1
|
Qoreishi SH, Gholizadeh N, Rokni GR, Babaei M. Advancements in Acne Scar Treatment: Exploring Novel Therapies. J Cosmet Dermatol 2025; 24:e70183. [PMID: 40314127 PMCID: PMC12046493 DOI: 10.1111/jocd.70183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/31/2025] [Accepted: 04/03/2025] [Indexed: 05/03/2025]
Abstract
BACKGROUND Acne-induced scarring remains a formidable challenge, compelling patients to explore surgical interventions. This study aims to delve into and showcase recent strides in acne scar treatment, with a specific focus on innovative therapies. METHODS Conducting a narrative review spanning studies from 2013 to 2023, this paper provides a general overview of interventions. The review included English-language studies with full-text availability. Rigorous data screening and extraction by two independent authors covered diverse facets, including study particulars, participant profiles, measurement tools, intervention durations, outcomes, and key findings. The initial search was performed within PubMed, Scopus, Google Scholar, and the gray literature. RESULTS Ultimately, 26 studies meeting inclusion criteria were included and reviewed for final analysis. CONCLUSION Recognizing the varied nature of acne scars, this narrative review underscores the need for personalized treatment strategies, considering scar type and severity. The study also emphasizes the potential necessity of combining treatments for optimal results. Despite substantial progress, ongoing research and more extensive studies are imperative to continually refine acne scar treatment outcomes, ultimately enhancing the well-being of those affected by this condition.
Collapse
Affiliation(s)
| | - Nasim Gholizadeh
- Department of DermatologyMazandaran University of Medical SciencesSariIran
| | | | - Mahsa Babaei
- Department of DermatologyMazandaran University of Medical SciencesSariIran
| |
Collapse
|
2
|
Choe J, Urbonas R, Xia E, Yan A, Gaurav A, Fladger A, Barbieri JS. An Assessment of Current Clinician- and Patient-Reported Outcome Measures for Acne Scarring and Dyspigmentation: A Scoping Review. J Invest Dermatol 2025:S0022-202X(25)00296-9. [PMID: 40023366 DOI: 10.1016/j.jid.2025.02.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 02/03/2025] [Accepted: 02/10/2025] [Indexed: 03/04/2025]
Abstract
Acne-associated scarring and dyspigmentation (ie, erythema, hyperpigmentation) are common sequelae with significant psychosocial impact, but little is known about what measures are most often used to assess these outcomes. This scoping review evaluates the use of current patient-reported outcome measures (PROMs) and clinician-reported outcome measures (ClinROMs) for acne scars and dyspigmentation. For scars, 7 PROMs and 18 ClinROMs were used, with most being unvalidated. Similarly, for dyspigmentation, 4 PROMs and 8 ClinROMs were identified, but no validated PROMs were identified. These results highlight reliance on unvalidated measures in research and clinical trials and suggest the need for developing high-quality validated measures, particularly PROMs, to improve research quality and develop better treatments.
Collapse
Affiliation(s)
- James Choe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Urbonas
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Eric Xia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Allison Yan
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ahana Gaurav
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Medical College of Georgia, Augusta, Georgia
| | - Anne Fladger
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; JAMA Dermatology, Chicago, Illinois, USA.
| |
Collapse
|
3
|
Wang H, Yang F, Wang H, Qin T, He J, Zhao C. Effect of CO2 fractional laser combined with recombinant human epidermal growth factor gel on skin barrier. Medicine (Baltimore) 2024; 103:e37329. [PMID: 38489702 PMCID: PMC10939677 DOI: 10.1097/md.0000000000037329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/17/2024] Open
Abstract
To evaluate the impact of CO2 fractional laser combined with recombinant human epidermal growth factor (rhEGF) gel on skin barrier in acne scar patients. In a retrospective analysis, we examined 105 acne scar patients admitted between July 2018 and August 2021. Of these, 51 received only CO2 fractional laser (control group), while 54 underwent a combination of CO2 fractional laser and rhEGF gel (observation group). We assessed treatment efficacy, symptom relief, skin barrier parameters, pre- and posttreatment inflammatory factors, adverse reactions, posttreatment quality of life, and patient satisfaction. The observation group exhibited a higher overall response rate, significantly shorter wound healing, scab formation, and scab detachment times. Additionally, this group showed increased stratum corneum water content, decreased pH, and transdermal water loss (TEWL), and reduced hypersensitive C-reactive protein and interleukin-6 expression posttreatment. Quality of life scores were higher, with fewer adverse reactions and greater treatment satisfaction. Combining CO2 fractional laser with rhEGF gel markedly improves acne scar treatment efficacy, enhances skin barrier function, reduces inflammation, and elevates quality of life. Its safety profile supports its broader clinical adoption.
Collapse
Affiliation(s)
- Hua Wang
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| | - Fan Yang
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| | - Hui Wang
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Shaanxi University of Chinese Medicine, Xixian New Area, Shaanxi Province, China
| | - Tao Qin
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| | - Jia He
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| | - Chan Zhao
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| |
Collapse
|
4
|
Sullivan DA, da Costa AX, Del Duca E, Doll T, Grupcheva CN, Lazreg S, Liu SH, McGee SR, Murthy R, Narang P, Ng A, Nistico S, O'Dell L, Roos J, Shen J, Markoulli M. TFOS Lifestyle: Impact of cosmetics on the ocular surface. Ocul Surf 2023; 29:77-130. [PMID: 37061220 PMCID: PMC11246752 DOI: 10.1016/j.jtos.2023.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.
Collapse
Affiliation(s)
| | | | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | | | - Sihem Lazreg
- Lazreg Cornea and Ocular Surface Center, Blida, Algeria
| | - Su-Hsun Liu
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Alison Ng
- Centre for Ocular Research & Education, School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Steven Nistico
- Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | | | | | - Joanne Shen
- Department of Ophthalmology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Maria Markoulli
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| |
Collapse
|
5
|
Hendel K, Karmisholt K, Hedelund L, Haedersdal M. Fractional CO 2 -laser versus microneedle radiofrequency for acne scars: A randomized, single treatment, split-face trial. Lasers Surg Med 2023; 55:335-343. [PMID: 36934435 DOI: 10.1002/lsm.23655] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Ablative fractional CO2 laser (AFL) is an established first-line energy-based treatment for acne scars. Microneedle radiofrequency (MNRF) is an emerging treatment, also targeting the skin in fractions. No studies have so far compared AFL with MNRF for acne scars in a direct controlled, side-by-side comparison. In this study, we compared AFL and MNRF treatments for acne scars in a randomized split-face trial with blinded response evaluation, objective measures, and patient-reported outcomes. STUDY DESIGN/MATERIALS AND METHOD Fifteen patients with moderate to severe acne scars were included. At baseline each patient had two similar test areas identified, these were randomized to receive a single treatment with either AFL or MNRF. Standardized multilayer techniques were applied with AFL and MNRF, first targeting the scar base, thereafter the entire scar area. Outcome measures included blinded evaluation of clinical improvement of scar texture (0-10 scale) at 1- and 3-months follow-up, local skin reactions (LSR), pain according to Visual Analogue Scale (VAS), skin integrity quantified by transepidermal water loss, and patient satisfaction. RESULTS Fifteen patients completed the study with a median test area size of 24.6 cm2 (interquartile range [IQR] 14.9-40.6). A single treatment with AFL or MNRF equally resulted in a median 1-point texture improvement after 3 months follow-up (p < 0.001). Best responders achieved up to a 3-point improvement (n = 3 test areas, 10% of treatment areas). Erythema and loss of skin integrity was more intense after AFL compared with MNRF after 2-4 days (p < 0.001). Patients reported MNRF (VAS 7.0) to be significantly more painful than AFL (5.5) (p = 0.009). Patients were generally satisfied with the overall outcome on a 10-point scale at median 6 for both treatments (IQR 5-7). CONCLUSION AFL and MNRF treatments are equally effective at improving texture in skin with acne scars. AFL resulted in more pronounced LSRs whereas MNRF was more painful. Patients were generally satisfied with the overall outcome.
Collapse
Affiliation(s)
- Kristoffer Hendel
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Katrine Karmisholt
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lene Hedelund
- Department of Dermatology, Aaarhus University Hospital, Aarhus, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
6
|
Zou B, Zheng W, Pan H, Yang B, Liu Z. Research trends and hotspot analysis of fractional carbon dioxide laser: A bibliometric and visualized analysis via Citespace. J Cosmet Dermatol 2022; 21:5484-5499. [PMID: 35869829 DOI: 10.1111/jocd.15267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION There is limited basic research on carbon dioxide (CO2 ) fractional laser, indicating blind spots in CO2 fractional laser treatment of certain diseases. This study aimed to organize previous literature, summarize the current research, and speculate on possible future development. METHODS We searched document data on fractional CO2 lasers from the Web of Science core collection database and retrieved 928 articles from 2004 to 2021. CiteSpace software was used to analyze the main institutions, authors, subject hotspots, and research frontiers in global CO2 fractional laser research. RESULTS The results revealed that 928 related papers were published in the past 18 years (2004-2021), and the number has increased annually. The publications were written by 3239 authors from 626 institutions in 60 countries/regions. The United States (US) dominates this field (312 documents), followed by Italy (289), and South Korea (88). Lasers in Surgery and Medicine is the journal with the most publications and citations, and Uebelhoer is the central author. The main research hotspots include vulvovaginal atrophy, fractional photothermolysis, keloids, drug delivery, gene expressions, facial acne scarring, resurfacing, vitiligo, and photo damage. CONCLUSION Using CiteSpace, this paper draws a map of authors, institutions, and keywords in fractional CO2 laser from 2004 to 2021; summarizes the main authors, institutions, research hotspots, and cutting-edge topics of global fractional CO2 laser technology in recent years; and summarizes the current application status of global fractional CO2 laser in disease treatment. It also provides new ideas for the future application and research of fractional CO2 lasers.
Collapse
Affiliation(s)
- Boya Zou
- The First Clinical Medical College, Southern Medical University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Wenyue Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Hongju Pan
- Guangdong Provincial Engineering Technology Research and Development Center for External Drugs, Foshan City, Guangdong Province, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Zhenfeng Liu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
7
|
Zhang YJ, Chen YM, Shao XY, Liu L, Pu YH, Zhang LZ, Chen JY, Chen J. Combination treatment with 30% salicylic acid and fractional
CO
2
laser for acne scars: A 20‐week prospective, randomized, split‐face study. Dermatol Ther 2022; 35:e15693. [PMID: 35791845 DOI: 10.1111/dth.15693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Y. J. Zhang
- The First Affiliated Hospital of Chongqing Medical University
| | - Y. M. Chen
- The First Affiliated Hospital of Chongqing Medical University
| | - X. Y. Shao
- The First Affiliated Hospital of Chongqing Medical University
| | - L. Liu
- The First Affiliated Hospital of Chongqing Medical University
| | - Y. H. Pu
- The First Affiliated Hospital of Chongqing Medical University
| | - L. Z. Zhang
- The First Affiliated Hospital of Chongqing Medical University
| | - J. Y. Chen
- The First Affiliated Hospital of Chongqing Medical University
| | - J. Chen
- The First Affiliated Hospital of Chongqing Medical University
| |
Collapse
|
8
|
Ud-Din S, Bayat A. Controlling Inflammation Pre-Emptively or at the Time of Cutaneous Injury Optimises Outcome of Skin Scarring. Front Immunol 2022; 13:883239. [PMID: 35711461 PMCID: PMC9197255 DOI: 10.3389/fimmu.2022.883239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Inflammation plays an active role during the wound healing process. There is a direct association between the extent of injury as well as inflammation and the amount of subsequent cutaneous scarring. Evidence to date demonstrates that high levels of inflammation are associated with excessive dermal scarring and formation of abnormal pathological scars such as keloids and hypertrophic scars. In view of the multiple important cell types being involved in the inflammatory process and their influence on the extent of scar formation, many scar therapies should aim to target these cells in order to control inflammation and by association help improve scar outcome. However, most current treatment strategies for the management of a newly formed skin scar often adopt a watch-and-wait approach prior to commencing targeted anti-inflammatory therapy. Moreover, most of these therapies have been evaluated in the remodelling phase of wound healing and the evaluation of anti-inflammatory treatments at earlier stages of healing have not been fully explored and remain limited. Taken together, in order to minimise the risk of developing a poor scar outcome, it is clear that adopting an early intervention prior to skin injury would be optimal, however, the concept of pre-emptively priming the skin prior to injury has not yet been thoroughly evaluated. Therefore, the aim of this review was to evaluate the available literature regarding scar therapies that aim to target inflammation which are commenced prior to when a scar is formed or immediately after injury, with a particular focus on the role of pre-emptive priming of skin prior to injury in order to control inflammation for the prevention of poor scarring outcome.
Collapse
Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom.,Medical Research Council - South Africa (MRC-SA) Wound Healing Unit, Division of Dermatology, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
9
|
Treatment of acne scars with fractional carbon dioxide laser in Asians: a retrospective study to search for predicting factors associated with efficacy. Lasers Med Sci 2022; 37:2623-2627. [DOI: 10.1007/s10103-022-03528-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
|
10
|
Ghazzawi R, Hamadah O. A systematic review of evaluating the efficacy of acne scar treatment by Fractional Laser with or without using adjunctive treatments. J COSMET LASER THER 2022; 23:97-104. [PMID: 35109741 DOI: 10.1080/14764172.2022.2033785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Raghad Ghazzawi
- Physics and Laser Technology, The Higher Institute for Laser Research and Applications, Laboratroy of Medical Laser, Syria
| | - Omar Hamadah
- Physics and Laser Technology, The Higher Institute for Laser Research and Applications, Laboratroy of Medical Laser, Syria.,The Faculty of Dental Medicne, Oral Medicine Department, Damascus University, Syria.,Fixed Prosthodontics Department, Al-Sham Private University, Syria
| |
Collapse
|
11
|
Husein-ElAhmed H, Steinhoff M. Vergleichende Metaanalyse zur Behandlung atropher Aknenarben mit Erbium-Laser versus CO 2 -Laser. J Dtsch Dermatol Ges 2021; 19:1559-1570. [PMID: 34811904 DOI: 10.1111/ddg.14546_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/20/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Husein Husein-ElAhmed
- Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Martin Steinhoff
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.,Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, College of Medicine, Doha, Qatar.,Qatar University, Medical School, Doha, Qatar.,Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
12
|
Husein-ElAhmed H, Steinhoff M. Comparative appraisal with meta-analysis of erbium vs. CO 2 lasers for atrophic acne scars. J Dtsch Dermatol Ges 2021; 19:1559-1568. [PMID: 34558190 DOI: 10.1111/ddg.14546] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/20/2021] [Indexed: 12/31/2022]
Abstract
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.
Collapse
Affiliation(s)
- Husein Husein-ElAhmed
- Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Martin Steinhoff
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.,Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, College of Medicine, Doha, Qatar.,Qatar University, Medical School, Doha, Qatar.,Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
13
|
van Zuuren E, Arents B, Miklas M, Schoones J, Tan J. Identifying and appraising patient-reported outcome measures on treatment satisfaction in acne: a systematic review. Br J Dermatol 2021; 185:36-51. [PMID: 33176002 PMCID: PMC8359297 DOI: 10.1111/bjd.19675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND After dermatitis, acne is the next skin disease to contribute most to the burden of skin diseases worldwide. Recently, seven core outcome domains have been identified, which together form an Acne Core Outcome Set (ACORN). One of these was satisfaction with acne treatment. OBJECTIVES To identify studies that described the development of patient-reported outcome measures (PROMS), evaluated one or more measurement properties of a PROM, or evaluated the interpretability of a PROM in patients with acne regarding treatment satisfaction. METHODS The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy for identifying PROMS on acne treatment satisfaction was used. We searched PubMed, MEDLINE, Embase, LILACS, Web of Science, Cochrane Library, Emcare, PsycINFO and Academic Search premier (June 2020). Study selection, data extraction and assessment of methodological quality according to COSMIN guidance were carried out independently by two authors. RESULTS Only one study could be included, describing the development of a treatment satisfaction measure in patients with acne. The development was assessed as inadequate and data on measurement properties were lacking. Additionally, we found 188 studies reporting treatment satisfaction solely as an outcome, using a wide variety of methods, none of them standardized or validated. CONCLUSIONS We could not find a PROM on treatment satisfaction to recommend for a core outcome set in acne. There is an unmet need for a PROM on treatment satisfaction in acne that is robustly developed, designed and validated.
Collapse
Affiliation(s)
- E.J. van Zuuren
- Dermatology DepartmentLeiden University Medical CentreLeidenthe Netherlands
| | - B.W.M. Arents
- Skin Patients Netherlands (Huidpatiënten Nederland)Nieuwegeinthe Netherlands
| | - M. Miklas
- Windsor Clinical Research Inc.WindsorONCanada
| | - J.W. Schoones
- Walaeus LibraryLeiden University Medical CentreLeidenthe Netherlands
| | - J. Tan
- Windsor Clinical Research Inc.WindsorONCanada
- Western UniversityLondonONCanada
| |
Collapse
|
14
|
Tatlıparmak A, Aksoy B, Shishehgarkhaneh LR, Gökdemir G, Koç E. Use of combined fractional carbon dioxide laser and fractional microneedle radiofrequency for the treatment of acne scars: A retrospective analysis of 1-month treatment outcome on scar severity and patient satisfaction. J Cosmet Dermatol 2019; 19:115-121. [PMID: 31141299 DOI: 10.1111/jocd.13004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/14/2019] [Accepted: 04/25/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Acne scars lead to social and psychological problems for patients, and they should be treated effectively. Ablative and nonablative lasers have been used for the treatment of acne scars in recent years. AIMS The aim of this study was to evaluate the effectivity of combined FCL and FmRF treatment for acne scars retrospectively. METHODS A total of 72 patients with acne scars who received FCL + FmRF treatment between 2014 and 2016 were included in this study. Photographs of patients before treatment and 1 month following the last treatment session were scored by two blinded researchers, according to the ECCA acne scar scoring method. Patients were contacted via telephone after 1 month following the last treatment and asked to evaluate their satisfaction with the treatment outcome using a 5-point Likert-type scale. RESULTS A significant decrease was noted in ECCA scores after the treatment along with temporary side effects. Change from pretreatment scores was significantly higher in patients very satisfied vs satisfied with treatment. The number of treatment sessions was positively correlated with treatment-related change in ECCA scores. CONCLUSIONS In conclusion, our findings revealed association of FCL + FmRF treatment with significantly improved ECCA scores, mild pain experience, and low rate of side effects in patients with acne scars, despite usage of high-energy FLC dose and five sessions of treatment on average. More remarkable improvement in ECCA scores during treatment seems to be associated with higher patient satisfaction and to be more likely in patients with darker skin types.
Collapse
Affiliation(s)
- Aslı Tatlıparmak
- Department of Dermatology, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey.,Dermatology Clinic, Bahçeşehir Medicalpark Hospital, Istanbul, Turkey
| | - Berna Aksoy
- Department of Dermatology, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey.,Dermatology Clinic, VM Medicalpark Hospital, Kocaeli, Turkey
| | | | | | - Erol Koç
- Medical Park Hastanesi, Ankara, Turkey
| |
Collapse
|
15
|
Datz E, Schönberger C, Zeman F, Koller M, Berneburg M, Landthaler M, Karrer S, Hohenleutner U, Hohenleutner S. Fractional carbon dioxide laser resurfacing of skin grafts: long-term results of a prospective, randomized, split-scar, evaluator-blinded study. Lasers Surg Med 2018; 50:1010-1016. [DOI: 10.1002/lsm.22950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Elisabeth Datz
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Carmen Schönberger
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
- Operative Dentistry and Periodontology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Florian Zeman
- Centre for Clinical Studies; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Michael Koller
- Centre for Clinical Studies; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Mark Berneburg
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Michael Landthaler
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Sigrid Karrer
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Ulrich Hohenleutner
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Silvia Hohenleutner
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| |
Collapse
|
16
|
Du F, Yu Y, Zhou Z, Wang L, Zheng S. Early treatment using fractional CO 2 laser before skin suture during scar revision surgery in Asians. J COSMET LASER THER 2018; 20:102-105. [PMID: 28895756 DOI: 10.1080/14764172.2017.1358452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Fractional CO2 laser is one of the most effective treatment options used to resurface scars. However, most previous studies have been performed on mature scars at least 2 months after surgery. Recent studies have emphasized the importance of early treatment to reduce scar formation. In the present study, we described our experience with fractional CO2 laser intervention before skin suture during scar revision surgery in Asians, and found the treatment was safe and effective.
Collapse
Affiliation(s)
- Feiya Du
- a Department of Aesthetic Plastic Surgery Center , The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , P. R . China
| | - Yusheng Yu
- b Department of Plastic Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , P. R . China
| | - Zhiqin Zhou
- a Department of Aesthetic Plastic Surgery Center , The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , P. R . China
| | - Liujia Wang
- a Department of Aesthetic Plastic Surgery Center , The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , P. R . China
| | - Shusen Zheng
- c Department of General Surgery , The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , P. R . China
| |
Collapse
|
17
|
Lueangarun S, Tempark T. Efficacy of MAS063DP lotion vs 0.02% triamcinolone acetonide lotion in improving post-ablative fractional CO2
laser resurfacing wound healing: a split-face, triple-blinded, randomized, controlled trial. Int J Dermatol 2018; 57:480-487. [DOI: 10.1111/ijd.13922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/27/2017] [Accepted: 01/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Suparuj Lueangarun
- Division of Dermatology; Chulabhorn International College of Medicine; Thammasat University; Amphur Klongluang Pathumthani Thailand
| | - Therdpong Tempark
- Department of Pediatrics; Faculty of Medicine; Chulalongkorn University; Pathumwan Bangkok Thailand
| |
Collapse
|
18
|
Kravvas G, Al-Niaimi F. A systematic review of treatments for acne scarring. Part 2: Energy-based techniques. Scars Burn Heal 2018; 4:2059513118793420. [PMID: 30627441 PMCID: PMC6305948 DOI: 10.1177/2059513118793420] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Firas Al-Niaimi
- Department of Dermatological Surgery and Lasers, St John’s Institute of Dermatology, London, UK
| |
Collapse
|
19
|
Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation. Lasers Med Sci 2017; 32:2047-2054. [PMID: 28894992 DOI: 10.1007/s10103-017-2322-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the efficacy and safety of fractional carbon dioxide laser for the treatment of acne scars. Thirty-one participants, 15 female and 16 male, whose mean age was 34.84 ± 10.94 years, were included in this prospective study. The study took place between 2012 and 2016. Participants were evaluated with the "ECCA Grading Scale" before the first session, 3 months (short-term evaluation) and 3 years after the last session (long-term evaluation). Participants received two or three treatment sessions at 4-week intervals, with a 10,600 nm fractional carbon dioxide laser with pulse energies ranging between 100 and 160 mJ, 120 spot type, 75-100 spot/cm2 density, and 30 W power. Self-assessments by the participants were done 3 months and 3 years after the last session. The mean ECCA score was 107.90 ± 39.38 before the first session, and 82.17 ± 36.23 at the time of short-term evaluation (p = 0.000). The grade of improvement at the short-term evaluation was as follows: no improvement, mild, moderate, and significant improvement for 7 (22.6%), 11 (35.5%), 9 (29%), and 4 (12.9%) of the participants, respectively. Regarding self-assessments, 80.6 and 61.3% of the participants rated themselves as having at least mild improvement at the short-term and the long-term follow-up periods, respectively. The results of this study suggest that fractional carbon dioxide laser is an efficient treatment option for acne scars. Furthermore, self-assessment results show that more than half of the participants still experience at least mild improvement at the end of 3 years.
Collapse
|
20
|
Treatment of Facial Acne Scarring With Fractional Carbon Dioxide Laser in Asians, a Retrospective Analysis of Efficacy and Complications. Dermatol Surg 2017; 43:1137-1143. [PMID: 28746258 DOI: 10.1097/dss.0000000000001219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fractional carbon dioxide (CO2) laser resurfacing unites the idea of fractional photothermolysis with an ablative 10,600-nm wavelength. This technology permits effective treatment of acne scarring, with shorter recovery and a decreased side effect profile as compared to traditional CO2 laser resurfacing. OBJECTIVE The aims of this study were to study the efficacy and safety of fractional CO2 laser for acne scars in Asian patients. METHODS This was a retrospective study of all patients treated with the fractional CO2 laser for facial acne scarring between January 2, 2008, and December 31, 2010, at the National Skin Centre, Singapore. Data reviewed included sex, age, and severity of acne, type of scarring, previous treatment history, frequency of treatments, adverse events, and efficacy. RESULTS Two hundred and ten fractional CO2 laser treatments for facial acne scars were performed on 107 patients (65 men and 42 women, Fitzpatrick skin Types II to V) during the study period. Sixteen of 107 patients experienced (15.0%) adverse events. The adverse events include hyperpigmentation (6.4%), blistering (4.0%), crusting (2.9%), aggravation of inflammatory acne lesions (1.7%), and scarring (0.6%). There were no reported side effects of hypopigmentation, bacterial or viral infection. Follow-up results after final laser treatment showed that 66.4% of patients reported Grade 1 skin texture improvement, that is, <25% (n = 71); 30.0% had Grade 2 improvement, that is, 25% to 50% improvement (n = 31); 3.7% had Grade 3 improvement, that is, 51% to 75% improvement (n = 4); and 0.9% had Grade 4 improvement, that is, >75% improvement (n = 1). CONCLUSION The study demonstrated the efficacy and safety of a fractional CO2 laser in the treatment of acne scars in Asian. Future studies are required to establish optimum treatment parameters and achieve better clinical results.
Collapse
|
21
|
McGoldrick RB, Theodorakopoulou E, Azzopardi EA, Murison M. Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars. Scars Burn Heal 2017; 3:2059513116689805. [PMID: 29799579 PMCID: PMC5965340 DOI: 10.1177/2059513116689805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Rory Boyd McGoldrick
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | - Evgenia Theodorakopoulou
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | | | - Maxwell Murison
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| |
Collapse
|
22
|
Abdel Hay R, Shalaby K, Zaher H, Hafez V, Chi C, Dimitri S, Nabhan AF, Layton AM, Cochrane Skin Group. Interventions for acne scars. Cochrane Database Syst Rev 2016; 4:CD011946. [PMID: 27038134 PMCID: PMC7069546 DOI: 10.1002/14651858.cd011946.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acne scarring is a frequent complication of acne and resulting scars may negatively impact on an affected person's psychosocial and physical well-being. Although a wide range of interventions have been proposed, there is a lack of high-quality evidence on treatments for acne scars to better inform patients and their healthcare providers about the most effective and safe methods of managing this condition. This review aimed to examine treatments for atrophic and hypertrophic acne scars, but we have concentrated on facial atrophic scarring. OBJECTIVES To assess the effects of interventions for treating acne scars. SEARCH METHODS We searched the following databases up to November 2015: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2015, Issue 10), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers, and checked the reference lists of included studies and relevant reviews for further references to randomised controlled trials. SELECTION CRITERIA We include randomised controlled trials (RCTs) which allocated participants (whether split-face or parallel arms) to any active intervention (or a combination) for treating acne scars. We excluded studies dealing only or mostly with keloid scars. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data from each of the studies included in this review and evaluated the risks of bias. We resolved disagreements by discussion and arbitration supported by a method expert as required. Our primary outcomes were participant-reported scar improvement and any adverse effects serious enough to cause participants to withdraw from the study. MAIN RESULTS We included 24 trials with 789 adult participants aged 18 years or older. Twenty trials enrolled men and women, three trials enrolled only women and one trial enrolled only men. We judged eight studies to be at low risk of bias for both sequence generation and allocation concealment. With regard to blinding we judged 17 studies to be at high risk of performance bias, because the participants and dermatologists were not blinded to the treatments administered or received; however, we judged all 24 trials to be at a low risk of detection bias for outcome assessment. We evaluated 14 comparisons of seven interventions and four combinations of interventions. Nine studies provided no usable data on our outcomes and did not contribute further to this review's results.For our outcome 'Participant-reported scar improvement' in one study fractional laser was more effective in producing scar improvement than non-fractional non-ablative laser at week 24 (risk ratio (RR) 4.00, 95% confidence interval (CI) 1.25 to 12.84; n = 64; very low-quality evidence); fractional laser showed comparable scar improvement to fractional radiofrequency in one study at week eight (RR 0.78, 95% CI 0.36 to 1.68; n = 40; very low-quality evidence) and was comparable to combined chemical peeling with skin needling in a different study at week 48 (RR 1.00, 95% CI 0.60 to 1.67; n = 26; very low-quality evidence). In a further study chemical peeling showed comparable scar improvement to combined chemical peeling with skin needling at week 32 (RR 1.24, 95% CI 0.87 to 1.75; n = 20; very low-quality evidence). Chemical peeling in one study showed comparable scar improvement to skin needling at week four (RR 1.13, 95% CI 0.69 to 1.83; n = 27; very low-quality evidence). In another study, injectable fillers provided better scar improvement compared to placebo at week 24 (RR 1.84, 95% CI 1.31 to 2.59; n = 147 moderate-quality evidence).For our outcome 'Serious adverse effects' in one study chemical peeling was not tolerable in 7/43 (16%) participants (RR 5.45, 95% CI 0.33 to 90.14; n = 58; very low-quality evidence).For our secondary outcome 'Participant-reported short-term adverse events', all participants reported pain in the following studies: in one study comparing fractional laser to non-fractional non-ablative laser (RR 1.00, 95% CI 0.94 to 1.06; n = 64; very low-quality evidence); in another study comparing fractional laser to combined peeling plus needling (RR 1.00, 95% CI 0.86 to 1.16; n = 25; very low-quality evidence); in a study comparing chemical peeling plus needling to chemical peeling (RR 1.00, 95% CI 0.83 to 1.20; n = 20; very low-quality evidence); in a study comparing chemical peeling to skin needling (RR 1.00, 95% CI 0.87 to 1.15; n = 27; very low-quality evidence); and also in a study comparing injectable filler and placebo (RR 1.03, 95% CI 0.10 to 11.10; n = 147; low-quality evidence).For our outcome 'Investigator-assessed short-term adverse events', fractional laser (6/32) was associated with a reduced risk of hyperpigmentation than non-fractional non-ablative laser (10/32) in one study (RR 0.60, 95% CI 0.25 to 1.45; n = 64; very low-quality evidence); chemical peeling was associated with increased risk of hyperpigmentation (6/12) compared to skin needling (0/15) in one study (RR 16.00, 95% CI 0.99 to 258.36; n = 27; low-quality evidence). There was no difference in the reported adverse events with injectable filler (17/97) compared to placebo (13/50) (RR 0.67, 95% CI 0.36 to 1.27; n = 147; low-quality evidence). AUTHORS' CONCLUSIONS There is a lack of high-quality evidence about the effects of different interventions for treating acne scars because of poor methodology, underpowered studies, lack of standardised improvement assessments, and different baseline variables.There is moderate-quality evidence that injectable filler might be effective for treating atrophic acne scars; however, no studies have assessed long-term effects, the longest follow-up being 48 weeks in one study only. Other studies included active comparators, but in the absence of studies that establish efficacy compared to placebo or sham interventions, it is possible that finding no evidence of difference between two active treatments could mean that neither approach works. The results of this review do not provide support for the first-line use of any intervention in the treatment of acne scars.Although our aim was to identify important gaps for further primary research, it might be that placebo and or sham trials are needed to establish whether any of the active treatments produce meaningful patient benefits over the long term.
Collapse
Affiliation(s)
- Rania Abdel Hay
- Faculty of Medicine, Cairo UniversityDepartment of Dermatology13th Abrag OthmanKournish el MaadiCairoEgypt11431
| | | | - Hesham Zaher
- Faculty of Medicine, Cairo UniversityDepartment of Dermatology13th Abrag OthmanKournish el MaadiCairoEgypt11431
| | - Vanessa Hafez
- Cairo UniversityDepartment of Dermatology, Faculty of MedicineKasr El Aini Hospital Medical School15 Nasser Street from Fatma Roshdi St.Haram, GuizaCairoEgypt
| | - Ching‐Chi Chi
- Chang Gung Memorial HospitalDepartment of Dermatology and Centre for Evidence‐Based Medicine6, Sec West, Chia‐Pu RoadPuzihChiayiTaiwan61363
- Chang Gung UniversityCollege of MedicineTaoyuanTaiwan
| | - Sandra Dimitri
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of MedicineRamsees street, AbbaseyaCairoEgypt11566
| | - Ashraf F Nabhan
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of MedicineRamsees street, AbbaseyaCairoEgypt11566
| | - Alison M Layton
- Harrogate and District NHS Foundation TrustDepartment of DermatologyHarrogateUK
| | | |
Collapse
|
23
|
You HJ, Kim DW, Yoon ES, Park SH. Comparison of four different lasers for acne scars: Resurfacing and fractional lasers. J Plast Reconstr Aesthet Surg 2016; 69:e87-95. [PMID: 26880620 DOI: 10.1016/j.bjps.2015.12.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/03/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Hi-Jin You
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Deok-Woo Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eul-Sik Yoon
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Ha Park
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
24
|
Faghihi G, Nouraei S, Asilian A, Keyvan S, Abtahi-Naeini B, Rakhshanpour M, Nilforoushzadeh MA, Hosseini SM. Efficacy of Punch Elevation Combined with Fractional Carbon Dioxide Laser Resurfacing in Facial Atrophic Acne Scarring: A Randomized Split-face Clinical Study. Indian J Dermatol 2015; 60:473-8. [PMID: 26538695 PMCID: PMC4601415 DOI: 10.4103/0019-5154.159616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Gita Faghihi
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Nouraei
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asilian
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shima Keyvan
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahareh Abtahi-Naeini
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Sayed Mohsen Hosseini
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
25
|
Cohen BE, Brauer JA, Geronemus RG. Acne scarring: A review of available therapeutic lasers. Lasers Surg Med 2015; 48:95-115. [PMID: 26414762 DOI: 10.1002/lsm.22410] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/07/2022]
Abstract
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.
Collapse
Affiliation(s)
- Brandon E Cohen
- The Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, 240 East 38th Street, New York, NY 10016
| | - Jeremy A Brauer
- The Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, 240 East 38th Street, New York, NY 10016
- Laser & Skin Surgery Center of New York, 317 E 34th St, New York, NY 10016
| | - Roy G Geronemus
- The Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, 240 East 38th Street, New York, NY 10016
- Laser & Skin Surgery Center of New York, 317 E 34th St, New York, NY 10016
| |
Collapse
|
26
|
Carniol PJ, Hamilton MM, Carniol ET. Current Status of Fractional Laser Resurfacing. JAMA FACIAL PLAST SU 2015; 17:360-6. [DOI: 10.1001/jamafacial.2015.0693] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paul J. Carniol
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Summit
| | - Mark M. Hamilton
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Greenwood
| | | |
Collapse
|