Irajiv Gandhi University of Health Sciences

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ANNEXURE II

SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME AND ADDRESS OF DR LALITHA C CANDIDATE ROOM NO :10, LADIES HOSTEL , VICTORIA HOSPITAL CAMPUS, BANGALORE, KARNATAKA. 2. NAME OF THE INSTITUTION BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE , BANGALORE, KARNATAKA. 3. COURSE OF STUDY AND M.D (DERMATOLOGY, SUBJECT VENEREOLOGY AND LEPROLOGY). 4. DATE OF ADMISSION TO THE 5TH OF MAY, 2009. COURSE 5. TITLE OF THE TOPIC PERCUTANEOUS COLLAGEN INDUCTION (MICRONEEDLING) THERAPY: AN ALTERNATIVE TREATMENT FOR POST ACNE SCARS.

6 . BRIEF RESUME OF THE INTENDED WORK 6.1 NEED FOR THE STUDY: Acne vulgaris is a common chronic inflammatory disorder of pilosebaceous unit affecting adolescents and young adults psychologically. Untreated acne especially the inflammatory type results in often distressing and difficult to treat scars.(1) Acne scars result from tissue proliferation or tissue loss. Broadly, acne scars are classified as atrophic and hypertrophic scars. Atrophic acne scars have been further classified as ice pick, rolling and boxcar. (2) There are various modalities to treat acne scars like chemical peels, dermabrasion, lasers. Microneedling (dermaroller) therapy is a new addition to the treatment armamentarium which offers simple and reportedly effective results. (3)

6.2 REVIEW OF LITERATURE : Microneedling (dermaroller) works on the principle of percutaneous collagen induction therapy. Microneedles of the Dermaroller in fact do not set injuries .They pass the skin in fractions of seconds resulting in enhancing the cascade of wound healing without actual injury. The Dermaroller action is non-ablative as the epidermis stays intact. (4, 5, 6 ) There are many advantages with Dermaroller. There is no epidermal injury (shorter healing phase), minimal downtime associated with the procedure, affordable, it can be performed in an office setting, no extensive special training required, is a non –invasive /or non –ablative procedure.(3) A few disadvantages being need for complete anaesthesia of skin while performing the procedure, unsightly swelling and burning for first 4-7 days and finally results take longer than with laser resurfacing.(7, 8) Imran Majid conducted a study on 37 patients using microneedling therapy. Overall 36 patients out of 37 patients completed the treatment schedule and evaluated for its efficacy. Out of these 36 patients, 34 patients achieved reduction in severity of scarring by 1 to 2 grades. More than 80% assessed their treatment as excellent on a 10 point scale. No significant adverse effects noted in any of these patients. (3) Mathias C Aust Des Fernandes, Peikles Kolokythan Hilton M, Kaplan. M. Vogt performed a retrospective analysis of 480 patients with fine wrinkles, lax skin, acne scarring and stretch marks treated with percutaneous collagen induction therapy in South Africa and Germany. Of these15 patients in Germany the average preoperative Vancouver scar scale score was 7.5 +/- 11.5 (range 4 to 11) which improved to 4.8 +/- 15.5 ( range 1 to 6) at one year after percutaneous collagen induction therapy. The patient and the observer scar assessment scale scores improved on average from 27 +/- 13.5 ( range 14 to 38 ) pre operatively to19+/- 11.5 ( 14 to 25) at one year after percutaneous collagen induction therapy. Postoperatively, none of the patients experienced photosensitivity or developed any post inflammatory hyperpigmentation or hypopigmentation.(9)

6.3 OBJECTIVES OF STUDY To evaluate the efficacy and complications of microneedling ( Dermoroller) in the treatment of acne scars.

7. MATERIALS AND METHOD 7.1 SOURCE OF DATA: 30 patients with post acne scars attending Victoria Hospital and Bowring & Lady Curzon Hospital will be included in the study. Inclusion criteria Patients willing for the procedure. Patients in the age group 18-40 years (both male and female). Patients with post acne scars (grade 2-3). Exclusion criteria Patients on isotretinoin for past 1 year. Patients with keloids, family h/o keloids. Patients with active viral /bacterial infection. Patients with malignant tumours of face. Patients with evolving dermatosis. Patients with active inflammatory lesions especially nodulocystic acne.

7.2 METHODOLOGY Patients presenting with acne scars will be included in the study. Written informed consent will be taken for their participation in the study. Details of duration, site, depth of scars, skin type, h/o of treatment with isotretinoin, anticoagulants , h/o keloid , presence of active inflammatory acne ,viral, bacterial infection, local tumours and evolving dermatosis will be recorded. Photographs will be taken before and after treatment. 30 patients with post acne scars will be treated with microneedling therapy in 4 sittings with interval of 4-6 weeks and at the end of 6th month, the efficacy of the treatment will be assessed. Post procedure sunscreen and emollients will be prescribed.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION /OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS AND ANIMALS? IF SO DESCRIBE.

Routine investigations like Hb, BT, CT

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION.

8. LIST OF REFERENCES:

1. N.B. Sinpson,W.J.Cunliffe, Disorders of Sebaceous Glands, In: Tony Burns, Stephan Breathnach, Neil Cox, Christopher Griffith, Editors. Rooks Textbook of Dermatology.7th edition. Oxford: Blackwell Publisher,2004. p 43.15 2. Jacob Cl , Dover JS , Kaminer MS. Acne scarring: A classification system and review of treatment options. J Am Acad Dermatol :2001; 45: 109-17.

3. Imran Majid . Microneedling therapy in atrophic facial scars: An objective assessment: Journal of Cutaneous and Aesthetic Surgery :2009; 2(1): 26-30.

4. Shawn P Davis , Mark G Allen , Mark R Prausnitz . The mechanics of microneedling . Proceeding of the 2nd EMBS conference ;2002 Oct 23-26; Houston , TX .

5. Oretriech DS , Orentriech N . Subcutaneous incisionless ( subcision ) surgery for the correction of depressed scars and wrinkles . Dermatol Surg : 1995; 21(6) :543-9 .

6. Camirand A , Doucet J . Needle dermabrasion . Aesthetic Plastic Surgery : 1997 ; 21(1) : 48-51.

7. Fernandes D . Percutaneous collagen induction : An alternative to laser resurfacing . Aesthetic Surg Journal : 2002 ; 22:315

8. Fernandes D . Skin needling as an alternative to laser .Proceeding of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery Conference; 1999 Jun 26-30; San Francisco, California.

9. Matthias C Aust , Des Fernandes , Perikles Kolokythas , Hilton M Kaplan , Peter M Vogt . Percutaneous Collagen Induction Therapy : An Alternative Treatment for Scars , Wrinkles ,and Skin Laxity . PRS Journal : 2008;121 (4) 1421-9.

9. NAME OF THE DR LALITHA C. CANDIDATE AND SIGNATURE. 10. REMARKS OF Acne and post acne scarring is very distressing as GUIDE. acne scars both the face and mind and such scars are always a challenge to treat. Microneedling has emerged as an effective treatment option for such scars, as it is a simple, easy to do, cost effective, non ablative minimally invasive procedure with excellent results and minimal social downtime. Study of such a new method is very much needed. 11.1 NAME AND DR LEELAVATHY B DESIGNATION OF ASSOCIATE PROFESSOR, GUIDE. DEPARTMENT OF DERMATOLOGY, VENEREOLOGY AND LEPROSY. BOWRING AND LADY CURZON HOSPITAL, BMC&RI, BANGALORE. 11.2 SIGNATURE OF THE GUIDE.

11.3 NAME OF THE DR MALLIKARJUN M HEAD OF THE DEPARTMENT OF DERMATOLOGY, DEPARTMENT. VENEREOLOGY AND LEPROSY. BMC&RI, BANGALORE. 11.4 SIGNATURE OF THE HEAD OF THE DEPARTMENT. 12.1 REMARKS OF THE DIRECTOR. 12.2 SIGNATURE OF THE DIRECTOR.