Microneedling in the threatment of post-acne symptom complex

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Abstract

The review presents data from foreign and domestic clinical studies on the efficacy and safety of microneedling application in the treatment of post-acne symptom complex. An analysis of the database of systematic reviews of Russian, European, American researchers, comparative studies on the effectiveness of the microneedling therapy in patients with different skin types for the treatment of postacne symptom complex is presented. Possibilities of microneedling monotherapy and variants of combined treatment, in particular the combinations of microneedling with PRP-therapy, acid peels, non-ablative lasers, injection gels (PMMA-collagen, hyaluronic acid, sodium succinate) are shown.

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About the authors

Aleksandr S. Bykanov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: doctor.bykanov@mail.ru

Graduate Student

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

Elena S. Snarskaya

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: snarskaya-dok@mail.ru
ORCID iD: 0000-0002-7968-7663
SPIN-code: 3785-7859
Scopus Author ID: 8714450500

Dr. Sci. (Med.), Professor

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

References

  1. Goodman GJ. Treatment of acne scarring. Inter J Dermatol. 2011;50(10):1179–1194. doi: 10.1111/j.1365-4632.2011.05029.x
  2. Kruglova LS, Gryazeva NV, Talybova AM. Post-acne symptom-complex: methods of prevention and treatment. Russian Journal of Clinical Dermatology and Venereology. 2020;19(5):622–629. (In Russ).
  3. Snarskaya ES, Vishnevskaya OA, Ostretsova MN. Rational therapy of acne and prevention of postacne symptom. Russian Journal of Skin and Venereal Diseases. 2016;18(2):108–109. (In Russ).
  4. Dorozhenok IYu, Matushenko EN. Nosogenic mental disorders in patients with acne. Mental Disorders in General Medicine. 2009;(2):32–36. (In Russ).
  5. Asif M, Kanodia S, Singh K. Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study. J Cosmet Dermatol. 2016;15(4):434–443. doi: 10.1111/jocd.12207
  6. O’Brien CS, Jafferany M, Carniciu S, Abdelmaksoud A. Psychodermatology of acne: psychological aspects and effects of acne vulgaris. J Cosmet Dermatol. 2020;20(4):1080–1083. doi: 10.1111/jocd.13765
  7. Lepidoth M, Levi A. Post acne scars treatment – do picosecond lasers offer a superior non-ablative modality? J Eur Acad Dermatol Venereol. 2020;34(12):2687–2688. doi: 10.1111/jdv.17017
  8. Nilforoushzadeh MA, Fakhim T, Heidari-Kharaji M, et al. Efficacy evaluation of Endolift-based Subcision on acne scar treatment. J Cosmet Dermatol. 2020. doi: 10.1111/jocd.13876
  9. Borovaya A, Olisova O, Ruzicka T, Sardy M. Does isotretinoin therapy of acne cure or cause depression? Inter J Dermatol. 2013;52(9):1040–1052. doi: 10.1111/ijd.12169
  10. Tan J, Thiboutot D, Gollnick H, et al. Development of an atrophic acne scar risk assessment tool. J Eur Acad Dermatol Venereol. 2017;31(9):1547–1554. doi: 10.1111/jdv.14325
  11. Snarskaya ES. Complex therapy of aesthetic skin defects as a result of pathological fibrogenesis. Consilium Medicum. Dermatology. 2013;(2-3):15–20. (In Russ).
  12. Dreno B, Khammari A, Orain N, et al. ECCA grading scale: an original validated acne scar grading scale for clinical practice in dermatology. Dermatology. 2007;214(1):46–51. doi: 10.1159/000096912
  13. Achtyamov SN. Practical Dermatocosmetology. Acne, postacne scars and acne-like dermatoses. Moscow: Medicine; 2010. (In Russ).
  14. Araviiskaya ER, Sokolovsky EV., eds. Guide to Dermatocosmetology. Saint Petersburg: Foliant; 2008. (In Russ).
  15. Snarskaya ES, Kryazheva SS. Epigallokotechin-3-gallate (Egallohit) in the correction complex of postacne symptoms. Russian Journal of Skin and Venereal Diseases. 2010;13(6):46–50. (In Russ).
  16. Olisova OYu, Andreeva EV. Once more about hyperpigmentation. Russian Journal of Skin and Venereal Diseases. 2014;17(2):20–24. (In Russ).
  17. Tan JK, Tang J, Fung K, et al. Development and validation of a comprehensive acne severity scale. J Cutan Med Surg. 2007;11(6):211–216. doi: 10.2310/7750.2007.00037
  18. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162–169. doi: 10.4161/derm.1.3.9364
  19. Szabo K, Kemeny L. Studying the genetic predisposing factors in the pathogenesis of acne vulgaris. Human Immunol. 2011;72(9):766–773. doi: 10.1016/j.humimm.2011.05.012
  20. Lichtenberger R, Simpson MA, Smith C, et al. Genetic architecture of acne vulgaris. J Eur Acad Dermatol Venereol. 2017;31(12):1978–1990. doi: 10.1111/jdv.14385
  21. Golousenko IYu. Acne in women: etiological and pathogenetic mechanisms, diagnosis and treatment [dissertation abstract]. Moscow; 2014. (In Russ).
  22. Nast A, Dreno B, Bettoli V, et al.; European Dermatology Forum. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol. 2012;26(Suppl 1):1–29. doi: 10.1111/j.1468-3083.2011.04374.x
  23. Tolstaya AI. Combined method of treatment and rehabilitation of patients with papulopustular acne and atrophic post-acne scars [dissertation abstract]. Moscow; 2013. (In Russ).
  24. Perlamutrov YuN, Olkhovskaya KB, Lyapon AO. Acne therapy in adolescent children. Vestnik dermatologii i kosmetologii. 2018;94(6):60–66. (In Russ).
  25. Shavlovskaya OA. Therapy of asthenia and associated conditions with vitamin and mineral supplements. Medical Council. Russian Journal. 2015;(17):55–61. (In Russ). doi: 10.21518/2079-701X-2015-17-55-61
  26. Halvorsen JA, Stern RS, Dalgard F, et al. Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study. J Invest Dermatol. 2011;131(2):363–370. doi: 10.1038/jid.2010.264
  27. Tasoula E, Gregoriou S, Chalikias J, et al. The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece. Results of a population survey. An Bras Dermatol. 2012;87(6):862–869. doi: 10.1590/s0365-05962012000600007
  28. Schrom K, Nagy T, Mostow E. Depression screening using health questionnaires in patients receiving oral isotretinoin for acne vulgaris. J Am Acad Dermatol. 2016;75(1):237–239. doi: 10.1016/j.jaad.2016.02.1148
  29. Kang L, Liu J, An R, et al. Depression in patients with facial acne vulgaris and the influential factors. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2015;40(10):1115–1120. doi: 10.11817/j.issn.1672-7347.2015.10.010
  30. Zhiltsova EE, Ermoshina NP. Psychosomatic aspects quality life in patients with acne. The Russian Archives of Internal Medicine. 2016;6(S1):79–81. (In Russ).
  31. Muzychenko HP, Kachuk MV. Features psychosomatic patients with acneiform dermatoses. ARS MEDICA. 2014;25(1):67–72. (In Russ).
  32. Nguyen CM, Beroukhim K, Danesh MJ, et al. The psychosocial impact of acne, vitiligo, and psoriasis: a review. Clin Cosmet Investig Dermatol. 2016;9:383–392. doi: 10.2147/CCID.S76088
  33. Kungurov NV, Zilberberg NV, Tolstaya AI, Kokhan MM. Pathogenetic and clinical basis of the effectiveness of combination therapy in patients with acne and post-acne. Lechashiy vrach. 2013;(10):24–28. (In Russ).
  34. Eming SA, Martin P, Tomic-Canic M. Wound repair and regeneration: mechanisms, signaling, and translation. Sci Transl Med. 2014;6(265):265sr6. doi: 10.1126/scitranslmed.3009337
  35. Strong AL, Neumeister MW, Levi B. Stem cells and tissue engineering: regeneration of the skin and its contents. Clin Plast Surg. 2017;44(3):635–650. doi: 10.1016/j.cps.2017.02.020
  36. Suskova VS, Pinson IYa, Olisova OYu. Immunopathological mechanisms of psoriasis. Russian Journal of Clinical Dermatology and Venereology. 2006;4(1):68–70. (In Russ).
  37. Olisova OYu. Teplyuk NP, Pinegin VB. Modern methodes of psoriasis treatment. Russian Journal of Medicine. 2015;(9):483–486. (In Russ).
  38. Fabbrocini G, Annunziata MC, D’Arco V, et al. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010:893080. doi: 10.1155/2010/893080
  39. Portou MJ, Baker D, Abraham D, Tsui J. The innate immune system, toll-like receptors and dermal wound healing: A review. Vascul Pharmacol. 2015;71:31–36. doi: 10.1016/j.vph.2015.02.007
  40. Roupe KM, Nybo M, Sjobring U, et al. Injury is a major inducer of epidermal innate immune responses during wound healing. J Invest Dermatol. 2010;130(4):1167–1177. doi: 10.1038/jid.2009.284
  41. Huang C, Ogawa R. Pharmacological treatment for keloids. Exp Opin Pharmacother. 2013;14(15):2087–2100. doi: 10.1517/14656566.2013.826651
  42. Kruglova LS, Stenko AG, Shmatova AA. On the issue of correction of hypertrophic and keloid cicatricial deformities. Russian Journal of Clinical Dermatology and Venereology. 2012;15(6):46–54. (In Russ).
  43. Orekhova EM, Konchugova TV, Lukiyanova TV, et al. Application of the drug Longidaza 3000ME for diseases accompanied by pathology of connective tissue: a guide for doctors. Moscow; 2008. (In Russ).
  44. Stoddard MA, Herrmann J, Moy L, Moy R. Improvement of atrophic acne scars in skin of color using topical synthetic Epidermal Growth Factor (EGF) serum: a pilot study. J Drugs Dermatol. 2017;16(4):322–326.
  45. Wang HB, Fang Y, Yu WR. [Advancement in the research of fractional carbon dioxide laser in treating burn scars. (In Chinese)]. Zhonghua Shao Shang Za Zhi. 2012;28(6):465–467.
  46. Gafarov TYu, Enikeev DA, Idrisova LT, et al. Simulation of atrophic cicatricial skin defect in laboratory animals. Advances in current natural sciences. Russian Journal. 2013;(6):28–42. (In Russ).
  47. Techieva SG. Combined use of placenta extract phoresis and laser technology in the correction of atrophic scars [dissertation abstract]. Moscow; 2016. (In Russ).
  48. Fisenko GI. Correction of cicatricial changes in the skin of the face by the method of early repeated dermabrasion [dissertation abstract]. Moscow; 2005. (In Russ).
  49. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45(1):109–117. doi: 10.1067/mjd.2001.113451
  50. Goodman GJ, Baron JA. Postacne scarring – a quantitative global scarring grading system. J Cosmetic Dermatol. 2006;5(1):48–52. doi: 10.1111/j.1473-2165.2006.00222.x
  51. Dreno B, Tan J, Rivier M, et al. Adapalene 0.1%/benzoyl peroxide 2.5% gel reduces the risk of atrophic scar formation in moderate inflammatory acne: a split-face randomized controlled trial. J Eur Acad Dermatol Venereol. 2017;31(4):737–742. doi: 10.1111/jdv.14026
  52. Tolstaya AI. Post-acne scars: pathogenesis, types, methods of correction. Cosmetic International. 2011;(1):89–94. (In Russ).
  53. Kang S, Lozada VT, Bettoli V, et al. New atrophic acne scar classification: reliability of assessments based on size, shape, and number. J Drugs Dermatol. 2016;15(6):693–702.
  54. Fabbrocini G, De Vita V, Pastore F, et al. Collagen induction therapy for the treatment of upper lip wrinkles. J Dermatol Treat. 2012;23(2):144–152. doi: 10.3109/09546634.2010.544709
  55. Sobanko JF, Alster TS. Management of acne scarring, part I: a comparative review of laser surgical approaches. Am J Clin Dermatol. 2012;13(5):319–330. doi: 10.2165/11598910-000000000-00000
  56. Harth Y, Eiman M, Ackerman E, Frank I. Depressed acne scars – effective, minimal downtime treatment with a novel smooth motion non-insulated microneedle radiofrequency technology. J Cosmet Dermatol Sci Applic. 2014;4(3):212–218. doi: 10.4236/jcdsa.2014.43029
  57. Snarskaya ES, Korneva LV, Kryazheva SS. Combined therapy of cicatricial changes in the skin using enzymatic drugs. Russian Journal of Clinical Dermatology and Venereology. 2012;15(2):28–32. (In Russ).
  58. Flaks GA, Taganov VV, Gladko VV, et al. Comparative assessment of different treatments for keloid and hypertrophic scars. Experimental and Clinical Dermatocosmetology. Russian Journal. 2012;(3):43–46. (In Russ).
  59. Iriarte C, Awosika O, Rengifo-Pardo M, Ehrlich A. Review of applications of microneedling in dermatology. Clin Cosmet Investig Dermatol. 2017;10:289–298. doi: 10.2147/CCID.S142450
  60. Aust M, Walezko N. [Acne scars and striae distensae: Effective treatment with medical skin needling. (In German)]. Hautarzt. 2015;66(10):748–752. doi: 10.1007/s00105-015-3662-5
  61. Boen M, Jacob C. A review and update of treatment options using the acne scar classification system. Dermatol Surg. 2019;45(3):411–422. doi: 10.1097/DSS.0000000000001765
  62. Ibrahim MK, Ibrahim SM, Salem AM. Skin microneedling plus platelet-rich plasma versus skin microneedling alone in the treatment of atrophic post acne scars: a split face comparative study. J Dermatol Treat. 2017;29(3):281–286. doi: 10.1080/09546634.2017.1365111
  63. Yang D, Chen M, Sun Y, et al. Microneedle-mediated transdermal drug delivery for treating diverse skin diseases. Acta Biomat. 2020;121:119–133. doi: 10.1016/j.actbio.2020.12.004
  64. Villani A, Annunziata MC, Luciano MA, Fabbrocini G. Skin needling for the treatment of acne scarring: a comprehensive review. J Cosmet Dermatol. 2020;19(9):2174–2181. doi: 10.1111/jocd.13577
  65. Singh A, Yadav S. Microneedling: Advances and widening horizons. Indian Dermatol Online J. 2016;7(4):244–254. doi: 10.4103/2229-5178.185468
  66. Park JY, Lee EG, Yoon MS, Lee HJ. The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin. J Cosmet Dermatol. 2015;15(2):102–107. doi: 10.1111/jocd.12195
  67. Alessa D, Bloom JD. Microneedling options for skin rejuvenation, including non-temperature-controlled fractional microneedle radiofrequency treatments. Facial Plast Surg Clin North Am. 2020;28(1):1–7. doi: 10.1016/j.fsc.2019.09.001
  68. Pathania V, Oberoi B, Bhatt S, Shankar P. Sindle-handed vampire facial: combining microneedling with platelet-rich plasma for single-hand use. J Am Acad Dermatol. 2021;84(2):e77–78. doi: 10.1016/j.jaad.2019.08.013
  69. Alster TS, Graham PM. Microneedling: a review and practical guide. Dermatol Surg. 2018;44(3):397–404. doi: 10.1097/DSS.0000000000001248
  70. Taub AF. The treatment of acne scars, a 30-year journey. Am J Clin Dermatol. 2019;20(5):683–690. doi: 10.1007/s40257-019-00451-9
  71. Bhargava S, Cunha PR, Lee J, Kroumpouzos G. Acne scarring management: systematic review and evaluation of the evidence. Am J Clin Dermatol. 2018;19(4):459–477. doi: 10.1007/s40257-018-0358-5
  72. Alster TS, Li MK. Microneedling of scars: a large prospective study with long-term follow-up. Plast Reconstr Surg. 2020;145(2):358–364. doi: 10.1097/PRS.0000000000006462
  73. Olisova OYu, Vladimirova EV, Babushkin AM. The skin and the sun. Russian Journal of Skin and Venereal Diseases. 2012;15(6):57–62. (In Russ).
  74. Al Qarqaz F, Al-Yousef A. Skin microneedling for acne scars associated with pigmentation in patients with dark skin. J Cosmet Dermatol. 2018;17(3):390–395. doi: 10.1111/jocd.12520
  75. Dogra S, Yadav S, Sarangal R. Microneedling for acne scars in Asian skin type: an effective low cost treatment modality. J Cosmet Dermatol. 2014;13(3):180–187. doi: 10.1111/jocd.12095
  76. Moftah NH, El Khayyat MA, Ragai MH, Alaa H. Carboxytherapy versus skin microneedling in treatment of atrophic postacne scars: a comparative clinical, histopathological, and histometrical study. Dermatol Surg. 2018;44(10):1332–1341. doi: 10.1097/DSS.0000000000001560
  77. Minh PP, Bich DD, Hai Van NT, et al. Microneedling therapy for atrophic acne scar: effectiveness and safety in Vietnamese patients. Open Access Maced J Med Sci. 2019;7(2):293–297. doi: 10.3889/oamjms.2019.098
  78. Bandral MR, Padgavankar PH, Japatti SR, et al. Clinical evaluation of microneedling therapy in the management of facial scar: a prospective randomized study. J Maxillofac Oral Surg. 2019;18(4):572–578. doi: 10.1007/s12663-018-1155-7
  79. Konicke K, Knabel M, Olasz E. Microneedling in dermatology: a review. Plast Surg Nurs. 2017;37(3):112–115. doi: 10.1097/PSN.0000000000000197
  80. Kontochristopoulos G, Platsidaki E. Chemical peels in active acne and acne scars. Clin Dermatol. 2017;35(2):179–182. doi: 10.1016/j.clindermatol.2016.10.011
  81. Rana S, Mendiratta V, Chander R. Efficacy of microneedling with 70% glycolic acid peel vs microneedling alone in treatment of atrophic acne scars-A randomized controlled trial. J Cosmet Dermatol. 2017;16(4):454–459. doi: 10.1111/jocd.12377
  82. Sharad J. Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. J Cosmet Dermatol. 2011;10(4):317–323. doi: 10.1111/j.1473-2165.2011.00583.x
  83. Saadawi AN, Esawy AM, Kandeel AH, El-Sayed W. Microneedling by dermapen and glycolic acid peel for the treatment of acne scars: Comparative study. J Cosmet Dermatol. 2019;18(1):107–114. doi: 10.1111/jocd.12827
  84. Ali B, ElMahdy N, Elfar NN. Microneedling (Dermapen) and Jessner’s solution peeling in treatment of atrophic acne scars: a comparative randomized clinical study. J Cosmet Laser Ther. 2019;21(6):357–363. doi: 10.1080/14764172.2019.1661490
  85. Hashim PW, Levy Z, Cohen JL, Goldenberg G. Microneedling therapy with and without platelet-rich plasma. Cutis. 2017;99(4):239–242.
  86. Chang HC, Sung CW, Lin MH. Combination therapy with microneedling and platelet-rich plasma for acne scarring: a systematic review and meta-analysis. Dermatol Surg. 2020;46(8):1118–1122. doi: 10.1097/DSS.0000000000002033
  87. Schoenberg E, O’Connor M, Wang JV, et al. Microneedling and PRP for acne scars: A new tool in our arsenal. J Cosmet Dermatol. 2020;19(1):112–114. doi: 10.1111/jocd.12988
  88. Amer A, Elhariry S, Al-Balat W. Combined autologous platelet-rich plasma with microneedling versus microneedling with non-cross-linked hyaluronic acid in the treatment of atrophic acne scars: Split-face study. Dermatol Ther. 2021;34(1):e14457. doi: 10.1111/dth.14457
  89. El-Domyati M, Abdel-Wahab H, Hossam A. Microneedling combined with platelet-rich plasma or trichloroacetic acid peeling for management of acne scarring: A split-face clinical and histologic comparison. J Cosmet Dermatol. 2017;17(1):73–83. doi: 10.1111/jocd.12459
  90. El-Domyati M, Moftah NH, Nasif GA, et al. Amniotic fluid-derived mesenchymal stem cell products combined with microneedling for acne scars: A split-face clinical, histological, and histometric study. J Cosmet Dermatol. 2019. doi: 10.1111/jocd.13039
  91. Bhargava S, Kumar U, Varma K. Subcision and microneedling as an inexpensive and safe combination to treat atrophic acne scars in dark skin: a prospective study of 45 patients at a Tertiary Care Center. J Clin Aesthet Dermatol. 2019;12(8):18–22.
  92. Rullan PP, Olson R, Lee KC. A combination approach to treating acne scars in all skin types: carbolic chemical reconstruction of skin scars, blunt Bi-level cannula subcision, and microneedling: a case series. J Clin Aesthet Dermatol. 2020;13(5):19–23.
  93. Biesman BS, Cohen JL, DiBernardo BE, et al. Treatment of atrophic facial acne scars with microneedling followed by polymethylmethacrylate-collagen gel dermal filler. Dermatol Surg. 2019;45(12):1570–1579. doi: 10.1097/DSS.0000000000001872
  94. Von Dalwig-Nolda DF, Ablon G. Safety and effectiveness of an automated microneedling device in improving acne scarring. J Clin Aesthet Dermatol. 2020;13(8):17–22.
  95. Keiran N, Ceperuelo-Mallafre V, Calvo E, et al. SUCNR1 controls an anti-inflammatory program in macrophages to regulate the metabolic response to obesity. Nat Immunol. 2019;20(5):581–592. doi: 10.1038/s41590-019-0372-7
  96. Van Diepen JA, Robben JH, Hooiveld GJ, et al. SUCNR1-mediated chemotaxis of macrophages aggravates obesity-induced inflammation and diabetes. Diabetologia. 2017;60(7):1304–1313. doi: 10.1007/s00125-017-4261-z
  97. Mills EL, Kelly B, Logan A, et al. Succinate dehydrogenase supports metabolic repurposing of mitochondria to drive inflammatory macrophages. Cell. 2016;167(2):457–470. doi: 10.1016/j.cell.2016.08.064
  98. Maharjan AS, Pilling D, Gomer RH. High and low molecular weight hyaluronic acid differentially regulate human fibrocyte differentiation. PloS One. 2011;6(10):e26078. doi: 10.1371/journal.pone.0026078
  99. Golub NYu, Panova OS, Gurochkina LP, Sanches EA. Application of the new generation injection preparation HYALUAL as an effective redermalizing agent in cosmetology practice. Injection Methods in Cosmetology. Russian Journal. 2014;(4):160–163. (In Russ). 100. Trong HN, Phuong T, Van TN, et al. The efficacy and safety of hyaluronic acid Microinjection for skin Rejuvenation in Vietnam. Open Access Macedon J Med Sci. 2019;7(2):234–236. doi: 10.3889/oamjms.2019.059

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