Successful Treatment of Depressed, Distensible Acne Scars Using Autologous Fibroblasts: A Multi-Site, Prospective, Double Blind, Placebo-Controlled Clinical Trial

Of all the skin changes possible after inflammatory and nodulocystic acne eruptions of the face, including postacne erythema, dyschromia, and scarring, scarring leaves the most potentially permanent, cosmetically and psychologically devastating effects.1 Active acne, and probably facial acne scarring, is associated with negative psychosocial effects and poor quality of life.1 Acne scarring may not resolve spontaneously, and procedural interventions including surgery are required to reverse these skin changes. Acne scarring can be classified morphologically into atrophic or hypertrophic, or more specifically boxcar or fixed, icepick, and distensible or rolling scars.2,3 As expected given the diversity of acne scarring morphology and severity, certain treatment modalities are more effective with certain subgroups of scarring.4 For example, distensible scars are amenable to volumetric correction with dermal fillers. Even with the development of new treatment options, multiple treatment modalities are likely to be required to treat acne-scarred individuals.5–6 The advent of dermal fillers began with bovine collagen usage in the 1980s. In a small series, bovine collagen was shown to have efficacy in the treatment of acne scarring.7 Several studies have characterized the effectiveness and longevity of different types of permanent and semipermanent dermal fillers in the treatment of acne scarring.8,9 Such fillers include hyaluronic acid (HA)-based products with varying degrees of cross-linking. These HA products have themselves been shown to stimulate endogenous collagen formation over time, which could contribute to sustained volumetric correction of treated scars,11 but the use of dermal fillers is not without risk,12 and an awareness of existing treatment algorithms is needed to manage potential complications.13 Classically, device treatments such as dermabrasion and laser resurfacing have been considered first-line treatment of atrophic acne scarring.2–14 Most recently, fractional carbon dioxide (CO2) ablative laser was used successfully to treat atrophic acne scarring in a small randomized controlled, blinded evaluation.15 Subjects received three treatments at 4- to 5-week intervals. The authors concluded that acne scars can be safely improved using ablative fractional CO2 laser resurfacing, with improvement seen as soon as after 1 month and sustained 6 months after treatment. They noted that the use of higher energy levels might have improved the results and possibly induced significant adverse effects.15 The purpose of the study was to compare the safety and efficacy profile of autologous fibroblast treatments (LaViv, azficel-T, Fibrocell Sciences, Inc, Exton, PA) of moderate to severe depressed, distensible acne scars with that of vehicle control treatments.