Although the fractional ablative CO2 laser is a first-line treatment for acne scarring, the potential for side effects from repetitive treatments leaves room for improvement with additive therapies, according to a recent review. However, its authors add, adjunct options ranging from pharmaceuticals to platelet-rich plasma (PRP) require further study.
When treating acne scars with laser alone, the incidence of adverse events rises with the number of treatments, say authors led by Yun Zhu Mu, M.D., department of dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China. These adverse events can include prolonged erythema and edema and, particularly in skin of color, postinflammatory hyperpigmentation. The review appeared in Dermatologic Therapy.1
Options ranging from isotretinoin and topical steroids to devices, stem cells and PRP may potentially improve results while reducing downtime. Regarding PRP, small studies have shown significant improvement in acne scarring and post-treatment side effects in combination with fractional CO2 laser. However, Mu et al. note that in two recent studies, adding topical PRP prolonged postprocedural erythema and edema.2,3 Interpreting such mixed results is difficult, says Ashish C. Bhatia, M.D., who was not involved with the review. There could be variations in the type of PRP used or in patients treated. Because PRP uses each person’s autologous plasma-derived growth factors, he adds, results are inherently difficult to generalize. Dr. Bhatia is associate professor of clinical dermatology at Northwestern University Feinberg School of Medicine, Chicago. He also is co-director of dermatologic, laser and cosmetic surgery and medical director for dermatologic research at Oak Dermatology in Chicago.
Mu et al. highlight two studies showing that combining intense pulsed light (IPL) with fractional CO2 yielded better therapeutic effects with diminished redness versus laser alone.
Subcutaneous incision releases tethering beneath a scar’s surface and loosens scar fibers that are fixed to the dermis as a first step in treating atrophic acne scars. In a 50-patient study, combining subcision with fractional CO2 laser achieved statistically significant improvements over laser alone. In another study, the “cure rate” of combination therapy was 54.7% vs 43% for laser-only treatment (P<0.001). However, the combination treatment side had a higher incidence of hyperpigmentation and bruising.4
Dr. Bhatia is a Cutera investigator, speaker and consultant and Solta Medical consultant
1. Mu YZ, Jiang L, Yang H. Dermatol Ther. 2019 Sep 8:e13084.
2. Faghihi G, Keyvan S, Asilian A, Nouraei S, Behfar S, Nilforoushzadeh MA. Indian J Dermatol Venereol Leprol. 2016;82:162-168.
3. Al Taweel AI, Al Refae AA, Hamed AM, Kamal AM. J Cosmet Dermatol. 2019;18:150-155.
4. Nilforoushzadeh MA, Faghihi G, Jaffary F, Haftbaradaran E, Hoseini SM, Mazaheri N. Adv Biomed Res. 2017;6:20.