Zidan, A., Azzam, E., Elwakeel, H. (2020). Assessment of Microneedling Devices as Transepidermal Drug Delivering System for Corticosteroid in Treatment of Hypertrophic Scars. The Egyptian Journal of Plastic and Reconstructive Surgery, 43(3), 533-537. doi: 10.21608/ejprs.2020.68214
Ahmed A Zidan; Ehab Z Azzam; Helmy Elwakeel. "Assessment of Microneedling Devices as Transepidermal Drug Delivering System for Corticosteroid in Treatment of Hypertrophic Scars". The Egyptian Journal of Plastic and Reconstructive Surgery, 43, 3, 2020, 533-537. doi: 10.21608/ejprs.2020.68214
Zidan, A., Azzam, E., Elwakeel, H. (2020). 'Assessment of Microneedling Devices as Transepidermal Drug Delivering System for Corticosteroid in Treatment of Hypertrophic Scars', The Egyptian Journal of Plastic and Reconstructive Surgery, 43(3), pp. 533-537. doi: 10.21608/ejprs.2020.68214
Zidan, A., Azzam, E., Elwakeel, H. Assessment of Microneedling Devices as Transepidermal Drug Delivering System for Corticosteroid in Treatment of Hypertrophic Scars. The Egyptian Journal of Plastic and Reconstructive Surgery, 2020; 43(3): 533-537. doi: 10.21608/ejprs.2020.68214
Assessment of Microneedling Devices as Transepidermal Drug Delivering System for Corticosteroid in Treatment of Hypertrophic Scars
The Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, Egypt
Abstract
Background: Hypertrophic scars are one of dermal fibroproliferative disorders which can lead to pruritus, disfigurement and pain. The use of microneedling to introduce topical agents or drugs into the dermis is a rapidly growing and popular skin/scar treatment. Patients and Methods: This is a prospective randomized study that included 30 patients suffering from Hypertrophic scars and they are candidate for the proposed technique. Microneedling by Dermapen device with application of topical triamcinolone acetonide solution on scar tissue for three sessions with 3 weeks interval in between. Results: During one year, 30 patients were recruited in our study, the mean age of the patients was 28.16±11.24 (range 21-58 year) and 52% of patients were female. Lesions location were anterior chest (8), extremities (18) and back (4). Mean zero VSS scores were achieved with triamcinolone transepidermal injection in respect of scar height (week 15th) and pliability (week 15th). Conclusion: Our results did support the capability of triamcinolone transepidermal injection using Dermapen in treatment of hypertrophic scars, with an efficient, less painful and cost-effective procedure.
1- Bock O., Schmid-Ott G., Malewski P. and Mrowietz U.: Quality of life of patients with keloid and hypertrophic scarring. Arch. Dermatol. Res., 297 (10): 435, 2006. 2- O'Sullivan S.T., O'Shaughnessy M. and O'Connor T.P.: Aetiology and management of hypertrophic scars and keloids. Ann. R. Coll. Surg. Engl., 78 (3 Pt 1): 168, 1996. 3- Al-Attar A., Mess S., Thomassen J.M., Kauffman C.L. and Davison S.P.: Keloid pathogenesis and treatment. Plast. Reconstr. Surg., 117 (1): 286-300, 2006. Table (1): Mean VSS scores during therapy and follow-up. VSS Time parameter Height Pliability Vascularity Pigmentation VSS Week 0 2.63±0.41 3.90±0.78 2.44±0.50 2.74±0.37 11.98±1.36 Week 3 1.96±0.49 2.88±0.65 2.22±0.54 2.62±0.45 9.66±1.29 Week 6 1.18±0.62 1.88±0.79 1.7±0.54 2.40±0.49 7.18±1.75 Week 9 0.6±0.57 0.94±0.76 1.36±0.45 2.32±0.50 5.18±1.75 Month 3 0.22±0.50 0.32±0.62 1.22±0.41 2.28±0.49 4.06±1.27 p-value <0.001 <0.001 <0.001 <0.001 <0.001 Table (2): Symptoms change in the studied cases. Symptoms change Improvement Unchanged 10 3 Number of patients Egypt, J. Plast. Reconstr. Surg., October 2019 537 4- Gauglitz G.G.: Management of keloids and hypertrophic scars: Current and emerging options. Clin. Cosmet. Investig. Dermatol., 6: 103, 2013. 5- Tanzi E.L. and Aister T.S.: Laser treatment of scarsadvances in dermatologic surgery. Skin. Ther. Lett., 9 (1): 4-7, 2004. 6- Robertson J.C., Hodgson B., Druett J.E. and Druett J.: Pressure therapy for hypertrophic scarring: Preliminary communication. J. R. Soc. Med., 73 (5): 348-54, 1980. 7- Hatamipour E., Mehrabi S., Hatamipour M. and Shirazi H.R.: Effects of combined intralesional 5-fluorouracil and topical silicone in prevention of keloids: A double blind randomized clinical trial study. Acta Med. Iran, 49 (3): 127, 2011. 8- Chrousos G.P. and Margioris A.N.: Adrenocorticosteroid & cortico-adrenal antagonists in Katzung BG. Basic and clinical pharmacology. 8th ed. The McGraw-Hill: United States of America, 574-89, 2003. 9- Garg G.A., Sao P.P. and Khopkar U.S.: Effect of carbon dioxide laser ablation followed by intralesional steroids on keloids. J. Cutan. Aesthet. Surg., 4 (1): 2-6, 2011. 10- Elsaie M.L., Baumann L.S. and Elsaie L.T.: Striae distensae (stretch marks) and different modalities of therapy: An update. Dermatol. Surg., 35 (4): 563-73, 2009. 11- Gómez C., Costela A., García-Moreno I., Llanes F., Teijón J.M. and Blanco D.: Laser treatment on skin enhancing and controlling transdermal delivery of 5-fluorouracil. Laser Surg. Med., 40 (1): 6-12, 2008. 12- Donelly R.F., Morrow D.I., McCarron P.A., Woolfson A.D., Morrissey A., Juzenas P., Juzeniene A., Iani V., McCarthy H.O. and Moan J.: Microneedle-mediated intradermal delivery of 5-aminolevulinic acid: Potential for enhanced topical photodynamic therapy. J. Control Release, 129 (3): 154-62, 2008. 13- Issa M.C.A., Kassuga L.E.B.P., Chevrand N.S. and Pires M.T.F.: Topical delivery of triamcinolone via skin pretreated with ablative radiofrequency: A new method in hypertrophic scar treatment. Int. J. Dermatol., 52: 367- 70, 2012. 14- Wolfram D., Tzankov A., Pülzl P. and Piza-Katzer H.: Hypertrophic scars and keloids-a review of their pathophysiology, risk factors, and therapeutic management. Transepidermal Drug Delivery: Overview, Concept and Applications. Dermatol. Surg., 35 (2): 171-81, 2009. 15- Schwarz M. and Laaff H.A.: Prospective controlled assessment of microneedling with the Dermaroller device. Plast. Reconstr. Surg., 127 (6): 146e-148e, 2011. 16- Niwat P.: Percutaneous collagen induction with dermaroller for management of atrophic acne scars in 31 Thai patients. J. Cosmet. Dermatol., 2 (1): 1-13, 2009. 17- Baryza M.J. and Baryza G.A.: The Vancouver Scar Scale: An administration tool and its interrater reliability. J. Burn Care Res., 16: 535-8, 1995. 18- Haerdersdal M., Sakamoto F.H., Farinelli W.A., Doukas A.G., Tam J. and Anderson R.R.: Fractional CO(2) laserassisted drug delivery. Laser Surg. Med., 42 (2): 113- 22, 2010. 19- Stumpp O.F., Welch A.J., Milner T.E. and Neev J.: Enhancement of transepidermal skin clearing agent delivery using a 980nm diode laser. Lasers Surg. Med., 37 (4): 278-85, 2005. 20- Wang K.F., Fang J.Y., Hu C.H. and Lee W.R.: Erbium: YAG laser pretreatment accelerates the response of Bowen's disease treated by topical 5-fluorouracil. Dermatol. Surg., 30 (3): 441-5, 2004. 21- Sharad J.: Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. J. Cosmet. Dermatol., 10 (4): 317-23, 2011. 22- Orentreich D.S. and Orentreich N.: Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol. Surg., 21 (6): 543-9, 1995. 23- Aust M.C., Reimers K., Repenning C., Stahl F., Jahn S., Guggenheim M., Schwaiger N., Gohritz A. and Vogt P.M.: Percutaneous collagen induction: Minimally invasive skin rejuvenation without risk of hyperpigmentation-fact or fiction? Plast. Reconstr. Surg., 122 (5): 1553-63, 2008. 24- Patnaik V.V.G., Singla R. and Bala S.: Anatomy of 'a beautiful face & smile'. J. Anat. Soc. India, 52 (1): 74-80 16. Sharad J. (2011) Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. J. Cosmet. Dermatol., 10 (4): 317-23, 2003