| DERMATOLOGY | PEER-REVIEW
being agreed between patient and physician. It was decided not to record the amount of product used as this was not felt to be contributory to the final result. Histologic evaluation of cutaneous biopsies were not obtained before or during treatment, although it was offered to at least one of the patients who had a resultant adverse reaction. Betadine cleansing was used in most patients and doxycycline 100 mg for 2 days was given as prophylaxis in 11 patients, who were felt to be at risk of infection as they still seemed to have active acne. One patient, who had a previous photoallergic reaction to doxycycline, was prescribed Augmentin-Duo twice daily for 2 days. Subjects were not excluded from the study on the basis
meant the patients were enrolled sporadically, rather than entering the study at the same time. The subjects ranged in age from 16–63 years, and all acne scarring severity scores fell between 4 and 30 on the Goodman system (Table 1). Patients were also evaluated using digital photography and an improvement graduation scale at each subsequent treatment visit, at 1, 3, 6, 12 and 24 months post-procedurally: ■ 0 = no improvement ■ 1 = 0Ð 25% improvement ■ 2 = 25Ð50 % improvement ■ 3 = 50Ð 75% improvement ■ 4 = 75Ð 100% improvement ■ 5 = 100% improvement. Multiple acne scar grading classification systems of
varying complexities have been introduced. The most basic, practical system divides atrophic acne scars into three main types: icepick, rolling, and boxcar scars29 (Figure 1). It is common for patients to have more than one type of scar.
Treatment Subscision of each atrophic scar was performed 1 week prior to injection with CaHA to give a more uniform aesthetic effect. Radiesse was injected using a 27 gauge needle into the space left after subscision of the acne scar in the region of the mid- to deep dermis, although final placement also depended on the presence of fibrous and cystic tissue in this region of the skin. The total volume of CaHA used varied with each patient, with an end-point
Figure 4 23-year-old male patient (A) before treatment with Radiesse, and (B) 2 weeks after treatment
Subscision of each atrophic scar was
performed 1 week prior to injection with CaHA to give a more uniform aesthetic effect.
of bleeding disorders or whether they were taking anticoagulants/anti-inflammatory agents, as it was felt that while the bruising may be unsightly, it would likely improve overall healing. Patients who had received synthetic collagen, HA, PMMA, CaHA, or autologous fibroblast injections to treated areas within the previous 6 months were excluded from the study. Clinical assessment scores were determined at each treatment session and follow-up visit. Patient satisfaction surveys and digital photography were used where they were appropriate to both parties, although both were considered subjective, with patients tending to focus on the smallest detail and physicians photographically favouring the better results. All patients were reviewed at 2 or 4 weeks post-treatment for a top-up of Radiesse, if required. It was noted that 17 patients required a top-up of at least 0.15 ml CaHA at one of the first two visits. Smaller amounts (< 0.1 ml) were not recorded, as it was felt that the patient may have seen some defects under deeper scrutiny that were initially missed during the procedure. A series of 13 patients (7 male, 6 female; skin phototypes I–IV) with varying degrees
of atrophic acne scarring were treated in a similar manner with low molecular weight cross-linked HA, and monitored over a 12-month period. Patients were randomly selected on the basis that they did not want to present for laser resurfacing as a treatment for their problem.
Figure 5 26-year-old old male patient (A) before treatment with CaHA and (B) 4 weeks after treatment
Results Twenty-seven patients entered this 12-month study. Moderate to excellent clinical improvement was
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