In addition to this objective assessment, the change in the severity or grading of scars was assessed photographically also. The appearance and grading of scars was then compared with that in the pre-treatment period and any change in the grading of scars was noted. The final assessment and grading of scars was done at the end of two months of follow-up and repeat photographs were then taken. After the end of the treatment regimen, the scars were again assessed and graded by the same trained dermatologist, and the patients were followed up monthly for the next two months. In patients with deep-seated scarring, the skin was stretched in a perpendicular direction to the dermaroller movement so that the base of the scars could also be reached. Dermarollers with 1.5mm long needles were used and the endpoint for any treatment session was the presence of uniform bleeding points over the scarred area. Area of interest was anesthetized using a thick application of topical anesthetic cream (eutectic mixture of prilocaine and lignocaine), about 30-45 min before the procedure. A minimum of three treatment sessions was considered essential for inclusion for assessment. Microneedling or dermaroller treatment was performed at monthly intervals till a satisfactory outcome was achieved or a maximum of four sittings whichever was earlier. Informed written consent was obtained from all the patients who were enrolled for the study. Presence of any active infection anywhere, active acne on the face or a keloidal tendency in the patient also served as exclusion criteria. A history of application of topical retinoids, use of systemic retinoids or any other scar treatment procedure in the previous three months were used as exclusion criteria. Only patients with Grade 2 to Grade 4 atrophic scarring were enrolled for the study. The patients were photographed and assessed clinically at the time of enrolment to grade the severity of scarring, by a single trained dermatologist as per the grading system proposed by Goodman and Baron. The present study was performed on 37 patients suffering from localized or generalized atrophic facial scarring of variable etiology. The present study is aimed at ascertaining the efficacy of dermaroller treatment objectively in the management of atrophic facial scars. This grading system can also be used to assess the severity of other etiological types of facial scars. This grading system, proposed by Goodman and Baron, encompasses all the morphological types of post-acne scars and uses a simple clinical examination as the tool to grade the scars on objective lines. Recently, a clinical grading system has been devised to grade the severity of post-acne facial scars. Post-acne facial scars have been classified into many morphological types and the ideal treatment option depends upon the type of scarring. However, there is a definite paucity of objective clinical trials on the efficacy of dermaroller treatment in facial and other types of scars. There are some pathological as well as clinical studies now available in the world literature that have documented a favorable clinical and histopathological response in the skin after dermaroller treatment. Treatment with these hand-held devices is known by many names like microneedling therapy, collagen induction therapy or dermaroller therapy. New treatments and techniques are being added over the last few years to overcome these limitations. On the other hand, treatments like microdermabrasion and non-ablative resurfacing with lasers that are associated with a minimal or no downtime, do not show the same level of efficacy as the traditional, ablative resurfacing techniques. Treatment options like laser resurfacing or dermabrasion that offer significant improvement in facial scars are invariably associated with considerable morbidity and downtime interference with the daily activities of the patient in the post-treatment period. However, the majority of these treatment options suffer from the limitation of either being marginally effective or else having considerable morbidity. Facial scarring has always been a challenge to treat and there are different treatment options for the management of these scars. Post-acne facial scarring is a psychologically devastating condition and the affected patient invariably suffers from low self-esteem and many other psychological ill-effects because of this condition. Scars can arise on the face due to a number of causes, the commonest of which is acne vulgaris. Scarring is a particularly distressing phenomenon and is most unwelcome when it occurs on the face.
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