Combined treatment modalities in atrophic acne scars: a prospective study
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20190959Keywords:
Subcision, Micro-needling, TCA CROSS, Goodman and Baron qualitative gradingAbstract
Background: Atrophic acne scars are one of the sequalae that follows acne vulgaris. These scars are big cosmetic concern presenting with varied morphology like ice-pick, rolling and boxcar scars and it needs multimodal approach to treat effectively rather than a single modality. Our main aim is to study the efficacy of combination therapy using subcision, micro-needling and trichloro acetic acid chemical reconstruction of skin scars (TCA CROSS) in a sequential manner for the management of atrophic acne scars.
Methods: Total 30 patients of either sex with grade 2, 3, and 4 atrophic acne scars were graded using Goodman and Baron qualitative grading and were enrolled in the study. After single sitting of subcision, micro-needling and 50% TCA CROSS were performed alternatively at 3 weeks interval for a total of 3 sessions of each. Grading of acne scars were done by taking photographs at pre-treatment, post treatment, 1st and 3rd month after last treatment session.
Results: Out of 14 patients with grade 4 acne scars, 9 (64.3%) patients improved to grade 2 and 5 (35.7%) patients improved to Grade 3. Out of 10 patients with Grade 3 scars, 6 (60%) patients improved to grade 1, and 4 (40%) patients were improved to grade 2 at the end of study. All 5 patients with Grade 2 scars showed significant improvement from baseline.
Conclusions: Subcision, micro-needling and TCA CROSS, if they are combined and adequately done in proper manner will have excellent response in all types of atrophic acne scars.
References
Pandey SS. Epidemiology of acne vulgaris. Indian J Dermatol. 1983;3:109-10.
Rivera AE. Acne scarring: A review and current treatment modalities. J Am Acad Dermatol. 2008;59:659-76.
Khunger N. IADVL Task Force. Standard guidelines of care for acne surgery. Indian J Dermatol Venereol Leprol. 2008:74:28-36.
Orentreich DS, Orentreich N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg. 1995;21:543-9.
Alam M, Han S, Pongprutthipan M, Disphanurat M, Kakar R, Nodzenski M, et al. Efficacy of a needling device for the treatment of acne scars. A randomized clinical trial. JAMA Dermatol. 2014;150:844-9.
Aust MC, Fernandes D, Kolokythas P, Kaplan HM, Vogt PM. Percutaneous collagen induction therapy. An alternative treatment for scars, wrinkles, and skin laxity. Plast Reconstr Surg. 2008;121:1421-9.
Fabbrocini G, Cassiapouti S, Fardella N, Pastore F, Monfrecola G. CROSS technique: chemical reconstruction of skin scars method. Dermatol Ther. 2008;21(3):529-3213.
Khunger N, Bhardwaj D. Evaluation of CROSS technique with 100% TCA in the management of ice pick scars in darker skin types. J Cosmet Dermatol. 2010;10:51-5714.
Lee JB, Chung WG, Kwahck H, Lee KH. Foal treatment of acne scars with trichloroacetic acid: Chemical reconstruction of skin scars method. Dermatol Surg. 2002;28:1017-21.
Goodman GJ, Baron JA. The management of postacne scarring. Dermatol Surg. 2007;33:1175-88.
Goodman GJ, Baron JA. Postacne scarring: A Qualitative global scarring grading system. Dermatol Surg. 2006;32:1458-66.
Jacob CI, Dover JS, Kaminer MS. Acne scarring : A classification system and review of treatment options. J Am Acad Dermatol. 2001;45:109-17.
Garg S, Baveja S. Combination therapy in the Management of of Atrophic Acne Scars. J Cutan Aesthet Surg. 2014;7(1):18-23.
Badheka AD, Mansuri UU, Solanki RB, A study of efficacy of subcision, micro-needling and carbon dioxide fractional laser for treatment of acne scars. Int J Res Med Sci. 2016;4:2623-9.
