الفهرس 
Acne ScarsOnly 14 pages are availabe for public view
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Abstract
Summary
Acne affects over 80% of the population at some point in their lives, yet not all people with acne develop scars. It is currently not possible to predict which patient may have scar and which may not. Facial acne scarring is a psychologically devastating condition (Layton et al., 1994; Goodman, 2003).
Different treatment modalities have been used to ameliorate atrophic scars with varying degrees of success. The majority of traditional treatment options suffer from the limitation of either being marginally effective or having considerable morbidity. Treatment options like laser resurfacing or dermabrasion that offer significant improvement in facial scars are invariably associated with considerable morbidity and long downtime and interfere with the daily activities of the patient in the post-treatment period. On the other hand, treatments like micro-dermabrasion and non-ablative resurfacing with lasers that are associated with minimal or no downtime do not show the same level of efficacy as the traditional, ablative resurfacing techniques (Majid, 2009).
The use of stem cells is becoming more realistic in both skin and scar repair. Stem cells can be isolated from BM and other tissues such as adipose tissue, umbilical cord and skin tissue. Stem cells may contribute to tissue repair or regeneration of many tissues including myocardium, blood vessels, damaged bone, tendons, cartilage, and skin (Kataoka et al., 2003; Nakagawa et al., 2005).
Platelet rich plasma is an autologous preparation of platelets in concentrated plasma. It has attracted much attention in various medical fields, including orthopedic, plastic, and dental surgeries and dermatology for its wound healing ability. Platelets release various cytokines and growth factors that promote angiogenesis, tissue remodeling, and wound healing (Kim et al., 2011).
Platelet rich plasma works by the degranulation of granules in platelets, which contain the synthesized and prepackaged growth factors. Many growth factors have short half lives; therefore greatest effectiveness may result if they are activated at or just before injection. Fibroblasts accumulate at the site of injection and start to lay down collagen; therefore PRP may be beneficial in the treatment of atrophic acne scars by promoting collagen deposition (Nofal et al., 2014).
In the presented study we aimed at studying the effectiveness of AT-ASCs and PRP in the treatment of atrophic rolling post acne scars and comparing both modalities. Twenty patients with atrophic rolling post acne scars were recruited from the dermatology outpatient clinic of Ain Shams University hospitals and were subdivided randomly and equally into two groups. In the first group of patients AT-ASCs were injected intradermally underneath the rolling scars and in the second group of patients PRP was injected intradermally underneath the rolling scars. A single session was done for all patients. Follow up was done one month and 3 months after the treatment session. Evaluation was done by photography, estimation of the percentage of reduction of the total surface area of the rolling scars measured by skin surface microscopy, histopathological examination of skin biopsies taken from a rolling scar, before and 3 months after the treatment session. In addition, patients satisfaction questionnaire and assessment of side effects were carried out.
The mean percentage of reduction in the total surface area of the rolling scars in the AT-ASCs group was 66.49% 3 months after the treatment session and this was rated as good response (51-75%). While, in the PRP group the mean percentage of reduction in the total surface area of the rolling scars was 80.2% three months after single injection session and this was rated as excellent response (76-100%).
On comparing the mean of the total surface area of the rolling scars, before, 1 month and 3 months after the treatment session in each studied group, there was statistically significant improvement in the AT-ASCs group while in the PRP group the improvement was highly significant.
There was a statistically significant reduction in the mean percentage of the total surface area of the rolling scars in the PRP group in comparison to the AT-ASCs group between 1 month and 3 months and 3 months after treatment. But 1 month after treatment there was no statistically significant difference between both studied groups.
On histopathological examination of a skin biopsy taken from a rolling scar 3 months after the treatment session, H&E showed that the epidermis in both groups became acanthotic, and the dermis showed increased number and density of collagen fibers with less interfibrillary spaces. Epidermal thickness increases by 49% in the AT-ASCs group and 42% in the PRP group.
Masson trichrome stain showed increase in the number and density of collagen fibers, and decreased interfibrillary spaces. The collagen content increased by 34% in the AT-ASCs group and 35% in the PRP group.
Orcein stain showed increased number and density of elastic fibers. The elastin content increased by 30% in the AT-ASCs group and 40% in the PRP group.
According to patients’ satisfaction; in the AT-ASCs group, seven patients (70%) reported that they were satisfied, compared to nine patients (90%) in the PRP group reported that they were satisfied.
All patients in both groups experienced mild pain during injection which was resolved completely after finishing the injection procedure. Facial edema was observed immediately after treatment and resolved within 3 days.
Two patients among the AT-ASCs group suffered from ecchymosis at the liposuction site which was resolved within 2 weeks. Skin necrosis at the site of liposuction was reported by one patient, it was treated by topical and systemic antibiotic and healing occurred within one month leaving a hyperpigmented scar.