Acne vulgaris is an inflammatory disease of the pilosebaceous unit in teenagers. Acne-induced inflammation leads to acne scarring. Scholars have discussed acne scar treatments; however, energy-based devices with satisfactory outcomes remain unidentified.
Objective:
To measure quartile grading scale and visual analog scale (VAS) to study the difference between energy-based devices.
Methods:
We included randomized controlled trials that evaluated patients with acne scars. The primary outcomes were the quartile grading scale and VAS scores. We used Confidence in Network Meta-Analysis to evaluate indirectness, imprecision, heterogeneity, and incoherence.
Results:
A total of 26 studies met the inclusion criteria. The quartile grading scale results revealed that ablative fractional laser was significantly more effective than nonablative fractional laser (standard mean difference [SMD]: 0.516, confidence interval [95% CI]: 0.281–0.750) and radiofrequency treatment (SMD: 0.941, 95% CI: 0.540–1.342). Moreover, nonablative fractional laser was significantly more effective than radiofrequency treatment (SMD: 0.426, 95% CI: 0.049–0.802). No significant difference in VAS score was found among the devices.
Conclusion:
Ablative fractional laser is an effective treatment for acne scars although it is associated with more pain.
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References
1.
SalamehF, ShumakerPR, GoodmanGJ, et al.Energy-based devices for the treatment of Acne Scars: 2022 International consensus recommendations. Lasers Surg Med. 2022; 54(1):10–26.
2.
HollandDB, JeremyAH, RobertsSG, et al.Inflammation in acne scarring: a comparison of the responses in lesions from patients prone and not prone to scar. Br J Dermatol. 2004; 150(1):72–81.
3.
WerschlerWP, HerdenerRS, RossVE, et al.Critical considerations on optimizing topical corticosteroid therapy. J Clin Aesthet Dermatol. 2015; 8(8Suppl):S2–S8.
4.
ChayavichitsilpP, LimtongP, TriyangkulsriK, et al.Comparison of fractional neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064-nm picosecond laser and fractional 1550-nm erbium fiber laser in facial acne scar treatment. Lasers Med Sci. 2020; 35(3):695–700.
5.
Basta-JuzbašićA. Current therapeutic approach to acne scars. Acta Dermatovenerol Croat. 2010; 18(3):171–175.
6.
BhargavaS, CunhaPR, LeeJ, et al.Acne scarring management: systematic review and evaluation of the evidence. Am J Clin Dermatol. 2018; 19(4):459–477.
7.
KravvasG, Al-NiaimiF. A systematic review of treatments for acne scarring. Part 2: energy-based techniques. Scars Burn Health. 2018; 4:2059513118793420.
8.
BrittCJ, MarcusB. Energy-based facial rejuvenation: advances in diagnosis and treatment. JAMA Facial Plast Surg. 2017; 19(1):64–71.
9.
SadickNS, CardonaA. Laser treatment for facial acne scars: a review. J Cosmet Laser Ther. 2018; 20(7–8):424–435.
10.
ModenaDAO, MirandaACG, GreccoC, et al.Efficacy, safety, and guidelines of application of the fractional ablative laser erbium YAG 2940nm and non-ablative laser erbium glass in rejuvenation, skin spots, and acne in different skin phototypes: a systematic review. Lasers Med Sci. 2020; 35(9):1877–1888.
11.
MirzaHN, MirzaFN, KhatriKA. Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: a systematic review of 1093 patients. Dermatol Ther. 2021; 34(1):e14432.
12.
DaiR, XieH, HuaW, et al.The efficacy and safety of the fractional radiofrequency technique for the treatment of atrophic acne scar in Asians: a meta-analysis. J Cosmet Laser Ther. 2017; 19(6):337–344.
13.
AnsariF, Sadeghi-GhyassiF, YaaghoobianB. The clinical effectiveness and cost-effectiveness of fractional CO(2) laser in acne scars and skin rejuvenation: a meta-analysis and economic evaluation. J Cosmet Laser Ther. 2018; 20(4):248–251.
14.
HuttonB, SalantiG, CaldwellDM, et al.The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015; 162(11):777–784.
15.
SterneJAC, SavovićJ, PageMJ, et al.RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898.
16.
NikolakopoulouA, HigginsJPT, PapakonstantinouT, et al.CINeMA: an approach for assessing confidence in the results of a network meta-analysis. PLoS Med. 2020; 17(4):e1003082.
17.
AsilianA, SalimiE, FaghihiG, et al.Comparison of Q-Switched 1064-nm Nd: YAG laser and fractional CO2 laser efficacies on improvement of atrophic facial acne scar. J Res Med Sci. 2011; 16(9):1189–1195.
18.
ChengX, YangQ, SuY, et al.Comparison of 1565-nm nonablative fractional laser and 10600-nm ablative fractional laser in the treatment of mild to moderate atrophic acne scars. Dermatol Surg. 2021; 47(3):392–396.
19.
ChoSB, LeeSJ, ChoS, et al.Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation. J Eur Acad Dermatol Venereol. 2010; 24(8):921–925.
20.
Al-DhalimiMA, DahhamZ. Split-face clinical comparative study of fractional Er:YAG (2940nm) laser versus long pulsed Nd:YAG (1064nm) laser in treatment of atrophic acne scar. J Cosmet Laser Ther. 2021; 23(1–2):35–40.
21.
ElsaieML, IbrahimSM, SaudiW. Ablative fractional 10 600nm carbon dioxide laser versus non-ablative fractional 1540nm erbium-glass laser in Egyptian post-acne scar patients. J Lasers Med Sci. 2018; 9(1):32–35.
22.
ChaeWS, SeongJY, JungHN, et al.Comparative study on efficacy and safety of 1550nm Er:Glass fractional laser and fractional radiofrequency microneedle device for facial atrophic acne scar. J Cosmet Dermatol. 2015; 14(2):100–106.
23.
RongsaardN, RummaneethornP. Comparison of a fractional bipolar radiofrequency device and a fractional erbium-doped glass 1,550-nm device for the treatment of atrophic acne scars: a randomized split-face clinical study. Dermatol Surg. 2014; 40(1):14–21.
24.
Al-SultanyH. A comparative study of the efficacy of fractional CO2 laser versus micro needling fractional radiofrequency in the management of atrophic acne scars among IRAQI patients. Ann Trop Med Public Health. 2020; 23. doi: 10.36295/ASRO.2020.231816
25.
LuK, CaiS. Efficacy and safety comparison between 1927nm thulium laser and 2940nm Er:YAG laser in the treatment of facial atrophic acne scarring: a prospective, simultaneous spilt-face clinical trial. Lasers Med Sci. 2022; 37(3):2025–2031. doi: 10.1007/s10103-021-03465-0.
26.
ShiY, JiangW, LiW, et al.Comparison of fractionated frequency-doubled 1,064/532nm picosecond Nd:YAG lasers and non-ablative fractional 1,540nm Er: glass in the treatment of facial atrophic scars: a randomized, split-face, double-blind trial. Ann Transl Med. 2021; 9(10):862.
27.
SirithanabadeekulP, TantrapornpongP, RattakulB, et al.Comparison of fractional picosecond 1064-nm laser and fractional carbon dioxide laser for treating atrophic acne scars: a randomized split-face trial. Dermatol Surg. 2021; 47(2):e58–e65.
28.
EmamAAM, NadaHA, AtwaMA, et al.Split-face comparative study of fractional Er:YAG laser versus microneedling radiofrequency in treatment of atrophic acne scars, using optical coherence tomography for assessment. J Cosmet Dermatol. 2022; 21(1):227–236.
29.
ZhangZ, FeiY, ChenX, et al.Comparison of a fractional microplasma radio frequency technology and carbon dioxide fractional laser for the treatment of atrophic acne scars: a randomized split-face clinical study. Dermatol Surg. 2013; 39(4):559–566.
30.
LeeDH, ChoiYS, MinSU, et al.Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: a randomized split-face clinical study. J Am Acad Dermatol. 2009; 60(5):801–807.
31.
MinS, ParkSY, MoonJ, et al.Comparison between Er:YAG laser and bipolar radiofrequency combined with infrared diode laser for the treatment of acne scars: differential expression of fibrogenetic biomolecules may be associated with differences in efficacy between ablative and non-ablative laser treatment. Lasers Surg Med. 2017; 49(4):341–347.
32.
WenX, LiY, HamblinMR, et al.A randomized split-face, investigator-blinded study of a picosecond Alexandrite laser for post-inflammatory erythema and acne scars. Dermatol Ther. 2020; 33(6):e13941.
33.
YangQ, HuangW, QianH, et al.Efficacy and safety of 1550-nm fractional laser in the treatment of acne scars in Chinese patients: a split-face comparative study. J Cosmet Laser Ther. 2016; 18(6):312–316.
34.
KwonHH, ParkHY, ChoiSC, et al.Novel device-based acne treatments: comparison of a 1450-nm diode laser and microneedling radiofrequency on mild-to-moderate acne vulgaris and seborrhoea in Korean patients through a 20-week prospective, randomized, split-face study. J Eur Acad Dermatol Venereol. 2018; 32(4):639–644.
35.
DaiYX, ChuangYY, ChenPY, et al.Efficacy and safety of ablative resurfacing with a high-energy 1,064 Nd-YAG picosecond-domain laser for the treatment of facial acne scars in Asians. Lasers Surg Med. 2020; 52(5):389–395.
36.
AlsterTS, McMeekinTO. Improvement of facial acne scars by the 585nm flashlamp-pumped pulsed dye laser. J Am Acad Dermatol. 1996; 35(1):79–81.
37.
MinSU, ChoiYS, LeeDH, et al.Comparison of a long-pulse Nd:YAG laser and a combined 585/1,064-nm laser for the treatment of acne scars: a randomized split-face clinical study. Dermatol Surg. 2009; 35(11):1720–1727.
38.
AshC, DubecM, DonneK, et al.Effect of wavelength and beam width on penetration in light-tissue interaction using computational methods. Lasers Med Sci. 2017; 32(8):1909–1918.
39.
ConnollyD, VuHL, MariwallaK, et al.Acne scarring-pathogenesis, evaluation, and treatment options. J Clin Aesthet Dermatol. 2017; 10(9):12–23.
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