Majority (80%-90%) of patients who develop acne scars have atrophic scars associated with loss of collagen compared to a minority who show hypertrophic scars and keloids. 1 Loss of dermal matrix in the form of collagen breakdown during the inflammatory stage leads to atrophic scars. The ratio of MMPs (Matrix Metalloproteinases) to tissue inhibitors of MMPs determines the development of atrophic or hypertrophic scars. Inadequate deposition of collagen leads to formation of an atrophic scar while, if the healing response is excessive, a hypertrophic scar is formed. 2Current treatment options for atrophic acne scars are dominated by non-pharmacological, invasive procedures which may not be suitable or affordable to all patients. To the best of our knowledge, there are only few studies evaluating the role of topical preparations in the management of acne scars.The various topical agents that have been tried in the management of acne scars as enumerated in Table 1 are described as follows along with their levels of evidence according to the Oxford Centre for Evidence Based Medicine. | INDIVIDUAL AG ENTS | Tretinoin (level of evidence: 4)Tretinoin 0.05% is used in the treatment of keloid scars, but there have been scarcity of reports of its use in the less aggressive acne
BACKGROUND The management of melasma is an ongoing challenge. Platelet-rich plasma (PRP) therapy has been reported to be beneficial, but there is paucity of studies on PRP therapy in melasma. OBJECTIVE To compare the efficacy of PRP therapy and hydroquinone versus hydroquinone alone in melasma. MATERIALS AND METHODS Thirty patients were randomized to receive PRP microinjections on one side and normal saline on the other in a total of 3 sittings. Patients were concurrently advised 4% hydroquinone (HQ) cream application on both sides of the face. Efficacy was evaluated with hemi-modified Melasma Area Severity Index (MASI) scoring and a 4scale patient satisfaction grading. RESULTS Majority of the subjects (53.3%) in PRP + HQ group and 76.7% in HQ group had 25% to 50% improvement in their MASI scores. However, 40% in the PRP + HQ group and only 3.3% in the HQ group had 51% to 75% improvement. The difference in the percentage improvement was statistically significant. There was a greater percentage of subjects reporting a good response among the HQ + PRP group (53.3%) as compared with the HQ group (27%). CONCLUSION Microinjections of PRP combined with topical HQ has better efficacy than topical HQ alone.
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