The last 20 years have witnessed rapid developments in aesthetic medicine and the myriad of non-invasive techniques. Obsession with cosmetic surgery regularly hits headlines globally because of its high take-up rate by both women and men — and even in the most conservative cultures. 

Acne vulgaris is a common disorder of the pilosebaceous follicle with multiple pathogenic factors. While previous anti-acne treatment algorithms focused on antibiotics, the incidence of antibiotic resistance and the availability of more effective, well‑tolerated topical agents have led to new treatment paradigms. The 2009 Global Alliance to Improve Outcomes in Acne guidelines recommend that mild-to-moderate acne is best treated with retinoid-based topical agents. With the rise of new technologies and in-office procedures, light and laser therapies, photodynamic therapy and chemical peels are growing in popularity as adjunctive treatments, and may offer alternatives to those who desire better efficacy, quicker onset of action, an improved safety profile, and a reduced risk of antibiotic resistance.

Chemical peeling is a form of skin resurfacing that induces epidermal or dermal injury followed by regeneration of the tissues. The success of peeling is crucially dependent on the physician’s understanding of the chemical and biological processes, as well as of the depth of penetration of the peel, clinical effectiveness, and side-effects of the procedure.

Microneedle therapy has long been used by dermatologists in the form of collagen induction therapy (CIT) to fade scars, and generally as an anti-ageing treatment. Smaller sizes of microneedles were then recognised for their capacity to dramatically increase the bioavailability of topical treatments and enhance their transcutaneous absorption. Microneedle technology, as a physical enhancement method, offers a minimally-invasive and painless route of drug administration as microneedles are too short to reach dermal nerves or blood vessels. After treatment, keratinocytes proliferate and release growth factors to promote collagen deposition by the fibroblasts. This technology is currently being used to treat skin conditions such as wrinkles, acne, and burn scars. However, data on safety is insufficient and requires more in-depth study to confirm and establish a consensus of guidelines for use.

The initial conception of fractional photothermolysis is one of the most significant milestones in the field of laser technology and cutaneous resurfacing. Based on the mechanisms of action, non-ablative fractional photothermolysis held great promise in the treatment of skin textural abnormalities and pigment variation, with a lower incidence of adverse effects. Scientific research in the field of energy- and light-based procedures made it possible to develop an innovative generation of lasers that combine the benefit of a non-ablative and a fractional laser device, promising skin rejuvenation without harming the epidermis.

This issue of PRIME sheds light on many of the topics most attractive in this area, and which are of increasing interest.