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

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

The present work aimed to systematically identify the efficacy and safety of fractional carbon dioxide (CO2) laser plus hyaluronic acid (HA) dressing in dealing with facial atrophic acne scars. Randomized controlled trials (RCTs) concerning fractional CO2 laser in combination with HA dressing for treating atrophic acne scars were screened in 8 electronic databases (containing PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, Sinomed as well as VIP). Besides, for the purpose of evaluating the risk of bias of the enrolled RCTs, the Cochrane Collaboration tool was adopted. Statistical analysis was completed using Revman5.3 software and Stata 14.0 software. Meanwhile, the quality of evidence was assessed by the GRADE system. Finally, 6 studies involving 623 patients were enrolled. According to the findings in this study, compared with fractional CO2 laser alone, fractional CO2 laser therapy combined with HA dressing reduced the scores of ECCA (échelle d'évaluation clinique des cicatrices d'acné) grading scale (MD=-3.37,95% CI [-5.03, -1.70], P<0.0001), shortened the time of crust formation (MD=-0.42,95% CI [-0.80, -0.04], P=0.03) and the time of crust removal(MD=-1.31,95% CI [-1.67, -0.95], P<0.00001), enhanced patient satisfaction (RR=1.85, 95% CI [1.44, 2.38], P<0.00001). All the reported adverse events including hyperpigmentation, erythema, edema, mild itching, and slight burning pain were controllable. In addition, fractional CO2 laser combined with HA dressing therapy had a lower incidence of hyperpigmentation than fractional CO2 laser alone (RR=0.37, 95% CI [0.23, 0.61], P<0.0001). The level of evidence for outcomes was classified to be low to moderate. According to our findings, fractional CO2 laser combined with HA dressing is efficacious and safe option for facial atrophic acne scars. Nevertheless, more high-quality trials are required for further verification in the future.

Chemical peels for atrophic acne scarring: Evolution of peel types and methods

Acne vulgaris is a common condition among those of adolescent age. Prolonged inflammation associated with the disease can result in substantial scaring which is detrimental to both the physical and psychological well-being of the patient. Chemical peels are a commonly used treatment modality for acne scarring that is widely available and can be administered with a low associated cost. This article aims to illustrate the current best practice and highlight new advances in chemical peeling in the treatment of acne scarring.

Efficacy and adverse reactions of fractional CO2 laser for atrophic acne scars and related clinical factors: a retrospective study on 121 patients

OBJECTIVE

This study was performed to analyze the efficacy, adverse reactions of fractional CO₂ laser for atrophic acne scars, and related clinical factors.

METHODS

The clinical data of 121 patients with atrophic acne scars treated with ultra-pulsed fractional CO₂ laser in the Cosmetic Dermatology from August 2014 to March 2020 were retrospectively analyzed. The efficacy and adverse reactions of atrophic acne scar after fractional CO₂ laser therapy were statistically analyzed. The clinical factors related to efficacy and adverse reactions after the first therapy session were analyzed by multivariate logistic regression.

RESULTS

A total of 121 patients received 206 sessions of fractional CO₂ laser therapy, with an average of 1.7 sessions. Moderate to excellent improvement rate reached 50.4% after the first session. Multivariate logistic regression analysis indicated that rolling scars responded better to fractional CO₂ laser treatment than icepick scars (OR = 7.3, 95% CI [1.2, 43.4], P = 0.029), and scar improvement was more significant in the high-energy laser group than in the low-energy laser group (OR = 10.9, 95% CI [1.1, 106.8], P = 0.041). The main adverse reactions after fractional laser surgery were pigmentation, skin sensitivity, persistent erythema and acneiform eruption. Multivariate logistic analysis revealed that the longer the scar duration, the higher incidence of postoperative adverse reactions (OR = 1.3, 95% CI [1.1, 1.5], P = 0.008). Compared with icepick scars, rolling scars (OR = 10.4, 95% CI [2.3, 47.7], P = 0.003) and boxcar scars (OR = 12.0, 95% CI [3.3, 44.0], P < 0.001) had higher risk of developing adverse reactions. The incidence of postoperative adverse reactions was also higher in the combined mode group (DeepFX mode + ActiveFX mode) than in the single mode group (OR = 7.8, 95% CI [2.4, 25.5], P < 0.001).

CONCLUSION

Fractional CO₂ laser was effective in the treatment of atrophic acne scars, without serious adverse reactions. Scar type and laser energy were independent clinical factors affecting its efficacy. Scar course, scar type and fractional laser mode were independent clinical factors affecting its adverse reactions.