Patient Satisfaction and Reported Long-Term Therapeutic Efficacy Associated with 1,320 nm Nd:YAG Laser Treatment of Acne Scarring and Photoaging

BACKGROUND AND OBJECTIVE: Nonablative laser treatments have become increasingly used for the treatment of acne scarring and photoaging. While nonablative laser treatments are more convenient and relatively safer than ablative laser resurfacing, efficacy and patient satisfaction with the level of improvement of textural abnormalities in acne scarring and rhytids associated with photoaging needs further study. DESIGN/MATERIALS AND METHODS: Structured interviews were performed with 34 patients from a referral-based academic practice who each previously received a series of 6 monthly treatments with a 1,320 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for treatment of acne scarring or photoaging. Topical anesthesia was applied 1 hour before each treatment. Patients were interviewed at least 3 months after cessation of treatment (range 3-12 months). RESULTS: Patients tolerated the treatments well. Combined results for acne scarring and photoaging patients were as follows: (a) patient satisfaction with treatment was rated at 62%, and (b) textural improvement was reported at 31% at the end of the six treatments, and 30% at the date of interview. When results were stratified by diagnosis, patient satisfaction was slightly higher for treatment of acne scarring than for photoaging. Overall degree of improvement on a 1-10 scale was 5.4 for acne scarring and 3.8 for wrinkling. CONCLUSION: Nonablative treatment with the 1,320 nm Nd:YAG laser induced significant patient-reported improvement in both acne scarring and photoaging. The majority of patients reported satisfaction with the degree of improvement.     

Treatment of inflammatory facial acne vulgaris with combination 595-nm pulsed-dye laser with dynamic-cooling-device and 1,450-nm diode laser

BACKGROUND AND OBJECTIVES: The 585-nm pulsed-dye laser and the 1,450-nm diode laser have been found effective for the treatment of mild-to-moderate inflammatory facial acne. This study was designed to evaluate the efficacy and safety of the combined treatment with the 595-nm pulsed-dye laser and the 1,450-nm diode laser for inflammatory facial acne. STUDY DESIGN/MATERIALS AND METHODS: Fifteen patients with inflammatory facial acne were treated with a combination of the 595-nm pulsed-dye laser and the 1,450-nm diode laser. Patients' subjective response to treatment was evaluated regarding improvement in acne, acne scarring, oiliness, and redness of the skin. RESULTS: All patients had reductions in acne lesion counts. Mean lesion counts decreased 52% (P < 0.01), 63% (P < 0.01), and 84% (P < 0.01) after one, two, and three treatments, respectively. Patients described moderate-to-marked improvement in acne, acne scarring, and post-inflammatory erythema. Adverse effects were limited to mild, transient erythema. CONCLUSIONS: The combination of the 595-nm pulsed-dye laser and the 1,450-nm diode laser is safe and effective for the treatment of inflammatory facial acne, acne scarring, and post-inflammatory erythema.     

Improvement of Atrophic Acne Scars with a 1,320 nm Nd:YAG Laser: Retrospective Study

Background. Facial acne scarring has been treated with multiple methods with varying degrees of improvement. Although the 1,320 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been widely used to improve photoaging, studies analyzing its effects on atrophic acne scarring are limited.
Objective. To evaluate the efficacy of a dynamic cryogen-cooled 1,320 nm Nd:YAG laser for the treatment of atrophic facial acne scars in a larger cohort of patients with long-term follow-up.
Methods. Twenty-nine patients (skin phototypes I–IV) with facial acne scarring received a mean of 5.5 (range 2–17) treatments with a 1,320 nm Nd:YAG laser. Objective physician assessment scores of improvement were determined by side-by-side comparison of preoperative and postoperative photographs at a range of 1 to 27 months (mean 10.4 months) postoperatively. Subjective patient self-assessment scores of improvement were also obtained.
Results. Acne scarring was significantly improved by both physician and patient assessment scores. Mean improvement was 2.8 (  p < .05  ) on a 0- to 4-point scale by physician assessment and 5.4 (  p < .05  ) on a 0- to 10-point scale by patient assessment. No significant complications were observed.
Conclusions. Nonablative laser skin resurfacing with a 1,320 nm Nd:YAG laser can effectively improve the appearance of facial acne scars with minimal adverse sequelae.     

Nonablative Acne Scar Reduction after a Series of Treatments with a Short-Pulsed 1,064-nm Neodymium:YAG Laser

BACKGROUND: Effective treatment of facial acne scarring presents a major challenge. Nonablative lasers and radiofrequency devices work by thermally stimulating dermal collagen remodeling, thereby softening acne scars in a minimally invasive fashion. One such laser, a 1,064-nm short-pulsed Nd:YAG, uses rapidly scanned low-energy infrared pulses to heat the dermis selectively through the normal dermal microvasculature. OBJECTIVE: In this pilot study, the safety and efficacy of a novel short-pulsed Nd:YAG laser were investigated for the treatment of moderate to severe facial acne scarring. MATERIALS AND METHODS: Nine of 10 enrolled patients with moderate to severe facial acne scarring received eight sequential 1,064-nm Nd:YAG treatments (laser parameters 14 J/cm2, 0.3 milliseconds, 5-mm spot size, 7-Hz pulse rate, 2,000 pulses per side of face). Patients were graded for the presence and severity of three scar morphologies: superficial (rolling), medium-depth (boxcar), and deep (ice pick). Outcome measures included blinded evaluation of before and after photographs by three physician observers (scar severity score) and patient self-assessment. RESULTS: Acne scarring improved in 100% of the nine patients completing the study. Scar severity scores improved by a mean of 29.36% (95% confidence interval, 16.93%-41.79%; p = .006); 89% of patients noted greater than 10% scar improvement. No treatment-related adverse events were seen. CONCLUSION: Our findings support the use of a short-pulsed, low-fluence 1,064-nm Nd:YAG laser as a safe, effective treatment for facial acne scarring. Scar improvement was noted in all treated subjects with minimal discomfort and no downtime. This protocol appears to be most effective at reducing scar depth and softening scar contours. A laser upgrade needed for the study was provided to the authors at a reduced price.     

Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study

BACKGROUND Atrophic scars are dermal depressions caused by collagen damage most commonly occurring after inflammatory acne vulgaris. There are little published data regarding the effectiveness and safety of minimally invasive lasers in the treatment of atrophic acne scars in darker skin types.
OBJECTIVE The purpose was to evaluate the efficacy and safety of a low-fluence 2,940-nm erbium:YAG laser in the treatment of atrophic acne scars in Asian patients.
MATERIALS AND METHODS Nine patients aged 19 to 45 years with mild to moderate atrophic facial scars and Skin Types IV and V were treated with topical anesthesia and one to two passes with an erbium:YAG laser two times at 1-month intervals. Treatment parameters were 6-mm spot size, fluence of 400 mJ, pulse duration of 300 μs, and repetition rate of 2 Hz.
RESULTS At 2 months after the last treatment, mild to moderate clinical improvement was noted in all patients compared to baseline. Treatment was well tolerated. Side effects consisted of posttreatment erythema, peeling, and crusting, which resolved within 1 to 2 weeks. There was no postinflammatory hyper- or hypopigmentation, blistering, or hypertrophic scarring.
CONCLUSION Low-fluence erbium:YAG facial resurfacing was effective and safe in patients with mild to moderately severe atrophic acne scarring.     

Use of 1,320 nm Nd:YAG laser for wrinkle reduction and the treatment of atrophic acne scarring in Asians

BACKGROUND AND OBJECTIVES: The role of 1,320 Nd:YAG in non-ablative skin rejuvenation in Asians is has not been established. Furthermore, no study has investigated the effectiveness of 1,320 Nd:YAG laser in the treatment of atrophic scarring in Asians. The objective of our study was to investigate the effectiveness of 1,320 Nd:YAG laser in wrinkle reduction and the treatment of atrophic acne scarring in Asians. STUDY DESIGN/MATERIALS AND METHODS: Twenty-seven female patients were included in the study: seven were treated for acne scarring and the others for wrinkle reduction. A 1,320 nm Nd:YAG laser (Cooltouch II, Roseville, CA) was used to treat both the cheeks and forehead for the patients with wrinkles, and both cheeks only for patients with atrophic acne scarring. All patients received treatment in the post-auricular areas. A spot size of 10 mm was used, and three passes were performed (two pre-cooling and one post-cooling). Patients were treated monthly for 6 months. All patients were subjectively assessed before and after their last treatment sessions using a structured questionnaire, and objectively assessed by the use of clinical photographs for by independent observers. A cutometer was used to assess viscoelasticity, and biopsies were taken at the post-auricular site for assessment by a pathologist. RESULTS: The overall degree of patients' satisfaction was rated as 4.9 (range 0-9.8) for wrinkle reduction and 4 (range 0-10) for acne scarring. In terms of objective assessment by independent observers, the degree of improvement was considered to be mild or no change in most cases. The independent pathologist who assessed the degree of improvement in terms of increased collagen production detected no change in 8 patients, mild improvement in 9, and moderate improvement in 10.There was also improvement in term of epidermal thickness in 13 cases. Assessment by viscoelasticity indicated a significant degree of improvement in most parameters in both groups of patients. Blistering occurred in five cases, all in the central facial areas, and post-inflammatory hyperpigmentation occurred in three cases. All cases of PIH resolved after the use of 4% hydroquinoine. There was no scarring or hypopigmentation. CONCLUSIONS: The 1,320 nm Nd:YAG laser is effective for wrinkle reduction and atrophic acne scar improvement, but to further enhance the clinical outcome a combination approach with another device such as IPL and a surgical technique such as subcision is necessary.     

Facial acne and fine lines: transforming patient outcomes with plasma skin regeneration

BACKGROUND: A novel device for skin rejuvenation has been developed and tested. The device converts a stream of nitrogen into a plasma of ionized gas, which ablates surface tissue in a controlled manner. METHODS: Eleven patients were followed up for 6 months. The results were assessed objectively using skin molds to measure skin irregularity, as well subjectively using patient- and doctor-assessed parameters. RESULTS: Plasma skin regeneration was shown to reduce fine line wrinkles by an average of 24% at 6 months (P = 0.005, Mann-Whitney rank sum test) and to improve acne scarring by 23% at 6 months (P = 0.001, Mann-Whitney rank sum test). CONCLUSIONS: The main benefit of this system was that the patients had minimal erythema lasting only 1-6 days and no pigmentary changes. This is therefore a device with proven efficacy and limited morbidity.     

A Preliminary Study of Utilization of the 1320-nm Nd:YAG Laser for the Treatment of Acne Scarring

BACKGROUND: Multiple treatment modalities have been used for the revision of acne scarring with varying degrees of success. Nonablative laser resurfacing has recently been shown to improve the appearance of atrophic acne scars. OBJECTIVE: The objective was to determine the efficacy of a 1320-nm Nd:YAG laser for the treatment of acne scars. METHODS: Eight patients with facial acne scars received six monthly treatments with a 1320-nm Nd:YAG laser with built-in cryogen cooling. Results were evaluated by objective and patient assessment using a 6-point improvement scale: 1=no improvement, 6=80% to 100% improvement. RESULTS: Acne scar improvement was statistically significant at both the 5-month and 1-year marks. Mean improvement by objective assessment was 3.9 points (p=0.002) at 5 months and 4.3 points (p=0.011) at 1 years. The mean acne scar improvement by patient assessment was 3.6 points (p=0.002) at 5 months. CONCLUSION: The 1320-nm Nd:YAG laser with cryogen cooling significantly improves the appearance of acne scarring.     

A pilot investigation comparing low-energy, double pass 1,450 nm laser treatment of acne to conventional single-pass, high-energy treatment

BACKGROUND AND OBJECTIVES: Laser treatment using a 1,450 nm diode laser has been shown to improve acne and acne scarring. Its widespread adoption in younger populations has been significantly limited by discomfort. STUDY DESIGN/MATERIALS AND METHODS: Six subjects with active papular acne were treated in a pilot study to determine parameters for a split-face, double-pass, low-energy protocol of 1,450 nm laser treatment. Sides of the face were randomized to receive single-pass, high-energy treatment (13-14 J/cm(2)), or double-pass, low energy treatment (8-11 J/cm(2)), for a total of four treatments delivered at monthly intervals. Acne counts and standardized, digital photograph were performed 2 months following the final treatment, and compared to pre-treatment counts and photographs. RESULTS: Improvement was evaluated comparing pre- and post-treatment photos and averaged 2.5 for the high-energy, single-pass side and 2.3 for the low-energy, double-pass side, using a 0 (worse) to 4 (max improvement) scale. Acne counts were reduced 78% on the high-energy, single-pass side and 67% on the low-energy, double-pass side. Pain ratings on a 1 (min) to 10 (max) scale averaged 5.6 (range 1-9) for the high-energy, single-pass side and 1.3 (range 1-2) for the low-energy, double-pass side. CONCLUSIONS: Low-energy, double-pass 1,450 nm laser treatment effectively reduces acne counts 2 months post-treatment, and dramatically reduces the pain associated with treatment. The treatment parameters used in this study have eliminated the need for anesthetic cream in daily practice.     

Treatment of Atrophic Facial Acne Scars with a Dual-Mode Er:YAG Laser

BACKGROUND: Scar revision with CO2 and Er:YAG lasers has become popular in recent years. Reports on the newest (modulated, dual-mode) Er:YAG systems have been limited mostly to the treatment of photodamaged skin and rhytides. OBJECTIVE: To prospectively evaluate the efficacy and safety of a dual-mode 2940 nm Er:YAG laser for atrophic scar revision. METHODS: Twenty-five consecutive patients with moderate to severe atrophic facial acne scars received treatment with a dual-mode Er:YAG laser. Clinical assessments using a standard grading scale and photographic documentation were performed at 1, 3, 6, and 12 months postoperatively. Postoperative recovery was monitored and the rate of side effects and complications recorded. RESULTS: Average clinical grading scores reflected good to excellent response of atrophic scars to the dual-mode Er:YAG laser system. Side effects and complications were limited to transient hyperpigmentation and acne flare-ups. No hypopigmentation or scarring was seen. Prolonged erythema (longer than 1 month) was observed in 1 patient (4%). CONCLUSION: Dual-mode Er:YAG laser skin resurfacing is a safe and effective modality for the treatment of atrophic facial scarring.     

Prolonged Clinical and Histologic Effects from CO2 Laser Resurfacing of Atrophic Acne Scars

BACKGROUND: The recent development of high-energy pulsed CO2 lasers that minimize thermal injury to uninvolved adjacent structures has revolutionized the manner in which atrophic facial scars are recontoured. Significant improvement of atrophic scars with laser resurfacing has clearly been demonstrated; however, the exact timing for assessment of skin for further treatment has varied due to the unknown amount of time needed after laser scar resurfacing to effect maximal collagen formation and remodeling. OBJECTIVE: The aim of this study was to determine the immediate and long-term (12-18 months) histologic and clinical effects of atrophic acne scars after CO2 laser resurfacing in order to provide physician guidelines for postoperative clinical assessment for retreatment. METHODS: Sixty patients (50 women, 10 men, mean age 38 years, skin types I-V) with moderate to severe atrophic facial scars were evaluated. Nineteen patients received regional cheek treatment and 41 patients received full-face resurfacing with a high-energy pulsed CO2 laser. Independent clinical assessments of treated scars were performed at 1, 6, 12, and 18 months and blinded histologic analyses were made of skin biopsies immediately prior to and after laser resurfacing, and at 1, 6, 12, and 18 months postoperatively in six patients. RESULTS: Significant immediate and prolonged clinical improvement in skin tone, texture, and appearance of CO2 laser-irradiated scars was seen in all patients. Average clinical improvement scores were 2.22 (69%) at 1 month, 2.1 (67%) at 6 months, 2.37 (73%) at 12 months, and 2.5 (75%) at 18 months. Continued collagenesis and subsequent dermal remodeling were observed on histologic examination of biopsied tissue up to 18 months after surgery. CONCLUSION: Continued clinical improvement was observed as long as 18 months after CO2 laser resurfacing of atrophic scars, with an 11% increase in improvement observed between 6 and 18 months postoperatively. We propose that a longer postoperative interval (12-18 months) prior to assessment for re-treatment be advocated in order to permit optimal tissue recovery and an opportunity for collagen remodeling.     

Selective Nonablative Treatment of Acne Scarring With 585 nm Flashlamp Pulsed Dye Laser

BACKGROUND: Selective nonablative wrinkle reduction with low-fluence pulsed dye laser has been shown to provide cosmetic benefits by stimulating the production of dermal collagen. The clinical efficacy for improving the appearance of acne scarring using selective nonablative laser treatments has yet to be established. OBJECTIVE: To evaluate the improvement in the appearance and topography of acne scarring following application of a 585 nm pulsed dye laser with a temporal profile and pulse duration designed specifically to target healthy microvasculature in the dermis. METHODS: Ten patients (mean age 34.8 years) with Fitzpatrick skin types I-IV and shallow to moderately deep, saucerized facial acne scars were enrolled in a prospective trial to receive a single laser treatment of both cheeks. Patients were evaluated at 30, 60, 90, and 120 days to assess the degree of clinical improvement. The evaluation process included assessment of pre- and posttreatment photography by two independent observers, patient assessment surveys, and surface profilometry using silicone imprints in order to quantify the degree of clinical improvement. RESULTS: All 10 patients reported visible cosmetic improvement in the treated areas while surface profilometry showed that, on average, the depth of the acne scars was reduced by 47.8%. No adverse effects of this treatment were reported. CONCLUSION: The treatment of acne scars utilizing a 585 nm pulsed dye laser with a temporal profile and pulse duration designed specifically to target healthy microvasculature in the dermis may be a safe and effective noninvasive alternative for a natural result.     

Blue and red light combination LED phototherapy for acne vulgaris in patients with skin phototype IV

BACKGROUND AND OBJECTIVES: Blue light is effective for acne treatment, inducing photodynamic destruction of Propionibacterium acnes (P. acnes). This study was designed to investigate the efficacy of combined blue and red light-emitting diode (LED) phototherapy for acne vulgaris. MATERIALS AND METHODS: Twenty-four patients with mild to moderately severe facial acne were treated with quasimonochromatic LED devices, alternating blue (415 nm) and red (633 nm) light. The treatment was performed twice a week for 4 weeks. Objective assays of the skin condition were carried out before and after treatment at each treatment session. Clinical assessments were conducted before treatment, after the 2nd, 4th, and 6th treatment sessions and at 2, 4, and 8 weeks after the final treatment by grading and lesion counting. RESULTS: The final mean percentage improvements in non-inflammatory and inflammatory lesions were 34.28% and 77.93%, respectively. Instrumental measurements indicated that the melanin levels significantly decreased after treatment. Brightened skin tone and improved skin texture were spontaneously reported by 14 patients. CONCLUSION: Blue and red light combination LED phototherapy is an effective, safe and non-painful treatment for mild to moderately severe acne vulgaris, particularly for papulopustular acne lesions.     

Long-Pulsed 1064-nm Nd:YAG Laser-Assisted Hair Removal in All Skin Types

BACKGROUND: Although there are several different laser systems available for the reduction of unwanted hair, no single system has been shown to be superior in providing safe and effective hair removal in every skin type. The purpose of this study was to evaluate the safety and efficacy of a high-energy, long-pulsed, 1064-nm Nd:YAG laser with a contact cooling device for hair removal in skin phototypes I-VI. METHODS: Thirty-six adult patients (skin phototypes I-VI) with dark terminal facial or nonfacial hair were treated with a long-pulsed Nd:YAG laser (1064 nm, 10-mm spot size, fluence of 30 to 60 J/cm2). The selected pulse duration was dependent on the skin type of the patient: Skin types I/II, III/IV, and V/VI received 10, 20, and 30 ms, respectively. Three consecutive laser treatments were delivered to 36 skin sites at 4- to 6-week intervals. Hair counts and photographic evaluations of skin sites were obtained at baseline, immediately before each treatment session, and at 1, 3, and 6 months after the final laser treatment. RESULTS: Peak hair reduction was observed 1 month after the series of laser treatments with a mean hair reduction ranging from 58% to 62% on facial sites and 66% to 69% on nonfacial sites. At 6 months after a series of three long-pulsed Nd:YAG laser treatments, a mean hair reduction of 41% to 46% on the face and 48% to 53% on the body was found depending on the skin phototype. Adverse reactions included mild to moderate treatment pain, short-term erythema, and rare occurrences of transient pigmentary alteration without scarring. CONCLUSION: The long-pulsed 1064-nm Nd:YAG laser with contact cooling is a safe and effective method of hair reduction in patients of all skin types. Side effects were limited and transient.     

强脉冲光美容效果的评价

目的观察强脉冲光对皮肤表浅色素性和血管性疾病、寻常痤疮的疗效;评价其嫩肤美容及脱毛的疗效。方法采用GP666型强脉冲比（IPL）治疗仪对皮肤老化、面部色沉性皮损、皮肤毛细血管扩张、寻常痤疮及多毛症各20例共100例进行治疗,光子嫩肤每3周治疗1次,5次为1个疗程;脱毛每月治疗1次。结果经5次治疗,色素痫和血管痫有效率为90％,痤疮疗效为75%,美容效果为100％,脱毛效果为90％。无小可逆不良反膻发牛。结论IPL能有效治疗皮肤浅表色素沉着性皮损和毛细血管扩张;有较好的关容效果;脱毛效果肯定。     

3D in-vivo optical skin imaging for topographical quantitative assessment of non-ablative laser technology.

BACKGROUND: A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, a new noninvasive objective assessment is required to accurately assess the outcomes of these procedures. OBJECTIVE: The purpose of this study was to measure and objectively quantify facial skin using a novel, noninvasive, In-vivo method for assessing three-dimensional topography. This device was used to quantify the efficacy of five treatment sessions with the 1064 nm QS Nd:YAG laser for rhytides and acne scarring, for up to six months following laser treatment. METHODS: Two subjects undergoing facial rejuvenation procedures were analyzed before and after therapy using a 30-mm, three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin using a Digital Micromirror Device (DMD Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at three and six-month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to In-vivo acquisition. RESULTS: Skin roughness decreased by 11% from baseline after three treatment sessions in the wrinkles subject, while a 26% improvement of skin roughness was recorded by 3D In-vivo assessment six months following the fifth treatment session. The subject with acne scarring demonstrated a 33% decrease in roughness analysis after three treatment sessions by 3D In-vivo assessment. A 61% improvement in surface topography was recorded 3-months following the fifth treatment session, which was maintained at the 6-month follow-up. CONCLUSION: Three-dimensional In-vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines following multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. This imaging technique provided objective verification and technical understanding of nonablative laser technology. Wrinkle depth and skin roughness decreased at the three and six-month follow-up evaluations by 3D In-vivo assessment, indicating ongoing dermal collagen remodeling after the laser treatment protocol. Future applications may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists.     

Atrophic and a Mixed Pattern of Acne Scars Improved With a 1320-nm Nd:YAG Laser

BACKGROUND: Acne scar correction remains a challenge to the dermatologic surgeon. With nonablative laser resurfacing, this correction is imputed to dermal collagen remodeling and acne scar reorganization. Although atrophic acne scars tend to respond to laser treatment, the deeper ice pick and boxcar scars tend to be laser resistant. OBJECTIVE: To investigate the treatment of atrophic and a mixed pattern of facial acne scars, we evaluated a 1320-nm Nd:YAG laser. Twelve subjects with atrophic facial acne scars (N=6) or a combination of atrophic and pitted, sclerotic, or boxcar scars (N=6) received three laser treatments. Physician and patient acne scar ratings were performed at baseline and at 6 months after the last treatment. Acne scars were rated with a 10-point severity scale. RESULTS: Mean acne scar improvement was 1.5 points on physician assessments (P=0.002) and 2.2 points on patient assessments (P=0.01). Acne scars were rated more severely by patients than by the physician at all intervals. There were no noted complications at 6 months. CONCLUSION: The 1320-nm Nd:YAG laser is a safe and effective nonablative modality for the improvement of atrophic and a mixed pattern of facial acne scars.     

A Comparison of Microneedling versus Glycolic Acid Chemical Peel for the Treatment of Acne Scarring

BackgroundAcne vulgaris is a common skin disease that frequently results in scarring. Scars secondary to acne can lead to physical disfigurements and a profound psychological impact. Early and effective treatment is the best means to minimize and prevent acne scarring. In patients with darker skin tones, current acne scar treatments pose complications, including dyspigmentation, further scarring, and overall unsatisfactory clinical outcomes.ObjectiveWe sought to compare the efficacy of microneedling versus 35% glycolic acid chemical peels for the treatment of acne scars.MethodsSixty patients with Fitzpatrick Skin Phototype IV to VI with atrophic acne scars were randomized into two groups: Group A underwent microneedling every two weeks for a total of 12 weeks and Group B received chemical peels every two weeks for a total of 12 weeks. Acne scar treatment efficacy was represented by an improvement greater than one grade from baseline according to the Goodman and Baron Scarring Grading System, measured two weeks after the completion of the last treatment session.ResultsGroup A demonstrated more improved outcomes in acne scar treatment compared to Group B; 73.33% (n=22) of patients in Group A achieved treatment efficacy while 33.33% (n=10) in Group B did the same. Additionally, 26.67% (n=8) in Group A showed no efficacy after treatment compared to 66.67% (n=20) in Group B.ConclusionMicroneedling provided better treatment outcomes compared to 35% glycolic acid peels for acne scar treatment in our patient population with Fitzpatrick Skin Phototypes IV to VI.     

Fractional Resurfacing for the Treatment of Hypopigmented Scars: A Pilot Study

BACKGROUND: Treatments for hypopigmented scars have shown limited efficacy and variable safety profiles. OBJECTIVE This study evaluated the safety and efficacy of fractional resurfacing (1,550-nm Fraxel SR laser, Reliant Technologies, Mountain View, CA) for the treatment of hypopigmented scars on the face in seven patients. MATERIALS AND METHODS: Seven patients with hypopigmented scars on the face received between two and four successive treatments at 4-week intervals with the 1,550-nm Fraxel SR laser. Energy settings ranged from 7 to 20 mJ and a total density of 1,000 to 2,500 microthermal zones per square centimeter. Digital photographs were taken before each treatment and at 4 weeks after the last treatment. Independent physician clinical assessments were performed. RESULTS: Independent physician clinical assessment 4 weeks after the final Fraxel SR laser treatment revealed improvements of 51% to 75% in hypopigmentation in six of seven patients. One patient had only 26% to 50% improvement in hypopigmentation. Additionally, clinical improvements were noted in the overall texture of the treated skin. The patient's degree of satisfaction paralleled the physician's assessment of improvement. All patients reported improvement in hypopigmentation lasting greater than 3 months after the last treatment. Side effects were limited to mild pain during the treatment and mild posttreatment erythema and edema, which resolved in 2 to 4 days. CONCLUSION: Fractional resurfacing is a potentially effective modality for the treatment of hypopigmented scarring on the face. No adverse effects were observed.     

Resurfacing of Pitted Facial Acne Scars with a Long-Pulsed Er:YAG Laser

BACKGROUND: Conventional short-pulsed Er:YAG lasers show less effective hemostasis and weak photothermal damage on papillary dermis. Recently, newer long-pulsed Er:YAG laser systems has been developed. OBJECTIVE: To evaluate the clinical and histologic effects of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars. METHODS: Thirty-five patients with pitted facial acne scars were treated with a long-pulsed Er:YAG laser. All patients had Fitzpatrick skin phototypes III-V. A pulsed Er:YAG laser with a 5 mm handpiece at a setting of 7.0-7.5 J/cm2 with a 10-msec pulse duration was used. The laser was fired at 5 Hz, with four to five passes. In 28 patients, the results of laser treatment were evaluated for the degree of clinical improvement, duration of erythema, pigmentary change, and any adverse events at 2 weeks, 1 month, and 3 months. In seven patients, skin biopsy specimens were obtained at the following intervals: immediately, 1 week, 2 weeks, 4 weeks, and 8 weeks postoperatively for histologic examination. RESULTS: The results of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars were excellent in 10 patients (36%), good in 16 patients (57%), and fair in 2 patients (7%). Erythema occurred in all patients after laser treatment and lasted longer than 3 months in 15 patients (54%). Postinflammatory hyperpigmentation occurred in 8 patients (29%). But the pigmentation faded or disappeared within 3 months. One patient (4%) experienced mild hypopigmentation. Pruritic symptoms that required medical intervention occurred in 16 patients (57%). Mild to moderate postoperative acne flare-up occurred in 8 patients (29%). No other adverse effects such as scarring, bacterial infection, or contact dermatitis were observed. CONCLUSION: In conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and very effective treatment modality for pitted facial acne scars.