Fractional Microneedling Radiofrequency Treatment for Acne- TGNCVGF2QUVKpƀcoocvqt['T[VJGOC

Acta Derm Venereol 2015 Epub ahead of print

INVESTIGATIVE REPORT Fractional Microneedling Radiofrequency Treatment for Acne- TGNCVGF2QUVKPƀCOOCVQT['T[VJGOC

Seonguk0,11,2#, Seon Yong3$5.1,2#, Ji Young<2212, Hyuck Hoon.:211,2 and Dae Hun SUH1,2 1Department of Dermatology, Seoul National University College of Medicine, 2Acne and Rosacea Research Laboratory, Seoul National University Hospi- tal, Seoul, South Korea #These 2 authors contributed equally to this work.

3RVWLQÀDPPDWRU\HU\WKHPDLVDFRPPRQUHVXOWRIDFQH adverse effects and rapid recovery times, are becoming LQÀDPPDWLRQDQGLVFRVPHWLFDOO\XQDFFHSWDEOHZLWKRXW popular (5, 6). Fractional microneedling radiofrequency HIIHFWLYH WUHDWPHQW )UDFWLRQDO PLFURQHHGOLQJ UDGLRIUH- (FMR) delivers bipolar radiofrequency directly to the TXHQF\ )05 KDVSRWHQWLDOIRUWUHDWPHQWRISRVW-LQÀDP- dermis using an array of microneedles (7). FMR has PDWRU\HU\WKHPD7KHDLPRIWKLVVWXG\ZDVWRHYDOXDWH been reported to improve skin laxity and wrinkles (7–9). WKHHI¿FDF\DQGVDIHW\RIWKLVWUHDWPHQW$UHWURVSHFWLYH Bipolar radiofrequency has been reported to induce FKDUWUHYLHZZDVXQGHUWDNHQRISDWLHQWVWUHDWHGZLWK profound neoelastogenesis and neocollagenesis, which VHVVLRQV RI UDGLRIUHTXHQF\ DW -ZHHN LQWHUYDOV DQG has been suggested as a potential mechanism of clinical SDWLHQWV WUHDWHG ZLWK RUDO DQWLELRWLFV DQGRU WRSLFDO HI¿FDF\ 0RUHRYHU)05KDVEHHQVKRZQWRKDYH DJHQWV(I¿FDF\ZDVDVVHVVHGWKURXJKDQLQYHVWLJDWRU¶V DWKHUDSHXWLFHIIHFWRQLQÀDPPDWRU\VNLQGLVHDVHV JOREDO DVVHVVPHQW RI SKRWRJUDSKV DQG WKH DQDO\VLV RI such as acne (11). We hypothesized that the dermal HU\WKHPDZLWKLPDJHDQDO\VLVVRIWZDUHDQGSKRWRPHWULF UHPRGHOOLQJDQGDQWLLQÀDPPDWRU\HIIHFWVRI)05PD\ GHYLFHV +LVWRORJLFDO FKDQJHV UHVXOWLQJ IURP WKH WUHDW- VXFFHVVIXOO\WUHDW3,(FDXVHGE\SHUVLVWHQWLQÀDPPDWLRQ PHQW ZHUH HYDOXDWHG E\ VNLQ ELRSV\ )05 WUHDWPHQW and destruction of the dermal matrix. UHVXOWHG LQ VLJQL¿FDQW LPSURYHPHQWV LQ HU\WKHPD ZLWK 7RGDWHQRVWXG\KDVHYDOXDWHGWKHHI¿FDF\RIUDGLR- QRVHYHUHDGYHUVHHIIHFWV+LVWRORJLFDOVWXG\UHYHDOHGD IUHTXHQF\WUHDWPHQWLQSRVWLQÀDPPDWRU\HU\WKHPD UHGXFWLRQLQYDVFXODUPDUNHUVDQGLQÀDPPDWLRQ)05 The aim of this retrospective study was to evaluate the LVDVDIHDQGHIIHFWLYHWUHDWPHQWIRUSRVW-LQÀDPPDWRU\ HI¿FDF\VDIHW\DQGKLVWRORJLFDOFKDQJHVRI)05LQ HU\WKHPD ZLWK SRWHQWLDO DQWL-LQÀDPPDWRU\ DQG DQWL- SRVWLQÀDPPDWRU\HU\WKHPD7RWKHEHVWRIRXUNQRZ- DQJLRJHQHWLFSURSHUWLHV.H\ZRUGVDFQHSRVWLQÀDPPD- OHGJHWKLVLVWKH¿UVWUHSRUWRI)05IRUWKHWUHDWPHQW WRU\HU\WKHPDIUDFWLRQDOPLFURQHHGOLQJUDGLRIUHTXHQF\ RI3,(LQGXFHGE\DFQHLQÀDPPDWLRQ Accepted Jun 3, 2015; Epub ahead of print Jun 10, 2015 Acta Derm Venereol 2015; XX: XX–XX. 0$7(5,$/6$1'0(7+2'6 Dae Hun Suh, Department of Dermatology, Seoul National Study design and subjects University College of Medicine, 101 Daehak-ro, Jongno- A retrospective chart review was undertaken of 52 patients who gu, Seoul 110-744, South Korea. E-mail: [email protected] visited the Department of Dermatology, Seoul National University Hospital, South Korea, between August 2013 and February 2014. The study protocol was conducted in accordance with the Decla- Acne affects approximately 80% of adolescents and UDWLRQRI+HOVLQNLDQGZDVDSSURYHGE\WKH,QVWLWXWLRQDO5HYLHZ \RXQJDGXOWV 6HYHUHDFQHLQÀDPPDWLRQFDQUH- Board of Seoul National University Hospital (No.1407-136-597). sult in subsequent erythema or hyperpigmentation and 7ZHQW\¿YHVXEMHFWVZLWK3,(ZLWKIHZRUQRDFWLYHDFQHOHVLRQV who had been treated with FMR on the face, were included in the even permanent acne scarring. There are many reports )05WUHDWHGJURXS7ZHQW\VHYHQSDWLHQWVZLWK3,(DQGOLWWOHRU of various treatments for pigmentation or acne scarring. no active acne, who had been treated with oral and/or topical anti- However, there are few reports concerning treatment for biotics, were included in the control group. Exclusion criteria were: UHVLGXDOHU\WKHPDLQGXFHGE\DFQHLQÀDPPDWLRQ3RVW patients with no photographs, hypertrophic or keloid scarring, LQÀDPPDWRU\HU\WKHPD 3,( LVYHU\FRPPRQIROORZLQJ patients being treated with any other treatment for acne scarring LQÀDPPDWRU\DFQHDQGLVRIWHQFRVPHWLFDOO\XQDFFHSW or erythema, including chemical or mechanical skin resurfacing, RUXVHRIWRSLFDORURUDOUHWLQRLGVIRUDWOHDVWPRQWKVSULRUWR¿UVW DEOHWRSDWLHQWV 3DWLHQWVXVXDOO\KDYHSHUVLVWHQWUHG study. None of the patients underwent other acne scar treatments, PDUNVDIWHUFOHDULQJRIWKHDFXWHLQÀDPPDWLRQIROORZLQJ including chemical or laser resurfacing during treatments. DFQHWUHDWPHQW)DFLDO3,(LPSURYHVZLWKWLPHEXWYHU\ VORZO\DQGLQVRPHFDVHVFRPSOHWHFOHDUDQFHRI3,( Preparation and laser treatment cannot be achieved (4). All treatment procedures were performed by a single surgeon Radiofrequency devices, associated with preserva- 60 7RSLFDODQDHVWKHVLDZLWK(0/$® (AstraZeneca, Söder- tion of the epidermis, and with fewer complications or WlOMH6ZHGHQ ZDVDGPLQLVWHUHGPLQEHIRUHODVHUWUHDWPHQW

FRPPHQFHG7KHVXEMHFWVLQWKH)05WUHDWHGJURXSKDGUHFHLYHG IDFWRU 9(*) 6DQWDFUX]'DOODV7;86$ 7KHLQWHQVLW\RI,+& VHVVLRQVRI)05 ,1),1,®/XWURQLF*R\DQJ6RXWK.RUHD VWDLQLQJZDVDVVHVVHGE\XVHRIDQLPDJHDQDO\VLVSURJUDP /HLFD treatment at 4-week intervals. The applicator tip comprised 49 4:LQYHUVLRQ/HLFD0LFURV\VWHPV:HW]ODU*HUPDQ\ insulated microneedles over an area of 1 cm2. The FMR system delivered the bipolar RF energy to the dermis at a frequency of 1 0+]DQGDWDGMXVWDEOHSRZHUOHYHOVUDQJLQJIURP:WR: Statistical analysis in 2.5 W increments. The exposure time, for which the RF energy Student’s t-test was used to compare the differences between ZDVÀRZLQJSHUVKRWFRXOGEHDGMXVWHGIURPPVWRPV GDWDREWDLQHGEHIRUHDQGDIWHU)05WUHDWPHQW 6366YHUVLRQ ,QWKHFXUUHQWVWXG\OHYHOV : WR : ZHUHXVHGZLWK 6366,QF&KLFDJR,/86$ 6WDWLVWLFDOVLJQLILFDQFH exposure times of 50 – 70 ms. Three passes of treatment were was accepted at p-values < 0.05. GRQHSHUHDFKVHVVLRQ,FHSDFNVZHUHDSSOLHGWRUHGXFHSDLQ followed by application of topical antibiotics, immediately after WUHDWPHQW6XEMHFWVZHUHDOORZHGWRXVHHPROOLHQWDQGFRVPHWLFV 5(68/76 from the next day onwards. 7ZHQW\¿YHSDWLHQWV PHQZRPHQ LQWKH)05 Clinical outcome assessment treated group and 27 patients (19 men, 8 women) in the 2QDYHUDJHVXEMHFWVLQWKH)05WUHDWHGJURXSZHUHIROORZHG control group were included in the study (p = 0.100). up at 4-week intervals during the treatment period (2 treatment 7KHSDUWLFLSDQWVDOOKDG)LW]SDWULFNVNLQW\SHV,,,±,9 sessions) and 8 weeks after the final session of treatment. A 7KHPHDQDJHRIWKHVXEMHFWVZDVDQG\HDUV standardized medical photograph was taken using identical ca- in FMR-treated group and control group, respectively, PHUDVHWWLQJV (26'®; Canon, Tokyo, Japan) and lighting conditions. Assessment of the clinical photographs was conduc- ZLWKQRVLJQL¿FDQWGLIIHUHQFH7KHPHDQEDVHOLQHHU\ WHGE\LQGHSHQGHQWGHUPDWRORJLVWV '+6DQG6<3 (IILFDF\ thema indices were 19.6 and 19.3, and mean baseline ZDVDVVHVVHGE\LQYHVWLJDWRU¶VJOREDODVVHVVPHQW ,*$ ZKLFK D VFDOHDQGUHVSHFWLYHO\ZLWKQRVLJQL¿FDQW comprised 5 points associated with degree of improvement differences between the 2 groups. The number of FMR (grade 0: no improvement, grade 1: 0–25% improvement, grade treatment sessions was 2. There were no serious ad- 2: 26–50% improvement, grade 3: 51–75% improvement, grade ±LPSURYHPHQW 2EMHFWLYHHYDOXDWLRQRIHU\WKHPD verse effects that resulted in stopping treatment. was routinely done via 2 photometric devices (Spectropho- tometer CM-2002®; Konica Minolta, Tokyo, Japan; Derma- Erythema improvement spectrometer®; Cortex Technology, Hadsund, Denmark). At every visit, patients were asked to report any adverse effects. The gradHRI3,(LPSURYHGLQDOOSDWLHQWV LQ 6XEMHFWV¶VXEMHFWLYHDVVHVVPHQWRIWKHUDSHXWLFHIIHFWLYHQHVV the FMR-treated group and in 5 patients (5/27) in the was surveyed using a visual analogue scale (VAS) ranging from FRQWUROJURXS,QWHUUDWHUDJUHHPHQWZDVHYDOXDWHGZLWK LQLWLDOYLVLWVWDWXVRI3,( WR FRPSOHWHFOHDUDQFH IRUWKH FMR. Satisfaction was also measured by use of a VAS ranging țVWDWLVWLFV țYDOXH p < 0.001), demonstrating from 0 to 10 (0: dissatisfied, 10: fully satisfied). congruence between the 2 raters. There was a signi- ¿FDQWGLIIHUHQFHEHWZHHQWKH)05WUHDWHGJURXSDQG Computer-aided erythema evaluation WKHFRQWUROJURXSLQ,*$VFRUH p < 0.001). The mean 0DQ\WH[WXUDOIHDWXUHVIRUTXDQWL¿FDWLRQRIUHGQHVVLQFOXGLQJ ,*$VFRUHIRUWKH)05WUHDWHGJURXSZDVZKLFK mean, standard deviation, smoothness, uniformity and entropy, indicates an improvement of approximately 45%. By ZHUHH[SORUHGZLWKDFRPSXWHUSURJUDP0$7/$%® (The Math- FRQWUDVWWKH,*$VFRUHIRUWKHFRQWUROJURXSZDV :RUNV,QF1DWLFN0$86$ WRGLVWLQJXLVKFRORXUGLIIHUHQFHV (a 7.5% improvement). LQ3,(IURPVXUURXQGLQJQRUPDOVNLQ,QDGGLWLRQPDQ\FRORXU 3KRWRPHWULFPHDVXUHPHQWVRIHU\WKHPDUHYHDOHG channel transformations, including grey channel, red channel, EOXHUHGGLIIHUHQFHFKDQQHODQGD IURP/ D E ZHUHWHVWHGWR consistently decreased redness after FMR treatment assess the severity of erythema. Among them, smoothness using compared with the baseline or control group (Fig. 1). a* channel was used in this study to maximize the description of 7KHUHZHUHVLJQL¿FDQWUHGXFWLRQVLQWKHHU\WKHPDLQGH[ colour difference. “Smoothness” is a measure of the smoothness (p = 0.002) and a* scale (p < 0.001) in the FMR-treated 2 RILQWHQVLW\DFFRUGLQJWRWKHIROORZLQJIRUPXOD5 ± ı ), group compared with the control group. where R is 0 for a region of contrast intensity and approaches 1 for regions with large excursions in the values of its intensity Clinical photographs illustrating the improvement levels. The medical photographs, taken at baseline and 8 weeks in redness in the FMR-treated group and the lack of after the second session of treatment in the FMR-treated group, improvement in the control group are shown in Fig. 2. and at baseline and after a similar term in the control group, were There were no severe adverse effects of FMR, other analysed with this program and smoothness values were obtained. than mild adverse effects, such as pain during the pro- cedure and erythema lastiQJIRU±GD\V1RVXEMHFWV Histopathology dropped out due to erythema. Skin specimens were obtained by punch (2-mm) biopsy from the cheek in 6 available patients in each group 8 weeks after the last session of treatment. Written informed consent was obtained from Erythema analysis by software DOOVXEMHFWVSULRUWRVNLQELRSV\6HFWLRQVZHUHVWDLQHGZLWKKDHPD- WR[\OLQHRVLQ + ( DQGĮVPRRWKPXVFOHDFWLQ Į60$ 7LVVXH Smoothness from the a* channel was calculated with ® ZDVDOVRSURFHVVHGIRULPPXQRKLVWRFKHPLFDO ,+& VWDLQLQJIRU WKH0$7/$% program. There were no statistical 1)ț%LQWHUOHXNLQ ,/ DQGYDVFXODUHQGRWKHOLDOFHOOJURZWK differences in smoothness between the 2 groups at

Acta Derm Venereol 95 )ractional microneedling radiofrequency in post-inÀammatory erythema 3

sions of treatment with FMR (Fig. S11). 5HGXFWLRQVLQ,/1)ț%DQG9(*) staining intensity were also observed 8 weeks after the second session of treat- PHQW,PDJHDQDO\VLVVKRZHGVLJQL¿FDQW differences in the mean area percentages for controls and FMR-treated patients, UHVSHFWLYHO\DQGIRU,/ (p DQGIRU1)ț% (p = 0.032), and 24.8% and 9.4% for 9(*) p = 0.008), (Fig. 4).

Fig. 1.3KRWRPHWULFPHDVXUHPHQWVRIWKHIUDFWLRQDOPLFURQHHGOLQJUDGLRIUHTXHQF\ )05 WUHDWHG group and control group. Decreased (A) erythema index and (B) a* scale in the FMR-treated ',6&866,21 group after 2 sessions of treatment (*, † p < 0.05). There is no established treatment for DFQHUHODWHG3,()05WUHDWPHQWZDV baseline (0.000219 vs. 0.000214) or between baseline ¿UVWLQWURGXFHGWRLPSURYHVNLQDJLQJKRZHYHUWKHUH DQG¿QDOHYDOXDWLRQLQWKHFRQWUROJURXS have been several reports that it can improve acne vs. 0.000211). However, the FMR-treated group had a LQÀDPPDWLRQ 7KHUHIRUHZHFRQGXFWHGWKH lower smoothness value from a* channel than the con- present retrospective study to determine whether FMR WUROJURXSDW¿QDOHYDOXDWLRQ YV FDQLPSURYH3,(DVVRFLDWHGZLWKLQÀDPPDWLRQ p DQGDVLJQL¿FDQWGHFUHDVHLQVPRRWKQHVV 7RGDWHWKHUHKDYHEHHQIHZVWXGLHVRI3,(WUHDWPHQW from a* channel was seen in the treated group compa- 3XOVHGG\HODVHUDQGQRQDEODWLYHQPIUDFWLRQDO red with baseline (0.000138 vs. 0.000219; p < 0.001). ODVHUKDVEHHQVKRZQWRLPSURYH3,( 7KH 7KHPHDQUDWLRRIVPRRWKQHVVEHWZHHQ¿QDOHYDOXDWLRQ present study demonstrated dramatic improvements in DQGEDVHOLQHZDVVLJQL¿FDQWO\OHVVLQWKH)05WUHDWHG 3,(DFFRUGLQJWRWKHLQYHVWLJDWRUV¶DQGSDWLHQW¶VVXE- (66.8%) than in the control group (104.3%) (p < 0.001) MHFWLYHDVVHVVPHQWVDQGHYDOXDWLRQXVLQJSKRWRPHWULF (Fig. 3). devices and image analysis. The adverse effects of FMR ZHUHPLQLPDO)DFLDO3,(FRQWULEXWHVWRWKHHPRWLRQDO Patient’s subjective assessment social and psychological disability induced by acne (14). FMR could be an effective and safe treatment The satisfaction score and the therapeutic effectiveness method of resolving this stressful skin condition. for the FMR treatment were 7.8 ± 0.3 and 3.6 ± 0.3, Erythema has been evaluated in some previous UHVSHFWLYHO\$OOVXEMHFWVVFRUHGJUHDWHUWKDQIRU studies via clinical photographs with computer-aided VDWLVIDFWLRQ2XWRIVXEMHFWV VFRUHG image analysis. Zhao et al. (15) analysed changes in greater than 4 for effectiveness. erythema index after photodynamic therapy for port- ZLQHVWDLQVXVLQJ,PDJH- IUHHVRIWZDUH 7KHFXUUHQW Histological ¿ndings VWXG\GHYHORSHGDQRYHOYDULDEOHVPRRWKQHVVIRU3,( + (VWDLQLQJUHYHDOHGUHGXFHGLQÀDPPDWLRQDQGĮ60$ staining showed decreased microvessels after 2 ses- 1KWWSZZZPHGLFDOMRXUQDOVVHDFWDFRQWHQW"GRL

Fig. 2.&OLQLFDOSKRWRJUDSKVVKRZLQJLPSURYHPHQWLQSRVWLQÀDPPDWRU\HU\WKHPD 3,( 7KHWUHDWHGJURXSVKRZHGLPSURYHPHQWLQUHGQHVVZHHNV after the second session of treatment (B) compared with baseline (A), whereas the control group showed no improvement (D) compared with baseline (C).

Acta Derm Venereol 95 4 S. Min et al.

haemoglobin and small-diameter vascular processes. 3DUNHWDO SURSRVHGWKDWQPIUDFWLRQDOODVHU treatment targets tissue water and causes photothermal destruction of dermal vasculature, resulting in improvement in erythema. A suggested mechanism for FMR is remodelling of the dermal structure and decreased sebaceous gland activity due to the thermal effect of UDGLRIUHTXHQF\ ,QWKHSUHVHQWVWXG\GHFUHDVHG LQWHQVLW\RI1)ț%,/DQG9(*)ZDVREVHUYHG XQGHU,+&VWDLQLQJ:HK\SRWKHVL]HWKDWLQÀDPPDWLRQ may contribute to neovasculogenesis, resulting in re- sidual erythema after resolution of active acne lesions. 7KHUHIRUH)05FRXOGLPSURYH3,(E\PRGXODWLQJ LQÀDPPDWRU\DQGYDVFXODUFRPSRQHQWV 1)ț%SOD\VDNH\UROHLQUHJXODWLQJWKHLPPXQH Fig. 3. Computer-aided erythema analysis. A variable “smoothness” UHDFWLRQDQGFRQWUROVPDQ\JHQHVLQYROYHGLQLQÀDP- VKRZHGUHGXFWLRQLQSRVWLQÀDPPDWRU\HU\WKHPD 3,( ZHHNVDIWHUWKH PDWLRQ1)ț%LVFKURQLFDOO\DFWLYHLQPDQ\LQÀDPPD- second session of treatment in the fractional microneedling radiofrequency (FMR)-treated group (*, † p < 0.05). WRU\GLVHDVHV 1)ț%FDQDFWLYDWH,/DQG9(*) H[SUHVVLRQYLDELQGLQJWR1)ț%VLWHVRIWKHSURPRWHU RIWKHVHJHQHV 1)ț%LQKLELWRUVORZHUWKHOHYHOV evaluation by assessing the colour differences between RI9(*)SURGXFWLRQDQGRYHUH[SUHVVLRQRI1)ț% the lesional area and normal area of skin, and it sho- LQKLELWRU ,ț%D UHVXOWVLQGHFUHDVHG9(*)OHYHOV wed similar degrees of improvement, as measured by ,/FDQDOVRXSUHJXODWH9(*)H[SUHVVLRQYLD photometric devices. Smoothness calculated from a* YDULRXVPROHFXODUSDWKZD\V ,QWXPRXUIRUPD- channel could be used to evaluate macular erythema tion, the tumourigenic process can be enhanced by in other dermatoses, but its usefulness has not yet been LQÀDPPDWRU\F\WRNLQHVE\XSUHJXODWLQJDQJLRJHQHVLV HYDOXDWHGREMHFWLYHO\ PHGLDWRUVVXFKDV,/DQG9(*) 0RUHRYHUWKH 3UHYLRXVVWXGLHVRQ3,(WUHDWPHQWZLWKRWKHUODVHUV vascular changes associated with angiogenesis could have shown clinical improvement, but have not clearly occur not only in cancer but also in other diseases, demonstrated the mechanism of the effect. Bae-Harboe including cardiovascular disease, rheumatoid arthritis, *UDEHU XVHGSXOVHGG\HODVHUWRWUHDW3,(DQGVXJ- hypersensitivity and asthma (21). gested that its effectiveness is attributable to targeting Although the mechanism by which FMR regulates 1)ț%RU,/LVXQNQRZQZHVXJJHVWWKDW)05WUHDW PHQWPD\UHGXFHLQÀDPPDWLRQRIWKH3,(OHVLRQDQG WKLVLVVXSSRUWHGE\GHFUHDVHGH[SUHVVLRQRI1)ț% UHVXOWLQJLQGRZQUHJXODWLRQRI9(*)YLDDGLUHFWRU LQGLUHFW YLDORZHULQJ,/ SDWKZD\ This study was done by retrospective review. Thus, we tried to avoid information bias of study results. First, clinical assessment was done by independent two der- matologists. We also evaluated the inter-rater agreement E\&RKHQ¶VNDSSDWHVW6HFRQGREMHFWLYHPHDVXUHPHQWV using photometric devices were done. Third, clinical photographs were analyzed by digital image processing SURJUDP 0$7/$% +RZHYHUWKHUHLVVWLOOPRUHULVN of selection bias compared with prospective study. ,QFRQFOXVLRQ3,(LVDQXQGHUVWXGLHGVHTXHODHRI DFQHDQGLWVFOLQLFDOVLJQL¿FDQFHFDQEHRYHUORRNHG compared with active acne or depressive acne scar- Fig. 4.,PDJHDQDO\VLVRILPPXQRKLVWRFKHPLVWU\VWDLQLQJRIVSHFLPHQIURP ring. This study demonstrates that FMR is a safe and fractional microneedling radiofrequency (FMR)-treated group and control HIIHFWLYHPHWKRGIRU3,(WUHDWPHQWLWVHIIHFWLYHQHVVLV JURXS6LJQL¿FDQWO\GHFUHDVHGLQWHQVLW\RIYDVFXODUHQGRWKHOLDOFHOOJURZWK SURYHQE\VHYHUDOREMHFWLYHDQGVXEMHFWLYHDVVHVVPHQWV IDFWRU 9(*) ZDVREVHUYHGDIWHU)05WUHDWPHQW FRPSDUHGZLWKFRQWURO FMR treatment could improve erythema by reducing group, p 6LJQL¿FDQWGRZQUHJXODWLRQRI1)ț% FRPSDUHGZLWK LQÀDPPDWLRQDQGDEQRUPDOYHVVHOSUROLIHUDWLRQ$QWL control group, p DQGLQWHUOHXNLQ ,/ FRPSDUHGZLWKFRQWURO group, p ZKLFKLVDVVRFLDWHGZLWKLQÀDPPDWRU\UHDFWLRQZDV LQÀDPPDWRU\DQGDQWLDQJLRJHQHWLFHIIHFWVRI)05 shown after FMR treatment (*p < 0.05). may have therapeutic effects in skin diseases other than

Acta Derm Venereol 95 Fractional microneedling radiofrequency in post-inÀammatory erythema 5

3,()XUWKHUUHVHDUFKPD\UHYHDORWKHULQGLFDWLRQVIRU HODVWRJHQHVLVDQGQHRFROODJHQHVLV/DVHUV6XUJ0HG )05WUHDWPHQWDQGRWKHURSWLRQVIRUWUHDWPHQWRI3,( 41: 1–9. 11. /HH6-*RR-:6KLQ-&KXQJ:6.DQJ-0.LP<. et al. Use of fractionated microneedle radiofrequency for $&.12:/(*(0(17 WKHWUHDWPHQWRILQÀDPPDWRU\DFQHYXOJDULVLQ.RUHDQ patients. Dermatol Surg 2012; 38: 400–405. This work was supported by the National Research Foundation 12.

Acta Derm Venereol 95 Supplementary material to article by S. Min et al. ´Fractional Microneedling Radiofrequency Treatment for Acne-related Post-inÀammatory Erythema”

Fig. S1,QÀDPPDWRU\FHOOLQ¿OWUDWLRQZDVUHGXFHGDIWHUIUDFWLRQDOPLFURQHHGOLQJUDGLRIUHTXHQF\ )05 WUHDWPHQW 8 weeks after the second session of treatment (B) compared with the control group (A) (haematoxylin and eosin + ( VWDLQLQJRULJLQDOPDJQL¿FDWLRQî ĮVPRRWKPXVFOHDFWLQ Į60$ VWDLQLQJUHYHDOHGDGHFUHDVHLQYHVVHOV DIWHU)05WUHDWPHQW ' FRPSDUHGZLWKWKHFRQWUROJURXS & 'LDPLQREHQ]LGLQHVWDLQLQJRULJLQDOPDJQL¿FDWLRQ î 6FDOHEDUP

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