Efficacy of Saline Injection Therapy in Atrophic Acne Scars
Condition: Atrophic; Scars
MeSH terms: Atrophy
Study type: Interventional
Phase: Early Phase 1

Summary: 
      The purpose of the study was to determine the efficacy of saline injection in post-acne
      atrophic scars on face. All patients with mild, moderate & severe post-acne atrophic scars,
      above age of 15 years without any co-morbid conditions were included in the study. After
      giving local anesthesia, the isotonic saline solution has been administered intra- and
      sub-dermally in post-acne atrophic scars on face. The sessions were done weekly, for 12
      weeks. The results were assessed by the photographs, sharquie scoring system & Dermatology
      Life Quality Index score at the start and at the end of the treatment. SPSS 23 was used to
      analyze the data. The analysis of data showed that the response of saline injection was
      significant in mild and moderate scars, without any significant side effects.
    

Detailed description: 
      The study was conducted for the determination of saline injection effectiveness in post-acne
      atrophic scars in patients referred to the department of dermatology in Jinnah postgraduate
      medical centre, Karachi, Pakistan from January 2019 to July 2019, after receiving approval
      letter from the institutional ethical and research committee of the hospital.

      Forty-nine patients were selected after calculating the sample size through the NCSS
      software. The patients were selected with the age ranging from 15-35years of either gender,
      after excluding hypertension, cardiovascular disorders, pregnancy, lactation &
      hypersensitivity to lidocaine. The procedure has been explained to each patient & written
      consent was taken. Before starting treatment, the photographs were taken for each patient
      with their permission & sharquie scoring system for grading scars and Dermatology Life
      Quality Index scores were calculated.

      During each session, after all sterilization techniques, patient has been pain-free with the
      application of local anesthesia, then 0.9% isotonic saline is injected intra- and
      sub-dermally in post-acne atrophic scars with 1cc syringe of 30-gauge needles, on both sides
      of face. The volume of saline injected depends upon the numbers, width and depth of the
      individual scars. It has been injected up to scar elevation by overfilling with saline &
      spreading into surrounding tissue as well.

      A total of 12 sessions were done weekly. The efficacy of treatment has been assessed by
      comparing photographs, sharquie scoring system for grading scars and Dermatology Life Quality
      Index scores at the start and at the end of treatment.

      The sharquie scoring system for grading scars has been calculated through assessing number of
      scars, proportion of the area of the face involved, morphology of scars including color or
      type and social behavior of the patient. The final scores obtained by adding all scores, were
      compared with the initial ones, at the end of treatment.

      The Dermatology Life Quality Index (DLQI) has been calculated through simple questionnaire,
      consisting of 10 questions related to the effect of disease and its treatment on the daily
      activities of patient and the impact on the social behavior of the patient towards friends
      and relatives. DLQI scores has been interpreted, regarding the effect on patients' life as
      follows:

        -  0-1 = No effect

        -  2-5 = Small effect

        -  6-10 = Moderate effect

        -  11-20 = Very large effect

        -  21-30 = Extremely large effect

      At the end of treatment, results were compared to assess the improvement in everyday
      activities and social behaviors of the patients.

      The evaluation of result was done by SPSS version 23. The side effects were also assessed
      regarding erythema, itching , pain & dys-pigmentation.

      In this study three patients of post-acne atrophic scars also had atrophic scars due to
      trauma in the childhood, on their face. On the request of the patients, these scars were also
      filled with saline injection, in addition to their post-acne atrophic scars.

      During treatment, change in the post-acne pigmentation, skin tightening, eruption of new acne
      lesions, healing of old lesions has also been observed.
    

Intervention name(s): saline injection therapy in post-acne atrophic scars
Intervention type(s): Drug
Intervention description(s): saline injection contains 0.9% isotonic sodium chloride solution
Other intervention name(s): normal saline, isotonic saline
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Acne; Scars; DLQI