Introduction. Traditional treatments for problem skin have a surgical, physical, or chemical nature, but all these methods have side effects, especially if accompanied by scarring [1, 2, 3]. The modern stage of development of combustiology, cosmetology, plastic surgery and transplantology is characterized by the lack of fundamental principles and concepts for carrying out programmed controlled effective treatment methods to avoid the risk of complications that would reliably stop the progression of a pathological scar and its recurrence after surgical treatment. Modern technologies of non-invasive methods in the field of cosmetology and aesthetic medicine make it possible to enhance the effect of renewal in the postoperative period and, at the end of the course of treatment, help to maintain the achieved result for a long time [4, 5, 6]. The reason for the inability to induce directed skin regeneration is insufficient knowledge of the process of reparative regeneration both after burns and after surgical interventions on the skin, which dictates the need for a deeper study of the mechanisms of wound healing [7, 8, 9].
Purpose of research. Choose a method of applying the effectiveness and safety of non-invasive skin rejuvenation. To select individually the best method of non-invasive treatment of problem skin, which will be the most accessible and applicable to a wider range of age patients who need aesthetic correction and patients with skin problems not only of an age nature, but also after burns, removal of neoplasms, skin transplantation due to traumatic and post-burn defects.
Material and methods. For the period 2015–2019, materials from the literature on aesthetic correction of skin defects and age-related cosmetology, as well as data from clinical practice, were taken as the basis for studying the effectiveness of a non-invasive technique. The clinical material was obtained in accordance with the Declaration of Helsinki (2000) and the 2013 amendments with the permission of the FEFU Ethics Committee.
Results of analysis of literature data. In the available literature, against the background of the numerous methods for treating skin lesions, there is no analysis of data on monitoring the consequences, long-term outcomes and results of the treatment performed when using various methods, which complicates the development of recommendations for choosing a treatment for problem skin.
1. One of the new non-invasive, non-thermal methods of treating problem skin is the method of exposure using pulsed electric fields. Golberg A., Khan S., Belov V. (2015). The authors developed a methodology and successfully proved the use of pulsed electric fields in rats, which led to a noticeable proliferation of the epidermis, the formation of microvessels and the secretion of new collagen in the treated areas without scarring.
The results show that pulsed electric fields can serve as a new non-invasive skin therapy for multiple degenerative skin diseases.
2. Pain is a common side effect of dermatological laser procedures (resurfacing for rejuvenation, removal of age spots, hair removal, leg telangiectasia, facial telangiectasia, removal of tattoo marks, removal of papillomas due to HPV lesions), therefore, for the effectiveness of treatment, it is necessary to use non-invasive anesthetics and anesthetic procedures. Use of local anesthetics or skin cooling is allowed. It is necessary to consider national and sex statistically significant differences in pain perception, women are easier to tolerate the pain. Local anesthetics effectively increase pain threshold than the skin cooling. All these data can be recommended for everyday clinical practice.
3. The use of radiofrequency radiation with multiple sources, combining 3 different methods for the patient: non-ablative radiofrequency skin tightening, fractional skin resurfacing, and the use of RF-microneedles for non-ablative coagulation and collagen remodeling.
4. Photodynamic therapy (PDT) is a method of treating various dermatological diseases, including actinic keratosis. PDT results in a marked improvement of skin aging signs. There are two types of PDT available, the traditional PDT (c-PDT) and the newly developed day PDT (DL-PDT). Both methods require a local photosensitizer, light source, and oxygen, and are comparable in efficacy for the treatment of photoinduced skin aging. The treatment is effective in eliminating fine wrinkles, skin roughness, actinic elastosis and macular hyperpigmentation. The most effective PDTs are 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL). Several pre-treatments help improve the absorption of the photosensitizer by the skin and result in a significant increase in effectiveness. The main limitation of c-PDT is the significant pain associated with treatment, but DL-PDT has proven to be almost painless. The duration of the treatment is 2-3 treatment cycles, and the results are completely obvious in 3-6 months after the treatment. The unique advantage of PDT is that it is a non-invasive procedure that effectively treats a range of dermatological conditions, including the prevention and therapy of precancerous actinic keratosis.
5. It was noted that a statistically significant improvement in the skin was observed in those patients who received non-invasive application of vitamin C. At the same time, rejuvenation was observed from the side of a decrease in the indicators of photoaging of the cheeks and perioral region (P = 0.01), the periorbital region, which is associated with improved hydration. The biopsy showed an increase in collagen as well as enhanced mRNA staining for type I collagen and no evidence of inflammation.
6. ECM is a unique therapy used in sports medicine cosmetology for pain relief. It consists in the accumulation of collagen fragments and agglutination of amorphous elastin. Chronic skin aging treatment requires preparation of the skin bed to optimize the results of rejuvenation procedures and skin care programs. This includes the application of agents, which are matrixins, peptides resulting from the fragmentation of matrix proteins that exhibit a wide range of biological activities. Emerging cosmetic and functional defects that cause psychological discomfort to the patient, impaired active social adaptation of patients after injuries and operations that significantly affect the quality of life, high probability and risk of developing cancer against the background of scarring after burns, the relevance of studying the features of skin alteration and regeneration in case of injuries of various etiologies is extremely high . Yi J., Hong T., Zeng H., Li P., (2020) believe that there are still complex clinical problems associated with the lack of effective treatment regimens with targeted control of the skin regeneration process after burns and autodermotransplantation in the wound area . At the present stage, the reasons why some keloids arise from a mature scar several years after the initiating injury are unknown, there is no data and monitoring of the methods used to treat skin problems in the patient's history [12, 13, 14]. Also, the reasons for the development of true keloid disease are not clear (Fig. 1, 2).
Figure 1 – Keloid scars of a 25-year-old woman
Figure 2 – Scars of the facial skin after burns of a 58-year-old woman (a); facial scars after burns of a 25-year-old woman (b); facial scars of a 34-year-old man after injury (c, d)
Besides PDT for aesthetic and cosmetic procedures has established itself in modern procedural dermatology as mono- or combination therapy. The main unique advantage of PDT is that it is a non-invasive procedure that effectively rejuvenates photodamaged skin and successfully treats a number of dermatological conditions, including the prevention and therapy of precancerous actinic keratosis .
Conclusion. There are many different skin rejuvenation techniques available, but pain is a common side effect of these procedures, which can be relieved by local anesthetics or cooling. However, recently developed photodynamic therapy (DL-PDT) has proven to be almost painless and one of the most effective treatments for problem skin.
The study was financially supported by the International Medical Research and Education Center (Vladivostok, Russia).
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