Efficacy of fractional CO2 laser therapy combined with hyaluronic acid dressing for treating facial atrophic acne scars: a systematic review and meta-analysis of randomized controlled trials

Clinical efficacy of the fractional ablative CO2 laser stacking method for depressed scars

Depressed scars, which are unsightly outcomes of trauma or skin lesions, can lead to significant physical and mental stress. Various treatments have been developed to alleviate these burdens, among which the laser stacking method has proven effective. In this study, we compared the outcomes of laser stacking treatments with those of single-pulse ablative laser treatments for depressed scars. Eighty patients with depressed scars were divided into two therapeutic groups: the ablative laser stacking therapy group (Group 1, n = 40) and the single pulse ablative laser therapy group (Group 2, n = 40). The scars were evaluated using the modified Vancouver Scar Scale (mVSS) before and after treatment. Patient-completed questionnaires were also utilized. Comparative analyses were conducted both before and after treatment, as well as between the two groups. Eighty scars from each patient underwent the complete laser treatment protocols. Group 1 showed significantly greater improvement in the mVSS indices for pigmentation, vascularity, pliability, and height than group 2 (P < 0.05). In terms of patient-reported outcomes, group 1 rated better than group 2 across three indices: appearance, alleviation of concavity, and overall improvement (P < 0.05). Ablative laser stacking therapy effectively alleviated depressed scars, demonstrating significant improvement in both observer- and patient-reported outcomes. An energy level of 20-30 mJ was employed, resulting in more favorable outcomes compared to a single pulse laser application of 10-15 mJ. Our findings highlight the benefits of the stacking method, which shows notable improvements while minimizing complications. Further research involving various protocols may optimize clinical outcomes and patient satisfaction.

Research Situation, Hotspots, and Global Trends in Laser Treatment of Acne Scars: A Bibliometric Analysis of Related Research From 2014 to 2024

BACKGROUND

Acne vulgaris is a chronic inflammatory skin condition, commonly resulting in acne scars. Treating acne scars remains a significant challenge in dermatology. With advancements in laser technology, its clinical use for treating acne scars has been increasing annually. However, bibliometric analysis on laser treatment for acne scars is lacking. This study aims to use bibliometrics to comprehensively understand the development trends and research hotspots in laser treatment for acne scars.

METHODS

Using "acne scar" and "laser" as search terms, literature on laser treatment of acne scars from 2014 to 2024 was retrieved from the Web of Science Core Collection (WoSCC) database. The literature data were visualized using VOSviewers, CiteSpace, and R software, generating maps of countries, research institutions, authors, journals, references, and keywords.

RESULTS

The analysis included 536 articles from 46 countries, with the United States and China leading in publications. Publications focusing on laser treatment of acne scars exhibit a consistent growth trend annually. Key research institutions include Mahidol University in Thailand, Cairo University in Egypt, and Hallym University in South Korea. The "Journal of Cosmetic Dermatology" had the highest number of articles in this field, while "Dermatologic Surgery" was the most cited publication. These publications involved contributions from 2135 authors, with Professor Manuskiatti Woraphong from Mahidol University in Thailand being the most prolific author in this field. Research on the efficacy of laser treatment for acne scars is a major focus in this field. Among the different types of lasers, CO2 lasers are the most commonly used. Emerging research focuses include therapies such as platelet-rich plasma, picosecond laser, trichloroacetic acid, and burn scar.

CONCLUSIONS

Treatment efficacy is the primary focus of research in the field of laser treatment for acne scars. Platelet-rich plasma, and novel picosecond lasers, have emerged as hot topics and trends in this research field. However, it is important to note that the impact factors of journals publishing in this field are currently low. Therefore, clinicians must consider and explore strategies for publishing high-quality clinical research in the future.

One Acne™: a holistic management approach to improve overall skin quality and treatment outcomes in acne with or without sensitive skin

Acne and sensitive skin can take a profound toll on patients' well-being, which can be exacerbated if the conditions are experienced together. This narrative review aims to identify appropriate treatments to facilitate a holistic management approach to acne (One Acne™), sensitive skin, and acne-induced sequelae and describe the role of treatments in improving skin quality. Topical retinoids are considered the preferred first-line option for acne treatment by dermatologists, either as monotherapy or in combination with other treatments, because of their ability to target various aspects of the disease. Tretinoin, trifarotene, adapalene, and tazarotene have all been assessed in clinical studies for managing acne-associated scarring, with varying success, with the latter three reported to improve skin quality. Moreover, some corrective procedures, e.g., injectable non-animal stabilized hyaluronic acid (NASHA) fillers, have proven effective for treating acne scarring. Both treatment types may complement each other to provide optimal treatment outcomes and patient satisfaction, as observed in several patients receiving concomitant treatment with NASHA fillers/topical trifarotene. Adjunctive use of cleansers, moisturizers, and photoprotection-containing ingredients such as vitamin B3, glycerin, or pro-vitamin B3 may also complement drug/corrective treatments to reduce skin irritation and risk of scarring, as well as improve skin hydration, tone, and overall appearance. This narrative review highlights that comprehensive skincare regimens should be used throughout acne patients' journeys to reduce treatment-related irritation, improve treatment outcomes, adherence, and satisfaction, and enhance overall skin quality. Patients with sensitive skin should choose tailored skincare products to maintain skin barrier integrity and restore skin function.

Comparing the efficacy and safety of microneedling and its combination with other treatments in patients with acne scars: a network meta-analysis of randomized controlled trials

This study aimed to analyze the efficacy and safety of microneedling (MN), both alone and in combination with other treatments, to refine the approach for treating acne scars using MN. We systematically searched Pubmed, Cochrane Library, Embase, and Web of Science for randomized controlled trials examining MN or its combinations in patients with acne scars. All statistical analyses were performed using Stata 18 software. A total of 24 studies involving 1546 participants were included. The analysis revealed that MN combined with chemical peels (CP) exhibited the best results in terms of degree of improvement, patient satisfaction, and treatment efficacy compared to other treatments examined, including MN alone, MN with hyaluronic acid (HA), MN with botulinum toxin‑A (TA), MN with platelet-rich plasma (PRP), PRP alone, CP, and laser therapy. The results for MN combined with additional treatments were obviously better than for MN alone. Side effects such as erythema, pain, and post-inflammatory hyperpigmentation showed no significant differences across all treatments assessed.

Efficacy of fractional carbon dioxide laser-assisted drug delivery in the management of post-burn scars - A prospective study

Objectives

The objective of our study is to assess the efficacy of fractional carbon dioxide (CO2) laser-assisted drug delivery (LADD) in the management of post-burn scars.

Material and Methods

It is a prospective study conducted from March 2021 to February 2022, with 32 patients ranging in age from 9 to 52 years. The scars lasted anywhere from 6 months to 18 years. The ethical clearance of the Institutional Ethics Committee was obtained. The patient's median age was 22 (range, 09-52). Patients were assessed using a modified Vancouver scar scale (mVSS) score before and after receiving fractional CO2 laser at monthly intervals.

Results

After one treatment, statistically significant improvements in pigment, thickness, and pliability were seen according to the mVSS scores, and these improvements persisted through the final laser session.

Conclusion

Our study has demonstrated that fractional CO2 LADD seems to be an encouraging approach in the management of post-burn scars with good patient satisfaction.

Advancements in the Management of Cervical Intraepithelial Neoplasia: A Comprehensive Review

Cervical intraepithelial neoplasia (CIN) represents a significant precursor to cervical cancer, posing a considerable threat to women's health globally. This comprehensive review examines recent advancements in the management of CIN, encompassing screening, diagnosis, and treatment modalities. The etiology and pathogenesis of CIN are explored alongside an analysis of traditional and emerging screening techniques, including liquid-based cytology and molecular biomarkers. Treatment options, from minimally invasive procedures to immunotherapy approaches, are evaluated for efficacy and potential impact on patient outcomes. Furthermore, this review highlights the implications of these findings for clinical practice, emphasizing the importance of staying abreast of evolving guidelines and integrating innovative strategies into routine care. Recommendations for future research and practice are provided, emphasizing personalized approaches, disparities in access to care, and the exploration of novel therapeutic avenues. By addressing these challenges and opportunities, this review aims to contribute to the ongoing efforts to mitigate the burden of CIN and cervical cancer, ultimately improving women's health outcomes worldwide.

Efficacy of Microneedling and CO2 Laser for Acne Scar Remodelling: A Comprehensive Review

Acne scarring is a prevalent issue affecting millions worldwide, with significant psychological and social implications. Microneedling and CO2 laser therapy have emerged as promising modalities for acne scar remodelling. Microneedling induces controlled micro-injuries to stimulate collagen production, while CO2 laser therapy precisely ablates scar tissue. This comprehensive review evaluates the efficacy, safety, and comparative benefits of microneedling and CO2 laser therapy. Literature synthesis reveals both modalities to improve acne scars, albeit with different mechanisms and risks. Factors influencing treatment selection and the role of combination therapy are discussed. Future directions include optimising protocols and exploring novel techniques. Overall, microneedling and CO2 laser therapy offer valuable options for acne scar management, empowering individuals to address the physical and emotional burden of scarring.