Confocal Microscopy Images to Monitor Skin Needling in the Treatment of Acne Scars

Background: Acne is a common and generally self-limiting skin disease. However, the severe sequel of acne scarring can lead to long-term psychological impairment. Although the occurrence of post-acne scarring, especially in the cases of papulopustular and nodulo-cystic variants, remains unknown, its incidence is extremely common. There is a wide range of modalities used in the treatement of acne scars such as surgical techniques, subcision, chemical peels, ablative lasers, fractional lasers and collagen induction therapy. Reflectance confocal microscopy is a new noninvasive technique for the examination of the skin "in vivo", which can be useful to evaluate the effectiveness of different therapeutic approaches. Aims: The aim of this study is to evaluate the modification and the improvement induced by skin collagen induction on acne scars through the use of confocal microscopy. Methods: 30 patients, who had previously been diagnosed with acne scars, were selected. All patients were clinically evaluated according to the qualitative grading scale of acne scars proposed by Goodman and Baron. In addition, quality of life was also assessed using DLQI. Finally, all patients were evaluated using GAIS system. Skin collagen induction (Dermaroller®) was performed in one session, with follow up assessments at 30 (T1) and 60 days (T2). In 10 patients confocal microscopy was performed at T0 and T2. Results: 28 out of 30 patients showed clinical improvement of acne scars and in all 10 patients confocal microscopy showed improvement of the texture and collagen neosynthesis induced by skin collagen induction. Conclusions: Skin needling is a very effective treatment for acne scars. Confocal microscopy observation can better define the modification induced by skin needling in the treatment of acne scars and open new perspectives on this treatment.