical phenotype of acne scarring characterized by papules occurring on the nose and chin. We have observed a similar presentation of nasal papules among patients seen in our clinic for acne and sought to further characterize the clinical and histopathological characteristics of this entity. Methods: In this single‐site case series, a retrospective review of electronic medical records of patients with nasal papules in association with acne vulgaris between April 2018 and April 2019 was performed. Clinical and histopathologic findings were recorded. Results: We identified 20 patients who presented with a similar clinical phenotype of predominantly skin‐colored, dome‐shaped papules concentrated on the nose and chin in association with a history of more classic facial acne vulgaris. Papular lesions were seen predominately in adolescent Hispanic males. Concomitant acne on other areas of the face was identified in 18 patients at presentation while two patients had a history of adolescent acne. Biopsies were performed for five patients. Histopathologic examination demonstrated features of fibrosis and dilated thin‐walled blood vessels, typical of angiofibromas. Conclusion: We present a series of adolescent patients with large, flesh‐colored to erythematous papules seen predominantly on the nose. These lesions are histologically indistinguishable from angiofibromas and may represent an under‐recognized yet disfiguring sequela of acne that may disproportionately affect adolescents with skin of color. [ABSTRACT FROM AUTHOR]

Background: Patients with acne scarring often have several types of acne scars, and combination therapies have demonstrated superior success to single treatment modalities. Chemical reconstruction of skin scars (CROSS) has gained popularity as the treatment for ice‐pick scars and fractionated laser therapy for rolling and boxcar scars. However, no study has looked at combination therapy with CROSS and fractionated nonablative laser for the treatment of atrophic acne scars. Aims: We sought to evaluate the efficacy and safety of combination therapy with CROSS and fractionated nonablative laser for atrophic acne scars. Methods: We conducted a retrospective analysis of patients treated with CROSS followed by fractionated nonablative laser treatment in the same visit for acne scars from 2016 to 2020. Treatment efficacy, defined as the percentage improvement in the appearance of acne scars, was assessed using a 5‐point scale: score 0 (worsening or 0% improvement), 1 (1% ‐ 25%), 2 (26% ‐ 50%), 3 (51%‐75%), and 4 (76%‐100%). Results: Twenty‐five patients (14 females and 11 males, Fitzpatrick Skin Type II –V) were enrolled. The average improvement score was 2.07 after 3 sessions and 2.78 after 5 sessions. All subjects reported satisfaction, while 24% were very satisfied. There were no permanent adverse effects, and only one patient developed a temporary hypertrophic scar. Conclusion: We concluded that combination therapy with CROSS and fractionated nonablative laser in the same visit is an effective and safe treatment option for atrophic acne scars in patients with various skin types, including skin of color. [ABSTRACT FROM AUTHOR]

Background: The use of platelet‐rich plasma (PRP) combined with noninvasive, nonenergy procedures for atrophic acne scars has shown promise. To date, there has not been a systematic review or meta‐analysis of the effectiveness of this therapy. Aims: To use meta‐analysis to compare Goodman and Baron qualitative scores, patient satisfaction outcomes, and adverse effects in patients undergoing combination procedures with PRP, combination procedures without PRP, and noninvasive monotherapy without PRP in the treatment of patients with atrophic acne scars. Patients/Methods: The Pubmed and Cochrane library databases were searched for relevant studies published before May 1, 2019. PRISMA guidelines were utilized. Studies that compared the use of PRP in combination with a noninvasive procedure and therapies without PRP for the treatment of atrophic acne scars were included. Cochrane's handbook was utilized to assess the individual biases of the included studies. Publication bias was assessed. Results: A total of 311 participants (153 whole‐face participants and 158 split‐face participants) were reviewed across eight included studies. Quantitative analysis of 241 participants across six included studies showed a statistically significant reduction in scar severity scores in favor of microneedling or subcision with PRP (P <.001). Combination therapy with intradermal or topical PRP was significantly more effective than monotherapy alone and combination therapy with an adjunct other than PRP (P <.001 and.001, respectively). Conclusion: This systematic review and meta‐analysis demonstrated that microneedling or subcision with PRP produced statistically significant improvement in validated outcomes over microneedling or subcision alone. [ABSTRACT FROM AUTHOR]

Acne scarring is a prevalent issue affecting millions worldwide, with significant psychological and social implications. Microneedling and CO 2 laser therapy have emerged as promising modalities for acne scar remodelling. Microneedling induces controlled micro-injuries to stimulate collagen production, while CO 2 laser therapy precisely ablates scar tissue. This comprehensive review evaluates the efficacy, safety, and comparative benefits of microneedling and CO 2 laser therapy. Literature synthesis reveals both modalities to improve acne scars, albeit with different mechanisms and risks. Factors influencing treatment selection and the role of combination therapy are discussed. Future directions include optimising protocols and exploring novel techniques. Overall, microneedling and CO 2 laser therapy offer valuable options for acne scar management, empowering individuals to address the physical and emotional burden of scarring., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Meghe et al.)

Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well-being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aimed to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefit compared to the implementation of a single method., (©Enas Attia. Originally published in JMIR Dermatology (http://derma.jmir.org), 21.02.2024.)

Summary: Background: Fractional CO2 laser and platelet‐rich plasma (PRP) treatments have been used in the treatment of acne scars. However, an objective method of assessment has been lacking. Objective: To evaluate the efficacy of CO2 laser versus the combination of PRP and fractional CO2 laser in treatment of acne scar. Patients and methods: Thirty patients with atrophic acne scar lesions were included in this study. Patients were randomized to receive fractional CO2 laser therapy to one side of the face while the other side of the face was treated with fractional CO2 laser followed by intradermal PRP injection. Follow‐up using the skin analysis camera system and photography was done for three months. Results: A dramatic improvement was observed in the scar depth on both sides of the face. However, the combined fractional CO2 laser and PRP showed more significant improvement. Improvements in the scar appearance and skin texture were reported by the patients. Although 70% of our patients were of a dark skin type, no hyperpigmentation was reported. Conclusion: The combined use of fractional CO2 laser and PRP achieved better results. It reduced the downtime of the fractional CO2 laser. The use of the skin analysis camera provided an objective assessment of the results. [ABSTRACT FROM AUTHOR]

Summary: Background: Multimodality therapies including minimally invasive modalities are increasingly used in atrophic scarring. Objective: To evaluate the role of platelet‐rich plasma (PRP) as adjunctive therapy to a combined subcision and needling treatment in severe (grade 4) atrophic acne scarring. Methods: A total of 30 patients with grade 4 acne scars were randomly divided into two groups, 15 patients each: Group A underwent three sequential treatments of subcision and needling while Group B, three sequential treatments of subcision, needling, and topical application of PRP that were performed at 3‐week intervals. Scar grading was assessed 3 months following the final session. Participant's assessment of treatment response was registered. Results: Scar improvement ≥50% was reported significantly more often by Group B than Group A patients (P = 0.025). Regarding physician‐based assessment of scar grading post‐therapy (number of patients with two grades improvement vs one grade or no improvement), there was a trend toward more improvement in Group B (P = 0.195). Physician's evaluation of acne scar improvement correlated with the patient's assessment of improvement: 60% of Group A and 66.6% of Group B patients appreciated an improvement of 25%‐49% and 50%‐74%, respectively. Mean duration of postprocedure erythema/edema was shorter among Group B than Group A patients (16.1 vs 32.9 hours, respectively). Overall, substantial improvement was noticed in rolling and boxcar scars with only a mild change in icepick scars. Conclusion: Platelet‐rich plasma appears to add to the improvement of grade 4 atrophic acne scars when combined with needling and subcision. These findings require further evaluation by future studies. [ABSTRACT FROM AUTHOR]

Background: Acne effects 80–90% of teenage population all around the world. Resulting scars can lead to facial disfigurement and psychological issues in affected population. To counter this problem many treatment options have been tried including resurfacing lasers, dermabrasion, peeling, fillers, platelet rich plasma therapy etc. All have shown variable results. Among these modalities, micro needling is showing promising results in treatment of acne scars due to collagen induction. This study was conducted to assess efficacy and safety of micro-needling on acne scars. Methods: In this cross-sectional study a total of 50 patients (female 35, male 15) underwent treatment for post acne scarring, 4 sessions of micro-needling were done under local anaesthesia 3 weeks apart over the span of 2 months. Initial and follow up qualitative assessment was done. Photographs were taken of each patient on their subsequent visit, they were analysed and compared for final results. Grading was done by using Goodman Baron scale. Results: 70% (35) were females and 30% (15) were males with mean age of 27.31±4.41 ranging from 19–35 years. After the treatment of scars, 73% (08) of Grade 4 scars have showed improvement by 2 grades, remaining 27% (03) showed improvement to Grade 3. In 20 patients with Grade 3 scars, 30% (06) showed improvement by 1 grade. Remaining 70% (14) improved by 2 grades. All patients with Grade 2 scar downgraded to grade 1 after treatment. Chi-square test was used to assess pre-treatment and post treatment grading improvement among subjects and was statistically significant. (X²=30.010 p=000). Conclusion: Micro needling is an effective tool for aesthetic improvement of post acne scarring. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study were to evaluate the efficacy, safety and patient satisfaction of a unique combination of wavelengths 589nm and 1,319nm for the treatment of facial acne vulgaris. Design: This was a small, randomized, prospective, split-face, single-blinded study of patients with moderate-to-severe acne vulgaris. Setting: The study took place at a single outpatient center study in Torrance, California. Participants: Nine patients underwent four treatment sessions at 2- to 3-week intervals. Each patient received one pass with the 1,319nm laser followed by one pass with the 589nm laser only to the randomized treatment side of the face. Measurements: A blinded, board-certified dermatologist reviewed photographs and counted acne lesions on treated and nontreated sides. Results: Of the nine patients, eight were Fitzpatrick Skin Type IV. At the final visit, inflammatory acne lesions were reduced by 2.5 (-23.1%) on the treatment side and increased by 1.1 (+11.1%) on the control side. No patients experienced bruising, edema, hyperpigmentation or scarring. At the conclusion of the study, 77.8 percent of the patients reported overall satisfaction. Conclusion: This unique combination of lasers appears to be safe in patients with Fitzpatrick Skin Type IV, and might be useful in treating moderate-to-severe acne vulgaris. [ABSTRACT FROM AUTHOR]

The treatment of acne vulgaris traditionally consists of a combination of topical and oral medications. The use of lasers to treat this condition has been an area of increasing research, and several types have previously been used in the treatment of acne. New 1726 nm lasers specifically target the sebaceous gland, which is known to be pivotal in acne pathophysiology. This laser wavelength demonstrates substantial potential as a safe and effective therapeutic option for moderate to severe acne without the risks of systemic therapy. This paper reviews the 1726 nm lasers for acne vulgaris., Competing Interests: Conflicts of interest: Julie Bittar and Perry Hooper have no conflicts to disclose. Jeffrey Dover has received funding for research and consulting from Cutera Inc.

Background: Acne is very common skin condition. Most patients with acne will have a degree of scarring as a result of their acne. In patients with darker skin color the scarring can be further complicated by hyperpigmentation. Several treatment options can be used to improve acne scarring, however the problem of post acne hyperpigmentation is not often addressed. This study especially focus on the treatment of pigmented post acne scarring using skin microneedling. Aims: The primary objective is to assess the improvement of pigmentation of acne scarring in patients with dark skin using microneedling. Secondary objectives include evaluation of post acne scarring improvement and the safety of microneedling in pigmented skin. Materials & Methods: 39 Patients with darker skin colors (types 3, 4 and 5) completed study. Baseline evaluation for both acne scars and pigmentation scores performed using "post acne hyperpigmentation index" (PAHPI) and Goodman-Baron scales (GB scale). Microneedling treatment done and subsequently patients reviewed at 2 weeks for initial assessment and then after at least 4 weeks from date of initial assessment using same scoring methods for both scars and pigmentation. Baseline photographs were taken and again at final assessment. Results: Both PAHPI and Goodman-Baron scales showed statistically significant improvement from baseline following microneedling treatment. Side effects were minor and of transient nature. None of our patients showed worsening of pigmentation. Conclusion: Microneedling is an effective treatment for both acne scars and associated pigmentation in patients with dark skin color. The treatment appears to be safe apart from transient redness, mild dryness, and small hematomas, however additional treatments may be needed in some patients to achieve more improvement in pigmentation. [ABSTRACT FROM AUTHOR]