Ocular surface changes in moderate-to-severe acne vulgaris

AIM:To investigate ocular surface disorders and tear function changes in patients with acne vulgaris and explore the potential relationship between acne vulgaris and dry eye.METHODS:This cross-sectional study included right eyes of 53 patients with acne vulgaris and 54 healthy controls.The participants completed the Ocular Surface Disease Index(OSDI)questionnaire.The following ocular surface-related parameters were measured:tear meniscus height(TMH),noninvasive tear breakup time(NIBUT),Schirmer I test(SIT),lipid layer thickness(LLT)score of the tear film,meibum score,meibomian gland orifice obstruction score,the ratio of meibomian gland loss,conjunctival hyperemia score,and corneal fluorescein staining(CFS)score.RESULTS:The stability of the tear film decreased in acne vulgaris patients.In the acne group,the TMH and NIBUT were lower,whereas the OSDI,meibum score,meibomian gland orifice obstruction score,ratio of meibomian gland loss,and conjunctival hyperemia score were higher compared with controls(P<0.05).There were no significant differences in the CFS score,SIT,or LLT score between the groups(P>0.05).In two dry eye groups,the TMH,NIBUT,and LLT score were lower in the acne with dry eye(acne-DE)group,and the meibum score,meibomian gland orifice obstruction score,ratio of meibomian gland loss and conjunctival hyperemia score in the acne-DE group were higher(P<0.05).There were no significant differences between OSDI,SIT,and CFS score(P>0.05).CONCLUSION:Patients with moderate-to-severe acne vulgaris are more likely to experience dry eye than those without acne vulgaris.Reduced tear film stability and meibomian gland structure dysfunction are more pronounced in patients with moderate-to-severe acne and dry eye.

Re-evaluating the necessity of routine laboratory monitoring during isotretinoin therapy for acne

In this letter,we discuss the topic of necessity of routine laboratory monitoring during isotretinoin treatment for acne.According to Park and colleagues,it is advisable to monitor the levels of triglycerides,alanine aminotransferase,and aspartate aminotransferase every 5 to 6 months.Additionally,the levels of total cholesterol and low-density lipoprotein should be checked within the first two months of treatment.Isotretinoin is a commonly prescribed agent mainly used to treat acne.Despite its high effectiveness,it necessitates regular monitoring of laboratory parameters due to its side effect profile.Currently,there remains a lack of consensus on the appropriate frequency for monitoring these parameters during treatment with isotretinoin.This letter will provide insight into this complex and controversial topic.Based on existing literature,we concluded that the incidence of changes in lipid and liver aminotransferase levels during isotretinoin treatment for acne was low and likely clinically insignificant.For generally healthy people,we recommend testing lipid and liver profiles once at baseline and a second time at the peak dosage.However,frequent testing might still be beneficial in certain populations of patients.

Serum level changes of inflammatory cytokines in patients with moderate to severe acne vulgaris treated with dual-wavelength laser

Background:Acne vulgaris(AV)is a common inflammatory skin disease.Although various mechanisms have been indicated in the etiopathogenesis of AV,the exact pathophysiology remains unknown.Various lasers have been used to treat AV;however,the serum level changes of inflammatory cytokines after laser therapy have not been elucidated.We aimed to investigate the relationship between inflammatory changes and remission on the opposite side in patients with moderate to severe AV after treating half of the face with 595-and 1064-nm dualwavelength laser.Methods:In total,18 patients(9 male and 9 female)between 16 and 35 years of age with moderate to severe AV were evaluated in the study.Disease severity was classified according to the Pillsbury grading system of acne.Patients were randomized to receive a series of two treatment sessions at intervals of 2 weeks and followed up at 2 weeks after the final treatment.A 3 mL blood sample was drawn from every subject each time,and serum levels of inflammatory cytokines such as interleukin(IL)-6,IL-8,and IL-22 were determined using enzyme-linked immunosorbent assay at baseline and 2 weeks after each treatment.Improvement was determined by a blinded assessment of photographs taken before and after the final evaluation.Results:Inflammation was significantly reduced on both the treated and untreated sides,and symptoms of AV lesions were alleviated.All patients showed a significant increase in serum IL-22 levels after the first laser therapy,with no significant difference in serum IL-6 and IL-8 levels.After the second laser therapy,serum IL-6,IL-8,and IL-22 levels were significantly decreased.No significant side effects such as bruising,edema,hyperpigmentation,hypopigmentation,or scarring were reported.Conclusion:Half-face treatment with 595-and 1064-nm dual-wavelength laser for moderate and severe AV showed a significant effect of full-face remission,which was associated with a gradual decrease in IL-6,IL-8,and IL-22 levels after half-face topical treatment.This suggests that reducing inflammatory cytokine levels in the serum can relieve inflammation in non-therapeutic sites.This laser treatment is effective,economical,and painless.

Optimal laboratory testing protocol for patients with acne taking oral isotretinoin

BACKGROUND Isotretinoin is a widely prescribed drug for various dermatological conditions,especially acne.Blood tests are routinely performed to monitor its side effects.However,the optimal testing schedule remains controversial.AIM To evaluate the laboratory monitoring tests and schedules of patients with acne taking isotretinoin to determine the most efficient testing regimen.METHODS We retrospectively reviewed electronic medical records from the Dermatology Department of Dongguk University Ilsan Hospital from 2005 to 2020 for patients prescribed isotretinoin for acne who underwent monthly blood tests.RESULTS Aspartate aminotransferase(AST),alanine aminotransferase(ALT),and trigly-ceride(TG)levels significantly changed between 5 and 6 mo when the total prescription period and dose variables were considered altogether.The high-density lipoprotein level also significantly changed between 5 and 6 mo.However,low-density lipoprotein(LDL)and total cholesterol levels significantly changed between 1 and 2 mo.CONCLUSION We recommend testing AST,ALT,and TG levels once every 5 to 6 mo.We also suggest testing LDL and total cholesterol levels during the first and second months.

过氧化物酶体增殖物激活受体-γ对P.acnes诱导的人角质形成细胞焦亡、增殖及凋亡的影响

目的分析过氧化物酶体增殖物激活受体-γ(peroxisomeproliferator-activatedreceptors,PPAR-γ)对痤疮丙酸杆菌Propionibacterium acnes(P.acnes)诱导的细胞焦亡、增殖及凋亡效应的影响,为痤疮的临床治疗提供新的理论依据。方法采用IHC方法检测痤疮患者皮损中PPAR-γ的表达。使用慢病毒转染,在HaCaT细胞中过表达PPAR-γ,1×107 CFU/mL P.acnes诱导细胞,通过Western blot验证PPAR-γ蛋白的表达;采用ELISA法检测细胞内焦亡相关炎症因子IL-1β和IL-18;EdU和流式细胞术检测细胞增殖和凋亡;Western blot检测细胞焦亡相关蛋白,如NOD样受体家族3(NLRP3)蛋白、活化的半胱天冬酶1(Caspase-1)、Gasdermin D(GSDMD)的表达水平。结果PPAR-γ在痤疮组织中表达明显降低(P<0.05)。与对照组相比,P.acnes处理后,细胞焦亡相关炎症因子IL-1β和IL-18增加(P<0.01);细胞焦亡相关蛋白NLRP3、Caspase-1和GSDMD的表达水平增加(P<0.05)。过表达PPAR-γ后,在P.acnes诱导下,过表达组与对照组比IL-1β和IL-18明显降低,细胞增殖能力增加,凋亡水平明显下降,细胞焦亡相关蛋白NLRP3、Caspase-1和GSDMD的表达减少,且差异均有统计学意义(P<0.05)。结论PPAR-γ可有效调节P.acnes诱导的细胞焦亡并对人角质形成细胞增殖、凋亡进行调控。

A Case Report of Concurrent Acne-Related Occurrence Complications: Telangiectasia, Post-Inflammatory Erythema, Post-Inflammatory Hyperpigmentation, and Atrophic and Hypertrophic Scars

Prior to his initial diagnosis, a 21-year-old male had been experiencing facial acne for two years and had been treated by a doctor in private practice. The patient visited our department because the clinical manifestations of mandibular acne did not improve. At the time of initial examination, telangiectasia (TE), post-inflammatory erythema (PIE), post-inflammatory hyperpigmentation (PIH), atrophic scars (ASs), and a hypertrophic scar (HS) with induration were observed on the right neck. We diagnosed this as an acne vulgaris complication. HS lesions were topically treated by injecting triamcinolone acetonide, and the patient was prescribed 8.1 g/day of oral Saireito (Japanese herb). Adapalene benzoyl peroxide gel and topical tacrolimus hydrate ointment were used to treat PIE and TE. Both HSs and PIE improved;however, TE and AS did not improve. Currently, the patient is under observation. We consider this to be a very rare concurrent occurrence of diverse complications of acne vulgaris, and present the following case study.

Effective Skin Care Guidance for Patients with Acne Vulgaris after Standard Treatment

With the introduction of new drugs, the treatment of acne vulgaris has improved dramatically;however, there remains a considerable gap between treatment outcomes and patients’ treatment goals. This study aimed to determine whether dermatologists’ guidance on appropriate skincare for skin symptoms such as post-inflammatory erythema and post-inflammatory hyperpigmentation (PIH), which are not covered by acne treatment, leads to an improvement in patients’ skin condition and patient satisfaction. Japanese women who had completed standard treatment for acne vulgaris and those with mild symptoms not requiring treatment were included in the study. The participants received instructions about skin care at the beginning of the study, which they continued to apply for 6 weeks. At the start and end of the study, participants were examined by a dermatologist;afterward, skin measurements, including skin color, skin surface lipid content, and image analysis by VISIA® Evolution, analysis of stratum corneum obtained from the skin surface, and Skindex-16 questionnaire for assessing quality of life (QOL), were performed. The following showed significant improvements: PIH score, number of inflammatory acne lesions, and number of non-inflammatory acne lesions observed via skin examination;skin surface lipid content and values of L* and a* obtained via instrumental measurement;n number of pore, texture, red spot, and pigmented spot obtained via by image analysis;and degree of multilayer exfoliation and interleukin-1α determined by analysis of epidermal stratum corneum. QOL measurement using Skindex-16 also improved significantly. Appropriate skin care guidance following standard acne vulgaris treatment is helpful in achieving patients’ treatment goals. .

SPS烧结温度对ACNs/Ti复合材料组织结构与力学性能的影响

通过放电等离子烧结(SPS)制备ACNs(无定形碳纳米颗粒)/Ti复合材料,并采用扫描电子显微镜、X射线衍射仪、光学显微镜以及电子万能试验机对不同烧结温度下ACNs/Ti复合材料的显微组织、相组成及力学性能进行表征。结果表明,较低烧结温度(800℃)下,未反应的ACNs虽然会对复合材料的强度有所贡献,但其与基体的界面结合较弱,会导致复合材料塑性严重下降。较高烧结温度(1000℃)下,与基体充分反应的TiC颗粒过度生长后尺寸较大,这一现象会造成材料强度下降。当烧结温度为900℃时,ACNs与Ti基体完全反应生成TiC颗粒,这种细小弥散的TiC沿着基体颗粒周围分布形成了准连续网状结构,此时ACNs/Ti复合材料具有最佳的强塑性匹配,其抗拉强度、屈服强度、延伸率分别为648.19 MPa、551.02 MPa、36.19%。

A study on the mechanism of acupuncture treatment of acne based on immune inflammation

Acne is a chronic inflammatory skin disease involving hair follicle sebaceous glands,which is characterized by acne,papules,pustules,nodules,cysts and so on.The disorder of immune inflammation is the key link.A variety of factors participate in the immune inflammatory response of acne and interact with each other,leading to the occurrence and development of acne inflammation.Acupuncture can regulate the immune and inflammatory response through many links and improve the skin lesions.This study explains potential mechanisms of acupuncture in the treatment of acne by regulating the body's immune inflammatory response,in order to provide new ideas.

基于等效ACN - PCN的机场重载车辆通行性能分析

近年来,机场改扩建工程日益增多,且大多涉及不停航施工,即施工期间有大量诸如挖掘机、推土机、载重卡车等重型工程车辆在飞行区通行。施工期间,重型车辆在现有机场道面不同区域的通行对道面板带来新的荷载负担。因缺乏成熟的机场重型车载道面评估计算方法,重型车辆轮载是否会造成现行道面结构承载性能下降已成为机场管理机构关注的重点问题。有鉴于此,基于民航现行飞机等级号ACN计算规则,以工程重载卡车为例,提出了基于ACN的概念式计算与ACN等效荷载精确计算两种评估重载车辆道面通行能力的评价方法;通过有限元仿真,基于道面板底最大弯拉应力小于容许应力的基本原则,对机场重载车辆通行道面板性能进行精确计算与分析,评估案例机场的重载车辆道面板性能。结果表明重载车辆的ACN概念式计算结果精度较低,与ACN等效荷载精确计算结果相差较大;经过有限元仿真精确计算后的案例机场等效ACN值小于机场通报的最小PCN值,表明该重载卡车满足通行条件;验证了ACN等效荷载道面性能评价方法的可靠性,为机场不停航施工运行安全及工程管理评估提供重要参考。

NMP法和ACN法在丁二烯抽提装置中的应用

介绍了国内某企业采用NMP(N-甲基吡咯烷酮)法和ACN(乙腈)法建设的2套丁二烯抽提装置。通过对NMP法和ACN法丁二烯抽提装置的工艺流程特点、产品质量要求、溶剂萃取性能及装置经济效益及投资等方面进行总结,结合2套装置的实际运行数据,发现NMP法丁二烯抽提装置工艺流程更加合理紧凑,运行成本更低且NMP溶剂对环境更加友好。

Curative observation and the influence on the mental status of the patients with acne scars treated with pixe12940 laser

目的：了解痤疮凹陷性瘢痕患者的心理健康状况，观察Pixel 2940激光治疗痤疮凹陷性瘢痕的疗效及对患者心理健康的影响。方法：2010年10月～2012年8月，笔者科室采用Pixel 2940激光治疗痤疮瘢痕患者39例，并在治疗前和治疗结束后1月用Cardiff痤疮心理评估量表评估患者心理状况。结果：Pixel 2940激光治疗痤疮凹陷性瘢痕有效率达94．9％，副反应少而轻；痤疮影响了患者的心理健康，患者常常感到焦虑、愤怒和自信心下降等，但治疗后心理明显好转。结论：用Pixel 2940激光治疗痤疮凹陷性瘢痕疗效稳定、副反应少，可改善患者心理健康状况。

Effects of cosmetics containing purified honeybee(Apis mellifera L.) venom on acne vulgaris

Acne vulgaris is a chronic dermatologic problem with multiple factors involved in its pathogenesis. Alternative solutions to acne treatment were instigated by antibiotic resistance despite of its extensive use. Purified bee venom （PBV） has been proposed as a promising candidate for that purpose. The present study was designed to confirm the antibacterial effect of PBV and access the efficacy of cosmetics containing PBV in subjects with acne vulgaris. METHODS： The skin bacterium Propionibacterium acnes was incubated with PBV at various concentrations and bacterial growth was evaluated using the colony forming unit （CFU） assay. The mechanism of PBV employed in killing P. acnes was examined by scanning electron microscopy （SEM） and transmission electron microscopy （TEM）. In addition, a total of 12 subjects were randomized in a double-blind, controlled trial to receive either cosmetics containing PBV or cosmetics without PBV for two weeks. Evaluations included lesion counts and skin microorganism. RESULTS： PBV exhibited antimicrobial activity in a concentration-dependent manner, reducing the number of P. acnes CFU by approximately 6 logs at a concentration of 0.5 mg. When PBV concentration was higher than 1.0 mg, no P. acnes colonies were spotted on an agar. TEM and SEM of untreated P. acnes illustrated the normal pleomorphic structure, whereas the PBV- treated bacterium lost the integrity of surface architecture. Significant difference （P=0.027） in the grading levels based on numbers of lesion counts for inflammatory and noninflammatory was observed in favour of the PBV group compared with the control group. In terms of average decrement of skin microorganism, subjects receiving cosmetics containing PBV experienced a significant 57.5% decrease of adenosine triphosphate levels, whereas participants receiving cosmetics without PBV experienced a nonsignificant decrease of 4.7%. CONCLUSION： These results show that the in vitro actions of antimicrobial activity of PBV were translated in vivo. Cosmetics containing PBV provided a certain degree of efficacy in terms of lesion counts and skin microorganism concentration compared with cosmetics without PBV in subjects with acne vulgaris. PBV may be a good candidate compound for developing therapeutic drua for the treatment of acne vulaaris.

Adherence to acne treatment guidelines in the military environment-a descriptive,serial cross-sectional study

Background:Acne vulgaris,a common skin disease,affects up to 80% of the population.Moderate to severe acne requires treatment with a combination of topical and oral drugs such as antibiotics,hormones and retinoids.Retinoids have many contraindications and adverse effects requiring close monitoring.The study's objectives were to describe prescribing trends in acne medication over time in a military setting,and assess physician adherence to guidelines for acne treatment,including drug precautions,clinical monitoring,and treatment progression.Methods:We conducted a descriptive,serial cross-sectional study of acne drugs prescribed in the Israel Defense Forces(IDF) in the years 2002–2007,analyzing the classes of drugs prescribed and patient characteristics.In addition,the clinical quality of the medical encounter was assessed by examining physician adherence to IDF guidelines.Results:Between 2002 and 2007,64,281 patients were treated for acne.Treatment courses generally persisted for 1–2 months.Over 70% of female patients receiving oral retinoids were not concomitantly receiving oral contraceptives.Conclusions:This study provides a unique perspective of acne treatment in a military setting,overall displaying good adherence to general guidelines.The common prescription of oral retinoids to young females without concomitant contraception is alarming.

逍遥散联合异维A酸对青春期后中重度痤疮患者IL-8和Qol-Acne评分的影响

目的:探究逍遥散联合异维A酸软胶囊治疗青春期后中重度痤疮患者的临床效果。方法:选取笔者医院收治的72例青春期后中重度痤疮患者为研究对象,随机分为观察组与对照组,每组36例,对照组给予异维A酸软胶囊口服治疗,观察组在对照组的基础上给予联合逍遥散口服治疗,两组均治疗1个月。比较两组患者的中医症候积分、炎性因子水平、皮损积分和生活质量评分。结果:治疗后,两组患者的中医证候积分均显著降低,且观察组低于对照组(P<0.05);两组患者的IL-8和TNF-α值均显著降低,且观察组低于对照组(P<0.05);两组患者的情感功能、社会功能、自我感知评分升高,观察组高于对照组,且皮肤病生活质量指数(DLQI)评分均降低,观察组低于对照组(P<0.05);随着治疗时间的延长,皮损积分逐渐降低,均低于治疗前,且每个时间点比较,观察组均低于对照组(P<0.05)。结论:逍遥散联合异维A酸软胶囊治疗青春期后中重度痤疮疗效显著,可明显减少皮损,并改善患者生活质量。

Depressed Acne Scars—Effective, Minimal Downtime Treatment with a Novel Smooth Motion Non-Insulated Microneedle Radiofrequency Technology

Background: The microneedle fractional RF handpiece used in our study (Intensif Handpiece, EndyMed Medical, Caesarea, Israel) is a novel handpiece that uses a tip with 25 non-insulated, gold plated microneedle electrodes. The needles are inserted into the skin by a specially designed electronically controlled, smooth motion motor minimizing patient discomfort. RF emission delivered over the whole dermal portion of the needle allows effective coagulation resulting in minimal or no bleeding, together with bulk volumetric heating. Study Design/Materials and Methods: The study included 20 patients, treated for depressed acne scars using the IntensifTM?Microneedles handpiece (EndyMed PRO Platform System, EndyMed Medical, Caesarea, Israel). The degree of clinical improvement was assessed by the global aesthetic improvement scale (GAIS) and subjects satisfaction by post treatment questionnaires. Results: The number of treatments per patient varied between 1 and 6 (average 3.3 treatments per patient). Eleven patients (55%) reported none to minimal pain, six (30%) moderate discomfort and only three (15%) reported significant pain. Objective evaluation of the improvement by a board certified dermatologist showed improvement in 95% of patients. 25% showed excellent improvement, 50% experienced good improvement, and the 20% showed minimal improvement. One patient showed no improvement. Conclusions: The presented results show that the tested electronically controlled motorized insertion, non-insulated microneedle treatment technology provides a minimal discomfort, minimal downtime, effective and safe treatment for depressed acne scars.

High-throughput RNA sequencing reveals the anti-inflammatory mechanism of baicalin on Propionibacterium acnes-induced acne in rabbits

Objective:Propionibacterium acnes(P.acnes)plays an important role in the development of acne,an inflammatory skin disease with a high-incidence.In this study,we used high-throughput RNA sequencing(RNA-seq)to reveal the anti-inflammatory mechanism of baicalin on P.acnes-induced acne in rabbits.Methods:The Kligman method was used to induce acne in the ears of New Zealand rabbits.The effect of baicalin on the acne model was evaluated by the number of acne lesions and hematoxylin and eosin(H&E)staining of acne tissues.Enzyme-linked immunoabsorbent assay was used to measure the protein expression levels of tumor necrosis factor a(TNFA),interleukin-1 b(IL1B),IL6,and IL8 in the serum of rabbits.RNA-seq was performed to investigate the mechanism of anti-inflammatory activities of baicalin on acne.Immunohistochemical analysis and Western blot were used to validate the expression levels of related proteins in acne tissues.Results:Baicalin treatment significantly reduced the number of acne lesions and lesions of the ear as well as levels of serum inflammatory cytokines.RNA-seq data showed that baicalin treatment globally suppressed inflammation,especially the TNF signaling pathway and Staphylococcus aureus infection pathway,in the rabbit acne model.Conclusion: Baicalin effectively ameliorates P. acnes-induced acne in rabbits by suppressingthe inflammatory response in rabbits.

Review of the Therapeutic Advance of Acne Treatment

Acne vulgaris is among the most frequent chronic skin disorders in adolescents, characterized by inflammation of the pilosebaceous unit. The psychological distress due to the disfiguring is the main problem that affects the quality of life for patients suffering from acne. Drugs for the treatment of acne are one of the main contents of drug research on common skin diseases. Acne treatment has remained relatively unaltered over the last years. Still, in conjunction with the increase of bacterial resistance to antibiotics throughout the world, there is a global trend away from antibiotic monotherapy treatment. This review discussed the currently used treatment options and evaluated the issues and evidence supporting their usage for patients with acne, including drug therapy with topical, oral, hormonal therapy, and so on. Drug therapy is the most common method in the clinic. Due to the multifactorial etiology of acne vulgaris, most drugs cannot meet the treatment requirements. Therefore, the screening and development of excellent drugs are one of the key targets for treating acne in the future.

Rapid remission of refractory synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome in response to the Janus kinase inhibitor tofacitinib: A case report

BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome is a rare autoinflammatory disease for which clinical treatment has not been standardized.Janus kinase(JAK)inhibitors represent a novel therapeutic option for rheumatoid arthritis,psoriatic arthritis,and some other autoinflammatory diseases.However,the clinical utility of JAK inhibitors in treating SAPHO syndrome has not been thoroughly investigated.In this study,we describe a patient with SAPHO syndrome who failed to respond to conventional treatment but demonstrated a remarkable and rapid response to the JAK inhibitor tofacitinib.CASE SUMMARY A 62-year-old female patient presented with swelling and pain at the sternoclavicular joints,back pain that limited her activities,arthralgia in the right knee,and cutaneous lesions.Her symptoms were unresponsive to nonsteroidal anti-inflammatory drugs,disease-modifying antirheumatic drugs,Tripterygium wilfordii hook f,and bisphosphonates.SAPHO syndrome was diagnosed in accordance with dermatological and osteoarticular manifestations and abnormal inflammatory factors.Multiple image studies have illustrated bone lesions and pathological fractures of vertebral bodies.Oral treatment with tofacitinib at 5 mg twice daily with methotrexate and bisphosphonates was initiated.The patient reported that her pain symptoms were relieved after 3 d and her cutaneous lesions were reduced after 4 wk of treatment.Vertebral lesions were improved after 6 mo on tofacitinib.No serious adverse effects were noted.CONCLUSION JAK inhibitor therapy may be a promising strategy to treat SAPHO syndrome.

Retrospective Study of the Use of a Fractional Radio Frequency Ablative Device in the Treatment of Acne Vulgaris and Related Acne Scars

Background: Acne vulgaris (AV) is a common disease that often results in disfiguring facial scarring that carries into adulthood. Here we report our experience with fractional radiofrequency (FRF) device in treatment of patients with acne and acne related scarring. Materials & Methods: We retrospectively reviewed the charts of all patients with acne scarring who completed a four treatment regimen in our clinic. Results: We identified eight patients who completed four treatments with median age of 20.5 years (range 17 - 41). All patients demonstrated significant improvement of acne lesions and acne scarring. Skin biopsies demonstrated reduction of scar depth and increased new collagen production, and repopulation of the scar tissue by elastic fibers and adnexal structures after the fourth treatment. Conclusion: FRF emerges as a safe and effective treatment modality for AV and acne related scars. Further randomized controlled studies are required to fully evaluate the magnitude of this positive effect and more basic science studies are needed in order to better characterize its mechanism of action on acne lesions.