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Background: Current approaches for assessment of acne scars are subjective, including counting scar subtypes, subjective self-assessment, or scoring global acne scar severity., Aims: We aimed to validate accuracy and present initial data of a new, simple, non-contact, high-resolution 3D stereoscopic optical imaging system in the setting of acne scarring., Patients/methods: Ten patients treated for acne scars in the dermo-esthetic outpatient clinics in our institution from July to December 2019 were recruited from medical files and completed by telephone interview. Each patient was assessed by the 3D imaging system, the Qualitative Scarring Grading Score (QSGS), and the patient's questionnaire for Self-assessment of Clinical Acne-Related Scars (SCARS) before and 4 weeks after a single intervention., Results: Scar depth measured by the imaging system correlated significantly with the actual depth of printed surface depressions and the 3D optical imaging assessments. The changes in SCARS and 3D optical imaging assessments correlated significantly, but there were no correlations between changes in QSGS and 3D optical assessment measures, or between the QSGS and SCARS results., Conclusion: The new stereoscopic optical system is a reliable and practical objective method for assessing the cumulative depth of atrophic acne scars and monitoring treatment response. It is more sensitive, accurate, and informative than subjective scales., (© 2021 Wiley Periodicals LLC.)

Background: The Chemical Reconstruction of Skin Scars (CROSS) technique was first described in 2002 and has since demonstrated safety and efficacy in multiple studies. We describe the treatment of six patients with a modified version of the CROSS method-the Painting CROSS trichloroacetic acid (TCA) technique. This technique has the advantage of offering even higher tissue selectivity and better control of the scar edges, enhancing both safety and efficacy., Methods: We retrospectively evaluated 31 scars of six patients who underwent a single treatment by the Painting CROSS TCA method. A 0.3 ml insulin syringe with a 30-gauge needle was filled with 0.05 ml of 85% TCA solution and then applied to the scar base with slight pressure until frosting was achieved. Patients were evaluated before and 3 months after treatment for scar volume deficit by a high-resolution three-dimensional imaging system., Results: The average volume of the 31 scars assessed in our study was 2.71 mm 3 before treatment and 1.96 mm 3 after treatment. There was a 26.3% average decrease in the volume of the scars after one treatment. Transient mild hyperpigmentation was noted in two patients after the treatment., Conclusion: Painting CROSS TCA technique has demonstrated efficacy in the treatment of acne scars after a single treatment., (© 2021 Wiley Periodicals LLC.)

Background: Melasma is a complex and poorly understood disorder, with high rates of treatment failure and recurrences., Objectives: We aimed to review the current knowledge of the pathogenesis of melasma and apply this knowledge to clinical implications on relevant therapeutic interventions., Methods: A systematic PubMed search was performed using the search term "((melasma[Text Word]) OR facial melanosis[Text Word]) AND (pathogenesis OR causality[MeSH Terms])" for articles published between 1990 and 2020. Included articles were then evaluated by two authors and assessed for relevant pathomechanistic pathways, after which they were divided into groups with minimal overlap. We then reviewed current treatment modalities for melasma and divided them according to the involved pathomechanistic pathway., Results: A total of 309 search results were retrieved among which 76 relevant articles were identified and reviewed. Five main pathomechanisms observed in melasma were identified: (1) melanocyte inappropriate activation; (2) aggregation of melanin and melanosomes in dermis and epidermis; (3a) increased mast cell count and (3b) solar elastosis; (4) altered basement membrane; and (5) increased vascularization. Treatment modalities were then divided based on these five pathways and detailed in 6 relevant tables., Conclusion: The pathophysiology of melasma is multifactorial, resulting in treatment resistance and high recurrence rates. This wide variety of pathomechanisms should ideally be addressed separately in the treatment regimen in order to maximize results., (© 2021 Wiley Periodicals LLC.)

Background: Acne vulgaris is common dermatologic condition with an estimated prevalence of 80%. Acne has been shown to have a significant impact on patient quality of life and mental health, especially as inflammatory lesions typically occur on cosmetically sensitive areas with the potential for permanent scarring. There have been numerous advances in the treatment of inflammatory acne with light-based and laser devices. This technology permits effective treatment of active acne and scarring, with a short recovery and a decreased side effect profile as compared to medicinal standard-of-care and photodynamic therapies., Objective: The case series study was aimed at evaluating the safety and efficacy of a 1064 nm Nd: YAG Quasi-longed pulse laser treatment for acne vulgaris., Methods: This was a prospective study of 19 subjects with moderate to severe. All subjects received 1064 nm Nd: YAG Quasi-longed pulse laser treatments, at 8 J/cm 2 fluence and accumulated 1000-4000 kJ according to treatment area at two weeks intervals. Primary end point was reaching a minimal AGSS score of between 1 and 2. Acne severity was assessed by two independent dermatologists according to AGSS scale before each treatment session and at the follow-up visit (8 weeks following last treatment). Subjects' self-assessment of Patient Global Impression of Change (PGIC) and overall satisfaction were also recorded. Safety was assessed by recording pain, adverse events, and downtime throughout the trial., Results: Investigator's US FDA AGSS scoring of acne appearance improvement shows an average of 6.6 treatments were required to reach the minimal AGSS score endpoint. Significant reduction in AGSS scores was recorded after 2 treatments (4.21 ± 0.65 vs 3.05 ± 0.83 p = 1.63E -05 ), and maintained a statistically significant reduction rate throughout the trial. Minimal AGSS scores were still detected after 8 weeks following final treatment. Subjects scored high satisfaction rates and PGIC scores (2.9 and 5.3, respectively). Some patients reported transient erythema as only adverse events recorded in the study., Conclusion: The 1064 nm Nd: YAG Quasi-longed pulse laser was found to be safe and highly effective for the treatment of facial acne. The treatments were well tolerated, and the subjects experienced no pain and no downtime. Light-based treatments do and will probably continue to play an important and enlarging role in acne management., (© 2021 Wiley Periodicals LLC.)

Background: Pulsed diode array laser systems are utilized extensively for various aesthetic indications such as removal of unwanted hair, treatment of vascular and pigmented lesions, and wrinkle reduction., Objective: The purpose of this study was to report and assess the experience of using a diode laser system delivering pulsed infrared laser light at the near-infrared (NIR) spectrum at wavelengths of 805 and 1060 nm., Methods: The study was a retrospective analysis of treatment outcomes in adult subjects treated at the clinic between January 2017 and April 2018 for wrinkles and pigmentation with a noninvasive aesthetic diode laser system. Subjects were treated at nominal wavelengths of 805 nm for pigmentation and 1060 nm for wrinkles reduction. Improvement in pigmentation and wrinkles, adverse events, and patient tolerability to treatment and satisfaction were evaluated., Results: Of 44 subjects with Fitzpatrick skin types II-IV, eight were treated for pigmentation and 36 for wrinkles. For both treatments, subjects reported tolerable pain levels. All immediate responses resolved within 48 hours post-treatment. Evaluation of treatment outcomes by two blinded evaluators demonstrated significant pigmentation clearance mean of 2.50 ± 0.15, (P < .05) in subjects treated for pigmentation, as well as significant improvement mean of 0.46 ± 0.12 (P = .005) in wrinkles in 13 subjects (41%) whose "before" and "after treatment" photographs were correctly identified by both blinded evaluators. Subjects were satisfied with the treatments., Conclusions: Use of the Diode laser effectively resulted in improvement in pigmentation and wrinkles, while maintaining a high safety profile with limited downtime., (© 2019 Wiley Periodicals, Inc.)