Authors:Dr. Amarjeet Singh Verma

INTRODUCTION

1. Acne scars, post inflammatory hyperpigmentation, dispigmentation and skin luminosity are the troublesome manifestation following acne vulgaris faced by younger age group. It also aids to social outcast and elevate stress among these patients which eventually make them vulnerable for further aggravation of lesions and associated side effects.

2. Microneedling is used to cause collagen induction for treatment of scaring and simultaneously providing channels for better absorption of Meso solution while performing the procedure.

3. Mesotherapy is a non-surgical minimally invasive method of drug delivery that consists of multiple intradermal or subcutaneous injection of a mixture of compounds “melange” in minute doses. The term is derived from Greek word “mesos” meaning “middle” and “therapcia” meaning to treat medically i.e. injecting into the middle layer of skin or interdermotherapy.

Review of literature

1. Arbutin is a glycoside; a glycosylated hydroquinone extracted from bearberry plant. It inhibits tyrosinase and thus prevents the formation of melanin. Arbutin is therefore used as a skin-lightening agent.

2. Glutathion is an antioxidant has recently been used as an inhibitor of melanin in the cosmetics industry. Glutathione competitively inhibits melanin synthesis in the reaction of tyrosinase and L-DOPA by interrupting L-DOPA's ability to bind to tyrosinase during melanin synthesis

3. Glycolic acid is the smallest Alpha-hydroxy acid and used as a peeling agent. It causes keratinocyte dyscohesion, stimulation of basal keratinocyte and thus used in atrophic photoaged skin, decrease melanin synthesis by direct inhibition of tyrosinase, fibroblast modulation, antioxidant and moisturizing action.

4. Vit-c (ascorbic acid) is an antioxidant and neutralizing free radicals. It also reduces alpha tyrosinase activity causing inhibition of melanin synthesis. It help in skin rejuvenation and whitening effects.

5. Kojic acid is a chelation agent, and causes inhibition of melanin synthesis. It is used as depigmeneted agents and causes reduction of dark spots. Bearberry extracts contain arbutin, ursolic acid, tannic acid, gallic acid, resin, hydroqinones etc; most of them are depigmented agents and used to decrease hyperpigmnetation. 6. Licorice extracts Licorice extract is obtained from the root of Glycyrrhia Glabra Linneva. Glabridin has been shown to prevent UVB-induced pigmentation and to inhibit tyrosinase activity, superoxide anion production and cyclo-oxygenase activity.

7. Azelaic acid act as a tyrosinase inhibitor and causes reduction of melanin synthesis. Azelaic acid has been used for treatment of skin pigmentation including melasma and post inflammatory hyperpigmentation, particularly in those with darker skin types.

Objective

• To evaluate the efficacy of Microneedling with Mesotherapy for the treatment of PIH, Acne scaring, hyperpigmentation and skin luminosity.
• 12 female patient of 15-30 age group having history of acne scars, postinflammatory hyperpigmentation, dischromic pigmnentation had been enrolled.

INCLUSION CRITERIA	EXCLUSION CRITERIA
1. Patient of 15-30 years of age group	1. Keloidal tendencies
2. Having indication of acne scars, PIH, dis-chromic pigmentation and decrease luminosity of face	2. Active lesions on face like herpes, acne, warts
3. Devoid of any systemic disorder	3. History of prior treatment
	4. History suggestive of any bleeding disorder.

Procedure on each sitting

1. Patient was kept supine and topical anesthesia was applied to whole face and draped with occlusion sheet.
2. Topical cream was removed after 2hr and head was kept stable in supine position. Face is divided into four quadrants & Microneedling is performed using meso roller having 512 needles of 1.5 mm size.
3. Rolling was done four times in four different direction which were perpendicular and diagonal to each other with to and fro motion. Pin point bleeding appears as a sign of dermal penetration.
4. 1ml of meso solution was poured uniformly over face using insulin syringe.
5. At the end of procedure erythema and odema appears, patient was allowed to go home and instructed for sun protection and avoiding face wash for 4 hrs.

Follow up & side effects

2nd day (24-48 hrs) – There is mild- moderate erythema & mild adema for face is normal. 3rd day (>72hr) - erythema may be there, adema subsided, dryness of face followed by peeling of skin.
7nth day- face become normal with no sign of procedure.
Side effects- side effects are minimal and transient; they are confined to microneedling only.

• Bruising, longitudinal streaks
• Milia formation
• Aggravation of active acne lesion or pyoderma
• Post inflammatory hyperpigmentation.

Results

Final evaluation is done by two independent dermatologist and patients itself on a scale of 1-10.

Acne scars were evaluated as Goodman’s classification score & photographic evidences.

Lesions count were evaluated for dark spots or postinflammatory hyperpigmnetation.

Photographic evaluation is done for dischromic hyperpigmentation.

subjective scoring was done for skin luminosity.

Patients score himself on clinical outcomes and satisfaction.

Score <4 = poor response (no response), 5-7 = good response, 8-10= excellent response)

The scoring was subjective and all the above parameter combined for final evaluation.

CONCLUSION

Mesotherapy using multiple extracts combining with microneedling can be used to treat several indication on face simultaneously.

The procedure is safe, good compliance as single sitting is done monthly, less down time following procedure & over all good efficacy.

Associated side effects are less and if they occur; will be transient.