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PROMOTION


EFFECTIVE SCAR TREATMENT: IMPACT TRANSEPIDERMAL DELIVERY


Dr Maria Claudia Issa discusses a new technique that treats scars and striae beneath the skin’s surface


improvement. One such modality — t ransepidermal delivery — is promising but has so far been unsuccessful. In a new treatment called iTED


S


DR MARIA CLAUDIA ISSA (MD, PhD) is an associate professor of clinical dermatology at Fluminense Federal University, Brazil, and operates the Dermavance dermatology clinic near Rio de Janeiro, Brazil.


Contact:


mariaclaudia@dermavance. com.br


(IMPACT Transepidermal Delivery), difficult-to-treat conditions such as scars and stretch marks can be effectively treated by combining the regenerative effect of fractional ablation with the healing effect of topical products such as tretinoin and glycolic acid, which are delivered beyond the epidermal–dermal junction via microchannels and Alma Lasers IMPACT acoustic ultrasound module.


inherent risk of post-inflammatory hyperpigmentation (PIH), especially in darker-skinned patients.


Microplasma fractional ablation Fractional ablation overcomes the stratum corneum by creating controlled microchannels, which pass the epidermal-dermal junction. While multiple fractional ablative lasers exist, such as the Erbium and CO2


, these technologies carry an


cars, especially when mature, are generally considered hard to treat, as existing treatment modalities do not bring significant


Alma Lasers developed a


fractional ablative technology that significantly reduces the risk of PIH. Based on UniPolar RF, the fractional ablative applicator is a roller with pyramid shaped cogs. The UniPolar RF flows through the roller, and as the pins approach the skin, a microplasma spark is formed between the cogs and the skin. The microplasma sparks produce microchannels 100–150 mm in depth (evaporation and thermal) and 80–120 mm in diameter on the skin surface.


It should be noted that the cogs do not penetrate the skin like other RF ablative technologies, but rather the ablation is fully formed by the microplasma spark. This microplasma ablation is independent of the patient’s skin type and is a chromophore-free event. A recent randomised split face


clinical study was performed by Professor Wei Lu and colleagues at the Shanghai Ninth People’s Hospital, China1


. In the study of 33 Asian


patients who received three sessions of either Alma Lasers’ fractional ablative microplasma or fractional ablative CO2


, the results showed that


both modalities have a similar therapeutic effect. However, 36.4% of


patients treated with the CO2 experienced PIH, while no patients treated with microplasma experienced PIH.


Acoustic pressure ultrasound module In histologies performed by Professor Arie Orenstien, Sheba Medical Center, Israel, and Dr Michael Gold, Nashville TN2


, comparing the 104 ❚


penetration of drugs to the skin following fractional ablation with and


March 2013 | prime-journal.com


Striae (A) before and (B) after two sessions


without the IMPACT acoustic ultrasound, it was proven that topically applied compounds do not penetrate the skin following fractional ablation alone. IMPACT uses a push– pull vibration cycle to act similar to mechanical pressure. The end result is a hammer-like effect that progressively advances the drugs beyond the epidermis–dermis junction.


Clinical study The author recently completed a study of 16 patients clinically diagnosed with alba striae distensae3


.


Half had a history of striae from 2–17 years (Group 1), while the other half had a history of striae from 3–20 years (Group 2). Group 1 was treated with


iTED — microplasma, retinoic acid and the IMPACT ultrasound — while


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