Tractament de cicatrius atròfiques post-acné amb laser fraccionals combinats amb plasma ric en plaquetes (prp)
- Autores: Ahmed Youssef Ibrahim
- Directores de la Tesis: Lluís Puig Sanz (dir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2021
- Idioma: catalán
- Tribunal Calificador de la Tesis: Vicente García-Patos Briones (presid.), Antoni Azón Masoliver (secret.), Torello Lotti (voc.)
- Programa de doctorado: Programa de Doctorado en Medicina por la Universidad Autónoma de Barcelona
- Materias:
- Enlaces
- Tesis en acceso abierto en: TDX
- Resumen
Purpose: To evaluate the efficacy of LASERs combination (AFL; Fractional CO2 and NAFL Fractional Er: Glass); if applied simultaneously followed by PRP for treatment of atrophic post-acne scar types. We hypothesize that this treatment combination would maximize improvement and minimize the previously reported adverse reactions for LASERs combination, especially if confining the AFL pulses and PRP injections only to the atrophic post-acne scars while applying NAFL for the entire face.
Methods: A prospective, interventional, observer-blinded, intra-patient, single-center study. Patients 18 years or older with atrophic post-acne scars were recruited after applying inclusion and exclusion criteria.
All patients had 3 excision biopsies from the three most marked scars immediately after the first treatment. One biopsy of an area neither LASERs nor PRP where used served as a control. The second biopsy site was treated only by LASERs combination, while the third biopsy was treated by both LASERs combination and PRP. Patients continued to receive another 3 similar treatment sessions of combined LASERs and PRP on monthly intervals, without biopsies and were then followed up for another 12 weeks (week 24).
Main outcomes were patients’ self-assessment tools; SCARS and FASQoL, at week 4, and blind assessors’ evaluation for 2 sets of digital photographs at week 24. While secondary outcomes were blinded histopathological and immunohistochemical evaluations for the biopsies of the three groups.
Results: Thirty-two patients were recruited. Only one patient was withdrawn. At week 4, FASQoL pre-treatment values were significantly lower than posttreatment values (20.64+9.76 vs 29.41+9.14, p< 0.0001). At week 24, only 1 patient was highly satisfied, 10 patients were satisfied, 19 patients were slightly satisfied, and 1 patient was poorly satisfied. Patients’ self-assessment of Atrophic Acne Scars VAS scores at weeks 0, 4, and 24 showed that the median score among the three assessments differed significantly (p< 0.0001).
The mean blind assessors’ pre-treatment values for atrophic acne scars score were significantly higher than posttreatment values (5.5+1.81 vs 3.15+1.41, p< 0.0001). The blind assessors graded the final improvement of 2 patients as highly satisfactory, 8 patients as satisfactory, 18 patients as slightly satisfactory, and 3 patients were unsatisfactory.
By Picrosirius red stain, we reported a significant rise in collagen (COL) III ratio (new immature COL) among control, Lasers + NSS and, Lasers + PRP groups (13.9 + 15.97 vs 24.17 + 21.67 vs 34.41 + 23.57, respectively, p< 0.0001). On the other hand, we reported a simultaneous significant decrease in COL III ratio (old mature COL) among control, Lasers + NSS and, Lasers + PRP groups (84.77 + 15.6 vs 75.05 + 21.05 vs 64.5 + 23.13, respectively, p< 0.0001).
Conclusions: Combinations of AFL, NAFL, and PRP for treatment of post-acne atrophic scars yield earlier significant improvements when used simultaneously from the first session. This triple combination enhanced the scar remodeling with minimal adverse effects based on patients´ self-assessment 4 weeks after the first session.
