Ultrapulse CO2 Laser Therapy Shows Promise for Chronic Acne Conglobata Sequelae

Ultrapulse fractional carbon dioxide (CO2) laser therapy may offer a minimally invasive approach for treating chronic structural lesions that develop after acne conglobata (AC), according to a retrospective case series.¹ The treatment was associated with clinical improvement, high patient satisfaction, no observed complications, and no recurrence of treated lesions during a median follow-up of 11 months.

Background

AC is a severe, recurrent inflammatory form of acne that can cause extensive scarring and persistent structural abnormalities, including sinus tracts, chronic abscesses, and epithelialized “skin bridges.” These lesions can cause pain, infection, and substantial cosmetic and psychosocial effects. Traditional approaches, including incision and drainage, deroofing, and surgical excision, may involve greater tissue trauma, prolonged healing, new scar formation, and recurrence. Extensive facial lesions may also require reconstructive procedures.²

Methods and Materials

The study evaluated 13 patients with AC who underwent ultrapulse fractional CO2 laser therapy between January 2022 and January 2026. The median patient age was 28 years, and the median duration of AC was 7 years. Nine patients were male, and 4 were female. Treatment focused on chronic structural sequelae rather than active inflammatory AC. Patients with uncontrolled acute inflammation, rapidly progressive infection, or lesions requiring urgent drainage were excluded.

In total, the investigators treated 301 skin bridges, 51 sinus tracts, and 8 chronic abscesses. Procedures were performed in an outpatient setting under local anesthesia. Using blunt-tipped tweezers to explore the lesions, the CO2 laser was used to open sinus tracts and abscesses and vaporize their roofs. Skin bridges were directly transected and removed. Rather than completely excising lesions through the subcutaneous fat, the technique was designed to remove overlapping epidermis while exposing the underlying normal epidermis.

Results

The median pain score during treatment was 4 on a visual analog scale, which the study characterized as mild and controllable. Median wound healing time was 22 days. No relevant complications, including bleeding, infection, hyperpigmentation, or scar hyperplasia, were observed. All 13 patients completed follow-up, which had a median duration of 11 months, with a range of 2.5 to 23 months.

No recurrence of treated structural lesions was observed during follow-up. All patients rated their satisfaction with treatment as 5, corresponding to excellent. In a blinded photographic assessment conducted by 2 independent observers, the median Global Improvement Score was 3, indicating marked improvement. The investigators reported that both observers noted clinical improvement, with most patients achieving marked improvement.

The authors proposed that the laser's ablative and thermal effects allow precise removal of pathological tissue while limiting damage to surrounding normal tissue. The approach was intended to excise skin bridges, open closed sinus tracts, relieve structural occlusion, and facilitate drainage and subsequent tissue repair. The authors also described potential sterilizing, anti-inflammatory, and dermal remodeling effects associated with the laser.

Conclusion

The study has several limitations. The retrospective design, small sample size, lack of standardized objective outcome measures and quality-of-life assessments, and relatively short follow-up limit conclusions about long-term efficacy and durability. The treatment is also intended primarily for chronic structural lesions rather than acute infectious abscesses, and pharmacologic treatment may be necessary for patients with active infection. Residual textural irregularities, pigmentation, fine lines, or deep depressions may require additional procedures.

The authors concluded that ultrapulse CO2 laser therapy may be a feasible minimally invasive option for chronic structural AC sequelae, while emphasizing the need for larger prospective studies with longer follow-up and standardized outcome measures.

References

1. Xu Y, Yang M, Zhang Y, Wang L. Ultrapulse Carbon Dioxide Laser in the Treatment of Secondary Scar Lesions of Acne Conglobata: A Novel, Minimally Invasive Method. J Cosmet Dermatol. 2 5, no. 8 (2026): e71144, doi:10.1111/jocd.71144.

2. Meyers SW, Bercovitch L, Polley K, et al. Massive exophytic abscesses and fibrotic masses of the chin: a variant of the follicular occlusion triad. J Am Acad Dermatol. 2003;48(5 Suppl):S47-S50. doi:10.1067/mjd.2003.145