Topical scar management: Current approaches
Inflammatory acne often leads to facial scarring, impairing quality of life, according to Dr. Jerry Tan (1,100 words, reading time: 6 mins)
Best dermatologic practices for patients of colour: Facial scars have a strong negative impact on the quality of life and can be frequent after inflammatory acne, noted Dr. Jerry Tan in a presentation at the Skin Spectrum Summit conference on ethnodermatology and skin of colour in Toronto.
He said there is a growing range of treatments, including topical approaches, for not only reducing the appearance of scars but also helping to prevent their formation.
For atrophic scars, one treatment that has been investigated in a study of patients with acne scars but no active acne is adapalene 0.3% gel.
“The vast majority of patients had moderate or greater improvement in terms of overall scar severity,” said Dr. Tan of that study. “What we saw is that the patients also had increased deposition of collagen and pro-collagen, which is what we expect if this product is going to be able to enhance repair.”
For hypertrophic scars, which are more common in reactive, darker skin, there are more options.
Treatments for hypertrophic scars that have already formed include silicone sheets and sometimes intralesional triamcinolone acetonide injections, said Dr. Tan. “And there are a lot of other options now, including some of the vascular lasers.”
However, when a lesion is progressing from macular erythema into the beginnings of hypertrophy, only a few options are available for which there is level 1 or 2 scientific evidence, he said.
These include silicone sheets and onion extract, the latter of which has been shown to produce good results on surgical scars.
Another new option is a topical formulation of putrescine. It has been studied in all sorts of hypertrophic scars in a cosmetic surgery clinic, as well as in the prevention of hypertrophic scars post-breast reduction, said Dr. Tan.
“This product reduces the activation of tissue transglutaminase, an enzyme that enhances cross-linking of collagen,” he said. Excess cross-linking of collagen can make the tissue very hard, forming a lump, hypertrophic scar or keloid which is undesirable.
“You want the soft [collagen] that helps to elevate and gives you tissue structure, but you do not want excessive cross-linking. And this agent seems to help with that.”
Crucial to preventing acne scars is getting inflammation under control quickly, Dr. Tan said. “In acne, the analogy is that of a forest fire: as long as the fire is burning, you are going to get stumps in the forest. So put out the fire quickly.”
The takeaway: It is also valuable to think about the nature of an individual patient’s scar risk. If it is mostly atrophic, there is evidence for topical retinoids. If there is concern about hypertrophic scars and the patient already has some, still has active acne and is receiving surgery on areas at high risk of hypertrophic scars — particularly a patient of colour — “then you may want to consider some of these topical options to help mitigate [the] risk of scar formation.”
Now test your knowledge retention of Dr. Tan’s key points. To take the 60-second snap quiz, click on the image below:
COLOURS OF BEAUTY
A research letter published in JAMA Dermatology (Oct. 2017) analyzed People magazine's “World's Most Beautiful” list to compare standards of beauty in 1990 with the present day. Dr. Neelam A. Vashi of the Boston University School of Medicine and coauthors compared 50 celebrities from the 1990 list with 135 celebrities from the 2017 list. Researchers extracted information from the list for age, sex, race, skin type, hair colour, eye colour and any visible dermatologic conditions.
The authors reported:
In 1990, lighter skin (Fitzpatrick skin types 1 to 3) represented 88 per cent and darker skin (Fitzpatrick skin types 4 to 6) represented 12 per cent of the list. In 2017, lighter skin types represented 70.4 percent and darker skin types 29.6 percent of the list.
FROM THE LITERATURE ON ACNE SCARRING
Treatment of atrophic acne scarring with fractional micro-plasma radio-frequency in Chinese patients: A prospective study
Although a variety of approaches can be used to treat atrophic acne scars, disadvantages such as long-healing time, dyspigmentation, infections, and prolonged erythema make these treatments unsatisfactory, especially for Asians. Dr. Ting Lan and colleagues evaluate the clinical effectiveness and safety of micro-plasma radio-frequency for the treatment of facial acne scars in Chinese patients.
Interventions for acne scars
A review of Cochrane and other databases conducted by Dr. Rania Abdel Hay and colleagues at Cairo University aimed to examine treatments for atrophic and hypertrophic acne scars, concentrating on facial atrophic scarring.
Efficacy of micro-needling on post-acne scars
Micro-needling is showing promising results in the treatment of acne scars due to collagen induction. A study conducted by Dr. Farrukh Farhan Afzal and colleagues at Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore, Pakistan assesses efficacy and safety of micro-needling on acne scars.
AT THE INTERSECTION OF SKIN & SOCIETY
João Stanganelli Junior (pictured below) is a 64-year-old Brazilian grandfather with a lifelong case of vitiligo. To help children who also have the pigmentation disorder, Mr. Stanganelli has acquired the hobby of knitting dolls that display symptoms of vitiligo. Read his story here.
THIS WEEK
Wednesday, Aug. 12 is United Nations International Youth Day
August is Gastroparesis Awareness Month
Thursday, Aug. 13 was the date of the now-postponedWorld Association of Medical Law annual conference in Toronto
Friday, Aug. 14 the University of Toronto medical faculty is conducting a grant-writing workshop
Something to think about during the week ahead:
NEXT WEEK
A report on a presentation by Dr. Sunil Kalia of Vancouver on sun protection. Subscribe to Skin Spectrum Weekly and have each issue sent directly to your phone or inbox.
Don’t forget to register now for the Skin Spectrum Summit 2020 Webinar Series, beginning October 1, 2020. Sign up here.