| DERMATOLOGY | PEER-REVIEW
45% of cases. Pore size was improved in 75% of patients. Sebum secretion decreased in 80% of cases26
.
Intense pulsed light Many studies have used intense pulse light (IPL) sources to treat acne27-29
. In one study, 180 randomised subjects
with mild to moderate inflammatory and comedonal acne received vacuum and IPL, IPL alone, and sebium H2
O Micellar Solution. The result supports the efficacy of
IPL especially when combined with vacuum for comedonal acne29
. The 530 nm IPL significantly reduces
inflammatory lesions by its anti-TN- effect and independent of IL-10 up-regulation30
signaling is upregulated in perilesional skin with mild-to- moderate inflammatory acne vulgaris31
. Also, TGF-1/Smad3 .
Radiofrequency Radiofrequency (RF) acts by reducing perifollicular inflammation. A combined RF and IPL treatment has been used to treat acne. In a study by Prieto et al, 4 weeks with twice-weekly sessions provided a 47% reduction of mean acne lesion counts in 32 patients32
. Also, a
monopolar radiofrequency device showed a reduction of more than 75% in inflammatory acne lesions after one treatment session in more than 90% of patients in a study conducted on 22 patients33
.
Photodynamic therapy During photodynamic therapy (PDT), aminolevulinic acid (ALA) is taken up by the pilosebaceous units. It is metabolised to protoporphyrin IX which when photoactivated converts to cytotoxic singlet oxygen and free radicals. This not only damages the pilosebaceous unit, but also causes the death of P. acnes34 PDT requires three factors, a photosensitiser, light, and
.
oxygen. The commonly used photosensitisers are (ALA) or methylaminolevilunate (MAL), the recent ones are indocyanine green (ICG) and indole-3-acetic acid. Arc lamps, light emitting diodes, IPL (filtered xenon flashlamps) filtered incandescent or fluorescent lamps, lasers, and sunlight are used as sources of light35
. In 2013, Ma et al suggested a low-dose (5%)topical ALA-
PDT regimen, 1 hour incubation and red light source of 3 treatment sessions as the optimal schedule modality for different severities of acne vulgaris. Effective rate overall and of grade II, III and IV were 82.1%, 71.6%, 79.6% and 88.2%, respectively. Eight weeks after the treatment completion, maximum efficacy was obtained. Severe cystic acne of grade IV shows superior efficacy with mild side effects36
.
Post-acne scar treatment with laser and light-based therapies Recently, laser skin modalities for acne scarring have been primarily centred on laser resurfacing with erbium- doped yttrium aluminum garnet (Er:YAG) and carbon
An infrared 1450 nm diode
laser accompanying a dynamic cooling device reduces sebaceous gland activity and inflammation of acne lesions safely and effectively.
Scar types
Atrophic scars are more
common than hypertrophic scars and keloids
Superficial macular scars are macules that may be discoloured
Deep dermal scarring refer to icepick, rolling and boxcar scars. Ice-pick scars are narrow (2 mm), punctiform, deep (forming a ‘V’ shape). Rolling scars have a wave like appearance. They tend to be wide and shallow. Boxcar scars are angular, with sharp vertical edges and are found on cheeks and temples10
.
Scars involving excess tissue
Hypertrophic scars are limited to the borders of the original injury and by pushing out the margin they increase in bulk.
Keloids extend beyond the boundaries of the original wound into adjacent tissue. They are often pruritic and tender.
Bridge is a fibrous string over healthy skin.
Papular scars are soft elevations, like anetodermas and are observed frequently on the trunk and mental area4
dioxide (CO2 . ) lasers. Although these lasers have proven
effective in improving scar appearance via collagen remodelling, they have been associated with extended recovery periods, prolonged erythema, hypo- and hyper pigmentation, and in rare cases, induction of additional scarring37-39
.
Ablative laser skin resurfacing Carbon dioxide laser CO2
laser remains the gold standard technology for the
most dramatic improvement in scars. Producing a wavelength of 10 600 nm, the CO2
laser penetrates
approximately 30 m into the skin by absorption and vaporisation of water-containing tissue40
. Sixty subjects
(50 females, 10 males, skin types I-V, mean age 38 years) with moderate to severe atrophic facial scars received resurfacing with a high-energy pulsed CO2
laser. Clinical
assessments and blinded histologic analyses of skin biopsies of treated scars were performed independently at 1, 6, 12, and 18 months. Significant clinical immediate and prolonged improvements were revealed in texture, skin tone, and appearance of CO2
laser-irradiated scars in
all patients. Average scores of clinical improvement were 2.22 (69%) at 1 month, 2.1 (67%) at 6 months, 2.37 (73%) at
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