Clinical trial of a pinpoint irradiation technique with the CO2 laser for the treatment of atrophic acne scars

Successful treatment of traumatic scars with combined nonablative fractional laser and pinpoint technique of standard CO2 laser

To evaluate the use of a pinpoint irradiation technique followed by nonablative fractional technique in treatment of traumatic scars. Thirteen patients with traumatic sacrs were treated with pinpoint technique of CO2 laser using traditional headpiece activating laser at a frequency (50 Hz) to deliver pulsed mode with power of 1 W using the focusing technique followed by 3-5 passes of the nonablative 1540 nm fractional Er:glass laser. An independent physician evaluator assessed the treatment outcomes using Vancouver scar scale (VSS) and 5-point grading scale (grade 0, no improvement; grade 1, 1-25%; grade 2, 26-50%; grade 3, 51-75%; grade 4, 76-100% improvement). After the final treatment, average percentage changes of VSS were 41.5%. Improvement was evident in terms of vascularity, pigmentation, and height, while insignificant in terms of Pliability. Based on physician's global assessment, mean grade of 2.5 was achieved. Patient's subjective satisfaction scores paralleled the physician's objective evaluation. Pinpoint irradiation technique by CO2 laser followed by nonablative fractional laser is a safe and effective modality in treatment of scars.

Skin needling as a treatment for acne scarring: An up-to-date review of the literature

Background

Skin needling is a technique used to improve the appearance of acne scarring.

Objective

To comprehensively review the medical literature regarding skin needling as a treatment for acne scarring.

Methods

A literature search was performed using the PubMed, Medline, and Embase databases, in addition to reviewing the bibliographies of relevant articles.

Results

Ten studies presented patients treated with skin needling alone, while eight studies discussed skin needling in combination with other treatments for acne scarring. All studies showed improvements in scarring after needling, with 12 reporting statistical significance. The median number of treatments when needling was used alone was three, the median duration between treatments was 4 weeks, and the median needle length used was 1.5 mm. Reported adverse events were infrequent and included post-inflammatory hyperpigmentation, “tram track” scarring, acne, and milia. There were no reports of bacterial infections.

Limitations

The studies reviewed were heterogeneous in design and of variable validity, with some not reporting statistical significance.

Conclusion

There is moderate evidence to suggest that skin needling is beneficial and safe for the treatment of acne scarring. However, double-blinded, randomized controlled trials are required to make more definitive conclusions.

Evaluating evidence for atrophic scarring treatment modalities

Introduction

Atrophic scars cause significant patient morbidity. Whilst there is evidence to guide treatment, there does not appear to be a systematic review to analyse the efficacy of treatment options.

Objectives

To retrieve all evidence relating to atrophic scar treatment and evaluate using the Clinical Evidence GRADE score in order to allow clinicians to make evidence-based treatment choices.

Method

Searches were performed in Medline, EMBASE, CINHL and Cochrane to identify all English studies published evaluating treatment of atrophic scars on adults excluding journal letters. Each study was allocated a GRADE score based on type of study, quality, dose response, consistency of results and significance of results. The end score allowed categorisation of evidence into high, moderate, low or very low quality.

Results

A total of 41 studies were retrieved from searches including randomised controlled trials, observational studies, retrospective analyses and case reports of which 7% were allocated a high-quality score, 10% a moderate score, 7% a low score and 75% a very low score. Treatment modalities included ablative laser therapy, non-ablative laser therapy, autologous fat transfer, dermabrasion, chemical peels, injectables, subcision, tretinoin iontophoresis and combination therapy.

Conclusion

There is a paucity of good-quality clinical evidence evaluating treatment modalities for atrophic scarring. Evidence supports efficacy of laser, surgery and peel therapy. Further biomolecular research is required to identify targeted treatment options and more randomised controlled trials would make the evidence base for atrophic scar treatment more robust.

Highlights of thirty-year experience of CO2 laser use at the Florence (Italy) department of dermatology

The CO₂ laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO₂ laser delivery system and the newer “superpulsed” and scanned CO₂ systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO₂ laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital.