Improvement of Atrophic Acne Scars in Skin of Color Using Topical Synthetic Epidermal Growth Factor (EGF) Serum: A Pilot Study
April 2017 | Volume 16 | Issue 4 | Original Article | 322 | Copyright © 2017
Marie Alexia Stoddard BS,a Jennifer Herrmann MD,b,c,d Lauren Moy MD,e and Ronald Moy MDb,f
aDavid Geffen School of Medicine at UCLA, Los Angeles, CA bMoy-Fincher-Chipps Facial Plastics/Dermatology, Beverly Hills, CA cDepartment of Dermatology, Keck School of Medicine at USC, Los Angeles, CA dDepartment of Dermatology, Harbor-UCLA Medical Center, Los Angeles, CA eAlbany Medical Center, Albany, NY fDepartment of Dermatology Keck School of Medicine at USC, Los Angeles, CA
BACKGROUND: Atrophic scarring in skin of color is a common, permanent, and distressing result of uncontrolled acne vulgaris. Ablative lasers and chemical peels are frequently used to improve the appearance of atrophic scars, primarily through the stimulation of collagen and elastin; however, these treatment modalities are associated with risks, such as dyspigmentation and hypertrophic scarring, especially in patients with darker skin.
OBJECTIVE: We evaluated the efficacy of topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars in skin of color.
METHODS: A single-center clinical trial was performed on twelve healthy men and women (average age 32.5) with Fitzpatrick Type IV-V skin and evidence of facial grade II-IV atrophic acne scars. Subjects applied topical EGF serum to the full-face twice daily for 12 weeks. Scar improvement was investigated at each visit using an Investigator Global Assessment (IGA), a Goodman grade, clinical photography, and patient self-assessment.
RESULTS: Eleven subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 3.36 (SEM = 0.15) to 2.18 (SEM = 0.33). Mean Goodman grade was reduced from 2.73 (SEM = 0.19) to 2.55 (SEM = 0.21). Of the eleven pairs of before and after photographs, nine were correctly chosen as the post-treatment image by a blind investigator. On self-assessment, 81% reported a “good” to “excellent” improvement in their scars compared to baseline (P = 0.004).
CONCLUSION: Topical EGF may improve the appearance of atrophic acne scars in skin of color. Additional, larger studies should be conducted to better characterize improvement.
J Drugs Dermatol. 2017;16(4):322-326.
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Acne vulgaris remains the most common dermatologic condition in all skin types, and accounts for 13.2% of visits to dermatologists in the United States.1,2 In previous surveys, acne vulgaris was found to be the most common dermatologic diagnosis in African-American, Latinos, Asian, and Arab-American patients.3-8 Although most cases develop during adolescence,9,10 acne continues to be a common skin problem in adulthood, with women being affected at higher rates than men.11 While acne is documented as a major source of anxiety and insecurity among patients,2,9-11 residual permanent scarring can be equally distressing.1,12,13 Acne scarring is a common complication of acne, with some degree of scarring observed in 95% of acne patients.14,15 Studies that have explored its psychological implications have linked acne scarring to embarrassment, poor self-esteem, depression, anxiety, and increased risk of sucide.12,13,16 Instead of fading with time, the appearance of scars often worsen with normal aging 16 or photodamage, further exacerbating the issue. Acne scars are generally classified based on their morphology, ranging from atrophic, hypertrophic, keloidal, or a combination.16 Atrophic acne scars are dermal depressions that can be further subdivided into boxcar (angular, well-defined edges), icepick (narrow and v-shaped), or rolling (wide and undulated) types with variable severity.16,17 Deep, punctiform icepick scars are considered the most severe, and, unfortunately, represent roughly 60-70% of cases.17 The pathogenesis of atrophic acne scars has not been fully determined, but it may relate to severe perifollicular inflammation that results in collagen destruction and dermal atrophy.14,18 This