Background Noninvasive technologies for treating acne scars use radiofrequency (RF)-emitting microneedles for both mechanical disruption of fibrotic strands and heat-mediated collagen remodeling. Objective Efficacy and safety evaluation of electronically controlled noninsulated RF microneedling system on acne scars in patients with dark skin. Methods Nineteen patients, 24 to 51 years old, skin types III to V, with acne scars were enrolled in the study. Each patient had 3 treatment sessions at monthly intervals using a multisource RF treatment platform with a microneedle RF applicator. Efficacy was evaluated by the Goodman and Barron's Global Qualitative Acne Scarring System. Results No bleeding points occurred during treatments. Post-treatment erythema was observed immediately after the treatment and lasted up to 10 hours after the treatment. Improvement of at least 1 acne scar grade was noted in 11 of 19 patients (57.9%) after 1 month and in 9 of 9 patients (100%) after 3 months. Conclusion The tested noninsulated electronically controlled RF microneedles were found to be safe and efficient in the treatment of atrophic acne scars in skin types III to V with minimal pain or downtime.

Treatment of Acne Scars on Darker Skin Types Using a Noninsulated Smooth Motion, Electronically Controlled Radiofrequency Microneedles Treatment System.

Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including acne scar, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. Moreover, during the last 10 years, many new innovations have been made to the initial instrument, which was used for microneedling. This technique can be combined with other surgical techniques to provide better results. In particular, it is a very safe technique for dark skin types, where risk of postinflammatory pigmentation is very high with other techniques that damage the epidermis. In this review article, we are updating on the different instruments now available for this procedure, and its efficacy when performed alone or in combination with other techniques for various indications.

Microneedling: Advances and widening horizons.

BACKGROUNDMicroneedling is a minimally invasive procedure that uses fine needles to puncture the epidermis. The microwounds created stimulate the release of growth factors and induce collagen production. The epidermis remains relatively intact, therefore helping to limit adverse events. The indicati

Microneedling: A Comprehensive Review.

Summary Background Patients who suffer from scars or wrinkles have several therapeutic options to improve the appearance of their skin. The available treatment modalities that provide desirable results are often overtly invasive and entail a risk of undesirable adverse effects. Microneedling has recently emerged as a non-ablative alternative for treating patients who are concerned with the aesthetic changes that result from injury, disease or ageing. Objective This review aims to evaluate the current evidence in the literature on microneedling. Methods A systematic literature review was performed by searching the electronic databases PubMed and Google Scholar. The reviewed articles were analysed and compared on study design, treatment protocol, outcome parameters, efficacy measurement and results to evaluate the strength of the current evidence. Results Microneedling was investigated in experimental settings for its effects on atrophic acne scars, skin rejuvenation, hypertrophic scars, keloids, striae distensae, androgenetic alopecia, melasma and acne vulgaris. Several clinical trials used randomisation and single-blindation to strengthen the validity of the study outcome. Microneedling showed noteworthy results when used on its own and when combined with topical products or radiofrequency. When compared with other treatments, it showed similar results but was preferred due to minimal side effects and shorter downtime. Conclusion This systematic review positions microneedling as a safe and effective therapeutic option for the treatment of scars and wrinkles. The current literature does show some methodological shortcomings, and further research is required to truly establish microneedling as an evidence-based therapeutic option for treating scars, wrinkles and other skin conditions.

Microneedling: Where do we stand now? A systematic review of the literature.

In ethnic skin, traditional skin resurfacing procedures such as dermabrasion, chemical peels, and laser therapy can be effective but can also be associated with prolonged recovery and risk of complications. These complications can include a higher risk of dyspigmentation and scarring, and unsatisfactory clinical outcomes. Microneedling is an evolving treatment technique for an expanding number of dermatologic conditions. Microneedling may offer a more advantageous safety profile, particularly in the skin-of-color population (Fitzpatrick skin types IV-VI), compared with more conventional resurfacing modalities. Thus far, it has been shown to be effective for a number of dermatologic conditions in this population, including scarring, melasma, melanosis, skin rejuvenation, acne vulgaris, and primary hyperhidrosis. This article aims to provide a comprehensive review of the literature regarding the efficacy and safety of microneedling in skin of color.

Microneedling in skin of color: A review of uses and efficacy

SummaryBackground
Microneedle fractional radiofrequency has been reported to be effective for improving wrinkles, enlarged pores and various scars. Sublative fractional radiofrequency has been shown to induce both fractional ablation of epidermis and upper dermal remodelling, which had rejuvenation effects in photoaged skin. Both modalities may have the potential synergy to improve acne scars.

Objective
To evaluate the efficacy and safety of combined microneedle and sublative fractional radiofrequency for acne scars in Asian skin.

Methods
Twenty subjects comprised 11 males and 9 females (mean age 23.65 ± 2.94, skin phototype III–IV) with moderate to severe acne scars. The subjects received three consecutive combined microneedle and sublative fractional radiofrequency at 4-week intervals over 12 weeks. Both blinded dermatologists and subjects assessed the clinical improvement based on the standardized photography and questionnaires, respectively. The quartile grading scale was utilized and defined as follows: grade 1, 0–25% improvement; grade 2, 26–50% improvement; grade 3, 51–75% improvement and grade 4, 76–100% improvement.

Results
All 20 subjects were assessed to have grade 2 or more clinical improvement by physicians; four (20%) had grade 4, 10 (50%) had grade 3, and six (30%) had grade 2 improvement. The subjects' grading also showed a good concordance as indicated by Kappa index of 0.695. The mean duration of post-therapy crusting was 5.2 days and post-therapy erythema lasted 2.5 days.

Conclusion
Combined microneedle and sublative fractional radiofrequency can have a positive therapeutic effect with no serious complications and may provide a new therapeutic approach on acne scars in Asians.

The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin

Background and Objective

A minimally invasive fractional radiofrequency microneedle (FRM) device has been used in skin rejuvenation and acne scars, and a recent pilot study demonstrated the positive therapeutic effect on acne. We evaluated the efficacy of FRM device for acne vulgaris in Asians and conducted objective measurement to assess its effect on sebum production.



Patients and Methods

Twenty Korean patients with acne vulgaris received a single full-face FRM treatment. Outcome assessments included standardized photography, physician's global assessment, patient's satisfaction scores, acne lesion count, and objective measurements of casual sebum level (CSL) and sebum excretion rate (SER). They were evaluated at baseline and 2, 4, 8 weeks after the treatment.



Results

After a single FRM treatment, the CSL and the SER showed 30–60% and 70–80% reduction, respectively, at week 2 (P < 0.01), and remained below the baseline level until week 8. Physician's global improvement scores for acne severity and acne lesion count also revealed clinical improvement with maximum efficacy at week 2, but returned to the baseline in most patients by week 8. Patients' satisfaction scores (0–4) were above 2 on average, and adverse effects were minimal.



Conclusion

This prospective study demonstrated the sebosuppressive effect from a single FRM treatment, but its therapeutic efficacy in acne requires further evaluation. Lasers Surg. Med. 45:639–647, 2013. © 2013 Wiley Periodicals, Inc.

Assessment of treatment efficacy and sebosuppressive effect of fractional radiofrequency microneedle on acne vulgaris

A minimally invasive fractional radiofrequency microneedle (FRM) device has been used in skin rejuvenation and acne scars, and a recent pilot study demonstrated the positive therapeutic effect on acne. We evaluated the efficacy of FRM device for acne vulgaris in Asians and conducted objective measurement to assess its effect on sebum production.

Assessment of Treatment Efficacy and Sebosuppressive Effect of Fractional Radiofrequency Microneedle on

Postherpetic neuralgia (PHN) is a sequela of herpes zoster that adversely affects quality of life seriously. The risk factors for PHN are well known but the effective interventions that reduce the incidence of PHN are less studied. The objective of this study is to evaluate the efficacy of treatment with gabapentin in patients with acute herpes zoster for preventing PHN. We performed a prospective randomized controlled study of 120 participants diagnosed with acute herpes zoster, aged 50 and over and complaining moderate to severe pain. All patients were treated with valacyclovir and acetaminophen. Half of the participants were assigned to the gabapentin group and received gabapentin 300 mg three times a day additionally. The intensity of pain at every visit and the incidence of PHN in both groups were measured. Total 52 and 49 patients in the gabapentin group and the control group, respectively, had completed 12 weeks of follow-up period. Although the incidence of PHN was higher in the control group, the difference was not statistically significant (6.1% vs. 3.8%, p = 0.67). Our results indicate that the use of low-dose gabapentin in acute herpes zoster seems not effective in the prevention of PHN.

Efficacy of low dose gabapentin in acute herpes zoster for preventing postherpetic neuralgia: a prospective controlled study.

Dear Editor, Congenital leukemia comprises less than 1% of childhood leukemia and skin infiltration by leukemic cells (known as “leukemia cutis”) only occasionally precedes systemic leukemia (so-called “aleukemic leukemia cutis”). We report a case of congenital aleukemic leukemia cutis, in which the follow-up bone marrow specimen confirmed acute myeloid leukemia (AML) with t(9;11)(p22;q23); MLL-MLLT3 6 months later. A 19-day-old male infant presented with asymptomatic cutaneous lesions which were noticed at birth. The patient was delivered by cesarean section at 38 weeks of gestation without any remarkable perinatal events. On examination, five violaceous nodules were noticed on his face and trunk (Fig.1a). His general status was good and other physical findings were normal. Skin biopsy specimen showed a dense infiltrate of atypical cells which diffusely extended from the reticular dermis to subcutaneous fatty tissue, sparing the epidermis (Fig.1b,c). These cells stained positively for CD68 and CD99 (MIC2), and showed a high proliferative index for Ki-67, but were negative for myeloperoxidase, S-100, CD1a, CD3, CD20, CD34, CD56 and CD117 (Fig.1d,e). Cutaneous lesions were interpreted as skin involvement of monocytic subtype of AML. Laboratory tests, including complete blood cell count (CBC) with differential count, peripheral blood smear and serum chemistry revealed no abnormality except for lower-thannormal level of serum 25-hydroxyvitamin D (<4.0 ng/mL). Chest X-ray, abdominal computed tomography scan, whole body bone scan and bone marrow examination showed no evidence of malignancy. During the following weeks, the initial cutaneous lesions regressed spontaneously, which necessitated no further treatment, and repeated CBC and blood smear were normal. However, at 6-month follow up, although neither suspicious symptoms nor abnormal CBC counts were encountered, bone marrow aspirate demonstrated medium-sized blasts up to 35.6%. Immunophenotyping studies revealed positivity for CD33, human leukocyte antigen DR, and myeloperoxidase, but negativity for CD3, CD5, CD7, CD10, CD13, CD14, CD19, CD20, CD22, CD34 and CD61. Cytogenetic analysis was performed on bone marrow sample where translocation (9;11) (p22;q23) with MLL-MLLT3 gene rearrangement was detected by reverse transcription polymerase chain reaction test. We did not perform cytogenetic testing on the skin specimen, which might have proved whether skin lesion accorded with the bone marrow infiltration. The patient was transferred to the department of pediatrics for conventional chemotherapy. While leukemia cutis is reported in 25–30% of congenital leukemia, less than 10% of cases are aleukemic. It may take a few weeks to several months before the diagnosis of hematological involvement in cases where cutaneous infiltration is the only manifestation. Unlike the adult counterpart, congenital leukemia cutis does not always imply a poor prognosis. Accompanying genetic abnormalities or the patient’s age should be considered all together. However, overall survival rate of congenital AML is reported as low as 26%, showing poor prognosis with MLL rearrangement. In our case, both the patient and his mother had lower-than-normal levels of vitamin D. Although the exact role of vitamin D in carcinogenesis needs to be elucidated, in recent reports, vitamin D has been shown to be capable of inducing AML blast cells in vitro to differentiate along the monocytic lineage, and it is a newly investigated treatment choice especially in AML and myelodysplasia. In general, systemic treatment, including conventional chemotherapy, is more advocated than local intervention even for aleukemic leukemia cutis. Interestingly, a few patients have been reported for spontaneous remission of skin lesions as in this case. In conclusion, this rare case of congenital leukemia cutis preceding bone marrow involvement emphasizes the importance

Eo Gin Lee

Papers

The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin

Assessment of treatment efficacy and sebosuppressive effect of fractional radiofrequency microneedle on acne vulgaris

Assessment of Treatment Efficacy and Sebosuppressive Effect of Fractional Radiofrequency Microneedle on

Efficacy of low dose gabapentin in acute herpes zoster for preventing postherpetic neuralgia: a prospective controlled study.

Congenital leukemia cutis preceding acute myeloid leukemia with t(9;11)(p22;q23), MLL-MLLT3