A comparison of wire brush and diamond fraise superficial dermabrasion for photoaged skin. A clinical, immunohistologic, and biochemical study.
BACKGROUND
Superficial dermabrasion has a proven beneficial effect on photoaged skin, but little is known about the differences between the two major modalities used in dermabrasion, the diamond fraise (DF) and the wire brush (WB).


OBJECTIVE
We compared the clinical, immunohistologic, and biochemical changes after superficial dermabrasion with DF and WB.


METHODS
Eight photoaged patients (mean age, 68 years; range, 49 to 80 years) underwent facial dermabrasion to the level of the papillary dermis. Clinical assessments were performed at baseline and at 3 and 12 weeks after dermabrasion. Biopsy specimens were taken from both dermabraded halves at the same time points and assessed by routine histologic and immunohistologic examinations, western blot analysis, and radioimmunoassay. Scoring of intracellular and extracellular transforming growth factor-beta 1 was based on a semiquantitative ordinal scale (0 = no staining to 4 = maximum staining) in half-unit increments. The score for each specimen represents the average of values obtained from four high-power fields.


RESULTS
Both methods of dermabrasion resulted in significant resolution of actinic keratoses, lentigines, and wrinkling. No statistical significance was noted between the two methods in regard to clinical efficacy. Significantly fewer milia occurred after DF than after WB. Solar elastosis decreased with both the WB and DF. Immunohistologic examination demonstrated a highly significant increase in papillary dermal fibroblast staining for amino terminal procollagen I (type I pN-collagen) at 3 weeks for both DF and WB compared to baseline. Staining at 12 weeks had decreased from the peak noted at week 3, but was still significantly increased from baseline. Western blotting of type I pN-collagen demonstrated a 5.4-fold (p = 0.01) increase from baseline at 3 weeks and a 4.9-fold (p = 0.002) increase at 12 weeks after dermabrasion with the WB. Similarly, the DF produced a 4.9-fold (p = 0.006) increase at 3 weeks and a 5.1-fold (p = 0.008) increase at 12 weeks after dermabrasion. Western blotting of amino terminal procollagen III (type III pN-collagen) showed a 6.1-fold (p = 0.07) increase from baseline at 3 weeks and a 3.9-fold (p = 0.04) increase at 12 weeks after dermabrasion with the DF. The WB showed a 3.8-fold (p = 0.07) increase from baseline at 3 weeks and a 5.1-fold (p = 0.05) increase at 12 weeks. Transforming growth factor-beta 1 demonstrated a significant increase in extracellular staining with DF (3.3 +/- 0.2) and WB (3.7 +/- 0.2) from baseline (1.2 +/- 0.2, p < 0.001) at 3 weeks.


CONCLUSIONS
Superficial dermabrasion with DF and WP appears to be similarly efficacious in the treatment of photoaged skin. Significant increases in type I pN-collagen, type III pN-collagen, and TGF-beta 1 occurred in the papillary dermis after both types of dermabrasion. These results suggest that increased fibroblast activity and consequent collagen I and III synthesis underlie the clinical improvement.
Nelson
B R
BR
Department of Dermatology, University of Michigan, Ann Arbor, USA.
Metz
R D
RD
Majmudar
G
G
Hamilton
T A
TA
Gillard
M O
MO
Railan
D
D
Griffiths
C E
CE
Johnson
T M
TM
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D015153:Blotting, Western; D003869:Dermabrasion / Q000009:adverse effects / Q000295:instrumentation*; D062109:Dermatologic Surgical Procedures; D018130:Diamond; D004814:Epidermal Cyst / Q000209:etiology; D004867:Equipment Design; D005145:Face / Q000601:surgery*; D005347:Fibroblasts / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007642:Keratosis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D007911:Lentigo / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D011347:Procollagen / Q000032:analysis; D012867:Skin / Q000737:chemistry / Q000473:pathology; D015595:Skin Aging / Q000473:pathology; D012871:Skin Diseases / Q000209:etiology; D016212:Transforming Growth Factor beta / Q000032:analysis
D010446:Peptide Fragments; D011347:Procollagen; D016212:Transforming Growth Factor beta; C047202:procollagen Type I N-terminal peptide; C041876:procollagen Type III-N-terminal peptide; D018130:Diamond