[Formula: see text] Introduction: Acne is a common condition that can result in permanent scarring. Acne scars can be broken down into three categories: atrophic; hypertrophic; and keloidal. Atrophic scars can be further sub-classified into: ice pick; rolling; and boxcar. Objectives and Methods: We have performed a comprehensive literature search of the last ten years in order to determine the efficacy and adverse reactions of commonly used treatments against post-acne scarring. Results: A total of 36 relevant articles were identified on the following interventions: subcision (n = 10), dermabrasion (n = 1), microneedling (n = 8), dermal fillers (n = 5), and chemical peeling (n = 12). Discussion: Improvement in the appearance of post-acne scarring following subcision is in the range of 10–100%. Microdermabrasion achieved the least significant results. A total of 27.3% patients did not achieve any benefit despite eight treatment sessions, and only 9.1% achieved good results. All patients treated with microneedling achieved some improvement in scar appearance in the range of 31–62%. Dermal fillers also led to favourable outcomes. In particular, treatment with PPMA led to improvement in 84% of patients. Utilising chemical peels, trichloroacetic acid (TCA) CROSS achieved &gt;70% improvement in 73.3% of patients, whereas 20% glycolic acid did not lead to any improvement in 25%. Conclusion: Post-acne scarring is a common and challenging condition with no easy and definitive solution. The above interventions have been used with varying degrees of efficacy, each having both pros and cons. All have been deemed to be safe with few and transient adverse reactions. However, further trials with a larger number of patients are necessary in order to reach more concrete conclusions regarding their efficacy. 3402 sbh Scars, burns & healing Scars Burn Heal SAGE Publications PMC5965325 5965325 5965325 29799567 10.1177/2059513117695312 A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques Kravvas Georgios 1 Al-Niaimi Firas 1 ✉ 1 Department of Dermatological Surgery and Lasers, St John’s Institute of Dermatology, London, UK ✉ Firas Al-Niaimi, Department of Dermatological Surgery and Lasers, St John’s Institute of Dermatology, London, UK. Shallow boxcar scars are more amenable to skin resurfacing treatments whereas deeper boxcar scars are more resistant to such superficial treatments. 6 However, it may be difficult to differentiate clinically between them, and different types of scars may also be present in the same patient ( Table 1 and Figure 1 ). Table 1. Acne scar classification (adapted from Jacob et al [49]). Acne scars subtype Clinical features Ice pick Ice pick scars are narrow (<2 mm), deep, sharply demarcated tracts that extend vertically to the deep dermis or subcutaneous tissue Rolling Rolling scars may reach ≥5 mm in diameter. On the subcision with implant side, three (15%) patients had no improvement, 15 (75%) had mild improvement and two (10%) had moderate improvement. In a randomised split-face study of ten patients, the effects of subcision with an 18-gauge Nokor needle were compared with those of collagen fillers in the treatment of different types of depressed acne scars. 19 Results were measured using the following scale: 1 = worse than before treatment; 2 = no change; 3 = minimal disappearance; 4 = moderate disappearance; 5 = complete disappearance. performed a randomised, split-face, placebo-controlled clinical trial in order to investigate the effects of microneedling on a mixture of various morphologic scar subtypes. 30 Fifteen individuals received three needling treatments that were performed at two-week intervals using an MTS Roller, CR10 (1.0 mm) or CR20 (2.0 mm). The roller depth was determined by clinical evaluation of skin thickness and scar severity. Two blinded dermatologists separately rated participants’ acne scars based on the quantitative global scarring grading system. After treatment, the mean score of PRP treated face was 7.08, with a 62.20% improvement in acne scars. The other half of the face had a mean score of 10.42, with 45.84% improvement of acne scars following treatment ( P <0.00001). Patient satisfaction evaluation on the water-treated side revealed excellent response in nine patients, good response in 30 patients, fair response in ten patients and poor response in one patient. The PRP-treated half of Forty-three out of 53 patients (81.1%) were either satisfied (n = 30, 56.6%) or very satisfied (n = 13, 24.5%) with their treatment. In a retrospective study of 35 patients, Chandrashekar et al. studied the efficacy of topical RA 0.025% and GA 12% combination. 45 The acne scars were graded according to Goodman and Baron’s quantitative global scarring grading system at baseline and after 12 weeks of treatment. Patient self-assessment revealed that the mean improvement for the side treated with phenol was 6.8 points and for the side treated with TCA was 6.9 points, indicating no statistical difference ( P >0.05) between the two. Kurokawa et al. used a combination of chemical peeling with 20% GA, followed by iontophoresis to treat 31 patients with acne vulgaris and post-acne atrophic scarring. 48 Treatments were performed three to four times at two-monthly intervals, at which point the effect of treatment was evaluated. Non-inflamed atrophic scars without erythema were evaluated in 20 cases. Excellent results were achieved in five patients, good in six, fair in four and no improvement was seen in five patients. Discussion Acne scarring is a common and persistent complication of acne vulgaris that affects a large proportion of the population. Despite its high prevalence, there is no single treatment modality that has been shown to be universally effective, posing a significant challenge for the treating physician. 38 However, there are multiple methods for the treatment of acne scars available, each with both pros and cons.

Introduction: Acne scarring is a very common problem, which can be extensive, and may lead to significant psychosocial morbidity. Multiple types of treatments are used to ameliorate atrophic scars with varying degrees of success. This paper provides an overview of the various energy-based modalities that are commonly employed against acne scarring. Objectives and methods: A comprehensive literature search of papers published since 2008 was performed in order to determine the efficacy and adverse reactions of commonly used energy-based treatments against post-acne scarring. Results: A total of 59 relevant articles were identified covering a multitude of different devices. Discussion: Ablative lasers seem to achieve the highest degree of efficacy, albeit this is associated with significant pain and downtime, and the risk for long-term pigmentary changes. Non-ablative fractional photothermolysis (FP) has a much safer profile but cannot achieve as good cosmetic results. The efficacies of fractional radiofrequency microneedling and radiofrequency are slightly inferior to that of FP but offer an even safer adverse profile. Little evidence is available on the remaining devices, with larger studies required in order to reach more solid conclusions. Conclusion: Multiple devices have been used with varying levels of efficacy and very different safety profiles. There is an overall lack of high-quality evidence about the effects of different interventions. Furthermore, no standardised scale is available for acne scarring, leading to variability in evaluation and interpretation of data in different studies. 3402 sbh Scars, Burns & Healing Scars Burn Heal SAGE Publications PMC6305948 6305948 6305948 30627441 10.1177/2059513118793420 A systematic review of treatments for acne scarring. Part 2: Energy-based techniques Kravvas Georgios 1 ✉ Al-Niaimi Firas 2 1 Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK 2 Department of Dermatological Surgery and Lasers, St John’s Institute of Dermatology, London, UK ✉ Georgios Kravvas, Dermatology, Royal Infirmary of Edinburgh, Lauriston building, Edinburgh EH3 9HA, UK. Multiple types of treatments are used to ameliorate atrophic scars with varying degrees of success. This paper provides an overview of the various energy-based modalities that are commonly employed against acne scarring. Objectives and methods: A comprehensive literature search of papers published since 2008 was performed in order to determine the efficacy and adverse reactions of commonly used energy-based treatments against post-acne scarring. Results: A total of 59 relevant articles were identified covering a multitude of different devices. 1 Such scarring is very common and can lead to impairment in quality of life, as well as being a risk factor for depression and even suicide. Furthermore, it has been linked to poor self-esteem, anxiety and lowered academic performance. 2 Despite the wide array of methods available to improve the appearance of acne scarring, no ‘gold standard’ modality has emerged to date that will clear such scars completely and consistently. Newer treatments and the combination of multiple modalities could therefore be key in achieving consistent results in a large percentage of patients, even in those with severe scarring. 2015 20 2.d Fractional RF and sublative fractional RF Mean improvement in rolling scars 3.3, boxcar scars 2.7, and ice-pick scars 1.8 (based on a 4-point scoring system) Pain, crusting, erythema, flushing, oozing, hyperpigmentation and aggravation of acne Peterson et al. 2011 15 2.d Combined RF and fractionated RF Mean scar severity decreased by 72.3% Discomfort Petrov et al. 2016 40 2.d Fractional CO 2 laser Average scores pre and post treatment: • Ice-pick: from 3.46 to 1.86 • Rolling: from 4.1 to 2.37 • Boxcar: from 3.5 to 1.9 (based on a 4-point scoring method) Erythema, oedema, prickling sensation and hyperpigmentation Ramesh et al. 19 Er:Glass FP is commonly employed for multiple cosmetic purposes, including the treatment of rhytides, stretch marks and melasma. 36 It is also widely used against acne scarring with moderate efficacy. More specifically, much better results can be achieved against boxcar and rolling scars, than against ice-pick scars. 54 Even though comparison FP and the TCA CROSS method achieved similar outcomes, closer scrutiny reveals that FP is more effective against rolling scars, whereas the CROSS method has a better effect against ice-pick scars. 1 Therefore, FRM may be a good option in patients who are sensitive to pain, those at risk of hyperpigmentation (darker skin phototypes or prior history of post-procedural hyperpigmentation) or those who prefer a shorter downtime. 1 , 9 The long-pulsed Nd:YAG achieved moderate efficacy against atrophic acne scars, mainly superficial boxcar and rolling scars, with measurable and statistically significant increase in the number of collagen fibres. 28 , 35 , 46 Combination treatment with the Nd:YAG and PDL lasers leads to synergistic effects. 28 The picosecond laser is a promising modality in this field. Unfortunately, small numbers of patients were treated with this laser as only one study utilised a 755-nm picosecond laser with a diffractive lens array. Results showed a 25–50% improvement against rolling type scars with minimal pain, little downtime and no pigmentary changes. 37 The efficacy of the non-ablative diode in isolation has been found to be low against acne scars while also leading to significant discomfort (especially in those with darker skin). 24 , 31 Even though the efficacy improved when treatment was combined with RF, it is unclear whether any synergistic effects were manifested. 24 , 55 , 62 The ablative YSGG laser achieved excellent improvement in appearance, in the range of 40–90%. However, given the small numbers of patients treated with this device, it is hard to judge the place of this modality in the overall treatment pathway of acne scars. Further

This narrative review summarizes current knowledge on the use of autologous platelet concentrates (APCs) in esthetic medicine, with the goal of providing clinicians with reliable information for clinical practice. APCs contain platelets that release various growth factors with potential applications in facial and dermatologic treatments. This review examines several facial esthetic applications of APCs, including acne scarring, skin rejuvenation, melasma, vitiligo, stretchmarks, peri-orbital rejuvenation, peri-oral rejuvenation, hair regeneration and the volumizing effects of APC gels. A systematic review of literature databases (PubMed/MEDLINE) was conducted up to October 2023 to identify randomized controlled trials (RCTs) in the English language on APCs for facial rejuvenation and dermatology. A total of 96 articles were selected including those on platelet rich plasma (PRP), plasma-rich in growth factors (PRGF), and platelet-rich fibrin (PRF). Clinical recommendations gained from the reviews are provided. In summary, the use of APCs in facial esthetics is a promising yet relatively recent treatment approach. Overall, the majority of studies have focused on the use of PRP with positive outcomes. Only few studies have compared PRP versus PRF with all demonstrating superior outcomes using PRF. The existing studies have limitations including small sample sizes and lack of standardized assessment criteria. Future research should utilize well-designed RCTs, incorporating appropriate controls, such as split-face comparisons, and standardized protocols for APC usage, including optimal number of sessions, interval between sessions, and objective improvement scores. Nevertheless, the most recent formulations of platelet concentrates offer clinicians an ability to improve various clinical parameters and esthetic concerns. 39 NRCT Spl‐f 40 patients ♀ = 27/♂ = 13 Age: 17–31 years Acne scars GR 1–4 Single spin 3600 rpm 15 min AC: ACD Grp A RHS MNPRP Grp B LHS – MN saline Depth 1.5 mm 4 treatment 1 month apart FU end of 4 months GBS Group A: 3.20 ± 0.40 at baseline, to 2.13 ± 0.56 Group B: 3.20 ± 0.40 to 2.36 ± 0.56 Final conclusion: Combination approach using MN and PRP is a better option than using MN alone in atrophic acne scars for clinical improvement, although not SS Asif et al. 40 NRCT Spl‐f 50 pts Age: 17–32 years Gr2‐3 acne scars Double spin 294 g 5 min 691 g 17 min Grp A RHS MN first then PRP intradermal Grp B LHS – MN first then distilled water intradermal 3 treatments 1 month apart 1.5 mm depth FU 12 weeks (GQS) Excellent in 60% Excellent in 40% Final conclusion: PRP has efficacy in the management of atrophic acne scars. It can be combined with microneedling to enhance the final clinical outcomes Nandini et al. 43 NRCT Spl‐f 30 patients ♀ = 12/♂ = 18 Age: 20–40 years Acne scars gr2–4 Single spin 3600 rpm 15 min AC: ACD Grp A RHS MN With PRP Grp B LHS – MN alone Four treatments once monthly FU 12 months GQS : Gr A 13 (43%) patients – excellent response Group B 6 (20%) patients – excellent response Patient's satisfaction Gr A 11 (36%) patients had more than 75% Group B 1 (3%) patient had more than 75% The study showed a decrease in scar severity grade in all the patients Final conclusion: A combination of PRP + MN was found to be more effective than a single method used for the treatment of acne scars Amer et al. 44 Spl‐f 40 patients ♀ = 20/♂ = 20 Age: 18–50 years Acne scars REMI R4C centrifuge 700 rpm 3 min 60 g RCF NO AC Spl‐f Grp A RHS first PRF the MN Grp B LHS – first then saline then MN 4 treatments 1 month apart FU 2 months Goodman and Baron Scale (GBS) Baseline mean GB grade: 3.45. At 24 weeks, mean GB grade was significantly reduced on the study side (1.47, SD 0.56) than control side (3.33, SD 0.53). Final conclusion: Mean patient satisfaction score was significantly higher on the right side (5.95) compared with the left side (5.35). 26 RCT Spl‐f 30 patients With acne scars Group 1 PRP: ♀ = 13/♂ = 2 Age: 18–33 years Group 2 PRF: ♀ = 11/♂ = 4 Age: 22–38 years Group I PRP double spin 900 rpm 5 min 2000 rpm 15 min AC EDTA Activated: 10% CaCl 2 Group II PRF 700 rpm 3 min Group I LHS intradermal PRP RHS: MN with PRP Group II LHS intradermal PRF RHS: MN with PRF 4 sessions with 3 weeks interval FU 1 month after last treatment GBGS The acne scars significantly improved in both sides of face in both groups (3‐fold). Overall a fold 5 higher “excellent” reported outcomes was found in the PRF injection group when compared to the PRP injection group. Additionally, an over 3 fold “Excellent” reported score was found in the PRF microneedling group when compared to the PRP microneedling group. In either case, microneedling was better for APC scar treatment when compared to injections. Results derived from Diab et al. 26 * represents p < 0.05. 6.4. Clinical guidelines The protocol using APCs for acne requires three treatments, 1 month apart. Thereafter, one treatment is recommended every 6 months for maintenance. Author Study type Subjects Gender Age Condition % Smokers Centrifuge rpm/min g force Anticoagulant Treatment protocol and follow‐up Grading System Outcome PRP Microneedling for acne scars Faghihi et al. 157 NRCT spl‐f 16 patients ♀ = 12/♂ = 4 Age: 22–52 years Acne gr2–4 PRP double spin 200 g 3 min 5000 g 5 min AC used Activator CaCl Two sessions 1 month apart: Ablative CO 2 laser the LHS Intradermal PRP vs. Addition of PRP did not improve the scar quality; however, the downtime and inflammation associated with laser treatment gets significantly reduced on the PRP‐treated side Min et al. 160 RCT Spl‐f 25 patients ♀ = 18/♂ = 12 Acne gr 2–4 Age: 24–34 years 160 g 10 min 400 g 10 min AC: ACD Activator CaCl Two sessions 1 month apart Fractional CO 2 laser LHS intradermal PRP, half face saline FU day 84 The mean IGA scores showed that the fractional CO 2 laser plus PRP resulted in an improvement of;75% vs.

Picosecond lasers are gaining increasing popularity in dermatology and aesthetic medicine due to their favorable safety profile and a wide range of therapeutic applications. While originally employed primarily for tattoo removal, their versatility has extended their use to the treatment of various aesthetic skin conditions, including hyperpigmentation, acne scars, stretch marks, and signs of photoaging. Owing to their ultra-short pulse duration, picosecond lasers effectively target pigment particles and stimulate dermal remodeling, offering patients a safe and effective solution to improve the appearance of their skin. The introduction of the picosecond laser into clinical dermatology practice marks a notable advancement in addressing a broad spectrum of skin problems.

AbstractBackgroundAcne scarring is an unfortunate complication of acne vulgaris. Acne scars occur in nearly 49% of people that suffer from acne and has shown psychosocial effects such as poor self‐esteem, social isolation, low confidence, in addition to a significant depression risk factor and suicide. Multimodal treatment approaches can improve efficacy and treatment considerations should be based on individualized patients. Utilizing lasers in treating acne scars as well as acne scars in ethnic skin are reviewed. Energy‐based devices include fractional (ablative and nonablative) for moderate to severe acne in addition to novel device systems.MethodsA literature review of treating acne scars with lasers including pulse dye laser, fractional (ablative and nonablative), picosecond, and novel devices.ResultsUse of lasers in treating acne scars is an effective approach and multimodal device options for acne scarring are presented in the review.ConclusionAcne‐scarring laser treatment modalities and evidence‐based treatments should be promoted for each individual patient. Updated laser treatments for acne scarring are covered, in addition to ethnic skin, along with a discussion and selection on laser treatment modalities.

This paper explores the impact of osteopathic medicine's principles and philosophy on dermatology conditions, focusing specifically on atopic dermatitis (AD), bullous pemphigoid (BP), and acne scars. The aim is to investigate how integrating osteopathic principles into dermatology can improve patient outcomes by addressing visible and internal health factors. The review was conducted through a literature search utilizing PubMed and Journal Storage. By focusing on the interconnectedness of mind, body, and spirit, osteopathic medicine could contribute to the effective treatment of AD. Stress management techniques have been found to significantly aid in the treatment of AD, as stress levels and social stress have a significant impact on the exacerbation of AD symptoms. Micro-needling is a promising treatment for atrophic acne scars, reducing scar severity scores by up to 68.3%. Combining micro-needling with trichloroacetic acid or non-ablative fractional laser technology further enhances treatment efficacy. The development of BP has been linked to alterations in the epidermis. Granzyme B has been identified as a contributing factor in dermal-epidermal junction separation and autoantibody formation, leading to BP. However, the specific link between osteopathic manipulation and Granzyme B levels in BP is not yet firmly established. Although osteopathic manipulation may impact the immune system and inflammation, further investigation is required to determine its precise effects on granzyme B and BP. Nonetheless, integrating osteopathic principles and philosophy into dermatology can improve patient outcomes by addressing visible and internal health factors. The benefits of such integration include improved patient-provider relationships, innovative treatments, better stress management, and individualized care plans. Practitioners should be educated on the significance of complete skin examinations for all patients, and future research should focus on exploring the benefits https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This article is available from https://www.cureus.com/articles/212089-integrating-osteopathic-principles-for-enhanced-dermatological-outcomes-a-literature-review This paper explores the impact of osteopathic medicine's principles and philosophy on dermatology conditions, focusing specifically on atopic dermatitis (AD), bullous pemphigoid (BP), and acne scars. The aim is to investigate how integrating osteopathic principles into dermatology can improve patient outcomes by addressing visible and internal health factors. The review was conducted through a literature search utilizing PubMed and Journal Storage. By focusing on the interconnectedness of mind, body, and spirit, osteopathic medicine could contribute to the effective treatment of AD. Stress management techniques have been found to significantly aid in the treatment of AD, as stress levels and social stress have a significant impact on the exacerbation of AD symptoms. Micro-needling is a promising treatment for atrophic acne scars, reducing scar severity scores by up to 68.3%. PCI holds promise as an effective solution to improve the appearance of atrophic acne scars. Clinical studies have demonstrated that this treatment method can significantly reduce acne scars and improve scar severity scores. There are several techniques for using PCI to enhance the appearance of scarring. In a study by Leheta et al. (2011), PCI was combined with the focal application of full-concentration trichloroacetic acid (TCA) to atrophic scars resulting from acne. This combined treatment resulted in a remarkable 100% improvement in acne scarring for all patients. Scar severity scores improved by 68.3% (p < 0.001) in patients who underwent four sessions. When combined with TCA, the scar severity scores showed an even more substantial improvement, with a mean of 75.3% (p < 0.001). Although the statistical difference between both groups was insignificant, the outcomes highlight the promising potential of PCI and TCA combination therapy in enhancing the appearance of acne scarring [ 17 ]. Leheta et al. (2014) conducted a comparative study to evaluate the efficacy of deep peeling methods in treating atrophic post-acne scars. The study compared phenol versus PCI combined with TCA (20%) in two groups of patients. Both treatment approaches resulted in noticeable improvements in the patient's skin. Statistical analysis of the results revealed that the group treated with PCI combined with 20% TCA showed a striking mean improvement of 69.43% (p < It can enhance the appearance of depressed and elevated facial scars by reducing the height of acne scarring and achieving a clinical response of 100% flattening with the surrounding skin. Compared to traditional surgical and ablative laser procedures, PCI offers a more comfortable treatment experience with minimal discomfort and downtime. As such, PCI is an ideal treatment option for facial scarring, especially for individuals seeking a safe and effective alternative to more invasive surgical or laser procedures [ 22 ]. Dermatologists can utilize the body's natural wound-healing cascade to treat various skin conditions such as acne scars, acne, post-traumatic/burn scars, alopecia, skin rejuvenation, hyperhidrosis, and stretch marks [ 16 ]. Tenet 3: Structure and Function Are Reciprocally Interrelated The skin is the largest organ in the human body and plays a crucial role in the body's immune system and defense mechanisms. It comprises three layers, the epidermis, dermis, and hypodermis, each with unique structures and functions. The epidermis is the outermost layer and includes five sub-layers: the stratum corneum, lucidum, granulosum, spinosum, and basale.