Evaluation of the effect of Dermaroller combined with Jessner’s peel on different types of atrophic post acne scars

Abstract

Acne vulgaris is a disease of the pilosebaceous unit characterized by the formation of open and closed comedones, papules, pustules, nodules and cysts. It is the most common disorder treated by dermatologists. The psychological impact of acne from inflammatory eruptions to post inflammatory acne scars may be devastating. Acne scarring is associated with considerable psychological distress, mainly in adolescents associated with poor self-esteem, depression, anxiety, body image alterations, embarrassment, low academic performance, and unemployment. Many systems were established for classification, grading and scaling of acne scars. Jacob et al (2001), proposed a widely accepted classification system, where acne scars were divided into: icepick scars, rolling scars and boxcar scars. Treatment of acne scars presents a challenge for a treating physician. Usually they cannot be effectively corrected by a single treatment modality because of their widely varied depth, width and structure. The problem of acne scarring cannot be solved by a single best treatment. It has been seen that a combination of various modalities gives better results than using a single method of treatment of atrophic post acne scars. Many therapeutic modalities have been developed to attempt cosmetic correction of acne scarring, including ablative laser resurfacing, chemical peeling, dermabrasion, punch techniques, subcuticular incision (subcision), microneedling, injection of dermal fillers, and most recently fractional photothermolysis. Microneedling also known as percutaneous collagen induction is a simple procedure for the treatment of atrophic acne scars. Percutaneous collagen induction with dermaroller 1.5mm needles was used for treatment of atrophic post acne scars in 15 patients. All patients were females, aging from 15-35 years, Fitzpatrick skin phototype (II-IV). They all had 4 treatment sessions, 3-weeks interval. Dermaroller was rolled onto the skin with mild pressure at the same intensity. This was done vertically, horizontally and diagonally till the presence of uniform bleeding points over the scarred area. Peeling with Jessner’s solution was then applied using cotton pad for 1-2 coats until frosting appeared which was the endpoint for the treatment session. The treatment was performed under local anesthesia with sterile aseptic technique. The overall success of our study was defined according to clinical improvement of post acne scars subjectively by patients’ satisfaction score which showed that 10 patients (67%) rated their improvement as excellent. Objective assessment was also done by Goodman and Baron’s (2006), quantitative global acne scarring grading system, which showed that the total mean percent of improvement was 47.19%. The improvement was more prominent in rolling (66.32%), and boxcar scars (52.71%), than icepick scars that showed the least improvement (33.68%). All skin phototypes involved in the study showed improvement with maximal percent for skin phototype II (31.8%), followed by type III (29.3%), then type IV (24.5%). However the difference was not statistically significant. No pigmentary changes nor post treatment complications were found other than mild transient pain and erythema. Histopathological evaluation by the image analyzer was also done, in which skin biopsies were performed before treatment, and 4 weeks after the last treatment session. All specimens were stained with H&E, Masson trichrome, and Orcein stains to assess the epidermal thickness, collagen, and elastic fibers remodeling respectively. There was 28% increase in the epidermal thickness. The dermis showed increased thickness with increase in the number and density of collagen fibers. Masson’s trichrome stain for collagen revealed increase in collagen fiber content, number, and density in the papillary dermis. Collagen fibers appeared arranged as thick wavy branching bundles. Orcein stain for elastic fibers revealed increase in the elastic fibers content in the papillary dermis as well.