Which type of atrophic acne scar (ice-pick, boxcar, or rolling) responds to nonablative fractional laser therapy?

Atrophic Postacne Scar Treatment: Narrative Review

Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well-being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aimed to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefit compared to the implementation of a single method.

Truncal Acne and Scarring: A Comprehensive Review of Current Medical and Cosmetic Approaches to Treatment and Patient Management

Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.

Clinical Factors Affecting the Effectiveness of 1550-nm Erbium-Doped Fractional Photothermolysis Laser for Individual Atrophic Acne Scar Types

INTRODUCTION

Although non-ablative fractional resurfacing is frequently used for atrophic acne scars, few studies have examined clinical factors affecting the effectiveness of non-ablative fractional laser in individual atrophic acne scar types (icepick, rolling, and boxcar scars). Herein, we evaluated the clinical factors affecting the effect of non-ablative fractional laser for individual atrophic acne scar types using objective assessment tools.

METHODS

Thirty-one patients who had been treated by 1550-nm erbium-doped fractional laser for atrophic acne scars were retrospectively reviewed. Icepick, rolling, and boxcar scars were counted using photographs, and acne scar reduction efficiency (ASRE%; the percentage reduction of post-acne scar count from baseline counts) was calculated.

RESULTS

The median count of each scar type was significantly reduced at the end of the final session. Boxcar scars responded better (median ASRE 59.2%) than rolling (ASRE 40.6%, p = 0.017) and icepick scars (ASRE 19.1%, p = 0.010). Concomitant isotretinoin use resulted in a greater ASRE and a significantly greater improvement in icepick scars. Patients aged 25 years or younger showed a higher ASRE, with a greater improvement in boxcar scars.

CONCLUSION

1550-nm fractional laser treatment for atrophic acne scars was more effective in patients who were younger and taking isotretinoin concurrently.

Fractional Q-Switched 1064 nm Laser for Treatment of Atrophic Scars in Asian Skin

Background and Objectives: Asian patients with Fitzpatrick skin type III-IV are a less studied subtype of patients in the medical literature. Q-Switched, 1064 nm neodymium-doped yttrium aluminum garnet (Nd: YAG) laser with a fractionated beam profile (QSF) is a new modality that was reported to be effective in the treatment of scars. This study aims to evaluate the efficacy and safety of QSF Nd: YAG laser in treating scars in Asian patients. Materials and Methods: A total of 29 Subjects were treated with 1064 nm QSF laser. Each patients had three treatments with a fractionated microlens array handpiece every 8 weeks). Efficacy of treatment was evaluated using the Goodman and Baron's quantitative grading scale before and 3 months after the last treatment. Results: All 29 patients treated had significant improvement of acne scars according to Goodman and Baron's Quantitative Global Acne Scarring Grading System. No side effect has been observed except some minor erythematous reactions in three patients. Conclusions: Our results confirm that the 1064 nm QSF Nd: YAG laser is a safe and effective technique for treating scars in Asians.

A systematic review of evaluating the efficacy of acne scar treatment by Fractional Laser with or without using adjunctive treatments

Fractional laser (FL) resurfacing has proved its effectiveness in acne scars treatments. To evaluate the efficacy of Fractional laser systems for treatment of acne scars as a monotherapy, and as adjunctive therapy with other treatment types. A systematic literature review was performed by searching the electronic databases PubMed, Google Scholar, and Embase. Fractional laser has proven therapeutic efficacy of over 26% in treating acne scars, with minor and transient side effects, and well-tolerant pain. The application of PRP not only accelerated recovery and reduced adverse events, but also enhanced localized collagen neogenesis and redistribution. The addition of surgical treatments to Fractional Laser Systemes (FLS) therapy delivers the best treatment results for Icepick scars. Fractional laser is an effective tool for treating acne scars. The degree of effectiveness varies according to the laser parameters, the number of treatment sessions, skin photo type, the severity and the type of scars. The application of Platelet-Rich Plasma (PRP) and Fractional Radiofrequency Microneedle (FRM) in addition to the FL treatment improves the therapeutic efficacy and reduces the appearance of Post Inflammatory Hyper-Pigmentation (PIH), and is the ideal treatment for dark-skinned patients. FL therapy along with surgical methods such as subsicion and punch techniques provided the best improvements for deep scars.

Energy-based devices for the treatment of acne scars: 2021 international consensus recommendations

BACKGROUND AND OBJECTIVES

Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs.

STUDY DESIGN/MATERIALS AND METHODS

An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence.

RESULTS

The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome.

CONCLUSION

Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.

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.

Comparison of 1565-nm Nonablative Fractional Laser and 10600-nm Ablative Fractional Laser in the Treatment of Mild to Moderate Atrophic Acne Scars

BACKGROUND

The 10,600-nm ablative fractional laser (AFL) is widely used for treating facial atrophic acne scars but with evident side effects. By contrast, the common Er:Glass non-AFL (NAFL) is safer but lacks of comparable outcomes. A novel 1,565 nm Er:Glass NAFL improves thermal energy delivery and could yield better outcomes.

OBJECTIVE

We aimed to compare the effectiveness and safety between the 1,565-nm NAFL and 10,600-nm AFL in treating mild-to-moderate facial atrophic acne scars.

METHODS

Nineteen patients with mild-to-moderate bilateral facial atrophic acne scars were enrolled in a randomized split-face trial, which involved 3-session procedures for each laser. The effectiveness and safety were evaluated by doctors and patients who were blinded to the treatment assignment.

RESULTS

Both lasers improved the acne scar profiles comparably. A marked reduction in erythema, crusting durations, and degree of pain were noted on the sides treated with the 1,565-nm NAFL, relative to those treated with the 10,600-nm AFL.

CONCLUSION

Both 1,565 nm-NAFL and 10,600-nm AFL can improve mild-to-moderate acne scars. Patients should never expect complete resolution. The 1,565-nm NAFL has less side effects.

Self-contrast study of pinprick therapy combined with super pulse fractional CO2 laser for the treatment of atrophic acne scars

AIMS

This study is to evaluate the clinical efficacy and safety of a "double-layer" mode of super pulse fractional CO₂ laser and a combined treatment of pinprick therapy with fractional CO₂ laser for the treatment of atrophic acne scars.

METHODS

A split-face and self-contrast method was applied. A total of 20 patients with atrophic acne scars randomly received the above mentioned therapy on the left or right side of the cheek for 3 times with an interval of 3 months. ECCA scores, IVA scores, patients' satisfaction, VAS scores, and adverse reactions were evaluated.

RESULTS

Atrophic acne scars on both sides of the cheek were improved obviously. The ECCA scores showed a significant decrease, while IVA scores significantly increased. Compared with the super pulse fractional CO₂ laser group, the decrease of ECCA scores, the increase of IVA scores, and the patients' satisfaction were significantly higher and improvement on V-shaped and U-shaped acne scars was significantly better in the combined treatment group. No patients had severe adverse reactions such as blister, infection, or hypertrophic scars.

CONCLUSIONS

Super pulse fractional CO₂ laser and pinprick treatment combined with fractional CO₂ laser are both safe and effective therapy for the treatment of atrophic acne scars.

Chemical reconstruction of skin scars (CROSS) method for atrophic scars: A comprehensive review

BACKGROUND

Chemical reconstruction of skin scars (CROSS) applies a high strength acid focally to treat atrophic scars. Although this method has gained popularity over the past two decades, no standardized treatment guideline exists for CROSS method in the treatment of atrophic scars.

AIMS

The purpose of this comprehensive review was to evaluate the indications, detailed techniques, efficacy, and safety of CROSS method.

MATERIALS AND METHODS

An extensive literature review was conducted to identify articles relating to CROSS method for atrophic scars from 2002 to 2018.

RESULTS

The literature search yielded 19 articles meeting criteria. CROSS method has been used for the treatment of acne scars, varicella scars, enlarged pores, and depressed surgical scars. In studies using the quantile grading scale for acne scars, 60%-100% of patients showed >25% improvement. In two studies for varicella scars, 83%-100% of patients showed >25% improvement. CROSS method seems to be effective specifically for ice-pick scars. It is well tolerated and safe in Fitzpatrick skin phototypes I-V. Most reported complications are temporary and include postinflammatory dyspigmentation, erythema, pain, pruritus, infection, and widening of scars.

CONCLUSION

This literature review suggests that CROSS method is a safe and effective treatment for atrophic scars, especially ice-pick scars, in skin types I-V. However, current published works have several limitations, including small sample sizes, lack of control group, different concentrations of acid, different frequency of treatments, and follow-up periods. Larger, randomized, controlled studies are needed to elucidate the optimal treatment protocol of CROSS method.

Treatment of atrophic acne scars with combination therapy of chemical reconstruction of skin scars method and fractionated nonablative laser: A retrospective analysis

BACKGROUND

Patients with acne scarring often have several types of acne scars, and combination therapies have demonstrated superior success to single treatment modalities. Chemical reconstruction of skin scars (CROSS) has gained popularity as the treatment for ice-pick scars and fractionated laser therapy for rolling and boxcar scars. However, no study has looked at combination therapy with CROSS and fractionated nonablative laser for the treatment of atrophic acne scars.

AIMS

We sought to evaluate the efficacy and safety of combination therapy with CROSS and fractionated nonablative laser for atrophic acne scars.

METHODS

We conducted a retrospective analysis of patients treated with CROSS followed by fractionated nonablative laser treatment in the same visit for acne scars from 2016 to 2020. Treatment efficacy, defined as the percentage improvement in the appearance of acne scars, was assessed using a 5-point scale: score 0 (worsening or 0% improvement), 1 (1% - 25%), 2 (26% - 50%), 3 (51%-75%), and 4 (76%-100%).

RESULTS

Twenty-five patients (14 females and 11 males, Fitzpatrick Skin Type II -V) were enrolled. The average improvement score was 2.07 after 3 sessions and 2.78 after 5 sessions. All subjects reported satisfaction, while 24% were very satisfied. There were no permanent adverse effects, and only one patient developed a temporary hypertrophic scar.

CONCLUSION

We concluded that combination therapy with CROSS and fractionated nonablative laser in the same visit is an effective and safe treatment option for atrophic acne scars in patients with various skin types, including skin of color.

Clinical and histopathological comparison of microneedling combined with platelets rich plasma versus fractional erbium-doped yttrium aluminum garnet (Er: YAG) laser 2940 nm in treatment of atrophic post traumatic scar: a randomized controlled study

Background: Different modalities have been tried for treating atrophic post traumatic scars.Objective: To compare the efficacy of microneedling combined with PRP with that of fractional erbium-doped yttrium aluminum garnet (Er: YAG) laser in treating post-traumatic atrophic scars.Methods: Forty-five patients with atrophic post traumatic scars were subdivided into three groups. Group I was subjected to four sessions of skin microneedling followed by topical application of platelet-rich plasma (PRP) immediately after each session. Group II was subjected to the same protocol of treatment but for six sessions. Group III was subjected to four sessions of fractional Er: YAG laser at 4 weeks intervals for four sessions. Response to treatment was assessed clinically using the Quartile Grading Scale and histopathologically using H&E stain, trichrome and Orcein special stains.Results: All patients showed significant clinical improvement regardless of the treatment. There was a significant difference in clinical and histopathological improvement between groups I and III, but there was no significant difference in improvement neither between groups I and II nor between groups II and III.Conclusion: microneedling could be as effective as a fractional laser when combined with PRP and when used for more sessions.

Efficacy of Microneedling Versus Fractional Non-ablative Laser to Treat Striae Alba: A Randomized Study

BACKGROUND

Striae distensae (SD), an unsightly cutaneous condition characterized by epidermal atrophy, can affect the quality of life of women.

OBJECTIVES

The aim of our study was to compare the efficacy of a neodymium:yttrium-aluminum-perovskite 1340 nm non-ablative fractional laser (NAFL) and the microneedling (MN) technique to treat striae alba (SA).

MATERIALS AND METHODS

NAFL and MN were used to treat striae on the longitudinally divided abdominal surface of 20 women classified as Fitzpatrick skin type III or IV (five sessions at monthly intervals). Photographs and skin biopsies were obtained during pretreatment and after the third and fifth treatment sessions for all patients. Patients and two independent evaluators assessed the clinical response using the Global Aesthetic Improvement Scale.

RESULTS

Patient-reported evaluation showed improvement of striae using both modalities, with no statistically significant difference between the groups. Collagen and elastic fibers were significantly increased (p < 0.01) after the third and fifth treatment sessions, with no significant difference between the modalities. In addition, Dermatology Life Quality Index scores showed significant improvement (p < 0.001) after the third and fifth treatment sessions compared with pretreatment values, with average values of 8.4 (standard error [SE] ± 1.21), 3.17 (SE ± 0.55), and 2.64 (SE ± 0.60), respectively. The mean pain score using the Visual Analog Scale in the MN group versus the NAFL group was 5.23 (SE ± 0.31) versus 2.39 (SE ± 0.22) [p < 0.001], and the mean duration of adverse events in the NAFL group versus the MN group was 4.03 days (SE ± 0.45) versus 3 days (SE ± 0.37) [p = 0.02].

CONCLUSION

NAFL and MN are safe for treating SD, particularly in individuals classified as phototype III or IV. MN is a useful non-technology-dependent, low-cost alternative therapy for SA.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03390439.

Concomitant Use of 1,550-nm Nonablative Fractional Laser With Low-Dose Isotretinoin for the Treatment of Acne Vulgaris in Asian Patients: A Randomized Split-Face Controlled Study

BACKGROUND

Nonablative fractional laser (NAFL) has been shown to improve the appearance of inflammatory acne and acne scars. Isotretinoin is effective for the treatment of moderate-to-severe cases of recalcitrant acne. However, the recommended dose of isotretinoin can have profound effects.

OBJECTIVE

To investigate the clinical efficacy and safety of performing NAFL treatment in patients with moderate-to-severe acne vulgaris under treatment with low-dose oral isotretinoin.

METHODS AND MATERIALS

Eighteen patients who received 10-mg oral isotretinoin per day completed 3 sessions of NAFL treatment on one half of the face and presented for each scheduled follow-up appointment.

RESULTS

Low-dose isotretinoin was effective in managing papules and nodule lesions (p < .001). Comedo lesions were significantly improved on NAFL-treated half-faces, compared with untreated half-faces (p < .05) as well as on the appearance of atrophic boxcar scars (superficial boxcar scar, p < .05; deep boxcar scar, p < .01). The most common side effects of oral isotretinoin were xerostomia and cheilitis. The most common discomforts associated with NAFL treatment were mild transient erythema and edema in the treated area.

CONCLUSION

The combination of NAFL with low-dose isotretinoin is a safe and effective treatment for moderate-to-severe acne.

A systematic review of treatments for acne scarring. Part 2: Energy-based techniques

INTRODUCTION

Acne scarring is a very common problem, which can be extensive, and may lead to significant psychosocial morbidity. Multiple types of treatments are used to ameliorate atrophic scars with varying degrees of success. This paper provides an overview of the various energy-based modalities that are commonly employed against acne scarring.

OBJECTIVES AND METHODS

A comprehensive literature search of papers published since 2008 was performed in order to determine the efficacy and adverse reactions of commonly used energy-based treatments against post-acne scarring.

RESULTS

A total of 59 relevant articles were identified covering a multitude of different devices.

DISCUSSION

Ablative lasers seem to achieve the highest degree of efficacy, albeit this is associated with significant pain and downtime, and the risk for long-term pigmentary changes. Non-ablative fractional photothermolysis (FP) has a much safer profile but cannot achieve as good cosmetic results. The efficacies of fractional radiofrequency microneedling and radiofrequency are slightly inferior to that of FP but offer an even safer adverse profile. Little evidence is available on the remaining devices, with larger studies required in order to reach more solid conclusions.

CONCLUSION

Multiple devices have been used with varying levels of efficacy and very different safety profiles. There is an overall lack of high-quality evidence about the effects of different interventions. Furthermore, no standardised scale is available for acne scarring, leading to variability in evaluation and interpretation of data in different studies.

Molecular effects of fractional ablative erbium:YAG laser treatment with multiple stacked pulses on standardized human three-dimensional organotypic skin models

The molecular changes in gene expression following ablative laser treatment of skin lesions, such as atrophic scars and UV-damaged skin, are not completely understood. A standardized in vitro model of human skin, to study the effects of laser treatment on human skin, has been recently developed. Therefore, the aim of the investigation was to examine morphological and molecular changes caused by fractional ablative erbium:YAG laser treatment on an in vitro full-thickness 3D standardized organotypic model of human skin. A fractional ablative erbium:YAG laser was used to irradiate organotypic human 3D models. Laser treatments were performed at four different settings using a variety of stacked pulses with similar cumulative total energy fluence (60 J/cm²). Specimens were harvested at specified time points and real-time PCR (qRT-PCR) and microarray studies were performed. Frozen sections were examined histologically. Three days after erbium:YAG laser treatment, a significantly increased mRNA expression of matrix metalloproteinases and their inhibitors (MMP1, MMP2, MMP3, TIMP1, and TIMP2), chemokines (CXCL1, CXCL2, CXCL5, and CXCL6), and cytokines such as IL6, IL8, and IL24 could be detected. qRT-PCR studies confirmed the enhanced mRNA expression of IL6, IL8, IL24, CXCLs, and MMPs. In contrast, the mRNA expression of epidermal differentiation markers, such as keratin-associated protein 4, filaggrin, filaggrin 2, and loricrin, and antimicrobial peptides (S100A7A, S100A9, and S100A12) as well as CASP14, DSG2, IL18, and IL36β was reduced. Four different settings with similar cumulative doses have been tested (N10%, C10%, E10%, and W25%). These laser treatments resulted in different morphological changes and effects on gene regulations. Longer pulse durations (1000 μs) especially had the strongest impact on gene expression and resulted in an upregulation of genes, such as collagen-1A2, collagen-5A2, and collagen-6A2, as well as FGF2. Histologically, all treatment settings resulted in a complete regeneration of the epidermis 3 days after irradiation. Fractional ablative erbium:YAG laser treatment with a pulse stacking technique resulted in histological alterations and shifts in the expression of various genes related to epidermal differentiation, inflammation, and dermal remodeling depending on the treatment setting applied. A standardized in vitro 3D model of human skin proved to be a useful tool for exploring the effects of various laser settings both on skin morphology and gene expression during wound healing. It provides novel data on the gene expression and microscopic architecture of the exposed skin. This may enhance our understanding of laser treatment at a molecular level.

Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars

The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies.

Fractional CO2 Laser vs Fractional CO2 with Topical Platelet-rich Plasma in the Treatment of Acne Scars: A Split-face Comparison Trial

Background:

It is a challenge to treat acne scars and a multimodal combination approach is necessary. While fractional CO₂ lasers (FCLs) are an established treatment option, the role of platelet-rich plasma (PRP) in the treatment of acne scars is not established though it is being used extensively in other fields of medicine owing to its healing properties. We combined the two methods to assess the proposed synergistic action on acne scars.

Aims and Objectives:

To evaluate the effect of FCL alone vs FCL combined with PRP on the quality of acne scars.

Materials and Methods:

This is a left–right split-face comparison study with 30 patients with moderate-to-severe acne scars. The patients underwent three sessions of FCL and FCL + topical PRP on right and left sides of the face, respectively, at monthly intervals.

Results:

There was significant improvement on both sides of the face (right side, P = 0.001; left side, P = 0.0001), but the difference between the right and the left sides of the face was not statistically significant (P = 0.2891). The symptoms of redness, edema, and pain on the treated areas with laser were significantly lesser on the FCL + PRP (left) side as compared to the FCL-only (right) side.

Conclusion:

Both methods were effective in management of acne scars. Addition of PRP does not improve the scar quality; however, the downtime and inflammation associated with laser treatment gets significantly reduced on the PRP-treated side.

Effects of non-ablative fractional erbium glass laser treatment on gene regulation in human three-dimensional skin models

Clinical experiences with non-ablative fractional erbium glass laser therapy have demonstrated promising results for dermal remodelling and for the indications of striae, surgical scars and acne scars. So far, molecular effects on human skin following treatment with these laser systems have not been elucidated. Our aim was to investigate laser-induced effects on skin morphology and to analyse molecular effects on gene regulation. Therefore, human three-dimensional (3D) organotypic skin models were irradiated with non-ablative fractional erbium glass laser systems enabling qRT-PCR, microarray and histological studies at same and different time points. A decreased mRNA expression of matrix metalloproteinases (MMPs) 3 and 9 was observed 3 days after treatment. MMP3 also remained downregulated on protein level, whereas the expression of other MMPs like MMP9 was recovered or even upregulated 5 days after irradiation. Inflammatory gene regulatory responses measured by the expression of chemokine (C-X-C motif) ligands (CXCL1, 2, 5, 6) and interleukin expression (IL8) were predominantly reduced. Epidermal differentiation markers such as loricrin, filaggrin-1 and filaggrin-2 were upregulated by both tested laser optics, indicating a potential epidermal involvement. These effects were also shown on protein level in the immunofluorescence analysis. This novel standardised laser-treated human 3D skin model proves useful for monitoring time-dependent ex vivo effects of various laser systems on gene expression and human skin morphology. Our study reveals erbium glass laser-induced regulations of MMP and interleukin expression. We speculate that these alterations on gene expression level could play a role for dermal remodelling, anti-inflammatory effects and increased epidermal differentiation. Our finding may have implications for further understanding of the molecular mechanism of erbium glass laser-induced effects on human skin.

Comparison of four different lasers for acne scars: Resurfacing and fractional lasers

BACKGROUND

Acne scars are common and cause cosmetic problems. There is a multitude of treatment options for acne scars, including dermabrasion, chemical peeling, and fillers, but the advent of laser technology has greatly improved the treatment of acne scars. Although several laser systems are available, studies comparing their efficacy are limited. This study compares the results of treatments using resurfacing (carbon dioxide, CO2; erbium-doped yttrium aluminum garnet, Er:YAG) versus fractional (nonablative fractional laser, NAFL; ablative fractional laser, AFL) lasers.

METHODS

A retrospective photographic analysis of 58 patients who underwent laser treatment for facial atrophic acne scars was performed. Clinical improvement was assessed by six blinded investigators with a scale graded from 0 to 10. Adverse events were also noted.

RESULTS

Mean improvement scores of the CO2, Er:YAG, NAFL, and AFL groups were 6.0, 5.8, 2.2, and 5.2, respectively. The NAFL group showed a significantly lower score than the other groups. The mean number of treatments was significantly greater in the fractional laser groups than in the resurfacing laser groups. The resurfacing laser groups had a prolonged recovery period and high risk of complications. The Er:YAG laser caused less erythema or pigmentation compared to the CO2 laser.

CONCLUSIONS

Although the CO2 laser, Er:YAG laser, and AFL improved the acne scars, the CO2 laser had a greater downtime. Three consecutive AFL treatments are as effective as a single treatment with resurfacing lasers, with shorter social downtime periods and less adverse effects.

Acne scarring: A review of available therapeutic lasers

BACKGROUND AND OBJECTIVE

The utilization of lasers in dermatology has greatly expanded in recent decades. Acne scarring is a common indication in which lasers play an important therapeutic role.

STUDY DESIGN/MATERIALS AND METHODS

Available lasers include traditional ablative lasers, such as carbon dioxide and erbium lasers, traditional non-ablative lasers, such as neodymium, diode, alexandrite, pulsed dye lasers and intense pulse light, as well as both ablative, and non-ablative fractional laser systems.

CONCLUSION

We sought to provide a framework for understanding the various types of lasers available to treat acne scars and review the primary literature pertaining to the efficacy, safety, and advantages of each laser discussed.

[Nonablative fractional lasers: Acne scars and other indications]

Nonablative photothermolysis has become an established technique in laser dermatology. It is mainly used for restructuring dermal connective tissue in order to treat, for example, acne scars or solar elastosis. It is also applied to the treatment of melasma and other benign cutaneous pigment disorders. This article discusses various indications in light of published observations and with regard to practical considerations.

Fractional CO2 Laser Resurfacing as Monotherapy in the Treatment of Atrophic Facial Acne Scars

BACKGROUND

While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between.

AIM

The aim of the present study is to assess the efficacy and safety of fractional CO2 laser resurfacing in atrophic facial acne scars.

MATERIALS AND METHODS

Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as 'excellent' if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and <25% improvement were labelled as 'good' and 'poor' response, respectively. The overall satisfaction of the patients and any adverse reactions to the treatment were also noted.

RESULTS

Most of the patients showed a combination of different morphological types of acne scars. At the time of final assessment 6 months after the last laser session, an excellent response was observed in 26 patients (43.3%) while 15 (25%) and 19 patients (31.7%) demonstrated a good and poor response respectively. Rolling and superficial boxcar scars responded the best while pitted scars responded the least to fractional laser monotherapy. The commonest reported adverse effect was transient erythema and crusting lasting for an average of 3-4 and 4-6 days, respectively while three patients developed post-inflammatory pigmentation lasting for 8-12 weeks.

CONCLUSIONS

Fractional laser resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar scars with minimal adverse effects.