Fractional carbon dioxide laser: Optimizing treatment outcomes for pigmented atrophic acne scars in skin of color

Abstract

Dark skin type has high propensity to acne scarring and is often complicated by persistent erythema or pigmentation at the base. Fractional lasers are available for the longest period and are able to improve most atrophic acne scars. Often pigmented scar bases and dark skin types limit the use of aggressive laser parameters. Long pulse mode is preferred over short pulse to prevent epidermal damage; low fluence is chosen versus high fluence and low density versus high density. Repeated treatments are needed to minimize complications and optimize results; all these must be achieved through a controlled stage of inflammation. Interventional priming with chemical peels and laser toning before ablative fractional carbon dioxide laser helps to reduce photodamage, recent tan, and pigment at scar base, thus minimizing the risk of post-inflammatory hyperpigmentation. Multiple recent literature evidence validates the combinations to optimize outcomes in atrophic acne scars as discussed in this review article.

A comparative clinical and histopathological pilot study of different fractional CO2 laser parameters in treatment of atrophic linear scars

“…Thermal injury generates coagulation and denaturation of collagen and re-epithelialization ensues. 5 Fractional CO 2 laser resurfacing has been successfully used in the treatment of atrophic acne scars and for skin rejuvenation. There are also some reports of its usefulness in hypertrophic as well as burn scars 6. Very few studies assessed fractional CO 2 laser in treatment of post-traumatic linear scars besides they were studied as part of different types of atrophic scarring.…”

“…MTZs formed are variable according to the fluence used and the depth of penetration achieved. Thermal injury generates coagulation and denaturation of collagen and re‐epithelialization ensues 5 . Fractional CO 2 laser resurfacing has been successfully used in the treatment of atrophic acne scars and for skin rejuvenation.…”

Application effect of lattice laser in facial rejuvenation

“…However, the tissue cells outside the heat loss area are not damaged and can be quickly repaired by cell migration. [ 12 – 13 ] So as to achieve the purpose of skin tightening, removing aging skin, and removing skin pigment spots. Generally speaking, the epithelium of the area treated by the lattice laser can be completely recovered within 24 hours, so that the risk of skin infection is low, and the erythema period of the skin is also shortened.…”

Pre-Emptive Priming of Human Skin Improves Cutaneous Scarring and Is Superior to Immediate and Delayed Topical Anti-Scarring Treatment Post-Wounding: A Double-Blind Randomised Placebo-Controlled Clinical Trial

“…There have been a lack of studies using these modalities for the prevention of scarring prior to injury, however, in vitro studies have demonstrated transdermal patches have the potential to inhibit hypertrophic scar formation [ 7 , 8 , 9 ]. Some recent studies support the concept of priming the skin prior to an invasive intervention for achieving an optimal result [ 10 , 11 , 12 , 13 , 14 , 15 ]. However, the concept of pre-emptively priming the skin prior to surgically induced injury has not been thoroughly evaluated.…”