Dermapen-kelocote COSMETEX 2013 - Bi

Percutaneous collagen induction performed with Dermapen and
application of Kelo-cote® gel is an effective treatment to improve C
section scars and other surgical scars
Prof. Gabriella Fabbrocini
University Federico II of Naples
SKIN NEEDLING
SKIN NEEDLING or Skin Collagen Induction which is
intended to
• smooth wrinkles
• improve depressed acne scarring
• reduce the appearance of hyperpigmentations and
stretch marks.
Percutaneous Collagen Induction Therapy’s Efficacy
THIS TRIALS CONFIRMED THE USE OF
THIS TECNIQUE IN MANY
DERMATOLOGICAL PATHOLOGIC
CONDITIONS
OTHER BIOMOLECULAR AND ULTRASTRUCTURAL
STUDIES ARE NECESSARY TO BETTER UNDERSTAND
MECHANISM OF ACTION
OPTIMIZE NUMBER OF SESSIONS
TIME OF APPLICATION
TECHNIQUE’S MODALITIES
MECHANISM OF ACTION
Microneedles skin penetration
Induction of local damage
Local Pseudo-Inflammatory response developing in 3 phases
Injury (Phase 1)
Proliferation (Phase 2)
Remodelling (Phase 3)
Horst Liebl , A hypothesis for the mechanism of action of collagen induction therapy (CIT) using Miccro-Needles, first edition February
2006, second revision January 2007.
Desmond Fernandes – Oral and Maxillofacial Surg Clin N Am 17 (2005) 51-63: Minimally Invasive Percutaneous Collagen Induction
J. Vandervoort, A. Ludwig: Microneedles for transdermal drug delivery: a minireview. Frontiers in Bioscience 13, 1711-1715, January 1, 2008
Histological Findings, Freiburg/Germany 2006 20 times magnification of tissue crosssections. Dr. Schwarz & Dr. Laaff
Example of stained skin
cross-section from
control biopsy
Example of stained skin
cross-section from a biopsy 6
weeks after micro-needling.
Collagen and elastin fibers
are increased by 1000% and
to a depth of 0,5 to 0,6 mm
Horst Liebl - Abstract reflections about COLLAGEN-INDUCTION-THERAPY (CIT) A Hypothesis for the Mechanism of Action of Collagen
Induction Therapy (CIT) using Micro-Needles 1st editition February 2006. 2nd revision January 2007
SKIN COLLAGEN INDUCTION
MEDICAL DEVICES
• Dermaroller®
• Dermapen®
SKIN COLLAGEN INDUCTION
Dermaroller®
supported and allowed to flow in all
directions, forwards and backwards, by
applying a certain equal pressure in the
various directions
PROCEDURE:
- Anamnestic Investigation
- Disinfection of the skin
- Occlusive topical anesthetic in about 30-45
minutes before
TECHNOLOGY…
 Roller
L= 0,15mm
P= 0,07 mm
N= 192
 Different types
 Roller is from 10 mm to 20 mm wide
and it is covered by a variable number
of stainless microneedles (96-192)
with a lenght of 0,15-1,5 mm placed
in 4 0r 8 rows
 Limitations
Not all the surface is always treated
Not always the same pressure
Very pain for the patient
L= 0,5mm
P= 0,5 mm
N= 192
L= 1,5mm
P=0,1-1,3mm
N= 192
L= 1,5mm
P=0,1-1,3mm
N= 96
Dermapen®
• Dermapen use vertical skin collagen induction
• Standardized pressure
• All the surface treated
• It has a superior effect on collagen and elastin
rejuvenation. Active ingredients are directly supplied to
the deeper layers of the skin
Dermapen®
•Dermapen’s multi-speed and adjustable needle depths
allows the needles to pierce the skin’s layers at 90
degrees and increases the effectiveness of treatments
by increasing the absorption of products.
•It reduces pain and patient downtime.
Dermapen®
Dermapen can effectively treat hard-to-reach places (e.g. around
the eyes, nose, and lips).
Because of the vertical delivery,
the needles can easily penetrate
scar tissue.
Dermapen Specifications
• Input Power – 5V=100mA, 12VA
• Adapter – AC100-240V, 50-60Hz
• Dimensions – Hand-piece 20X20X140
(mm)
• Weight – Total / 555g, Handpiece/82g
• Tip Length – Ranges from 0.25, 0.5
1.0, 1.5, 2.0 2.5 (mm)
• FDA and CE Registered
LASER AND ACIDS
SKIN NEEDLING
• Laser and acids
cause skin damage
• Infiammation,
proliferation
remodelling could
take on 1 month
• the new collagen
layer is relatively
thin
• Micro-needles
penetrate in upper
dermis
• the minute holes
close in short time
• the healing phase
instantly began
• the new collagen
layer is thick.
• treatment can be
repeated
SKIN NEEDLING & ACNE
G. J. Goodman and J. A. Baron, “Postacne scarring: a qualitative global scarring
grading system,” Dermatologic Surgery, vol. 32, no. 12, pp. 1458–1466, 2006.
SKIN NEEDLING & ACNE
Rolling scars
Box scars
Ice-pick scars
Hypertrofic scars
SKIN NEEDLING & ACNE
Grade
Description
Macular scarring or flat scarring that is characterized by flat areas of increased or decreased
1
pigmentation visible from a distance of > 500 mm
Mild disease that is visible at distances of <500 mm and can be covered by make-up. Examples include
2
mild rolling acne scars
Moderate disease that is visible at ³ 500 mm and is not easily covered with make-up or the normal
shadow of a shaved beard. Stretching the skin can flatten the scar. Examples include more significant
rolling scars, shallow boxcar scars and mild to moderate hypertrophic scars
3
Severe disease as in grade 3 but scarring is not flattened by stretching the skin. Examples include severe
boxcar scars, deep divots, ice pick scars and hypertrophic keloid scarring (very raised/pigmented scars).
4
G. J. Goodman and J. A. Baron, “Postacne scarring- a quantitative global scarring
grading system,” Journal of Cosmetic Dermatology, vol. 5, no. 1, pp. 48–52, 2006.
OUR RESULTS IN ACNE PATIENTS
23 years
Grade 2
Grade 1
OUR RESULTS IN ACNE PATIENTS:
Confocal Microscopy
GR
DINAMICITY
Dinamicity of Collagen Fibers
OUR RESULTS IN ACNE PATIENTS
27 years
Grade 4
Grade 3
OUR RESULTS IN ACNE PATIENTS:
Confocal Microscopy
Greater gradient of reflectance derived from an increased ratio
between old and new collagen fibers
OUR RESULTS IN ACNE PATIENTS
29 years
Grade 3
Grade 2
OUR RESULTS IN ACNE PATIENTS:
Confocal Microscopy
Improved organization of the collagen fibers
Skin needling and Hypertrophic scars
Keloids: is a growth of extra scar tissue where the skin has healed after injury
Keloids can be caused by: Acne
Burns
Chickenpox
Ear piercing
Minor scratches
Cuts from surgery or trauma
Vaccination sites
Skin needling and Hypertrophic scars
Keloids an overgrowth of dense fibrous tissue after healing of a
skin injury that expand outside the original injury and without
spontaneous regression
Hypertrophic scars erythematous, pruritic, raised fibrous
lesions that typically do not expand beyond the boundaries of
the initial injury and may undergo partial spontaneous
resolution.
Treatments
•
•
•
•
•
•
•
Corticosteroid injections
Freezing (cryotherapy)
Laser treatments
Radiation
Surgical removal
Slicone gel or patches
Low percentage of success (30 -40% of
improvement in average)
• None therapy are resolutive
Our study
We treated 20 patients with linear surgical
scars.
•10 patients had the whole scar treated by
skin needling and on half the scar Kelo-cote®
gel (silicone gel) was applied Group A
•10 patients were asked to apply Kelo-cote®
gel on the whole scar and skin needling was
performed on just half the scar Group B
Our study
• Skin needling was performed with Dermapen, using
1.5/2.5 mm needles, depending on the case
• Each patient underwent 3 treatments at 1 month
intervals
• Each patient applied Kelo-cote® gel once daily for 3
months during the skin needling treatment period
• The scars were assessed every month for the first 3
months and a final assessment was done 3 months
after the last skin needling treatment.
• No patients dropped out the study
Kelo-cote gel®
• Kelo-cote is a patented topical silicone gel for the treatment and
prevention of abnormal scars, such as hypertrophic scars and
keloids. The precise blend of silicones known as the Siliclear
Complex, enables Kelo-cote to cross-link and dry within minutes of
application, forming a breathable, transparent, waterproof layer.
• Deemed "substantially" equivalent" to silicone sheets, but preferred
by patients for ease of use*
• Binds to the skin creating a semi-occlusive, gas permeable
waterproof layer, eliminating maceration side effects
Plast Reconstr Surg.2002 Aug;110(2):560-71. International clinical recommendations on scar management.
Mustoe TA, Cooter RD, Gold MH, Hobbs FD Ramelet AA Shakespeare PG Stella M Téot L Wood FM Ziegler UE.
Our study
KELOIDS
HYPERTROPHIC SCARS
12 patients
8 patients
Needle type = Ranges from 0.25, 0.5 1.0, 1.5, 2.0 2.5 (mm)
Input Power = 5V=100mA, 12VA
Time of application: 5-10 minutes
CASE n°1
• 44 years
• Hypertrophic scar at
the abdominal area
Immediately after treatment
Group A: the whole scar treated by
Dermapen® and on half the scar
Kelo-cote® gel (silicone gel) was
applied
CASE n°1
Group A
After 2 treatments
After 1 treatment
CASE n°1
Group A
Before starting treatment
After 3 treatments
CASE n°2
• 40 years
• Hypertrophic scar at
the abdominal area
Immediately after treatment
Group A: the whole scar treated by
Dermapen® and on half the scar
Kelo-cote® gel (silicone gel) was
applied
CASE n°2
Group A
After 2 treatments
After 1 treatment
CASE n°2
Group A
Before starting treatment
After 3 treatments
CASE n°3
• 12 years
• Hypertrophic scars
of subclavian area
After 3 treatments
Before starting treatment
Group A: the whole scar treated by
Dermapen® and on half the scar
Kelocote® gel (silicone gel) was applied
Before starting treatment
After 1 treatment
After 2 treatments
CASE n°4
• 45 years
• Keloids of the
sovrapubic
region
Group A: the whole scar
treated by Dermapen®
and on half the scar
Kelocote® gel (silicone gel)
was applied
CASE n°5
• 35 years
• Scarring after
gestational
After 2 treatments
Before starting treatment
CASE n°6
Before starting treatment
• 25 years
• Hypertrophic
scars of the leg
Group B: Kelo-cote® gel on the
whole scar and Dermapen® was
performed on just half the scar.
After 3 treatments
Group B: Kelo-cote® gel on all scars and Dermapen® was
performed on just half group of the scars.
Before starting treatment
After 3 months
Only Kelo-cote® gel
CASE n°7
• 14 years
• Keloids of
the chest
Group B: Kelo-cote® gel on all scars and Dermapen® was
performed on just half group of the scars.
Before starting
treatment
After 3
treatments
CASE n°7
CASE n°8
Before starting treatment
• 32 years
• Keloids of the
neck
After 3 treatments
Group B: Kelo-cote® gel on the
whole scar and Dermapen® was
performed on just half the scar.
Half of the scar on which has been performed the Dermapen®
CASE n°8
Group B
Before
After
Results
Skin needling on
the whole scar
+
Kelo-cote® gel on
half the scar
Improvement
average
Of 55-75 %
Kelo-cote® gel on
the whole scar
+
Skin needling on
just half the scar
Improvement
Of 40-60 %
Conclusions
• Much less painful than the Dermaroller
• Allows better penetration of topical drugs
used to improve the clinical