Microneedling, fractional CO2 laser comparable for acne scars
Today's report also covers gastrointestinal comorbidity risks, pediatric acne, inflammatory acne, and more (1,600 words, 6 minutes, 50 seconds)
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Good morning, and welcome to the twelfth issue of Focus on Acne, presented by Skin Spectrum Weekly. This series provides up-to-date information on developing therapies and trends in acne treatment. We appreciate your feedback and suggestions and invite you to be in touch. Please write to us at health@chronicle.org
Microneedling, fractional CO2 laser comparable for acne scars
Both microneedling and fractional CO2 laser treatments improve the overall appearance of atrophic post-acne scars in patients with skin of colour. The latter is the more effective of the two treatments but results in a slightly longer healing time and greater post-procedure hyperpigmentation.
These findings come from a paper published in the Indian Dermatology Online Journal (Oct. 28, 2024; 15(6):942-948)
For this study, investigators included 30 patients, aged 20 to 40 years, with facial post-acne atrophic scars with the same Goodman and Baron (GB) grade on both sides of the face. After priming skin, the researchers performed four monthly sessions of fractional CO2 laser on the right side of patients’ faces and microneedling on the left side, with two months follow-up.
GB (3.53 to 2.37) grade and patient's subjective score (8.63 to 4.37) showed 32.9% and 49.4% improvement over the fractional CO2 laser side and 9.3% (3.53 to 3.20) and 19.7% (8.63 to 6.93) improvement over the microneedling side, respectively. The difference between the two modalities was statistically significant. Rolling (42.90% vs. 16.18%) and boxcar scars (36.18% vs. 3.74%) also showed more improvement with fractional CO2 laser. Ice-pick scars responded the least with both modalities. Scars present for less than 10 years responded better to both modalities with sustained improvement during the study. However, postinflammatory hyperpigmentation (30% vs. 6.67%) was greater with fractional CO2 laser, particularly in darker Fitzpatrick skin types.
Higher gastrointestinal comorbidity risk in acne
Findings from a new study suggest patients with acne vulgaris have higher risks of gastrointestinal comorbidities. The study authors suggest gastroenterology specialty consultation may be warranted for patients with moderate-to-severe acne.
Published in JAAD International (Sept. 27, 2024; 18:62-68), this case-control study used data from the Taiwan National Health Insurance Research Database from 1997 to 2013. Researchers stratified 185,491 patients with acne vulgaris and a control group by age and examined the association of gastrointestinal comorbidities across different ages, sex, and antibiotic use.
The largest proportion of individuals with acne vulgaris was adolescents, followed by adult-onset groups, with a female predominance observed across all age subgroups.
Investigators found patients with acne vulgaris exhibited a significantly elevated risk of developing gastrointestinal comorbidities, including peptic ulcers, irritable bowel syndrome, gastroenteritis, gastroesophageal reflux disease, and constipation. This increased risk was particularly notable in patients aged 12 years and older and those with moderate-to-severe acne.
The authors note that potential miscoding and misclassification in the database represent a limitation of the study.
Clindamycin phosphate/adapalene/benzoyl peroxide combo effective in pediatric acne
Pooled data from two phase 3 studies of once-daily treatment with topical clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel in pediatric acne show that more than half of participants achieved treatment success at week 12.
The findings were published in the Journal of Drugs in Dermatology (Dec. 1, 2024; 23(12):1049-1057).
For the study, researchers randomized participants nine years and older with moderate-to-severe acne (2:1) to once-daily CAB or vehicle gel. Endpoints included treatment success—at least a two-grade reduction from baseline in Evaluator's Global Severity Score and clear or almost clear skin—and least-squares mean percent change from baseline in inflammatory/non-inflammatory lesions. The investigators also evaluated any treatment-emergent adverse events (TEAEs) and cutaneous safety and tolerability. They conducted post hoc analyses in adolescents aged 12 to 17 years (CAB, n=123; vehicle, n=50) with descriptive data shown for children aged 10 to 11 (CAB, n=3; vehicle, n=2).
At week 12, 51.5% of CAB-treated adolescents achieved treatment success vs 24.9% with vehicle (p<0.01). CAB also provided inflammatory/non-inflammatory lesion reductions of 78.3%/73.7% vs 50.5%/42.9% with vehicle (p<0.001 for both). Most TEAEs were mild-to-moderate, and <2.5% of participants discontinued due to adverse events. Only the three children treated with CAB achieved treatment success, with lesion reductions ranging from 76% to 100%. One CAB-treated child experienced TEAEs, and none discontinued.
10% ALA-PDT effective in inflammatory acne
Treatment with 10% 5-aminolevulinic acid-(ALA) photodynamic therapy (PDT) is effective for acne vulgaris, though it is only more effective than red light therapy for inflammatory lesions. Increasing the ALA concentration also does not result in more significant reductions in acne lesions.
These findings come from a paper published in Annals of Dermatology (Dec. 2024; 36(6):329-340).
In a randomized, double-blind, split-face clinical trial, researchers recruited 25 patients with moderate to severe acne (Leeds grades 2-4). They randomly assigned the patients to two groups with different ALA concentrations applied on one cheek while a placebo was applied on the other. After a 1.5-hour incubation, illumination with 633 nm red light from a Light Emitting Diode (LED) lamp (96 J/cm2) was performed in three sessions with 7 to 10 day intervals. Investigators assessed treatment effectiveness by the lesion reduction rate based on lesion counts before the study, after each session, and at four and eight weeks after the last session.
The researchers found both 15% and 10% ALA-PDT treatments demonstrated significant reductions in inflammatory acne lesion counts compared to the placebo: 10% ALA-PDT showed a reduction of 27.36% versus 12.64% for the placebo (p=0.04), while 15% ALA-PDT showed a decrease of 40.45% compared to 13.41% (p<0.01). However, there was no significant difference between ALA-PDT and placebo in treating non-inflammatory lesions. Additionally, there was no difference between the effectiveness of 10% and 15% ALA in reducing any type of acne lesions.
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