title: A split-face comparative study to evaluate efficacy of combined subcision and dermaroller against combined subcision and cryoroller in treatment of acne scars.
abstract: BACKGROUND
  Acne scars occur consequent to abnormal wound healing following sebaceous follicular inflammation in acne. Various types of acne scars are icepick, rolling, boxcar, hypertrophic, and keloidal. Different modalities of treatment include subcision, dermaroller, cryoroller, punch excision, chemical peeling, and lasers.
  
  
  OBJECTIVE
  To compare the efficacy of combined subcision and dermaroller vs. combined subcision and cryoroller in acne scar treatment.
  
  
  METHODS
  Thirty patients (19 males and 11 females) with grade 2, 3, and 4 postacne scarring (Goodman and Baron qualitative grading system) were enrolled in the study. Three sittings each at 1-month interval were carried out of subcision under nerve block on the entire face followed by derma roller (2.5 mm) and cryoroller on one half of the face. Standardized digital photography was performed preprocedure and at 6 months. Grading of acne scar photographs using the Goodman and Baron qualitative and quantitative grading scale was carried out by a blinded observer pre- and postprocedure at 6 months. Patients' own evaluation based on patient scar severity perception scale of 1-10 was also taken into account.
  
  
  RESULTS
  Assessment using the quantitative grading scale showed a 57% improvement using combined subcision and cryoroller against 40% improvement with combined subcision and dermaroller. Average improvement perceived by the subjects was 61% with combined subcision and cryoroller against 45% with combined subcision and dermaroller. The data were analyzed using Wilcoxon signed rank test and found statistically significant. Postinflammatory hyperpigmentation on the cryoroller side and erythema, edema, and hematoma formation due to subcision was transient.
  
  
  CONCLUSIONS
  Combined subcision and cryoroller is more effective than combined subcision and dermaroller for treatment of acne scars.
authors.affiliation: Department of Dermatology, Nair Hospital, Mumbai, India.
authors.forename: Reshma
authors.initials: R
authors.lastname: Gadkari
authors.forename: Chitra
authors.initials: C
authors.lastname: Nayak
mesh_terms: D000152:Acne Vulgaris / Q000150:complications*; D000328:Adult; D002921:Cicatrix / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000009:adverse effects; D062109:Dermatologic Surgical Procedures / Q000009:adverse effects; D005145:Face; D005260:Female; D006801:Humans; D008297:Male; D009339:Needles; D010781:Photography; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D055815:Young Adult
keywords: acne scars; cryoroller; dermaroller; subcision