MICRO NEEDLING VERSUS CARBON DIOXIDE FRACTIONAL LASER IN MANAGEMENT OF ACNE SCARS

Objective: To compare the effectiveness of carbon dioxide fractional laser with micro needling in acne scarring. Study Design: Quasi experimental study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital Rawalpindi, from Jun 2019 to Mar 2020. Methodology: Overall 40 patients with acne scars assessed by consultant dermatologist were made part of study. The patients were divided into two treatment groups through lottery method. Group A, was managed by micro needling technique, while Group B was managed by carbon dioxide fractional laser, each to be done monthly for a total of three sessions. The response was measured by the dermatologist and patients in both the groups. The side effects were also compared in both the groups. Results: Out of 40 patients with acne scars included in study, 17 (42.5%) underwent micro-needling while 23 (57.5%) underwent carbon dioxide fractional laser treatment after randomization. Thirty (75%) patients were female while 10 (25%) were male. The patients with acne scars responded better in carbon dioxide fractional laser group as compared to micro needling in opinion of dermatologists (p-value=0.01) and also patients themselves (p-value=0.03). Side effects were significantly higher in carbon dioxide fractional laser group as compared to micro needling (p-value=0.02). Conclusion: Significant number of patients respond well to carbon dioxide fractional laser treatment and the response included both expert opinion and patients own opinion, but adverse effects were seen more in same group. Therefore, better response but at the cost of more adverse effects was noted.

Anti-PD-1 Therapy with Adjuvant Ablative Fractional Laser Improves Anti-Tumor Response in Basal Cell Carcinomas

The efficacy of anti-programmedcelldeath1therapy (aPD-1), which was recently approved for basal cell carcinoma (BCC) treatment, can be enhanced by adjuvant ablative fractional laser (AFL) in syngeneic murine tumor models. In this explorative study, we aimed to assess locally applied AFL as an adjuvant to systemic aPD-1 treatment in a clinically relevant autochthonous BCC model. BCC tumors (n = 72) were induced in Ptch1+/−K14-CreER2p53fl/fl-mice (n = 34), and the mice subsequently received aPD-1 alone, AFL alone, aPD-1+AFL, or no treatment. The outcome measures included mouse survival time, tumor clearance, tumor growth rates, and tumor immune infiltration. Both aPD-1 and AFL alone significantly increased survival time relative to untreated controls (31 d and 34.5 d, respectively vs. 14 d, p = 0.0348–0.0392). Complementing aPD-1 with AFL further promoted survival (60 d, p = 0.0198 vs. aPD-1) and improved tumor clearance and growth rates. The BCCs were poorly immune infiltrated, but aPD-1 with adjuvant AFL and AFL alone induced substantial immune cell infiltration in the tumors. Similar to AFL alone, combined aPD-1 and AFL increased neutrophil counts (4-fold, p = 0.0242), the proportion of MHCII-positive neutrophils (p = 0.0121), and concordantly, CD4+ and CD8+ T-cell infiltration (p = 0.0061–0.0242). These descriptive results suggest that the anti-tumor response that is generated by aPD-1 with adjuvant AFL is potentially promoted by increased neutrophil and T-cell engraftment in tumors. In conclusion, local AFL shows substantial promise as an adjuvant to systemic aPD-1 therapy in a clinically relevant preclinical BCC model.

Study of the effectiveness of fractional laser ablation in patients with atrophic postacne scars using the quantitative scar index

Introduction. Atrophic scars are common in acne patients. Regardless of their number and size, they are persistent defects and reduce patients' quality of life. With a variety of treatment options, effective scar correction remains a challenge. Laser technology continues to evolve and is considered promising for the treatment of scars.The aim of the study was to investigate the effectiveness of the fractional laser ablation method in patients with atrophic postacne scars using the quantitative postacne scar index.Materials and methods. The study involved 60 patients with ARP of II-IV severity, 35 women and 25 men. The patients underwent fractional ablation of scars with an Erbium laser (2940 nm). To assess the scars before and after treatment, we used the post-acne scar severity index according to the quantitative assessment scale according to G.J. Goodman et al. Goodman et al. (2006). The international scales Patient's Satisfaction Score, Physician's Satisfaction Score, and Definitive Graduated Score were used to assess physician and patient satisfaction with the results of the procedures.Results. The quantitative index of postacne scars before treatment ranged from 4.0 to 16.0 points and averaged 10.9±3.56 points; median was 12.0 points (8.0±13.0 points). After fractional laser ablation procedures, improvement of quantitative indexes scores (p<0.05), positive dynamics of the doctor's and patients' evaluation of procedure results were noted; no gender differences were noted.Discussion. Quantitative indices of scar expression reflect the severity of the affected skin areas in patients with postacne. This study confirms the effectiveness of fractional ablation with the Erbium laser in patients with ARP, which is confirmed by a decrease in quantitative scar severity indices. Dynamic growth of PSS, PhSS, DGS indices testifies to high satisfaction of the physician and the patient with the results of treatment and correlates with regression of clinical manifestations in these patients.Conclusion. Despite the limitations and laboriousness of counting quantitative indices of postacne scars, this approach allowed to establish and objectify the clinical efficacy of treatment of patients with ARP by fractionated ablation.

Transcriptomic analysis of human skin wound healing and rejuvenation following ablative fractional laser treatment

Ablative fractional laser treatment is considered the gold standard for skin rejuvenation. In order to understand how fractional laser works to rejuvenate skin, we performed microarray profiling on skin biopsies to identify temporal and dose-response changes in gene expression following fractional laser treatment. The backs of 14 women were treated with ablative fractional laser (Fraxel®) and 4 mm punch biopsies were collected from an untreated site and at the treated sites 1, 3, 7, 14, 21 and 28 days after the single treatment. In addition, in order to understand the effect that multiple fractional laser treatments have on skin rejuvenation, several sites were treated sequentially with either 1, 2, 3, or 4 treatments (with 28 days between treatments) followed by the collection of 4 mm punch biopsies. RNA was extracted from the biopsies, analyzed using Affymetrix U219 chips and gene expression was compared between untreated and treated sites. We observed dramatic changes in gene expression as early as 1 day after fractional laser treatment with changes remaining elevated even after 1 month. Analysis of individual genes demonstrated significant and time related changes in inflammatory, epidermal, and dermal genes, with dermal genes linked to extracellular matrix formation changing at later time points following fractional laser treatment. When comparing the age-related changes in skin gene expression to those induced by fractional laser, it was observed that fractional laser treatment reverses many of the changes in the aging gene expression. Finally, multiple fractional laser treatments, which cover different regions of a treatment area, resulted in a sustained or increased dermal remodeling response, with many genes either differentially regulated or continuously upregulated, supporting previous observations that maximal skin rejuvenation requires multiple fractional laser treatments. In conclusion, fractional laser treatment of human skin activates a number of biological processes involved in wound healing and tissue regeneration.

Effect of vitiligo treatment by compound Glycyrrhizin combined with fractional laser and Triamcinolone Acetonide injection on T Lymphocyte subpopulation

Objectives: To discuss the effective mechanism of vitiligo treatment by compound glycyrrhizin combined with fractional laser and triamcinolone acetonide injection. Methods: Forty-two patients with vitiligo vulgaris in the stable phase were classified into combined group (19 cases) and medicine group (23) admitted in dermatology department, Baoding First Central Hospital from January 2017 to July 2018. Both groups took 50mg compound glycyrrhizin orally three times per day, and applied halometasone cream externally once per day. Based on this treatment method, after the combined group adopted fractional laser, triamcinolone acetonide injection encapsulation was used immediately. After the treatment for six months, the curative effect was judged for both groups. Flow cytometry was used to test the changes of T lymphocyte subpopulation in peripheral blood before and after treatment. Meanwhile, immunohistochemical method was adopted to determine CD4+ and CD8+ T lymphocyte expression level. Besides, the normal control group was set up. Results: The efficacy of combined group and medicine group were 73.68% and 56.52% respectively, P<0.05. The comparison of CD3+, CD4+, CD8+ and CD4+/CD8+ T lymphocyte level in serum and skin damage before and after treatment had no statistical significance (P>0.05). Serum CD4+ T cells of vitiligo patients reduced, compared with the normal control group (P<0.05), and CD4+/CD8+ declined (P<0.05). CD4+ and CD8+ T lymphocytes at the skin damage of patients increased, compared with normal control group (P<0.05). Conclusions: Compound glycyrrhizin combined with fractional laser and triamcinolone acetonide injection has good clinical effect in the treatment of vitiligo vulgaris in the stable phase, and its effective mechanism may have nothing to do with T lymphocyte subpopulation. doi: https://doi.org/10.12669/pjms.38.1.4412 How to cite this:Li L, Gao L, Zhao Y. Effect of vitiligo treatment by compound Glycyrrhizin combined with fractional laser and Triamcinolone Acetonide injection on T Lymphocyte subpopulation. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4412 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The use of CO2 ablative fractional laser, non-ablative picosecond fractional lasers 1064 nm and 755 nm and needle mesotherapy in combined therapy to reduce stretch marks and skin laxity. A clinical case

Stretch marks are a common problem and a challenge for cosmetologists and aesthetic medicine doctors. Due to the complex etiopathogenesis and difficulties in their reduction, specialists use various therapeutic methods. In this study, the described case confirms the effectiveness of selected combined therapy in reducing stretch marks and skin laxity. Impressive surgical results were obtained with the implementation of combined therapy consisting of the use of non-ablative Nd:YAG fractional laser and alexandrite laser in picosecond technology, CO2 fractional ablative laser and needle mesotherapy treatments.