A Systematic Review of Laser Resurfacing for Acne Scars

Aim: To investigate the effectiveness of ablative and non-ablative Fractional Photothermolysis (FP) lasers for treating facial acne scars. Method: A systematic literature search was performed using Boolean search method. This yielded 629 papers (PubMed= 250; Scopus= 370). 201 duplicates were removed. Of remaining 428 papers, 26 studies (13=ablative FP; 13=non-ablative FP) were selected using inclusion and exclusion criteria. Outcomes included subjective and objective assessment of scar appearance, pre and postoperative treatment, side effects, pain scores and patient satisfaction levels. Results: Patients treated with either ablative or non-ablative FP experience a clinical improvement in scarring with histological evidence of new collagen and elastin formation in the upper and mid dermis. Clinical assessment showed an improvement range of 26-83% and 26-50% in ablative FP versus non-ablative FP respectively. 3D Optical Profiling Imaging showed significant improvement of skin surface smoothness and scar volume after 1-month of treatment but no further improvement at 3and 6-months in ablative FP. Similarly, a 2-year clinical assessment follow-up study on ablative FP shows no further improvement of scar appearance after 3 months. Patients who undergo ablative FP laser experience erythema for 3-14 days which resolves by 12 weeks. Patients who opt for the non-ablative FP laser experience erythema between 1-3 days and this resolves within a week. A higher proportion of patients (up to 92.3%) who undertake ablative FP experience post-inflammatory hyperpigmentation (PIH) than those who have non-ablative FP (up to 13%). The maximum duration of PIH in ablative FP is up to 6 months whereas PIH in non-ablative FP lasts up to 1 week. A single case of herpes simplex was identified in ablative FP. Ablative FP procedure can be more uncomfortable in comparison to non-ablative FP. Ablative pain score range from 5.90-8.10 (scale 1-10) and the non-ablative FP pain score range from 3.90-5.66 (scale 1-10). The percentage scar improvement for non-ablative FP depends on the number of treatments administered. Conclusions: Ablative FP may be more efficacious in fewer treatments. However, patients experience longer down time and higher risk of getting PIH. This is also a relatively painful procedure in comparison to non-ablative FP. Conflict of Interest: None A Systematic Review of Laser Resurfacing for Acne Scars Michal Wen Sheue Ong and Dr. Saqib J Bashir. King’s College London. Aim To investigate the effectiveness of ablative and non-ablative Fractional Photothermolysis (FP) lasers for treating facial acne scars. Methods A systematic literature search was performed using Boolean search method. This yielded 629 papers (PubMed= 250; Scopus= 370). 201 duplicates were removed. Of remaining 428 papers, 26 studies (13=ablative FP; 13=non-ablative FP) were selected using inclusion and exclusion criteria. Outcomes included subjective and objective assessment of scar appearance, pre and postoperative treatment, side effects, pain scores and patient satisfaction levels. A Systematic Review of Laser Resurfacing for Acne Scars Michal Wen Sheue Ong and Dr. Saqib J Bashir. King’s College London. Inclusion and Exclusion Criteria Studies reported on “acne scars” and “fractional photothermolysis” were included. Studies published between year-2003 to January 2011 were included in this review because this technology was only first introduced in 2003. Only human studies and English language articles were included. Case reports were excluded because this tends to overestimate the effects of treatment. Subjects with other skin conditions or scar types (e.g. hypertrophic, surgical scars) were excluded. Studies which did not state the overall improvement for acne scars, side effects or histological/ 3D optical profiling analysis were excluded. All quantitative and qualitative data from each article meeting structured review framework were examined carefully for analysable variables and entered into a spreadsheet. Completeness, quality and ambiguity of information was a primary criteria for inclusion, as where methodological similarities in trials. A Systematic Review of Laser Resurfacing for Acne Scars Michal Wen Sheue Ong and Dr. Saqib J Bashir. King’s College London. Pre and Post-operative Treatments Ablative FP Non-Ablative FP Pre-op Treatments Topical anaesthetic cream (2.5% lidocaine hydrochloric acid and 2.5% prilocaine) Facial nerve blocks (1% lidocaine plus epinephrine) Analgesics Sedative medications Not necessary Could use topical anaesthetic cream Post-op Treatments Antiviral Antibiotic Avoid sun exposure Use sun screen 10mg prednisolone Mild cleanser Non-comedogenic moisturising cream (Antiviral) (Antibiotic) Avoid sun exposure Use sun screen (10mg prednisolone) Mild cleanser Non-comedogenic moisturising cream A Systematic Review of Laser Resurfacing for Acne Scars Michal Wen Sheue Ong and Dr. Saqib J Bashir. King’s College London. Results : Improvement Range Ablative FP Non-ablative FP 26 83% 0 100% 26 50% Patients treated with either ablative or non-ablative FP experience a clinical improvement in scarring with histological evidence of new collagen and elastin formation in the upper and mid dermis. Clinical assessment showed an improvement range of 26-83% and 26-50% in ablative FP versus nonablative FP respectively. 3D Optical Profiling Imaging showed significant improvement of skin surface smoothness and scar volume after 1-month of treatment but no further improvement at 3and 6-months in ablative FP. Similarly, a 2-year clinical assessment follow-up study on ablative FP shows no further improvement of scar appearance after 3 months. The percentage scar improvement for non-ablative FP depends on the number of treatments administered. A Systematic Review of Laser Resurfacing for Acne Scars Michal Wen Sheue Ong and Dr. Saqib J Bashir. King’s College London.