Improvement in Atrophic Acne Scars Using Topical Synthetic Epidermal Growth Factor (EGF) Serum: A Pilot Study
September 2015 | Volume 14 | Issue 9 | Original Article | 1005 | Copyright © September 2015
Rachel Seidel BAa and Ronald L. Moy MD FAADb,c
aGeorgetown University School of Medicine, Washington, DC
bKeck School of Medicine of the University of Southern California, Los Angeles, CA
cMoy-Fincher-Chipps Dermatology, Beverly Hills, CA
Abstract
BACKGROUND: Atrophic acne scars are a common and psychologically devastating sequela of acne vulgaris that are refractory to the vast majority of topical treatments.
OBJECTIVE: We evaluated the efficacy of a topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars.
METHODS: A single-center clinical trial was performed on nine self-selected male and female patients with Goodman & Baron grade II-IV atrophic acne scars. Subjects followed a standardized treatment regimen, including twice-daily application of EGF serum to scarred areas over 12 weeks. Subject progress was evaluated at baseline and 4-week intervals by clinical photography, Investigator Global Assessment (IGA), Goodman grade and patient self-assessment. Final patient perceptions were shared by written self-assessment at the end of the study. Before and after photographs were also evaluated by a blind investigator.
RESULTS: Eight subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 2.875 (SEM= .327) to 2.38 (SEM = .375). Mean Goodman grade was reduced from 3.00 (SEM = .309) to 2.75 (SEM = .25). Of the eight pairs of before and after photographs given to a blind investigator, five were correctly chosen as the post-treatment image. Two were assessed as “excellent” (76-100%) improvement and three were assessed as "good" (50-75%) improvement. A one-tailed paired student t-test (α = .05) using blind investigator ratings of scar severity for each before and after photograph yielded a P-value of .0019, confirming the difference as statistically significant. On final self-assessment, all but one patient reported “good” to “excellent” improvement in their scars compared to baseline. 75% of patients who received alternative treatments in prior years reported EGF serum to be more efficacious.
CONCLUSION: These results suggest that topical EGF may improve the appearance of atrophic acne scars, though further study and more objective evaluation measures are required for definitive conclusions to be drawn.
J Drugs Dermatol. 2015;14(9):1005-1010.
INTRODUCTION
Acne remains the most common dermatologic condition in the United States, affecting roughly 80% of people between the ages of 11 and 30.1 It is well recognized as a major source of stress and insecurity among its sufferers, both adolescents and adults. However, often overlooked is the considerable psychosocial impact of residual scarring. Nearly 30% of individuals who experience acne at some point in their lives are left with scars ranging from mild to severe and which, in a majority of cases, are permanent.2,3 For many, severe scars contribute to depression, anxiety, body image alterations and generally low self-esteem.4 It may also be a risk factor for suicide.5
Acne scars are typically classified into three different types: atrophic, hypertrophic and keloidal, the former being the most common.3 Atrophic scars can be further subdivided into icepick, boxcar and rolling types. Though all are depressed, thin and often discolored secondary to tissue loss, severity is variable. Deep, punctiform icepick scars are considered the most severe, and, unfortunately, represent roughly 60-70% of cases.6
The pathogenesis of atrophic acne scars remains incompletely understood. The most accepted hypothesis points to dysregulated inflammation that culminates in collagen deficiency and tissue atrophy. This theory is supported by recent findings that activator protein (AP)-1, a transcription factor involved in inflammation, is over-expressed in inflammatory acne lesions.7 This abnormality is thought to underlie the increased levels of MMP-1 (collagenase-1) and other matrix metalloproteinases (MMPs) also found in areas of active acne.7 The well-recognized role of MMPs in collagen matrix degradation explains the tissue atrophy characteristic of depressed scars.7 Consequently, acne scar formation is highly correlated with delay in initiating treatment and, therefore, the duration of the inflammatory response.2
