Acne scar treatment by Dr. wutinan sithipolvanichgul,MD

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-Can Laser skin resurfacing effectively treat facial atrophic acne scars?
-Review treatment of acne scar in resurfacing laser
-รักษาหลุมสิวด้วยเลเชอร์

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Acne scar treatment by Dr. wutinan sithipolvanichgul,MD

  1. 1. Can Laser skin resurfacing effectively treat facial atrophic acne scars? Wutinan Sithipolvanichgul, Thailand, MD University of Hertfordshire, United Kingdom
  2. 2. Patient history • Female 25 years old suffered from acne for 1 year + • Few comedones on cheeks • A mixture of acne scars, including ice pick scars, boxcar scarring and rolling scars on both cheeks . • Skin type IV • No past illness and no keloid lesions • Lack of self-confidence
  3. 3. Can laser skin resurfacing effectively treat facial atrophic acne scars? 1. Magnani LR & Schweiger ES,2013 2. M.W.S. Ong & S.J. Bashir, 2012 Fractional Co2 laser Ablative Resurfacing Laser 2. M.W.S. Ong & S.J. Bashir, Non2012 Ablative non Fractional Fractional non Fractional FP = Fractional photothermolysis FPS= Non-ablative 1550-nm erbium-doped fractional photothermolysis systems CO2 FS = 10 600-nm carbon dioxide fractional laser systems Er:YAG Co2 laser 3. Manuskiatti W et al, 2013 Er:glass 1550 or 1540 4. Lene Hedelund et al,2013 5. M.W.S. Ong et al, 2010
  4. 4. Evidence for use of selected treatment Author(s) Type of evidence e.g. RCT, guidelines Details of study or publication Key findings & conclusions Magnani LR, Schweiger ES. Systematic Review Fractional CO2 Lasers for Atrophic Acne Scars, Journal of Cosmetic Laser Therapy (2013) 2008-2013 20 studies: 18 Prospective, 2 Retrospective Fractional CO2 laser resurfacing is a safe and effective treatment for atrophic acne scar. M.W.S. Ong , S.J. Bashir Systematic Review, Fractional laser resurfacing for acne scars: a review, British Journal of Dermatology (2012 ) 2003-2011 26 studies: 4 RCT 13 ablative FP, 13 nonablative FP Ablative FP had an improvement range of 26– 83% in acne scar. Non ablative FP had an improvement range of 26–50%. “There are limitations for comparing results of treatments between ablative and nonablative FP lasers”. Manuskiatti W, Iamphonrat T, Wanitphakdeede cha R, Eimpunth S RCT, Comparison(Er:YAG) vs (fractional CO2) in Resurfacing of Atrophic Acne Scars , Dermatologic Surgery (2013) N = 24 , randomly allocated. No significant differences in scar volume at baseline between the Er:YAG and fractional CO2 laser. One side of face - 24 (Er:YAG) vs 24 (CO2). Fractional CO2 laser treatment approaches need more studies to be done using uniform treatment parameters and reporting in order 2nd treatment showed statistically significant improvements in scar volume over baseline at the Er:YAG (p < .01) and CO2 laser (p < .01) sites
  5. 5. Author(s) Type of evidence e.g. RCT, guidelines Details of study or publication Lene Hedelund, Karen Estell R. Moreau , Ditte M. Beye RCT, Fractional non ablative 1,540-nm laser resurfacing of atrophic acne scars, Lasers Medical Science (2010) N = 10. Tx group 10 vs Control group 10 Author(s) Key findings & conclusions Laser-treated scars appeared more even smooth than untreated control sites 1 of 2 areas of acne scars Significantly lower scar texture scores similar size and appearance were obtained at treated with the 1540 laser 4 weeks (4.5, IQR2.0–6.5; P=0.0156) Areas randomized to and 12 weeks (4.5,IQR 2.5–6.5; treatment Type of evidence or no treatment. study or after treatment & Details of P=0.0313) Key findings SB Cho, SJ Lee, S Cho, SH Oh, WS Chung, JM Kang, YK Kim, DH Kim RCT, Comparison N = 8: . Tx e.g. RCT, guidelinesby FPS 8 vs Tx by publication Er:glass FPS vs CO2 FS CO2 FS 8 Half of each for acne scars, Journal subject’s face treated with of the European FPS vs other half was Academy of treated with CO2 FS Dermatology and Venereology (2010) Clinical improvements observed in conclusions acne scars in FPS and CO2 FS groups Clinical improvement scores in acne scars between FPS-treated sites and CO2 FS-treated sites were not significantly different depending on the scar types (rolling, P = 0.346; icepick, P = 0.317; and boxcar, P = 0.15). Sherling M, Friedman PM, Adrian R, Burns AJ, Conn H, Fitzpatrick R, Gregory R, Kilmer S, Lask G, Narurkar V, Katz TM, Avram M et al. Consensus recommendations on use of an erbiumdoped 1,550-nm fractionated laser and applications in dermatologic laser surgery. Dermatologic surgery (2010). Concluded after reviewing 2 trails and using own clinical experience that FP improved acne scars by as much as 50% 2 clinical trials of acne scar included in recommendation Conclusions is largely based on the personal experiences of the aforementioned laser experts.
  6. 6. Review of evidence: clinical implications •It is possible that laser resurfacing seem to improve the acne scarring. A summary of the overall effectiveness of laser resurfacing in acne scar have the improvement over 26% from baseline. •However , overall the published evidence to support use of lase resurfacing is limited – – – – – – The various parameters studied differed in each study, Most studies did not have a control or comparison group There were only few split-face RCTs Few studies and each has a small sample size Rating scales for quantifying visual improvement are subjective and differed widely across studies Using difference types of lasers and parameter for treatment of acne scar •Therefore, the current evidence to support use of lase resurfacing for improving acne scarring is insufficient . These studies cannot conclude the general efficacy of laser (or any particular type of laser resurfacing treatment) to improve atrophic acne scarring and should not be recommended to patients .
  7. 7. Recommendations for clinical practice • However, if patient insists on treatment, I would recommend non-ablative fractional laser resurfacing – (M.W.S. Ong & S.J. Bashirl, 2012; SB Cho et al.,2010) . • Fractional laser resurfacing (Fraxel® SR1500™ ) treatment should consist of eight passes with a pulse energy of 40 mJ/cm2 at level 6 (17% coverage/cm2/pass). A series of four to five treatments each spaced 1 month apart(SB Cho et al.,2010). Adverse effects • – – – • nonablative FP laser experienced erythema for between 1 and 3 days and this resolved within a week post-therapy hyperpigmentation can occur about 10% of treated patient, which spontaneously resolved within 2 weeks. there are a few evidence support. Ablative FP laser experienced erythema for 3–14 days which resolved by 12 weeks- (M.W.S. Ong & S.J. Bashir,2012).
  8. 8. References A.F. Alexis.(2013). Lasers and light-based therapies in ethnic skin: treatment options and recommendations for Fitzpatrick skin types V and VI. British Journal of Dermatology.169(3), 91–97 Cho SB, Lee SJ, Cho S, Oh SH, Chung WS, Kang JM, Kim YK, Kim DH. (2010). Non-ablative 1550nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation. Journal of the European Academy of Dermatology and Venereology.24(8),921-5
  9. 9. References Hedelund L, Moreau KE, Beyer DM, Nymann P, Haedersdal M. (2010). Fractional nonablative 1,540-nm laser resurfacing of atrophic acne scars. A randomized controlled trial with blinded response evaluation. Lasers Medical Science . 25(5),749-54. Magnani LR, Schweiger ES. (2013). Fractional CO2 Lasers for the Treatment of Atrophic Acne Scars: A Review of the Literature. Journal of Cosmetic Laser Therapy. [Digital Editions version].(doi:10.3109/14764172.2013.854639)
  10. 10. References Manuskiatti W, Iamphonrat T, Wanitphakdeedecha R, Eimpunth S.(2013). Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians. Dermatologic surgery.39(1 Pt 1),111-20. M.W.S. Ong and S.J. Bashir.(2012). Fractional laser resurfacing for acne scars: a review. British Journal of Dermatology.166(6),1160–1169
  11. 11. References Sherling M, Friedman PM, Adrian R, Burns AJ, Conn H, Fitzpatrick R, Gregory R, Kilmer S, Lask G, Narurkar V, Katz TM, Avram M. (2010). Consensus recommendations on the use of an erbium-doped 1,550-nm fractionated laser and its applications in dermatologic laser surgery. Dermatologic surgery.36(4),461-9

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