Pulsed Wave Mode of Fractional Radiofrequency Microneedling as a New Advance in the Treatment of Inflammatory Acne Vulgaris

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

I read your paper with interest since inflammatory acne is a great problem particularly in darker skin types.

I have question and comments:

Introduction

44; Resistance  far as in know only against antibiotics.

61-71: Is fore me advertising  and not scientific.

Methods

Why  use placebo and not an already proven effective method?

Groups are indeed comparable.

102; You realize that cleaning and alcohol is  treatment too. I assume it was done in both groups.

Results:

I assume the photographs are selected but impressive. No hyperpigmentation. I am interested of the pictures in the control group.

Discusssion:

235-262 Is this discussion or explanation and is this the right place/

 I wonder is this not a very expensive treatment for a condition that generally can be treated well.

 

Author Response

Responses to The Comments

 

We are grateful to the reviewers and editor for the thoughtful comments and the insightful suggestions that helped us improve our manuscript considerably. As indicated in the responses below, we have taken all their valuable comments and suggestions into consideration in the revised manuscript.  Please, note that Reviewers’ comments are written in bold and our responses are written in normal (regular).

 

First Reviewer

 

Introduction

 

• 44; Resistance far as in know only against antibiotics.

Thank you for your valuable comment. In this context, the term "resistance" specifically refers to resistance against antibiotics. We have clarified this point in the revised version of the manuscript to avoid any misunderstanding.

 

• 61-71: Is fore me advertising and not scientific.

Thank you for this very important point. Radiofrequency technology has seen significant global advancements, with companies developing new methods to enhance radiofrequency applications in the latest device updates. This technology has yielded remarkable results, particularly in the treatment of acne. It has been in use worldwide for several years, and numerous studies have proven its effectiveness, some of which are referenced in the discussion section. This study aims to evaluate and test the medical efficacy of the device, independent of any promotional or commercial association with the company behind it

 

Methods

• Why use placebo and not an already proven effective method?

Thank you for your note. Our study is aimed at assessing the efficacy of a new pulsed wave mode of fractional radiofrequency microneedling for treating inflammatory acne vulgaris. It is not a comparative study. The use of a placebo in the control group, rather than an already proven effective method, was specifically chosen to prevent bias. By ensuring that both the control and experimental groups have identical patient characteristics, we can accurately isolate and assess the true effectiveness of the new treatment without the influence of existing treatments."

 

• Groups are indeed comparable.

Thank you for this comment The two groups were similar in age, gender, and the severity of acne vulgaris.

 

• 102; You realize that cleaning and alcohol is treatment too. I assume it was done in both groups.

Thank you for your note. In our study we use rubbing alcohol to clean the skin before each session which done every 1.5 month and we do that for both groups (RF groups & control group) to prevent bias, while as we know that using alcohol as a treatment for inflammatory acne vulgaris require daily application for long term which is not a preferable method for treatment as it is associated with many adverse effects like redness, dryness, flaking, itchiness, peeling, pain and other.

 

 

Results:

• I assume the photographs are selected but impressive. No hyperpigmentation. I am interested of the pictures in the control group.

We Thank the reviewer for this important comment. The images related to the control groups have been added and uploaded with revised manuscript as supplementary materials.

 

Discussion:

• 235-262 Is this discussion or explanation and is this the right place.

Thank you for your valuable note. We have moved this section to the materials and methods section, as it serves as an explanation rather than a discussion. The information clarifies the materials and methods used in the study, which supports the overall understanding of the experimental design. As per your request, this adjustment helps maintain the focus of the discussion section on interpreting the results

 

• I wonder is this not a very expensive treatment for a condition that generally can be treated well 

Thank you for your concern. While traditional treatments for inflammatory acne vulgaris are effective, they often require daily applications, leading to non-compliance due to the burden of long-term use. Additionally, some patients struggle with side effects associated with these treatments. In contrast, the new pulsed mode of microneedling radiofrequency not only addresses acne lesions but also improves overall skin quality, including enlarged pores, sebum production, scarring, skin tone, and texture. Although the initial cost may seem high, the potential for enhanced skin health and reduced long-term treatment burdens can justify the investment for many patients.

 

Reviewer 2 Report

Comments and Suggestions for Authors

This is an interesting study on acne treatment but the manuscript has serious flaws.

1. title - is this a review article? I see it is not so please write informative title with the study design

2. line 11 - the abstract should not include references

3. line 17 is this mean or median age

4. line 26 - capital b in burns

5. line 40 - sentence does not make sense, please proofread entire manuscript for clarity and scientific flow

6. Latin words should be in italic

7. line 82 - how is this observational study if you have intervention

8. line 87 - placebo should be described in detail

9. line 89 - please improve English language this is hard to follow

10. Table 1 - missing percentage in half of the table

11. line 145 The documented? What?

12. line 148 : - ?

13. line 165 - text in next line?

14. explain under figure what do **** stand for

15. line 234 - start a discussion with your main findings

16. line 263-277 - this style is unacceptable, please rewrite this part so it has scientific style and flow

Comments on the Quality of English Language

Low quality, scientific style is also missing throughout the manuscript

Author Response

Responses to The Comments

 

We are grateful to the reviewers and editor for the thoughtful comments and the insightful suggestions that helped us improve our manuscript considerably. As indicated in the responses below, we have taken all their valuable comments and suggestions into consideration in the revised manuscript.  Please, note that Reviewers’ comments are written in bold and our responses are written in normal (regular).

 

 

Second Reviewer

 

 

1. Title - is this a review article? I see it is not so please writing informative title with the study design.

Thank you for your important observation regarding the title. We agree that the current title may misleadingly suggest that the study is a review article rather than an interventional study. In response to your request, we have updated the title to: 'Pulsed Wave Mode of Fractional Radiofrequency Microneedling as a New Advance in the Treatment of Inflammatory Acne Vulgaris.' This change better reflects the nature of our research

 

2. line 11 - the abstract should not include references.

Thank you for your important note. We believe there was some kind of an error affects the sequence of references. We have corrected this error, and the abstract has been updated to remove the references in the newly uploaded version of the manuscript.

 

3. line 17 is this mean or median age.

We appreciate the reviewer note. The value represents the mean age. The mean age is calculated by summing the ages of all individuals and dividing by the total number of individuals in the group. It provides an average, reflecting the central tendency of the dataset

 

4. line 26 - capital b in burns.

Thank you for your important note. We have corrected this error in the newly uploaded manuscript file.

 

5. line 40 - sentence does not make sense, please proofread entire manuscript for clarity and scientific flow.

Thank you for your important note. We have revised the manuscript thoroughly to enhance the clarity and the scientific flow.

 

6. Latin words should be in italic

Thank you for your observation regarding the formatting of Latin words. We acknowledge the importance of proper styling, and we have ensured that all Latin terms are italicized throughout the manuscript to adhere to academic standards. Your feedback is valuable, and we appreciate your attention to details.

 

7. line 82 - how is this observational study if you have intervention

Thank you for your question. While our study involves an intervention, it is classified as an observational study because we are observing the effects of the intervention in a natural setting without manipulating the participants beyond the treatment. The primary aim is to assess the outcomes of the intervention in real-world conditions, allowing us to gather valuable data on its efficacy and safety. We appreciate your valuable comment.

 

8. line 87 - placebo should be described in detail.

Thank you for your important note regarding the placebo. We would like to clarify that the placebo used in our study involves the application of distilled water. We have clarified this information in the newly uploaded manuscript to provide a more detailed description of the placebo. Your feedback is greatly appreciated.

 

9. line 89 - please improve English language this is hard to follow.

Thank you for your feedback regarding line 89.  We have revised this line to enhance the language and ensure it is easier to follow.

 

10. Table 1 - missing percentage in half of the table

Thank you for bringing this to our attention. We have reviewed the data and included the percentages in the revised version of the manuscript.

 

11. line 145 The documented? What?

Thank you for pointing that out. We have corrected it in the revised file that has been uploaded.

 

12. line 148 : - ?

Thank you for your valuable comment. We have addressed the issue and made the correction in the revised file that has been uploaded.

 

13. line 165 - text in next line?

Thank you for your important note. We have addressed the issue and made the correction accordingly, please refer to the revised file that has been uploaded.

 

14. explain under figure what do **** stand for.

Thank you for your question regarding the asterisks under the figure. We have now included explanation of the asterisks in the figure legend to provide clarity on the statistical relevance of our findings.

 

15. line 234 - start a discussion with your main findings.

Thank you for your feedback regarding the structure of the discussion section. We have revised it to begin with a clear presentation of our main findings and contextualization of the results within the broader literature. We appreciate your guidance in enhancing the clarity and flow of our discussion.

 

16. line 263-277 - this style is unacceptable, please rewrite this part so it has scientific style and flow

 

Thank you for your feedback regarding the manuscript's style. We have reviewed and revised the affected sections to ensure clarity and coherence of the flow throughout the document. Your input is valuable, and we appreciate your guidance in enhancing the quality of our manuscript.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

You have improved the manuscript and I believe it is now suitable for publication