Treatment of acne scarring with fractional CO2 laser

Abstract

Background: Fractional ablative CO₂ laser therapy is based on the theory of fractional photothermolysis. It can be effective in treating acne scars in a less invasive fashion than conventional ablative CO₂ laser therapy. Objective: In this clinical study, the safety and efficacy of a novel CO₂ fractional ablative laser was investigated for the treatment of facial atrophic acne scarring in Chinese individuals. Materials and methods: A total of 31 patients (11 females, 20 males, Fitzpatrick skin phototypes III–IV) with facial acne scarring received three sequential fractional treatments over a 6-month period. Outcome measurements included blinded evaluations of before and after photographs by two physicians at 3 and 12 months after the final treatment. Global improvement was noted as well as any untoward events. Results: At the 12 months follow-up time period, 12.9% of the patients showed excellent improvement in their acne scars, while 38.71% noted good to fair results. The clinical response at the 12-month follow-up visit tended to be better than at the 3-month follow-up visit, but was not statistically significant. Four patients experienced post-treatment and transient PIH but three patients were noted to have prolonged erythema. There was no evidence hypopigmentation or worsening of the scarring in any of the study patients. Conclusion: This high-energy pulsed and cool-scanned fractional ablative CO₂ laser system is safe and effective for facial atrophic acne scarring. Improvement in scarring was noted in the majority of patients with minimal discomfort and minimal downtime. Continued improvement over time is also an important clinical finding.     

Clinical trial of a laser device called fractional photothermolysis system for acne scars

Ablative laser resurfacing is an effective treatment for acne scars. However, edema and prolonged erythema are common. Additionally, scarring and hyperpigmentation are often induced. A new concept of laser called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation without significant side-effects. We treated 10 patients with acne scars using this laser system (Reliant Fraxel SR Laser). All the patients were successfully treated with minimal adverse effects. The fractional photothermolysis system represents an optional method for the treatment of acne scars.     

The efficacy of fractional ablative carbon dioxide laser combined with other therapies in acne scars

Fractional ablative carbon dioxide laser resurfacing is a frontline treatment for acne scars. It creates multiple microscopic treatment zones to accelerate the collagen formation and the healing process of reepithelialization, according the principle of fractional photothermolysis. At present, the fractional CO₂ laser with a wavelength of 10,600 nm is commonly used in the field of cosmetology and clinical therapies for various skin diseases, and it can effectively improve skin regeneration and scar formation. To obtain satisfactory results for patients with scars, repetitive fractional laser therapy is always required; however, this treatment could easily lead to complications such as erythema, edema, infection, and post‐inflammatory hyperpigmentation. In addition, different types of acne scars may have different responses to laser, further limiting its widespread use. In recent studies both home and abroad, a new pattern of fractional laser combined with other therapies to improve acne scar has been recommended to guarantee the safety and effective of treatment. This article reviews the recent pertinent literatures and summarized the progression of ablative fractional CO₂ laser combined with other therapies on acne scar.     

Fractional CO2 laser for the treatment of acne scars

Background Numerous reports have been published on skin rejuvenation by the so‐called fractional laser device that delivers a laser beam in a dot form over a grid pattern. Aims In this study, we characterized the effects of a fractional CO₂ laser on atrophic acne scars at the clinical and ultrastructural levels. Methods Seven healthy adult Japanese volunteers (aged 32–46 years, mean 37.6, five men and two women of Fitzpatrick skin type III) were recruited for this study. A fractional CO₂ laser device, SmartXide DOT (DEKA, Florence, Italy), was used with irradiation parameters set as follows: output power 10 W, pulse width 600 μs, dot spacing 800 μm, and stack 2 (irradiation output power 0.91 J/cm²). A clinical examination and punch biopsy of each subject was performed before and just after the irradiation, and also at week 3 after three irradiation sessions. The biopsy specimens were stained with toluidine blue and were examined ultrastructurally. Results Clinical improvement of the atrophic acne scars was observed at week 3 after the third irradiation session in all cases compared with the condition before treatment. Histologically, outgrowths of many degenerated elastic fibers were observed as irregular rod‐shaped masses in the superficial dermis prior to the treatment in the region of the acne scars. At week 3 after the third irradiation, the degenerated elastic fibers were no longer observed, and the elastic fibers were elaunin‐like. Conclusions The fractional CO₂ laser is considered to be very effective for treating atrophic acne scars.     

Randomized clinical trial of CO2 LASER pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars

Abstract

Background: Pinpoint irradiation technique CO₂ LASER and Chemical Reconstruction Of Skin Scars (CROSS) are effective treatments for atrophic acne scars as fractional photothermolysis. Objective: This study was designed to prospectively compare the use of a pinpoint irradiation technique versus TCA CROSS in treating ice pick acne scars. Methods: Thirty-two patients with ice pick acne scars were included in this open, label pilot study. Pinpoint irradiation technique by CO₂ LASER and TCA CROSS were applied for the study and control group, respectively. Twenty-eight patients with ice pick acne scars were included in this open, label pilot study. They were randomly assigned to two groups: the first group (14 patients) received pinpoint irradiation by CO₂ LASER as a study group, and the second group (14 patients) received TCA CROSS as a control group. In both treatments, there were four sessions at 3-week interval, and 3 months of follow up. Results: There were statistically significant difference in acne scar severity index and qualitative scarring grading system in the improvement results between the study and control groups (p < 0.05). Conclusion: Pinpoint irradiation technique by CO₂ LASER is safe and more effective than TCA CROSS technique. Clinical improvement was achieved in all 14 patients without dramatic adverse effects.     

超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕40例分析

目的：评价超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗效.方法：面部萎缩性痤疮瘢痕40例,根据患者皮肤类型、痤疮瘢痕形状、深度、密度选用超脉冲CO2点阵激光的参数治疗,并进行治疗前后对比.结果：与治疗前相比,总有效率为92.5%,治疗中未观察到严重不良反应.结论：超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕疗效显著,副作用小,安全性高.     

Efficacy of Punch Elevation Combined with Fractional Carbon Dioxide Laser Resurfacing in Facial Atrophic Acne Scarring: A Randomized Split-face Clinical Study

Background:

A number of treatments for reducing the appearance of acne scars are available, but general guidelines for optimizing acne scar treatment do not exist. The aim of this study was to compare the clinical effectiveness and side effects of fractional carbon dioxide (CO₂) laser resurfacing combined with punch elevation with fractional CO₂ laser resurfacing alone in the treatment of atrophic acne scars.

Materials and Methods:

Forty-two Iranian subjects (age range 18–55) with Fitzpatrick skin types III to IV and moderate to severe atrophic acne scars on both cheeks received randomized split-face treatments: One side received fractional CO₂ laser treatment and the other received one session of punch elevation combined with two sessions of laser fractional CO₂ laser treatment, separated by an interval of 1 month. Two dermatologists independently evaluated improvement in acne scars 4 and 16 weeks after the last treatment. Side effects were also recorded after each treatment.

Results:

The mean ± SD age of patients was 23.4 ± 2.6 years. Clinical improvement of facial acne scarring was assessed by two dermatologists blinded to treatment conditions. No significant difference in evaluation was observed 1 month after treatment (P = 0.56). Their evaluation found that fractional CO₂ laser treatment combined with punch elevation had greater efficacy than that with fractional CO₂ laser treatment alone, assessed 4 months after treatment (P = 0.02). Among all side effects, coagulated crust formation and pruritus at day 3 after fractional CO₂ laser treatment was significant on both treatment sides (P < 0.05).

Conclusion:

Concurrent use of fractional laser skin resurfacing with punch elevation offers a safe and effective approach for the treatment of acne scarring.     

Efficacy and safety of 1550-nm fractional laser in the treatment of acne scars in Chinese patients: A split-face comparative study

Objective: To evaluate the efficacy and side effects of 1550-nm fractional Er:Glass laser in treating atrophic acne scar. Materials and methods: Thirty Chinese patients aged 18–65 with atrophic acne scars on both cheeks received a split-face treatment, one side with four sessions of treatment with fractional 1550-nm Er:Glass laser at 20-day interval and the other with topical asiaticoside cream application three times daily as control. Clinical response and side effects were evaluated by a dermatologist three weeks after each treatment and again 12 weeks after the last laser treatment. In addition, self-evaluation of satisfaction by the patients was done at the end of treatment. Results: The study found that mean scores decrease after treatment was 5.65 ± 4.34 for the treated side and 1.23 ± 3.41 for the control side. The improvement in acne scars after the fractional Er:Glass laser 1550-nm treatment was more significant than the control side (p = 0.0001). The side effects were mainly local skin irritation and erythema, which disappeared within one week. Conclusion: The research results show that the fractional 1550-nm Er:Glass laser is an effective and safe treatment device for atrophic acne scars.     

The use of 1540 nm fractional photothermolysis for the treatment of acne scars in Asian skin: a pilot study

Background: Various modalities have been used to treat acne scars, but limited efficacy and considerable side effects have restricted their proper use. Recently, a new-generation fractional photothermolysis modality has been introduced that has deeper penetrating ability; however, a 1540 nm fractional photothermolysis study has not yet been performed.
Objectives: To evaluate the efficacy and safety of 1540 nm fractional photothermolysis for the treatment of acne scars in Asian skin.
Methods: Sixteen volunteers (Fitzpatrick skin types III–IV) with mild to moderate acne scars were enrolled. Acne scar lesions were treated with 1540-nm fractional photothermolysis (Starlux^™ 1540). Three treatment sessions were performed for each patient 4 weeks apart. Outcome assessments included the following four methods: (1) clinical evaluation of the photographs that were taken before and after the treatment; (2) comparison of the quality of life (QOL) of the patients before and after the treatment; (3) patients' satisfaction with the treatment; and (4) comparison of the quantity of collagen and elastic fibers in the skin biopsies before and 12 weeks after the last treatment.
Results: A mild to moderate clinical improvement was observed in most of the patients. Moreover, the QOL of all the patients improved, and all of them were satisfied with the results of the treatment. Significant collagen and elastic-fiber increases were also observed after the treatment, and side effects were limited to transient erythema and edema, which occurred in 50% of the patients. No severe side effect was observed.
Conclusions: 1540 nm fractional photothermolysis is an effective and safe method for improving acne scar, even in Asian skin.     

Efficacy and safety of a single treatment using a 10,600-nm carbon dioxide fractional laser for mild-to-moderate atrophic acne scars in Asian skin

BackgroundAblative laser therapy with carbon dioxide is effective for acne scars; however, the long downtime limits its use, especially in types III and IV skin. The fractional ablative 10,600-nm carbon dioxide laser system reportedly maximizes efficacy and minimizes side effects. The goal of this study was to evaluate the efficacy and safety of an ablative 10,600-nm carbon dioxide fractional laser system in a single treatment session on atrophic acne scars in Asian patients.MethodsTwenty-five patients with atrophic acne scars were enrolled. The laser fluences were delivered using the Deep FX mode. Comparative photographs were taken with VISIA complexion analysis. Physician evaluation and patient satisfaction were graded on a four-point scale.ResultsAt follow-up 1 month after treatment, four patients showed 51–75% improvement, 16 had 26–50% improvement, and five had minimal or no improvement. At 3 months, two patients had excellent results (76% and 100% improvement). Postinflammatory hyperpigmentation was present in six of the 25 (24%) patients; by 3 months' follow-up, this had faded in five of six cases.ConclusionA single treatment with the carbon dioxide fractional laser system is effective for acne scars in Asian patients, with minimal and acceptable side effects.     

Evaluation of autologous platelet-rich plasma plus ablative carbon dioxide fractional laser in the treatment of acne scars

Introduction: Acne scar is a common distressing complication of acne vulgaris. CO₂ laser resurfacing proved effective for the treatment of this problem, but the associated complications may limit its use. Platelet-rich plasma (PRP) may increase the chance of favorable outcome. Aim of the work: To evaluate the synergistic effects of autologous PRP with fractional CO₂ laser resurfacing in the treatment of acne scars among Egyptian patients. Patients and method: This study included 30 patients suffering from post-acne scars. CO₂ laser treatment was applied to both sides of the face followed by PRP injection for the right side. Evaluation was carried out through operating physicians, two blinded physicians as well as through patient’s satisfaction. Result: The right side of the face (PRP-treated side) achieved excellent improvement in 13.3% of the patients, while there was no excellent improvement on the left side. Conclusion: Combination of fractional CO₂ laser resurfacing and intradermal PRP was superior to CO₂ laser alone for acne scar treatment.     

Treatment of Striae Distensae with Nonablative Fractional Laser versus Ablative CO2 Fractional Laser: A Randomized Controlled Trial

Background

Striae distensae are atrophic dermal scars with overlying epidermal atrophy causing significant cosmetic concern. Although a variety of laser and light sources have been used for the treatment of striae distensae, to date no definite ''gold standard'' treatment modality has been determined.

Objective

To assess and compare the efficacy and safety of nonablative fractional photothermolysis and ablative CO₂ fractional laser resurfacing in the treatment of striae distensae.

Methods

Twenty-four ethnic South Korean patients with varying degrees of atrophic striae alba in the abdomen were enrolled in a randomized blind split study. The patients were treated with 1,550 nm fractional Er:Glass laser and ablative fractional CO₂ laser resurfacing. Each half of the abdominal lesion was randomly selected and treated three times at intervals of 4-weeks using the same parameters. Digital photography was conducted and skin elasticity and the width of the widest striae in each subject were measured at the baseline and 4 weeks after the final treatment. Clinical improvement was assessed by comparing pre- and post-treatment clinical photographs by two blinded physicians and participant satisfaction rates were evaluated. Skin biopsies were taken from three participants. All adverse effects were reported during the study.

Results

Although they do not statistically differ, both treatments with nonablative fractional laser and ablative CO₂ fractional laser showed a significant clinical and histopathologic improvement of striae distensae over pretreatment sites.

Conclusion

These results support the use of nonablative fractional laser and ablative CO₂ fractional laser as effective and safe treatment modalities for striae distensae of Asian skin. However, neither treatment showed any greater clinical improvement than the other treatment.     

Effectiveness of CO2 laser with subcision in patients with acne scars

Background: Post-acne facial scarring has always been a challenge to treat. It requires multiple therapeutic modalities as single modality is not hundred percent effective. Therefore, we have combined CO₂ laser resurfacing with subcision in patients with acne scars for better results. Objectives: The aim is to study the effectiveness and side effects of CO₂ laser with subcision in patients with atrophic acne scars. Methods: Fifty patients were selected for the study. Baseline grading was done with Goodman and Baron grading system. Twenty-five patients were randomly selected for subcision followed by CO₂ laser and the remaining patients were selected for CO₂ laser alone. The treatment was done for four sessions at 4-week interval. Clinical photographs were obtained for evaluation. Results: CO₂ laser with subcision showed excellent response in grade-2 and -3 acne scars. Statistically there is a significant difference between CO₂ laser following subcision and CO₂ laser alone at 5% level (p < 0.05). Both procedures were well tolerated with minimal side effects. Conclusion: The highly versatile CO₂ laser is useful for treating acne scars. Subcision prior to the CO₂ laser procedure showed better improvement when compared to CO₂ laser alone. Thus, in acne scars, multiple therapeutic modalities achieve better results.     

皮秒翠绿宝石激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗效与安全性比较

【摘要】 目的 通过前瞻性、半脸对照研究,比较皮秒翠绿宝石激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗效与安全性。方法 2015年10月至2017年10月在中国医学科学院皮肤病医院激光科收集面部对称性萎缩性痤疮瘢痕患者,左侧面部痤疮瘢痕采用超脉冲CO2点阵激光治疗,右侧采用皮秒翠绿宝石激光点阵模式治疗,治疗间隔为2个月,共治疗3次。治疗前后由皮肤科医生根据ECCA评价表对瘢痕进行评分,患者根据四分法自评临床疗效。记录治疗时疼痛程度和不良反应。两侧间、治疗前后ECCA评分及疼痛程度评分比较采用配对t检验,组间四分法评分比较采用 Wilcoxon 秩和检验。结果 治疗前皮秒激光侧和点阵激光侧间ECCA评分差异无统计学意义（t = 1.06,P = 0.300）,治疗3次后差异有统计学意义［（70.98 ± 21.48）分比（58.04 ± 17.63）分,t = 3.76,P = 0.001］。与治疗前相比,皮秒激光侧瘢痕改善评分（2.21 ± 1.09）分,CO2点阵激光侧（2.83 ± 1.11）分,两组差异有统计学意义（z = 2.70,P = 0.007）。与CO2点阵激光侧相比,皮秒激光侧不良反应更少,表现为一过性红斑、水肿,治疗疼痛评分亦明显降低［（3.71 ± 0.62）分比（6.23 ± 1.06）分,t = 11.93,P < 0.001］。结论 皮秒翠绿宝石激光与超脉冲CO2点阵激光均能有效改善萎缩性痤疮瘢痕,CO2点阵激光疗效更显著,而皮秒激光不良反应更少。     

点阵激光改善皮肤光老化作用机制的研究进展

点阵激光已广泛用于治疗各种皮肤疾病,包括皮肤光老化、痤疮瘢痕和色素性疾病等,其利用点阵光热分解的原理,点阵激光作用皮肤后形成微治疗区,周围仍见正常组织,角质形成细胞快速从周围迁移、增殖和上皮化,从而促进快速愈合,停工期短。主要概述点阵激光改善皮肤光老化的研究进展,从组织学改变和分子水平作用机制进行阐述。     

Fractional CO2 lasers for the treatment of atrophic acne scars: A review of the literature

Abstract

This review examines the efficacy and safety of fractional CO₂ lasers for the treatment of atrophic scarring secondary to acne vulgaris. We reviewed 20 papers published between 2008 and 2013 that conducted clinical studies using fractional CO₂ lasers to treat atrophic scarring. We discuss the prevalence and pathogenesis of acne scarring, as well as the laser mechanism. The histologic findings are included to highlight the ability of these lasers to induce the collagen reorganization and formation that improves scar appearance. We considered the number of treatments and different laser settings to determine which methods achieve optimal outcomes. We noted unique treatment regimens that yielded superior results. An overview of adverse effects is included to identify the most common ones. We concluded that more studies need to be done using uniform treatment parameters and reporting in order to establish which fractional CO₂ laser treatment approaches allow for the greatest scar improvement.     

富血小板血浆联合CO2点阵激光治疗萎缩性痤疮瘢痕疗效和安全性Meta分析

目的：系统评价富血小板血浆联合CO₂点阵激光治疗面部萎缩性痤疮瘢痕的有效性及安全性。方法：检索从建库到2019年7月Cochrane Library、Embase、Medline、中国知网、万方数据库及维普数据库中富血小板血浆联合CO₂点阵激光治疗面部萎缩性痤疮瘢痕的随机对照试验,筛选符合要求的文献并根据Cochrane偏倚风险评估方法评价纳入文献质量, 采用Revman5.3软件进行Meta分析。结果：最终纳入5个RCTs和Meta分析,结果显示：①联合疗法的总有效率和治愈率均高于单用激光组（P=0.008,0.0002）;②联合疗法和单用激光组的红斑、水肿持续时间及疼痛评分无统计学差异（P=0.21,0.35,0.50）。结论：富血小板血浆联合CO₂点阵激光治疗萎缩性痤疮瘢痕的疗效优于单独使用CO₂点阵激光,不良反应无明显差异。     

The efficacy of fractional CO2 laser in acne scar treatment: A meta‐analysis

Fractional CO₂ laser is a good option for treating acne scars. However, the clinical efficacy of this treatment modality requires further evidence. To perform a meta‐analysis to assess clinical improvements in acne scars with fractional CO₂ laser and non‐CO₂ laser therapies. Databases (PubMed, Embase, Cochrane Library) were searched using the search strategy to identify eligible studies. All statistical analyses were performed using the Review Manager 5.0, and a meta‐analysis was conducted to assess the effects of fractional CO₂ laser used as a treatment for acne scars. Eight studies were included for further analysis. There was no significant difference between fractional CO₂ laser and non‐CO₂ laser therapies in terms of clinical improvement, observer assessment (P = .19), patient assessment (P = .91), and incidence of post‐inflammatory hyperpigmentation (P = .69). The subgroup analyses showed that the duration of follow‐up had little effect on the evaluation of treatment effect. The efficacy of fractional CO₂ laser therapy in acne scars appeared to be equal to that of non‐CO₂ laser therapies. More well designed randomized controlled trials and more credible and standard evaluation criteria are needed, and the efficiency of combination therapy requires further analysis.     

铒激光联合E光治疗痤疮凹陷性瘢痕的临床效果评价

目的：评价铒激光联合E光治疗痤疮凹陷性瘢痕的临床疗效和安全性。方法：将大连市皮肤病医院美容皮肤科2013年1月至2016年6月就诊患者采用双色球方法随机分成治疗组和对照组,治疗组为铒激光联合E光治疗组;对照组为铒激光治疗组,每个月治疗一次,共3次。对照组与治疗组均于疗程结束1个月后比较两组患者治疗前后皮肤红斑、色沉,瘢痕,皱纹,粗糙度,光滑度的变化。结果：共就诊62例痤疮凹陷性瘢痕患者,治疗组31例,对照组31例,治疗组与对照组患者皮损治疗前光滑度、瘢痕、皱纹、粗糙度、色沉、红斑比较,差异无统计学意义(P＞0.05)。治疗后,治疗组,患者皮肤的光滑度,瘢痕,皱纹,粗糙度,红斑,色沉评分分别为73.32±0.236、2.21±0.152、168.6±0.177、63±0.128、8.63±0.122、5.20±0.232,对照组分别为70.45±0.354、3.28±0.138、180.6±0.412、66±0.422、13.62±0.121、11.22±0.121,两组比较差异有统计学意义(均P<0.05)。所有患者未见严重不良反应。结论：铒激光联合E光治疗痤疮凹陷性瘢痕较单独应用铒激光治疗组疗效明显提升。     

CO2点阵激光联合胶原贴敷料治疗面部痤疮凹陷性瘢痕的临床观察

目的 观察胶原贴敷料对CO2点阵激光治疗面部痤疮凹陷性瘢痕术后的修复作用及安全性。 方法 选择70例面部痤疮凹陷性瘢痕患者,随机分为试验组和对照组各35例。试验组CO2点阵激光治疗后外敷胶原贴敷料20 min,共10 d;对照组不用敷料,其余处理同试验组。治疗后随访6个月,观察治疗后急性炎症反应情况、痂皮脱落时间、患者舒适度评价、误工期、炎症后色素沉着率及其他不良反应发生情况。 结果 试验组急性炎症反应评分（W = 312,P < 0.01）、痂皮脱落时间（t = 2.08,P < 0.05）、激光术后自身舒适程度评价（W = 172,P < 0.01）均优于对照组,试验组炎症后色素沉着发生率（χ2 = 6.06,P < 0.05）、误工期（t = 3.14,P < 0.05）均低于对照组,两组均无新发生的瘢痕。 结论 CO2点阵激光术后应用胶原贴敷料可减少术后不良反应发生率,提高患者满意度。