A meta-analysis of fractional CO2 laser combined with PRP in the treatment of acne scar

A Network Meta-analysis to Explore the Effectiveness of the Different Treatment Modalities in Acne Scars

BACKGROUND

Multiple treatments are used to treat acne scars, but comparing the effectiveness of these treatments have not been studied yet. This research aimed to conduct a complete analysis of the effectiveness of commonly used therapies in acne scars.

METHODS

PubMed, Embase, and Cochrane's Library (Cochrane Center Register of Controlled Trials) databases were searched through May 2023. We used patient satisfaction score as the primary outcome and Goodman Baron qualitative scar grading system as the secondary outcome to evaluate the effectiveness of different commonly used therapies for acne scarring, including laser, microneedling (MN), platelet-rich plasma (PRP), autologous fat grafting and combined therapies.

RESULTS

Herein, 495 patients from 13 studies were included. Our results showed that PRP combined with laser was the most effective among therapies in treating acne scars. Ranking of effectiveness by the surface under the cumulative ranking (SUCRA) curve for patient satisfaction score was as following: PRP + laser (96.2%) > laser (71.2%) > MN (45.5%) > MN + PRP (42.0%) > autologous fat grafting (24.5%) > PRP (20.5%). Additionally, ranking of effectiveness by the SUCRA curve for Goodman Baron qualitative scar grading system was as following: PRP + laser (86.3%) > laser (64.2%) > MN + PRP (54.2%) > MN (37.2%) > PRP (8.1%).

CONCLUSION

This network meta-analysis indicated that the combined therapy of PRP and laser might be the most effective. Additionally, more high-quality randomized controlled trials are needed to verify our findings.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Procedural and surgical treatment modalities for acne scarring: Part II

The optimal treatment of acne scarring is challenging because several factors need to be considered, including the type and number of scars, Fitzpatrick skin type, and the amount of downtime permissible to the patient. This second article in the continuing medical education series discusses the procedural treatments available for acne scarring, including the use of chemical peels, fillers, radiofrequency microneedling, lasers, and surgical procedures. The indications for each modality, evidence for its benefits, and the adverse effects are discussed. This section aims to help guide the reader select and implement the most appropriate treatment based on the patient's preferences, acne scarring, and skin type.

Platelet-Rich Plasma: Advances and Controversies in Hair Restoration and Skin Rejuvenation

BACKGROUND

Platelet-rich plasma (PRP) and its combined therapeutic modalities have catalyzed new possibilities in dermatology; however, limitations in evidence and lack of consensus remain among clinicians regarding optimal composition, protocol, technique, and application.

OBJECTIVE

To provide an update and analysis of the evidence for PRP in hair restoration and skin rejuvenation through review of recent available data, highlighting controversies and expert insights to guide future studies, and stimulate discourse and innovations benefitting patients.

METHODS

A structured review and expert analysis of PubMed publications before October 2023, with a focus on recent literature from January 2020 through October 2023.

RESULTS AND CONCLUSION

Growing literature supports the utility and benefits of PRP and related autologous products for applications for skin and hair, with strongest evidence for androgenetic alopecia and skin rejuvenation. However, this is limited by lack of consensus regarding best practices and protocols. Randomized, controlled trials with uniform metrics comparing outcomes of various compositions of autologous blood products, preparation methods, dosimetry, and frequency of treatments are still required. This will allow the medical discourse to grow beyond the realm of expert opinion into consensus, standardization, and more wide spread adoption of best practices that will benefit patients.

Combining platelet rich plasma with ablative laser for post acne scars: A review

Background Acne scars are one of the most common sequelae of inflammatory acne. It commonly affects adolescents and young adults and hence is associated with significant psychological morbidity. It is historically resistant to oral as well as surgical modalities. In the last two decades, ablative lasers (fractional or otherwise) have proven to be effective in management of acne scars. Some studies have proven the efficacy of platelet rich plasma in reducing the adverse effects and improving the efficacy of lasers. Objective Review of the studies combining platelet rich plasma with ablative laser for post acne scars. Methods A literature review of the MEDLINE database for studies evaluating the combination of ablative lasers with platelet rich plasma was performed. Only studies with higher levels of evidence (randomised controlled trials and comparative studies) were included in this review. Results Adding intradermal platelet rich plasma to fractional ablative lasers in the management of post acne scars increases clinical efficacy, reduces downtime as well as frequency and duration of ablative lasers related adverse effects. The efficacy of topical platelet rich plasma is less as compared to intradermal platelet rich plasma. Limitations The studies analysed are heterogeneous in nature with varied protocols and duration of follow up. Conclusions It is recommended to combine the ablative lasers with intradermal platelet rich plasma for better clinical response and reduce adverse effects as well as downtime.

Safety and Effectiveness of Laser or Intense Pulsed Light Treatment for Early Surgical Scar: A Systematic Review and Meta-analysis

OBJECTIVE

We aimed to investigate the safety and efficacy of laser or intense pulsed light therapy for early treatment of surgical scar.

METHODS

A literature search was conducted for relevant prospective, randomized controlled trials published in PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Database, and VTTMS between January 2006 and January 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to extract literature data. The risk of bias was assessed by RevMan. Safety was assessed based on the presence of serious adverse reactions (blisters, infections, burns above the second degree), while effectiveness was assessed using the Vancouver Score Scale.

RESULTS

1512 related articles were preliminarily retrieved, including 1211 English articles and 301 Chinese articles. According to the inclusion criteria and exclusion criteria, 12 articles were selected for this analysis. In total, 475 patients were included (laser group, 238; control group, 236). All studies confirmed that the laser group was superior to the control group. In the subgroup analysis of 7 articles, the standardized mean difference was 1.99 (P = 0.0001).

CONCLUSIONS

This meta-analysis demonstrates that laser or intense pulsed light therapy is a safe and effective approach for early surgical scar treatment, resulting in improved scar appearance and minimal adverse reactions.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

TFOS Lifestyle: Impact of cosmetics on the ocular surface

In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.

Effect and Safety Analysis of PRP and Yifu Combined with Ultrapulsed CO2 Lattice Laser in Patients with Sunken Acne Scar

Objective

To investigate the effect and safety of PRP and Yifu combined with ultrapulsed CO₂ lattice laser in patients with sunken acne scar.

Methods

700 subjects were selected from the group of patients with sunken acne scar treated in our hospital from November 2010 to December 2020. They were divided into control group (n = 350) and study group (n = 350). The grouping was mainly based on the random number table method. Patients in the control group were treated with ultrapulse CO₂ lattice laser, while those in the study group were treated with ultrapulse CO₂ lattice laser combined with PRP and Yifu. The clinical effect, scar improvement and quality of life before and after treatment, and adverse events during treatment were compared between the two groups. The clinical effect was categorized into cure after treatment, significant effect, effective, and ineffective. The total effective rate = 1 − ineffective rate.

Results

After treatment, the total effective rate of the study group (81.43%) was higher than that of the control group (70.00%). After treatment, ECCA, VSS scores, daily activities, symptoms and feelings, work and study, leisure and entertainment, interpersonal relationship, treatment status, and total scores were all lower in both groups than before treatment, and the study group was lower than the control group. During the treatment, the incidence of adverse events in the study group (17.33%) was lower than that in the control group (28.57%), P < 0.05.

Conclusion

PRP and Yifu combined with ultrapulse CO₂ lattice laser in the treatment of sunken acne scar can effectively improve the scar, reduce the incidence of adverse events, and the treatment effect is obvious, which can improve the quality of life of the patients.

Comparative appraisal with meta-analysis of erbium vs. CO2 lasers for atrophic acne scars

Recent advances in laser technology allowed the development of systems that improve texture, appearance and pliability of skin in acne scars (AS). Currently, comprehensive comparative studies on the efficacy of the most commonly used fractional systems in AS are lacking. Thus, the aim of this work was to appraise and compare the clinical response to erbium versus CO₂ lasers in AS in the form of a meta-analysis. The databases MEDLINE, EMBASE, Cochrane library were searched. Main clinical outcomes were investigator-reported scar improvement and participant-reported scar improvement. Five studies were included in this meta-analysis. Scar improvement was similar for both types of laser in terms of investigator-reported scar improvement (RR: 0.60 95 % CI: 0.35-1.02) and participant-reported scar improvement (RR: 0.99 95 % CI: 0.79-1.25). A sensitivity analysis that excluded studies with high risk of bias found the CO₂ lasers to be superior to the erbium lasers (RR: 0.47 95 % CI: 0.24-0.93): However, the subgroup analysis showed the CO₂ laser not to be significantly different from either the non-ablative erbium (RR: 0.65 95 % CI: 0.34-1.24) or the ablative erbium laser (RR: 0.60 95 % CI: 0.35-1.02). The CO₂ laser produced a slightly greater clinical response compared to the erbium lasers based on the physician's assessment. Overall, the two devices do not differ largely in terms of efficacy but may be complementary, with each resurfacing laser better suited for different clinical tasks.

Combination of ablative fractional carbon dioxide laser and platelet-rich plasma treatment to improve hypertrophic scars: a retrospective clinical observational study

BACKGROUND

Hypertrophic scars are one of the main complications that affect the quality of life of patients after burns. Many methods have been shown to be effective in the treatment of hypertrophic scars, such as ablative fractional CO₂ laser (AFCL) and platelet-rich plasma (PRP). However, there are few studies on the effect of the combined application of these measures. The purpose of this study was to explore the therapeutic effect of AFCL combined with PRP on hypertrophic burn scars.

METHODS

A retrospective clinical observation study was conducted on 50 patients with hypertrophic burn scars. The AFCL+PRP group included 31 patients who received AFCL combined with PRP treatment; the AFCL group included 19 patients who received AFCL treatment only. The University of North Carolina 4P Scar Scale (UNC4P) and the Vancouver Scar Scale (VSS) scores that were collected before each treatment were used as indicators of the effectiveness of the previous treatment. The scores recorded at the second, fourth and seventh months were analysed.

RESULTS

The demographic data of the 2 groups were not significantly different. Before treatment, there was no difference in the UNC4P and VSS scores between the 2 groups. There was a significant decline in the UNC4P and VSS total scores over 6 months in both groups (p < 0.05) and scores in the 2 groups were comparable after 3 and 6 months (p < 0.05). UNC4P scores in the AFCL+PRP group decreased from a mean of 8.26 to 2.61 (p < 0.05) with a concomitant drop in VSS scores from a mean of 11.74 to 6.06 (p < 0.01). In the AFCL group UNC4P and VSS scores decreased from 7.68 to 4.63 (p < 0.05) and from 10.89 to 8.16 (p < 0.05), respectively. The sub-items of these 2 assessments were analysed and the results suggest that AFCL combined with PRP can comprehensively improve scarring.

CONCLUSIONS

This study shows that PRP is an effective adjunct for AFCL in the treatment of hypertrophic burn scars and that the combination of PRP and AFCL proved to be more useful than AFCL alone. This combination may be a new and effective clinical practice for the treatment of scars. However, larger and higher-level clinical studies are still needed to determine its efficacy and possible mechanisms.