Sequential Treatment With Topical Trifarotene and Injectable NASHA Gel in Acne Scars: A Case Series

May 2023 | Volume 22 | Issue 5 | 502 | Copyright © May 2023


Published online April 26, 2023

doi:10.36849/JDD.7630 Belmontesi, M. Sequential treatment with topical trifarotene and injectable NASHA gel in acne scars: a case series. J Drugs Dermatol. 2023;22(5):502-506.doi:10.36849/JDD.7630

Magda Belmontesi MD Dermatologist

Studio Medico Belmontesi, Milan, Italy

Abstract
Background: Topical retinoids are a mainstay in acne management and have been shown to improve skin texture. Injectable non-animal stabilized hyaluronic acid (NASHATM) gel as skin booster is largely used in aesthetic treatments to improve skin quality including the appearance of atrophic acne scars.
Objective: To evaluate a new sequential treatment with topical trifarotene and injectable skin booster NASHA gel in acne scars.
Methods: 10 patients between 19 and 25 years (3 males and 7 females) with previous moderate to severe acne vulgaris on the face with the outcome of atrophic and post-inflammatory slightly hyperpigmented scars were prescribed home short contact therapy (SCT) with topical trifarotene 50 μg/g at the evening for 3 months. A proper skincare routine for sensitive skin was also recommended. The 3-month retinoid therapy was followed by an injectable medical procedure with NASHA gel 20 mg/ml as skin booster. A minimum of 3 sessions to 10 sessions were carried out according to the severity of acne scars and the skin response observed.
Results: Adherence to the treatment was complete and the results evaluated by digital photography showed very effective results with high clinical improvement or almost complete resolution of atrophic acne scars.
Conclusion: The results observed in this case series show that the sequential treatment with topical trifarotene and injectable NASHA gel as skin booster can be effective in the progressive reduction of acne scarring, potentially related to a synergic effect of skin remodeling and collagen stimulation.

J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7630

Belmontesi, M. Sequential treatment with topical trifarotene and injectable NASHA gel in acne scars: a case series. J Drugs Dermatol. 2023;22(5):502-506.doi:10.36849/JDD.7630

INTRODUCTION

Topical retinoids are a mainstay in acne management and have been shown to improve skin texture.1 Injectable non-animal stabilized hyaluronic acid (NASHATM) gel as skin booster is largely used in aesthetic treatments to improve skin quality including the appearance of atrophic acne scars.

Scarring is a common, long-term complication of acne vulgaris.2 Eighty percent of people aged 11-30 get acne lesions at some point in their lives and about forty percent of them will be left with scarring.2  There are two main types of scarring, depending on a loss or increase in collagen and skin volume.2 Acne scarring can be classified as atrophic or hypertrophic/keloid scarring.3 Atrophic scars are characterized by a loss of collagen and skin volume and are the most frequent type of scarring seen in 80-90% of patients. Hypertrophic/keloid scars are characterized by an increase in collagen and skin volume. This type of scarring is present in a minority of patients, with an atrophic/hypertrophic scar ratio of 3:1.

Controlling inflammation is the key to preventing acne scars. Inflammation plays a crucial role in acne scar formation.3 The inflammatory reaction in patients with scar-prone acne appears to be stronger, more robust, and more durable.3,4 Inflammatory remodeling may alter sebaceous gland structures in scar-prone acne.4 In the NF-kB-dependent inflammatory pathway involved in acne scar formation, NF-kB activation triggers the release of inflammatory cytokines (ie, TNF-α, IL-1), which in turn stimulate leukocyte diapedesis, causing inflammation and leading to tissue damage and scarring. Prevention of acne scar development requires early, effective control of inflammation.3
 
A holistic approach is needed to prevent acne scar formation. Holistic skin care should focus on therapeutic treatment and include cleansing, moisturization, and photoprotection in accordance with different stages of the disease course. 

Since the best way to avoid acne scarring involves an early and sustained treatment of acne lesions, an initial treatment of acne aims to achieve a lesion clearance greater than 50%. Maintenance therapy with a proper topical treatment aims to avoid a relapse.5  Topical anti-inflammatory treatments can also reduce the risk of acne scarring. Early and sustained treatment of inflammation is essential for acne scar prevention in all patients regardless of their acne severity.5
Close Menu