No abstract

<p>Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia, characterized by recession of frontotemporal hairline with frequent involvement of eyebrows and affecting occasionally other body areas. Entitled an emerging epidemic, due to its rising incidence, FFA etiology remains unclear without proven effective therapies. This study reviews relevant publications on FFA, regarding pathogenesis, clinical findings, histology along with treatment and prognosis. A bibliographic search was conducted in the main international databases, using the term ‘FFA’. Guidelines, observational studies, randomized controlled trials, reviews, systematic reviews and meta-analysis regardless of publication date, presented in English, Portuguese or Spanish, were included in this review. 50 publications were fully analysed. The majority of FFA cases were observed in postmenopausal women, although both men and women from younger ages can be victims. From an etiological point of view, immune-mediated hypothesis is widely spread, as stem cells localized in the bulge region of the follicle are destroyed by an inflammatory infiltrate. However, environmental factors raised interest, since sunscreen use was related to a bigger incidence of FFA. Three clinical patterns have been described. Yet the failure to use standardized assessment methods in addition to the absence of prospective studies evaluating available therapies, do not concede comparable data. Spontaneous stabilization of disease can occur, but regrowth was only seen in scarce cases. Outcomes from randomized controlled trials and prospective studies are missing to draw further understanding of FFA.</p>

Introduction: Acne is an extremely prevalent condition. The healing of active acne lesions may result in the development of scars. Atrophic scars are the main scars caused by acne and result from the degradation of collagen fibers. Carboxytherapy is a minimally invasive method that involves the application of carbon dioxide subcutaneously through small infiltrations in the skin, which improves scar tissue by increasing collagen's deposition and reorganization. The aim of this study is to review the role of carboxytherapy in the treatment of atrophic facial scars, alone or in combination with other techniques. Methods: A literature search was conducted on several databases using MeSH terms “carboxytherapy”, “carbon dioxide/therapy” and “wounds” for guidelines, systematic reviews, randomized controlled trials, and observational studies, published over the last 20 years in Portuguese, English or Spanish languages. Results: A total of 129 articles were retrieved, of which four experimental studies and one case series were selected. Comparing the techniques of microneedling and carboxytherapy, both were considered non-invasive treatment modalities with equal effectiveness, tolerability and safety, resulting in similar histopathological changes. On the other hand, despite the improvement of acne scars in both treatment modalities, the results were significantly better in favor of carbon dioxide fractional laser, despite having more side effects than carboxytherapy. When these techniques are combined and carboxytherapy is used as a subcision method, there is a more marked and rapid improvement in the appearance of acne scars. Discussion: Carboxytherapy is a promising modality in the treatment of atrophic acne scars, alone or in combination with other techniques.