Microdermabrasion is used for many skin disorders. Most dermatologists routinely use it in their practices for photoaging, dyschromia, including postinflammatory hyperpigmentation (PIH) and melasma, noninflammatory acne. Less frequently, it is used for striae disten – sae and traumatic scars, such as dog bites (Fig.14.1). One of the first published reports in the United States on microdermabrasion was its use and benefit on all types of scars: acne, traumatic, varicella, and burns [15]. Its successful use in photoaging has been published as well [14,16]. Some experts have advocated its use for actinic keratosis, keratosis pilaris, seborrheic keratosis, milia, and hypertrophic scars [8,17]. The published benefit and
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routine use in melasma as well as mottled pigmentation is also well – known [8 , 18 , 19]. Improved skin roughness and overall appearance, as well as the improvement of oily skin, dilated pores and fine wrinkles have been reported [7,8]. Diminished pore size, which is a common perception of patients, has been reported in the literature [7,20].
Not all investigators have reported clinical benefits. Shim’s study, for example, showed no benefit visible for fine wrinkling or comedonal acne [8]. Another study of questionable scientific method, using no controls and having patients on concurrent retinoids and oral antibiotics, showed improvement in acne with microdermabrasion [21]. What could be an important finding is the improvement of postinflammatory hyperpigmentation seen in this study, although the retinoids that patients were using could exert this benefit as well. The format of this particular experiment makes any pure scientific interpretation difficult.
Dermatologists routinely use combination protocols in their offices for faster and more dramatic clinical results. One interesting study showed that microdermabrasion improved the results of retinoic acid 5% peels, over the results obtained from the peel alone [22].
Not surprising was a report that the retinoid adapalene 0.1% improved the results of microdermabrasion [20]. The more aggressive protocol of combining microdermabrasion and superficial glycolic acid peels has been advocated by some [23]. When an interesting study was performed, comparing the preference of patients between 20% glycolic peels on one side and microdermabrasion on the other, there was a slight preference for the glycolic treatment results [24]. The investigator ratings did not show differences, or even significant improvement in this study. It has been reported that a possible benefit of microdermabrasion over peels from the patient perspective is the short duration of erythema compared to glycolic peel: one day for microdermabrasion, four days for the peel [25].
Microdermabrasion has also been thought to improve the penetration of topical pharmacologic agents as well as cosmeceuticals. One study reported a 20-fold increase in penetration of magnesium ascorbyl phosphate (a hydrophilic pro-drug of ascorbic acid that is stable at neutral pH) into the skin [26]. Other hydrophilic compounds have been better injected into the skin, including 5-fluorouracil, and 5-aminolevulenic acid (ALA) using microdermabrasion [27]. Yet another study found a 5-15-fold higher penetration of ALA after microdermabrasion [28]. Katz and associates have found that microdermabrasion shortens the necessary incubation time of ALA prior to 595nm-pulsed dye laser photodynamic therapy to just 10 min [29]. Wang and associates, however, found no benefit from the addition of microdermabrasion prior to application of 5% lidocaine in a protocol to evaluate the effects on acne of a 1450nm diode laser [30]. In addition, there was no statistically significant benefit to adding the microdermabrasion in respect to the acne improvement itself.