RESUMEN

Context: Microneedling therapy is one of the recent advances in treating acne facial scars. Aim: To evaluate the efficacy of microneedling therapy in the treatment of atrophic acne facial scars. Settings and Design: A total number of 10 patients between the age group of 20 and 40 years (8 women and 2 men) who complained of acne scars from November 2012 to August 2014 were selected for the study. Subjects and Methods: Microneedling therapy was performed following the application of the Eutectic Mixture of Local Anesthetics in an interval of 2 months. All patients underwent three sessions. A follow-up of 2 months after the last sitting was carried out. Statistical Analysis: Cochran's Q-paired test, Kendall's W-test, and Pearson's correlation were used for statistical analysis. Results: Patients in our study had three forms of acne scars: box-scar, icepick form, and rolling scars. Patients were told to rate the outcome of the treatment at the end of the follow-up. Three observers randomly selected were shown the pre- and postoperative photographs of the patients to rate the treatment outcome. Statistically there was no interobserver bias. Ninety percent reduction in number of scars and depth of scars was noted at the end of three sittings. The improvement in pigmentation was insignificant. Seventy percent improvement in the skin texture was noted. Nine patients suffered from transient postinflammatory erythema and six patients had postoperative swelling. Conclusion: Microneedling therapy is a safe and effective method of treating acne scars.

RESUMEN

Stretch marks (striae distensae) are common dermal scarring associated with weight gain, overweight, and pregnancy. Scarring is caused by overstretching of the skin's dermis with permanent structural alteration of the collagen network fibers. Some individuals have naturally weak connective tissue and may develop major stretch marks without being overweight. Stretch marks can develop during puberty and after physical exercise with rapid muscle growth. Cortisone treatment and anabolic steroids often cause stretch marks. Stretch marks are of major cosmetic concern to many. They are red and swollen in the early sate and white and irregular in texture in the later stage. Many men and women suffer from poor self-esteem caused by stretch marks. Medical tattooing of stretch marks, also known as microneedling, can correct the skin pigmentation color in the normal direction, but not the actual textural change. However, abnormal texture may be modified by microneedling, by nonablative laser treatment, or by microdermabrasion. Treatments can also be combined, e.g., initial use of a method to flatten the skin, followed by tattooing to correct the color. Treatment options and strategies are reviewed.

Asunto(s)

Estrías de Distensión , Tatuaje , Masculino , Femenino , Humanos , Estrías de Distensión/etiología , Estrías de Distensión/terapia , Estrías de Distensión/patología , Tatuaje/efectos adversos , Cicatriz/complicaciones , Cicatriz/patología , Sobrepeso/complicaciones , Sobrepeso/patología , Piel/patología , Resultado del Tratamiento

RESUMEN

Background: Melasma is a common disorder of hyperpigmentation mainly affecting the face. It is difficult to treat and is a cause for great cosmetic concern for the patient. So, we did this research to compare the therapeutic efficacy of tranexamic acid (TXA) through oral route versus its transepidermal administration with a dermaroller in melasma. Materials and Methods: This was a hospital-based, interventional study carried over a span of 1 year on 40 patients with facial melasma. The enrolled patients were randomly divided into 2 groups of 20 patients each. Group A patients received oral tablet TXA in a dose of 250 mg twice daily for 12 weeks and Group B patients were given TXA solution transepidermally into the melasma lesions using a dermaroller at 2 weekly interval for 12 weeks. Thereafter, all patients were followed up for improvement in Melasma Area and Severity Index (MASI) score, adverse effects and relapse at 4 weekly intervals till 24 weeks. All the patients were evaluated for therapeutic outcome both objectively (by MASI) and photographically at 4, 8, 12, 18, and 24 weeks. Grading of improvement was done by assessing percentage reduction in MASI score. Results: Majority of the patients, 24 (60%) in our study had centrofacial pattern of melasma followed by malar pattern seen in 16 (40%) patients. The baseline MASI score was 11.98 (± 5.47) in Group A and 12.13 (± 3.16) in Group B. The mean MASI score in Group A at the end of 4, 8, 12, 18, and 24 weeks was 9.75 (±4.83), 6.09 (±3.64), 4.21 (±2.48), 2.56 (±1.95), and 3.10 (±3.38) while these values were 9.73 (±3.32), 6.06 (±2.75), 4.55 (±1.89), 2.94 (±1.36), and 3.09 (±1.32) for Group B. At the end of 24 weeks follow-up period, good (51%-75% improvement) and very good (>75% improvement) response occurred in 5 (25%) and 14 (70%) patients in Group A and 11 (55%) and 9 (45%) patients in Group B, respectively. However, the final reduction in MASI score was similar in both the groups. Relapse was uncommon and occurred at 24 weeks in 1 patient from Group A. Limitation: The major limitation was small sample size due to time limitation and long follow-up period. Conclusions: Oral and transepidermal TXA appear equally effective suggesting that the efficacy of TXA is perhaps independent of its route of administration. Oral therapy is convenient for the patient. Transepidermal therapy of TXA has the advantage of local action, hence systemic side effects are avoided, but it is slightly painful and the time period between consecutive microneedling sessions is left to the prerogative of the treating doctor, hence a proper quantification is lacking. Moreover, scheduling of maintenance sessions is necessary as melasma is prone for recurrence.

RESUMEN

Physical drug delivery enhancement in skin has been shown to enhance cosmeceutical actives efficacy. Among the physical drug delivery enhancement technologies, microneedle is the most commercially successful technology. However, there are pros and cons like other physical enhancement technologies including variabilities in penetration depth and lack of efficacy. In this study, three physical topical dug delivery enhancements, elongated microparticles, microneedles and dermaroller, were applied to ex vivo pig skin and compared. The model topical drug that was used is 5-Aminolevulinic acid, the most commonly used photosensitiser prodrug. The skin was pre-treated before mounting on to Franz cell diffusion apparatus. Transdermal epidermal water loss was measured, and receptor fluids were collected at 7 time points for HPLC analysis. The results show that all three technologies disrupted the skin surface. All microporation pre-treatments significantly enhanced mALA cumulative permeation over 8 h (p < 0.001), with the 24x dermaroller significantly greater than 12x dermaroller (p < 0.001) and both dermaroller treatments significantly greater than microneedles and elongated microparticles (p < 0.05). The microporation pre-treatments all significantly increased mALA deposition in the stratum corneum and deeper skin tissues compared to passive administration, with deposition increases ranging from 3.6x to 15.1x that of passive administration. The DR pretreatment showed highest enhancement ratios (amount 5-Aminolevulinic acid in skin at 8 h following pretreatment v passive) with the following order of enhancement: 24x dermaroller > 12x dermaroller > microneedles > elongated microparticles. In conclusion, physical enhancement tools such as microneedles, dermarollers and elongated microparticles demonstrated significant penetration and retention of mALA through/into piglet skin. Further study is needed to determine the cost, dose and patient compliance.

Asunto(s)

Ácido Aminolevulínico , Refuerzo Biomédico , Administración Cutánea , Animales , Piel/metabolismo , Absorción Cutánea , Porcinos

RESUMEN

Malaria caused by various types of Plasmodium has become a global health problem. One of the drugs used as the first line of malaria therapy is primaquine (PMQ). PMQ is generally administered through the oral route. However, the use of PMQ orally could potentially cause some side effects and undergo the first-pass metabolism in the liver, reducing its effectiveness. Therefore, it is necessary to develop another drug administration route to avoid this effect. In this study, for the first time, PMQ was formulated into a transdermal patch for transdermal delivery, combined with solid microneedles, Dermaroller®. Following several optimizations, HPMC and glycerin were used as the main polymer and plasticizer, respectively. Specifically, the concentration of PEG 400 as a permeation enhancer was also optimized. The transdermal patches were evaluated for weight uniformity, thickness, surface pH, folding endurance, moisture content, moisture absorption ability, bioadhesive evaluation, and drug content recovery. PMQ release and permeation were also investigated through in vitro and ex vivo tests on rats' skin tissue. Importantly, the safety of the transdermal patch was also evaluated through in vitro hemolytic and in vivo irritation tests which were confirmed by histopathological examinations. The results showed that all formulations showed desired physical and bioadhesive properties with a folding endurance of >300 folds. The results exhibited that 31.31 ± 5.25% and 22.55 ± 4.35% of primaquine were released from transdermal patches following the in vitro and the ex vivo permeation studies. Combined with Dermaroller®, the ex vivo permeation study showed an improved permeation profile with 45.89 ± 5.00% of primaquine permeated after 24 h with a zero-order kinetic during the first 8 h. Hemolysis percentage was found to be <5%, indicating the non-toxic of this approach. Finally, the histopathology study showed that there was no severe tissue damage following the administration of our approach. Further in vivo evaluations should be performed.

Asunto(s)

Preparaciones Farmacéuticas , Parche Transdérmico , Administración Cutánea , Animales , Preparaciones Farmacéuticas/metabolismo , Primaquina/metabolismo , Ratas , Piel/metabolismo , Absorción Cutánea

RESUMEN

BACKGROUND: Melasma is a commonly acquired, chronic, and relapsing disorder that results in symmetrical, brownish facial pigmentation. It is more common in women than in men, which generally starts between 20 and 40 years of age, and it can lead to considerable embarrassment and distress. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents. Microneedling has been described as a new technique to enhance the drug's transdermal penetration, and has also been reported to result in sustained long-term improvement of recalcitrant melasma. AIM: The aim of this article was to compare the therapeutic efficacy and safety of combined treatment of skin microneedling and depigmenting cream versus depigmenting cream alone in the treatment of melasma. MATERIALS AND METHODS: A prospective study was conducted with a sample size of 40 patients, with twenty in each of the treatment arms; 20 patients were treated with combined skin needling and depigmenting cream and 20 with depigmenting cream alone. The outcome was evaluated periodically for up to 2 months using the modified Melasma Area and Severity Index (MASI) score. RESULTS: Significant reduction was observed in modified MASI score in the combined treatment, with P value <0.05. CONCLUSION: Combining microneedling with Kligman's regimen gives better results in melasma treatment compared to topical treatment alone.

RESUMEN

Androgenetic alopecia (AGA) is an androgen-dependent hereditary trait resulting in hair miniaturization. It is the most common type of alopecia in men and women. During the last years, multiple treatment modalities have been studied, but only topical minoxidil and finasteride have been approved by the US Food and Drug Administration. Microneedling (MN) is a minimally invasive technique that induces collagen formation, as well as growth factors production and neovascularization. Even though not many studies of MN in alopecia have been performed, it remains a favorable treatment modality; however, no standardized protocol for MN in hair loss has been proposed yet. Current evidence is not sufficient to allow a direct comparison with other therapies, but it shows promises to increase hair density, thickness, and quality of hair, especially when combined with other treatments or when used as a drug delivery system. This article aims to summarize the available literature regarding the use of MN alone or associated with other therapies for the treatment of androgenetic alopecia.

Asunto(s)

Alopecia , Alopecia/diagnóstico , Alopecia/terapia , Finasterida , Cabello , Humanos , Terapia por Luz de Baja Intensidad , Minoxidil

RESUMEN

AIM: Microneedles (MNs) create micropunctures and deliver drugs or nutrients deep into skin layer. We demonstrated that MNs, coated with electrosprayed nanoparticles loaded with functional molecules, are useful for transdermal delivery. METHODS: Electrospraying was utilised to generate drug-loaded nanoparticles and to create uniform coating on MNs. Process parameters and release kinetics were evaluated in vitro. The in vivo efficacy of insulin-coated MNs was investigated using diabetic rats. RESULTS: Electrosprayed micro/nanoparticles loaded with dye or insulin were coated on MNs with particle size of 515 ± 286 and 522 ± 261 nm, respectively. Optimally coated MNs resulted in >70% transfer rate into porcine skins. Insulin-coated MNs were applied to diabetic rats resulting in reduction of blood glucose levels fluctuations, compared to subcutaneous injections. CONCLUSIONS: Electrospraying is shown to be an effective method to coat MNs with drug-loaded nanoparticles. Coated MNs provide a promising platform for cosmetic, drug and protein delivery applications.

Asunto(s)

Diabetes Mellitus Experimental/tratamiento farmacológico , Sistemas de Liberación de Medicamentos/instrumentación , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Nanopartículas/química , Administración Cutánea , Animales , Hipoglucemiantes/farmacocinética , Hipoglucemiantes/uso terapéutico , Insulina/farmacocinética , Insulina/uso terapéutico , Agujas , Ratas , Ratas Wistar , Piel/metabolismo , Absorción Cutánea

RESUMEN

BACKGROUND: The use of stem cells derived growth factors is representing a novel treatment modality in facial rejuvenation. Nowadays, skin needling is considered a very famous treatment of skin aging. However, the addition of such derived products, augments its therapeutic efficacy in the management and delay of skin aging. OBJECTIVE: Comparing the effect of amniotic fluid mesenchymal stem cell derived conditioned media (AF-MSC-CM) combined with skin needling versus the needling alone in the management of facial aging. METHODS: Both sides of the face of ten volunteers, suffering from facial aging, were treated with five sessions of skin needling, 2 weeks apart. After skin microneedling, AF-MSC-CM was added topically to the right side only. Clinical, histological, and morphometrical assessment of the treated skin was done at 1 month after the last session. RESULTS: The percentage of improvement of aged skin increased significantly on the combined treated side (AF-MSC-CM and dermaroller [DR]), when compared with the other side (DR only) (P < .001). Remodeling of the dermal structures was observed mainly on the combined side. Meanwhile, histometry of the epidermis revealed a significant increase in the epidermal thickness on both treated sides. CONCLUSION: AF-MSC-CM combined with skin needling was more efficient in managing facial aging than skin needling alone.

Asunto(s)

Rejuvenecimiento , Envejecimiento de la Piel , Anciano , Medios de Cultivo Condicionados , Epidermis , Humanos , Piel

RESUMEN

BACKGROUND: Therapies for postacne scarring act through modulation of elastin and collagen, and collagen III might therefore represent a biomarker of treatment effectiveness. PATIENTS AND METHODS: Patients (n = 70) with postacne scars and individuals without scars (n = 56) were included in this case-control study. Patients were treated with Dermaroller microneedling, trichloroacetic acid chemical reconstruction, punch excision, or scar subcision. Scar severity was graded immediately before and after treatment with a photographic quartile scale and the ECCA scale. Serum levels of collagen III were measured in control individuals and in patients, before treatment, 1 month after the first treatment session, and 4 months after the final session. RESULTS: Circulating levels of collagen III were significantly higher in patients with postacne scarring (24.1 ± 12.5) before treatment than in control individuals (2.6 ± 0.8). Circulating levels of collagen in patients were significantly lower 4 months posttreatment (14.3 ± 8.1) than at baseline. The mean percentage change in serum collagen III was positively correlated with both the mean percentage improvement by photographic evaluation (r = .530, P < .000) and the mean percentage change in the ECCA scale (r = .632, P < .000). CONCLUSION: Circulating collagen III is a biomarker for improvement of postacne scarring following different therapies.

Asunto(s)

Acné Vulgar/terapia , Cicatriz/terapia , Colágeno Tipo III/sangre , Piel/patología , Acné Vulgar/complicaciones , Adolescente , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Cáusticos/administración & dosificación , Cicatriz/sangre , Cicatriz/diagnóstico , Cicatriz/etiología , Colágeno Tipo III/metabolismo , Punción Seca , Femenino , Humanos , Hipertrofia/diagnóstico , Hipertrofia/etiología , Hipertrofia/terapia , Masculino , Fotograbar , Índice de Severidad de la Enfermedad , Piel/diagnóstico por imagen , Piel/efectos de los fármacos , Piel/metabolismo , Resultado del Tratamiento , Ácido Tricloroacético/administración & dosificación , Adulto Joven

RESUMEN

PURPOSE: To evaluate the therapeutic efficacy and complications of microneedling (dermaroller) therapy as a treatment modality in the treatment of facial scars resulting from acne, trauma and surgery. MATERIALS AND METHODS: Fifty patients with facial acne scar, traumatic scar, hypertrophic scars and scars with skin discoloration reporting to our institute were included in the study. Microneedling procedure was performed with the help of dermaroller. Postoperative wound was evaluated by three evaluators by comparing preoperative and postoperative clinical photographs. RESULTS: Seven out of the total 50 patients (14%) showed an excellent response to dermaroller treatment, while 26 patients (52%) had a good response. Fourteen patients (28%) had fair response, and 3 patients (6%) had poor response. CONCLUSION: Microneedling therapy with dermaroller is one of the simplest, yet most effective skin treatments for scars, stretch marks, deep wrinkles, etc. The dermaroller is a definitive credit crunch skin rescue option. It is simple yet effective and suitable for all skin types and skin tones.

RESUMEN

BACKGROUND: Postacne scars are still a challenge in its management. Microneedling is a popular minimally invasive technique in treatment of such scars. However, the addition of topical stem cell products after microneedling is considered a new treatment regimen for these scars. OBJECTIVE: To compare efficacy of amniotic fluid-derived mesenchymal stem cell-conditioned media (AF-MSC-CM) and microneedling vs microneedling alone in management of atrophic acne scars. METHODS: Ten cases with atrophic postacne scars received five sessions of microneedling, with 2-week interval on both sides of the face. Then, AF-MSC-CM was topically applied to right side of the face after microneedling. Clinical examination with histopathological and computerized histometric analysis was done 1 month after the sessions. RESULTS: There was significant increase in the improvement percentage of acne scars on right side (dermaroller and AF-MSC-CM) vs left side of face (dermaroller; P < 0.001). Histologically, improvement of character of collagen and elastic fibers was noticed, especially on right side. Meanwhile, significant increase in epidermal thickness on both sides of face was detected. CONCLUSION: Amniotic fluid-derived mesenchymal stem cell-conditioned media combined with microneedling is more effective in management of atrophic postacne scars than microneedling alone.

RESUMEN

BACKGROUND: Despite the wide therapeutic options available for the treatment of melasma, including many active topical medications, technologies with lights and peelings, clinical control of this disorder is extremely challenging. OBJECTIVES: To evaluate the effect of microneedling with topical vitamin C in the treatment of melasma. METHODS: Thirty female patients with melasma received six sessions of microneedling with addition of topical vitamin C every two weeks. At each session, photos were taken and Melasma Area and Severity Index (MASI) score was calculated to assess the clinical improvement. RESULTS: Mean age of the eligible patients was 33.2 ± 5.77 years. About 50% of cases were of Fitzpatrick skin type III. All patients showed improvement at the end of the sessions. Mean MASI score in the first session was 8.61 ± 4.45 and there was a gradual decline in its value till it reached a mean of 5.75 ± 4.16 in the last session (P < 0.0001). CONCLUSION: Microneedling with topical vitamin C is an effective and safe treatment option for epidermal melasma especially in Fitzpatrick skin phototypes I-III.

Asunto(s)

Técnicas Cosméticas/instrumentación , Fluorouracilo/administración & dosificación , Vitíligo/terapia , Administración Cutánea , Femenino , Humanos , Agujas , Satisfacción del Paciente , Pigmentación de la Piel/efectos de los fármacos , Resultado del Tratamiento

Asunto(s)

Técnicas Cosméticas , Fluorouracilo/uso terapéutico , Inmunosupresores/uso terapéutico , Vitíligo/terapia , Quimioterapia Adyuvante , Humanos , Agujas , Apósitos Oclusivos , Crema para la Piel

RESUMEN

Background: Fractional photothermolysis is creation of microscopic thermal zones of controlled depth, width and density. Microneedling is a simple treatment modality to reduce striae distensae. Objective: Evaluate and compare the efficacy of fractional carbon dioxide laser and microneedling as a treatment of striae distensae. Methods: Individuals with striae distensae received three split-body treatments at four-week intervals. The right side of the body was treated with fractional CO2 laser, while the other side with microneedling. Assessment was done by comparing photographs before and after treatments by two blinded physicians using a quartile grading scale. Evaluation also included patient satisfaction score and histopathological examination. Results: In total 33 subjects were enrolled and 30 completed the study. By quartile grading score, we recorded 55% moderate-excellent improvement of striae in the dermaroller-treated side but with fractional CO2 laser-treated side, we recorded 76% of patients had moderate-excellent improvement. Patients were more satisfied with fractional CO2 laser than the microneedling. Post-inflammatory hyperpigmentation, as a complication of fractional CO2 laser, appeared in 11 patients. Conclusion: Fractional CO2 laser is more effective in treating striae with acceptable side effects but still microneedling can be afforded as an effective, safe and cheap method.

Asunto(s)

Técnicas Cosméticas/instrumentación , Láseres de Gas/uso terapéutico , Agujas , Estrías de Distensión/terapia , Administración Cutánea , Adulto , Femenino , Humanos , Masculino , Satisfacción del Paciente , Resultado del Tratamiento

RESUMEN

BACKGROUND: Scarring due to acne is a frequently encountered problem in dermatological outpatient department. Microneedling has been a well-accepted modality for the treatment of atrophic acne scars. Platelet-rich plasma (PRP) is a newer option to investigate. AIMS: The aims of this study were (1) to compare the efficacy of combined dermaroller and PRP therapy with dermaroller alone in facial acne scars and (2) to assess the psychosocial impact due to acne scars and its treatment. METHODS: A total of 55 patients were included in the study and randomly divided into two groups, Group A: 28 and Group B: 27. Proper counseling was done, and detailed clinical findings were recorded. Patients in Group A were treated with dermaroller alone while Group B patients underwent treatment with a combination of dermaroller and intradermal PRP injections. A total of three sitting were done at monthly interval. Final response was assessed at 1 month after the last sitting. Criteria of evaluation included Goodman and Baron's quantitative scale, visual analog score, and dermatology life quality index scores. Side effects were noted. Results were analyzed using Chi-square test and t-test. RESULTS: Significant percentage improvement was noted in both the groups. However, Group B treated with both modalities had better results when compared with that in the Group A. CONCLUSION: A combination approach using dermaroller and PRP was a safe and better option than using dermaroller alone in atrophic acne scars for clinical improvement as well as for improvement in dermatology life quality index score.

RESUMEN

Background/aim: Even though new techniques are emerging to overcome the inconsistent long-term viability of fat grafts, current methods for increasing fat graft survival are not routinely adaptable to all clinical environments. The purpose of this study was to determine the efficacy of microneedling as an adjunct to fat grafting to the face. Materials and methods: Twenty-two patients that underwent fat grafting to the face with adjunctive microneedling were evaluated in terms of improvement in facial skin quality and facial volume and their results were compared to those in 18 patients that underwent fat grafting without microneedling. The evaluation was conducted with a modification of the Global Aesthetic Improvement Scale at the postoperative third month. Results: All patients that underwent fat grafting and microneedling demonstrated "much improvement" in skin quality and volume at the postoperative third month while "improvement" was noted in patients that underwent fat grafting alone. The difference between skin quality and volume improvement scores was found to be significantly in favor of the patients that received adjunctive microneedling. Conclusion: Fat grafting to the face with adjunctive microneedling is a practical and potentially mutual-acting technique that can be used both for its significant effect on increasing fat graft survival and improving skin quality.