Energy‐based devices for the treatment of Acne Scars: 2022 International consensus recommendations

Abstract

Background and Objectives: Acne scars are one of the most distressing and longterm consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs. Study Design/Materials and Methods: An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence. Results: The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome. Conclusion: Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.

Laser resurfacing in acne scarring: a review

“…Collagen remodeling is triggered when cells are heated above 50°C. Skin resurfacing in patients with acne scars using these lasers remains unexplored and repeated treatments are often needed [32]. Non-ablative laser resurfacing technology is relatively harmless, although excess energy dissipation to the skin leads to blistering or post-inflammatory hyperpigmentation.…”

“…Nevertheless, the side effects are still better tolerated than with ablative lasers. Even in a relatively aggressive setting with high fluence, it is rare to have post inflammatory hyperpigmentation and a lower number of treatments required than a non-ablative laser [19,32]. Moreover, fractional plasma formation at the skin's surface leads to secondary skin resurfacing, achieving further skin improvement benefits (Fig.…”

Use of Adipose Stem Cells Against Hypertrophic Scarring or Keloid

“…Therapeutic strategies for treating hypertrophic scars include steroid injection, surgical hypertrophic scar removal, radiotherapy, compression, and cryotherapy, pulsed dye and CO 2 laser, silicone gel, nanoparticles and radiotherapy, among others ( Salameh et al, 2021 ; Ogawa, 2021 ; Svolacchia et al, 2016 ; Nicoletti et al, 2013 ; Riccio et al, 2019a ; Jimi et al, 2020 ; Barrera, 2003 ; Aoki et al, 2020 ). However, existing treatments are not guaranteed to reduce recurrence of keloids, due to the high recurrence rate thereof at the hypertrophic scar excision site ( Coentro et al, 2019 ; Kumar and Kamalasanan, 2021 ).…”

Herbal Products for Acne Vulgaris: A Review

“…These are generally the resolving stage of an acne lesion which are seen as an area of eythmia [12] Fig. 6 -Maculae [20]…”