Comparative Evaluation of Efficacy and Safety of Tacrolimus and Dinoprostone Following Dermabrasion in Stable Vitiligo.

BACKGROUND: Dinoprostone (DNP), a prostaglandin E2 (PGE2) analogue, has been found to cause repigmenation in vitiliginous lesions. Combined medical and surgical therapy might be more useful for successful treatment of vitiligo. OBJECTIVES: In this study, we aimed to evaluate the efficacy and safety of dermabrasion followed by dinoprostone gel and to compare it with tacrolimus ointment following the same procedure in the treatment of localized stable vitiligo. METHODS: 40 patients of stable vitiligo were enrolled which were divided in two groups of 20 patients each. In group 1, dermabrasion followed by tacrolimus 0.1% ointment was done and in group 2, dermabrasion followed by dinoprostone gel was done. RESULTS: Group 1 patients showed slightly better response (P=0.039), whereas the side effect profile was better for group 2. CONCLUSION: DNP and tacrolimus have immunomodulatory and melanocyte stimulating effect and are well tolerated when combined with dermabrasion. Their effect on skin pigmentation could be enhanced by dermabrasion. J Drugs Dermatol. 2021;20(5):519-522. doi:10.36849/JDD.5751.

A Split-Scar Study Investigating the Effectiveness of Early Intervention With Electroabrasion on Improving the Cosmetic Appearance of Postsurgical Scars.

BACKGROUND: Electroabrasion, which uses an in-office electrosurgical device, is a method of surgical planning that ablates the skin to the papillary dermis. Several reports demonstrate that intraoperative ablative interventions with lasers or dermabrasion can modulate scar formation more effectively. This investigation uses electroabrasion intraoperatively to mitigate scar formation. OBJECTIVE: To evaluate the effectiveness of intraoperative electroabrasion for scar revision. MATERIALS AND METHODS: This was a prospective, randomized, observer-blinded, split-scar study with 24 linear scar segments resulting from primary closures in patients undergoing Mohs micrographic surgery. After placement of dermal sutures, half of the wound was randomly treated with electroabrasion. The other half was used as the control. Scar appearance was assessed by a blinded observer and by the patient using the Patient and Observer Scar Assessment Scale at 1 to 2 weeks, 1 month, and 3 months after surgery. RESULTS: At the 3-month follow-up, both patient and observer variables measuring scar contour improved on the treated side, whereas erythema was worse. Overall, no difference was seen in total scores between the 2 sides. CONCLUSION: Based on this pilot study, scars treated with electroabrasion revealed improved surface topography but worsened erythema. Future studies with more refined electrosurgical settings are needed for further evaluation.

Study the effect of erbium:YAG laser plus topical 5-flurouracil in stable vitiligo resistant to NB-UVB phototherapy.

BACKGROUND: NB-UVB phototherapy is still an effective treatment in vitiligo but requires more than 1 year for its completion. Topical 5-flurouracil could improve the proliferation and migration of melanocytes. Laser-assisted dermabrasion results in stimulation of the inactive melanocytes present at the outer root sheath of the lower portion of the hair follicle, which migrates upward until they reach the surface of the skin. OBJECTIVE: To evaluate the effect of Er:YAG laser skin ablation followed by topical 5-flurouracil on the outcome of NB-UVB phototherapy as a short term technique in resistant and stable vitiligo. METHODS: The current study included 40 patients suffering from bilateral stable vitiligo resistant to NB-UVB. For each patient, one side of the body subjected to 4 months NB-UVB sessions (control side). While the other side of the body subjected to one session of Er:YAG laser ablation combined with topical 5% 5-flurouracil application under occlusion followed by NB-UVB sessions for 4 months after complete re-epithelization. Outcomes were evaluated objectively based on standard digital photographs, histopathological examination, patient satisfaction, and adverse effects. RESULTS: There was a statistically significant improvement in the repigmentation in laser side compared with control side. Histopathological examination revealed expression of prominent melanin pigmentation, with marked expression for Melan-A in laser side, whereas these findings were negative in control side. CONCLUSION: Er:YAG laser ablation, followed by 5FU application before NB-UVB phototherapy for vitiligo, is a safe and tolerable technique that improves the outcome of short-term NB-UVB therapy and is expected to increase patient compliance.

Steel Wool-Aided Dermabrasion of Deep Partial-Thickness Burns.

Early tangential excision of the burn wound is essential for removal of necrotic tissue and promotion of burn wound healing process. However, the depth of the burn wound is not easily assessed during the tangential excision performed by hand-held dermatomes, and it may be possible to excise unburned vital dermis unnecessarily, which aids in primary epithelization of the burn wound by adnexal structures. We herein present early clinical results of steel wool-aided dermabrasion in patients with deep partial-thickness burns. This is a retrospective case study of 23 consecutive hospitalized patients with deep partial-thickness burns. All of the steel wool-aided dermabrasions were performed under general anesthesia within 48 hours after injury. Patients were excluded from the study if the admission was not within 24 hours after injury, and if the burn wound was entirely superficial partial- or full-thickness. Thirteen male and 10 female patients with a mean age of 26.2 ± 17.1 years were enrolled in the study. During the follow-up period, all of the patients had burn wounds primary epithelized on postburn day 15.1 ± 1.8, without any complications. None of the patients exhibited a mortal course, and redebridement or skin grafting of the previously dermabraded deep partial-thickness burn wounds were not required in any of the patients. Steel wool-aided dermabrasion is an easy, cost-effective, and reliable technique for the treatment of deep partial-thickness burns, which provides complete removal of necrotic tissue, preserves the vital dermis, reduces the requirement for skin grafting, and decreases length of hospital stay.

Effect of Dermabrasion and ReCell® on Large Superficial Facial Scars Caused by Burn, Trauma and Acnes△.

Objective To explore the effects of dermabrasion combined with ReCell® on large superficial facial scars caused by burn, trauma and acnes.Methods Nineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell®. According to the etiology, patients were classified into post-burning group (n=5), post-traumatic group (n=7) and post-acne group (n=7). Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score (PSS), Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) of each group were analyzed to compare the effect of the combined therapy on outcomes.Results The healing time of post-burning group (19.6±4.0 days), post-traumatic group (15.8±2.6 days), and post-acne group (11.4±3.1 days) varied remarkably (F=7.701, P=0.007). The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups (P<0.05), where the most significant improvement was shown in the post-acne group (P<0.05). The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group (all P<0.05), where the more significant improvement was also shown in the post-acne group (P<0.05).Conclusions The combined treatment of dermabrasion and ReCell® has remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.

Hiperpigmentación facial simétrica adquirida / Acquired Symmetric Facial Hyperpigmentation

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Recent advances in physical delivery enhancement of topical drugs.

The skin has evolved to resist the penetration of foreign substances and particles. Effective topical drug delivery into and/or through the skin is hindered by these epidermal barriers. A range of physical enhancement methods has been developed to selectively overcome this barrier. This review discusses recent advances in physical drug delivery by broadly separating the techniques into two main areas; indirect and direct approaches. Indirect approaches consist of electrical, vibrational or laser instrumentation that creates pores in the skin followed by application of the drug. Direct approaches consist of mechanical disruption of the epidermis using techniques such as microdermabrasion, biolistic injectors and microneedles. Although, in general, physical techniques are yet to be established in a clinical setting, the potential gains of enhancing delivery of compounds through the skin is of great significance and will no doubt continue to receive much attention.

Management of acne scars: fulfilling our duty of care for patients.

Inflammatory lesions commonly associated with acne have a propensity to form scars which can substantially impact an individual's quality of life. As a result of variations in collagen levels during the wound-healing process, different types of scars can form requiring a tailored approach to treatment; treatment success depends on the modality of the treatment chosen. Here, I briefly discuss the different acne scar types, and their relationship with skin anatomy and histology, in relation to the different treatment options available. This paper was developed to accompany my state of the art presentation at 'The Changing Faces of Acne' meeting in June 2014 and I aim to share my personal experiences in order to offer guidance for appropriate treatment decisions.

[Er:YAG laser: tissue interaction and histomorphological characterization]. / Laser a Erbium YAG: caratteristiche istomorfologiche da interazione energia-tessuto.

Authors describe Er:YAG laser interaction with tissues, in particular their histomorphological characteristics to identify a specific clinic area for laser application through the examination of different clinical international trials. This study includes experimental trials about pig and rat skin laser application to know laser Er: YAG capability and limits; investigation is extended to laser application in human soft tissues as mucosa, periosteum and bones, its utility in cutaneous pathologies and in antiageing treatments.

Dermabrasion.

This review presents skin anatomy, dermabraders, indications for dermabrasion and microdermabrasion, and dermabrasion techniques for the face, along with potential complications. Dermabrasion is a minimally invasive technique used for skin resurfacing. Its applications include treatment of rhytids, abnormal scarring, and premalignant lesions. The risks of complications are low and include pigment changes, hypertrophic scarring, and infection. Despite the introduction of newer therapies, such as lasers and chemical peels, dermabrasion remains an effective tool for physicians to combat the effects of aging without the downtime required for surgery.

Enhancement of facial scars with dermabrasion.

This article describes the physiology of wound healing, discusses considerations and techniques for dermabrasion, and presents case studies and figures for a series of patients who underwent dermabrasion after surgeries for facial trauma.

Optimization of microdermabrasion for controlled removal of stratum corneum.

Microdermabrasion has been shown to increase skin permeability for transdermal drug delivery by damaging or removing skin's outer layer, stratum corneum. However, relationships between microdermabrasion parameters and effects on the stratum corneum barrier have not been developed. In this study, we determined the effect of microdermabrasion crystal flow rate, time, and suction pressure applied in both static and dynamic modes on the extent of stratum corneum removal from excised porcine skin. In addition to controlling the depth of tissue removal by microdermabrasion parameters, we also controlled the area of tissue removal by applying a metal mask patterned with 125- or 250-µm holes to selectively expose small spots of tissue to microdermabrasion. We found that the extent of stratum corneum removal depended strongly on the crystal flow rate and exposure time and only weakly on pressure or static/dynamic mode operation. Masking the skin was effective to localize stratum corneum removal to exposed sites. Overall, this study demonstrates that optimized microdermabrasion in combination with a mask can be used to selectively remove stratum corneum with three-dimensional control, which is important to translating this technique into a novel method of transdermal drug delivery.