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Journal of Clinical Medicine Dec 2021Scars are a common disfiguring sequela of various events such as acne, hidradenitis suppurativa, surgery, trauma, and burns, which can lead to serious psychosocial...
Scars are a common disfiguring sequela of various events such as acne, hidradenitis suppurativa, surgery, trauma, and burns, which can lead to serious psychosocial problems with a negative effect on the quality of life. Many conventional approaches have been proposed for the treatment of scars, including surgical techniques, dermabrasion, chemical peels, topical silicone gel, 5-fluorouracile and dermal fillers injection or autologous fat transfer for atrophic scars, and corticosteroids injection for hypertrophic and keloid scars; however, they have sporadic effects. Ablative lasers, such as carbon dioxide laser or Erbium Yag laser, are associated with many collateral effects limiting their application. Non-ablative laser treatments have been shown to be safer and to have fewer side effects, but they have a reduction of clinical efficacy compared to ablative lasers and a minimal improvement of scars. The demand for minimal invasive and safe technology for the treatment of a scars has stimulated the search for more effective novel therapy with fewer collateral effects. Plasma radiofrequency ablation is a new technique consisting of the generation of plasma energy through the production of ionized energy, which thermally heats tissue in a uniform and controlled manner, through a plasma radiofrequency device, inducing a sublimation of the tissue. The aim of this study is to evaluate the effectiveness of P-RF ablation in the treatment of scars performed with D.A.S. Medical device (Technolux, Italia), which is a tool working with the long-wave plasma radiofrequency principle.
PubMed: 35011879
DOI: 10.3390/jcm11010140 -
Cureus Dec 2022Introduction Dermabrasion and chemical peels are infrequently utilized methods of treatment for medical-grade conditions despite demonstrations of favorable outcomes....
Introduction Dermabrasion and chemical peels are infrequently utilized methods of treatment for medical-grade conditions despite demonstrations of favorable outcomes. Insurance coverage status has previously been shown to impact availability and accessibility to specific treatments. The purpose of this study is to evaluate the rate of insurance coverage provided for dermabrasion and chemical peel procedures in the treatment of acne, acne scarring, and non-melanoma skin cancers (NMSC). Methods A cross-sectional analysis of 58 insurance companies by web-based search or phone interview determined the number of insurers with a publicly available policy on dermabrasion or chemical peels. Coverage status and any corresponding criteria were extracted from existing company policies. Results Thirteen (22%) and 22 (38%) policies discussed dermabrasion in the treatment of basal cell carcinoma and actinic keratosis, with 62% and 73% of these policies providing coverage. Acne scarring was discussed in significantly more dermabrasion policies than basal cell carcinoma (45% vs 22%; p=0.018). However, significantly more insurers denied coverage of dermabrasion for active acne and acne scarring when compared to dermabrasion to treat basal cell carcinoma or actinic keratosis (p<0.001). Eighty-seven percent of companies (n=20) with a chemical peel policy for premalignant lesions would provide coverage, with required criteria present in 95% (n=19) of the policies that would cover chemical peels for actinic keratosis specifically. Of the 25 companies (43%) that discussed the treatment of acne with chemical peel procedures, 14 (56%) provided coverage, and 11 (44%) denied coverage. Coverage was denied by significantly less insurers for the treatment of active acne with chemical peel procedures compared to treatment with dermabrasion (44% vs 83%; p<0.006). Conclusion Significant discrepancies were noted in both the presence of a public policy and the coverage status of dermabrasion or chemical peel procedures among the United States health insurance companies. These inconsistencies, along with multiple criteria required for coverage, may create an artificial barrier to receiving care for specific medical-grade conditions.
PubMed: 36726896
DOI: 10.7759/cureus.33184 -
Acta Bio-medica : Atenei Parmensis Mar 2020Striae distensae or stretch marks are mainly a cosmetic concern. They commonly occur in adolescence and in pregnant women. Although, generally more common in females;... (Review)
Review
Striae distensae or stretch marks are mainly a cosmetic concern. They commonly occur in adolescence and in pregnant women. Although, generally more common in females; physiological striae atrophicae of adolescence are more common in males. The pathophysiology is multifactorial with mechanical stretching of the skin being the most important. Despite of an abundance of treatment modalities none is 100% effective.
Topics: Adolescent; Chemexfoliation; Dermabrasion; Humans; Laser Therapy; Prevalence; Risk Factors; Striae Distensae
PubMed: 32191678
DOI: 10.23750/abm.v91i1.9248 -
Indian Journal of Dermatology,... 2021Darier disease (DD) is a rare type of inherited keratinizing disorder with no definitive therapeutic approach. The objective of this study is to provide a detailed... (Review)
Review
Darier disease (DD) is a rare type of inherited keratinizing disorder with no definitive therapeutic approach. The objective of this study is to provide a detailed literature review of all the available treatment modalities of Darier disease, including those that are both surgical and non surgical, to compare their efficacies and to propose a novel therapeutic approach. A complete search of the literature for all articles describing the different treatments of Darier disease, with no restrictions on patients' ages, gender or nationalities, was performed with the use of PubMed. A total of 68 articles were included in the study: 3 prospective studies, 44 case reports/case series and 21 letters/correspondences/clinical images. The treatments described were topical, oral or physical. Retinoids (isotretinoin, tazarotene and adapalene) and fluorouracil were the two most effective topical treatments. Oral retinoids were the most effective oral therapy and were prescribed in the cases of generalized Darier disease. For localized and resistant skin lesions, physical therapies including surgical excision, dermabrasion and CO2 laser ablation were the first line choices. Limitations of this article include the inability to verify the accuracy of the published data, the relatively small sample size, the absence of randomized controlled clinical trials and possible unidentified confounding factors in various studies. In every therapeutic approach to Darier disease, consideration of patient comorbidities, disease distribution, severity and treatment accessibility is essential. Large and randomized clinical trials are necessary for the comparison of the efficacy and the safety of all the treatments of Darier disease and settling a consensus for management.
Topics: Administration, Topical; Algorithms; Botulinum Toxins; Cetirizine; Cyclosporine; Darier Disease; Dermabrasion; Diclofenac; Dihydroxycholecalciferols; Doxycycline; Drug Combinations; Electrosurgery; Ethinyl Estradiol; Fatty Acids; Fluorouracil; Glucocorticoids; Humans; Lasers; Levonorgestrel; Magnesium Chloride; Naltrexone; Photochemotherapy; Retinoids; Tacrolimus
PubMed: 33580925
DOI: 10.25259/IJDVL_963_19 -
Actas Dermo-sifiliograficas 2020
Topics: Dermabrasion; Self-Injurious Behavior; Skin
PubMed: 32401724
DOI: 10.1016/j.ad.2019.03.017 -
JRSM Open Sep 2014Atrophic scars cause significant patient morbidity. Whilst there is evidence to guide treatment, there does not appear to be a systematic review to analyse the efficacy... (Review)
Review
INTRODUCTION
Atrophic scars cause significant patient morbidity. Whilst there is evidence to guide treatment, there does not appear to be a systematic review to analyse the efficacy of treatment options.
OBJECTIVES
To retrieve all evidence relating to atrophic scar treatment and evaluate using the Clinical Evidence GRADE score in order to allow clinicians to make evidence-based treatment choices.
METHOD
Searches were performed in Medline, EMBASE, CINHL and Cochrane to identify all English studies published evaluating treatment of atrophic scars on adults excluding journal letters. Each study was allocated a GRADE score based on type of study, quality, dose response, consistency of results and significance of results. The end score allowed categorisation of evidence into high, moderate, low or very low quality.
RESULTS
A total of 41 studies were retrieved from searches including randomised controlled trials, observational studies, retrospective analyses and case reports of which 7% were allocated a high-quality score, 10% a moderate score, 7% a low score and 75% a very low score. Treatment modalities included ablative laser therapy, non-ablative laser therapy, autologous fat transfer, dermabrasion, chemical peels, injectables, subcision, tretinoin iontophoresis and combination therapy.
CONCLUSION
There is a paucity of good-quality clinical evidence evaluating treatment modalities for atrophic scarring. Evidence supports efficacy of laser, surgery and peel therapy. Further biomolecular research is required to identify targeted treatment options and more randomised controlled trials would make the evidence base for atrophic scar treatment more robust.
PubMed: 25352991
DOI: 10.1177/2054270414540139 -
The Journal of Clinical and Aesthetic... Jan 2015Scarring is an unfortunate and frequent complication of acne, resulting in significant psychological distress for patients. Fortunately, numerous treatment options exist... (Review)
Review
BACKGROUND
Scarring is an unfortunate and frequent complication of acne, resulting in significant psychological distress for patients. Fortunately, numerous treatment options exist for acne scarring.
OBJECTIVES
To extensively review the literature on treatment options for atrophic acne scarring.
MATERIALS AND METHODS
A comprehensive literature search was conducted on the following topics: dermabrasion, subcision, punch techniques, chemical peels, tissue augmentation, and lasers.
RESULTS
The literature supports the use of various treatment modalities; superior results may be achieved when multiple modalities are combined for a multi-step approach to scarring.
CONCLUSION
The safety and efficacy of various treatment devices for acne scarring is well established, but there is a paucity of split-face trials comparing modalities.
PubMed: 25610524
DOI: No ID Found -
Scars, Burns & Healing 2017Acne is a common condition that can result in permanent scarring. Acne scars can be broken down into three categories: atrophic; hypertrophic; and keloidal. Atrophic... (Review)
Review
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 >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.
PubMed: 29799567
DOI: 10.1177/2059513117695312 -
Children (Basel, Switzerland) Jan 2024Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While... (Review)
Review
Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While clinical monitoring is the standard of care, many caregivers are interested in its removal to prevent psychosocial burden or to decrease risk. Although melanoma can occur regardless of CMN removal, there are a variety of treatments that may offer improved cosmesis or local symptom control, including surgical excision, laser therapy, and other superficially destructive techniques. Regardless of the selected management, these patients are monitored for ongoing melanoma risk. An extensive discussion with families regarding the risks and benefits of observation versus active intervention is essential. To facilitate these discussions, we herein summarize current CMN management strategies and considerations.
PubMed: 38255375
DOI: 10.3390/children11010062 -
Indian Dermatology Online Journal 2024Bowen's disease (BD) is a precancerous squamous cell carcinoma and has a high recurrence rate with any single treatment modality, necessitating combination therapy for...
BACKGROUND
Bowen's disease (BD) is a precancerous squamous cell carcinoma and has a high recurrence rate with any single treatment modality, necessitating combination therapy for a successful outcome.
AIM
This study aimed to the efficacy and safety of carbon dioxide (CO) laser ablation followed by manual dermabrasion and intralesional 5-fluorouracil (IL 5-FU) injection as combination therapy for BD.
MATERIALS AND METHODS
This was a retrospective, observational study comprising 29 clinically and histopathologically diagnosed BD patients with no history of prior treatment. Demographic characteristics and clinical examination of the lesions and regional lymph nodes were retrieved. All patients were subjected to CO laser ablation followed by manual dermabrasion and IL 5-FU injection.
RESULTS
Mean age was 61.93 ± 9.31 years with male preponderance (62.1%). Trunk (48.3%) was the most frequently involved site. Mean tumor size was 40.8 ± 16.4 mm (range: 15-86 mm). All lesions healed with a cure rate of 96.6%. Complications seen in patients included atrophic scarring with persistent post-inflammatory hyperpigmentation in three patients (10.3%), secondary infection in two cases (6.9%), and hypertrophic scar with early keloid in one patient (3.4%). Recurrence was reported in one patient (3.4%).
LIMITATION
The study was limited by retrospective study design, small sample size, and no comparison with standard therapy.
CONCLUSION
Combination approach using carbon dioxide laser ablation followed by manual dermabrasion and IL 5-FU injection has been proved to be effective, efficient and safe with good functional, oncological and aesthetic outcomes in treating BD.
PubMed: 38550815
DOI: 10.4103/idoj.idoj_339_23