Written by Joyce Smith, BS. The combination of needling and subcision was associated with improvement in grade 4 atrophic (indented) acne scars of participants with acne vulgaris.
More than 90 % of adolescents and 12-14% of adults have acne vulgaris, a long-term skin disease that occurs when dead skin cells and oil from the skin clog hair follicles to form blackheads, whiteheads, or pimples which can lead to scarring and even psychological and social problems 1,2. The different methods for acne scar treatment include resurfacing, lifting and volumization, tightening, or surgical removal and movement of tissue that is required to correct the scarring. The various procedures employed include microdermabrasion, chemical peels, percutaneous collagen induction (PCI) by microneedling and dermabrasion, soft-tissue augmentation, various ablative and nonablative lasers, and light energies 3. Combination therapies are often more effective than solo treatments 4 and should be tailored according to the patient’s needs, tolerance, and goals, while also considering the physician’s assessment, skills, and expectations.
PCI therapy is a combination of microneedling (using fine needles to prick the skin) and dermabrasion (rolling a preformed tool backward and forward with some pressure in various directions on the cutaneous and percutaneous areas affected by the acne scars). The theory is that the newly formed collagen and elastin in the dermis will help smooth out the skin’s appearance and fill in fine lines, wrinkles, and scars 5. Subcision is another technique in which a needle is inserted percutaneously adjacent to the scar to manipulate and release fibrous tissue, which pulls the scar down 6. During this process, bleeding is essential to clot formation and filling the created space, which allows for skin elevation secondary to detachment from the scar tissue underneath 7. The resulting synergistic effect on atrophic scars common in acne is both highly efficacious and inexpensive.
A total of 45 patients with atrophic acne scars were enrolled in a prospective study 8 in a tertiary-care teaching hospital from October 2016 to October 2017. They underwent four sessions, four weeks apart, of subcision and microneedling and three months after the final treatment session, scars were assessed and graded.
Before treatment, 64% of patients had Grade 4 scars, 27% had Grade 3 scars, and 9% had Grade 2 scars. However, at three months after the final treatment all grades of scars had improved. The proportion of patients with Grade 4 scars was reduced to zero (Z=3.88; p<0.001); patients with Grade 3 scars had increased from 27 to 47% (Z=1.58; p=0.06); patients with Grade 2 scars had increased from 9 to 42% (Z=3.12; p<0.001); patients with Grade 1 scars had increased from 0 to 11% (Z=2.75; p=0.02) reflecting a significant improvement in all participants. The rolling and boxcar scar types showed good response to treatment, while less improvement was observed for icepick scars.
As the demand for less-invasive, highly effective cosmetic procedures for acne scarring increases, the present combination of treatment for acne scars was effective not only in Grade 2 but also in the more severe Grades 4 and 3. Rolling scars with their sloping edges and wavy uneven appearance and boxcar scars with sharp edges that move straight down into the skin (and are not always the same size as the original acne) showed more improvement when compared to the deep and narrow icepick scars. This combination treatment was well-tolerated in Fitzpatrick Skin Types III (darker white skin), IV (light brown skin), and V (dark brown skin) with no failure rates. Among the participants, researchers found a high level of patient satisfaction with minimal downtime. Future long-term studies are warranted.
Source: Bhargava, Shashank, Ujjwal Kumar, and Krishnendra Varma. “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.” The Journal of clinical and aesthetic dermatology 12, no. 8 (2019): 18.
Posted March 10, 2020.
Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.
References:
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- Williams C, Layton AM. Persistent acne in women : implications for the patient and for therapy. Am J Clin Dermatol. 2006;7(5):281-290.
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- 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.
- Aust MC, Fernandes D, Kolokythas P, Kaplan HM, Vogt PM. Percutaneous collagen induction therapy: an alternative treatment for scars, wrinkles, and skin laxity. Plastic and reconstructive surgery. 2008;121(4):1421-1429.
- Orentreich DS, Orentreich N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 1995;21(6):543-549.
- Nilforoushzadeh M, Lotfi E, Nickkholgh E, Salehi B, Shokrani M. Can Subcision with the Cannula be an Acceptable Alternative Method in Treatment of Acne Scars? Medical archives (Sarajevo, Bosnia and Herzegovina). 2015;69(6):384-386.
- 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. The Journal of clinical and aesthetic dermatology. 2019;12(8):18-22.
