CLINICAL REPORT
947 ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Combined Fractional Treatment of Acne Scars Involving Non-ablative 1,550-nm Erbium-glass Laser and Micro-needling Radiofrequency : A 16-week Prospective , Randomized Split-face Study
Hyuck Hoon KWON 1 , Hae Young PARK 1 , Sun Chul CHOI 1 , Youin BAE 2 , Jae Yoon JUNG 1 and Gyeong-Hun PARK 2
1
Oaro Dermatology Clinic , Seoul , 2 Department of Dermatology , Dongtan Sacred Heart Hospital , Hallym University College of Medicine , Hwaseong , Korea
An optimized therapeutic regimen involving a nonablative fractionated laser or radiofrequency therapy for acne scars has not yet been established . To evaluate whether the combination of a non-ablative fractional laser ( NAF ) and fractional micro-needling radiofrequency ( FMR ) has clinical advantages for the treatment of atrophic acne scars compared with NAF alone , a 16-week prospective , randomized split-face study was performed . Each facial side of a patient was treated with 3 sessions of either NAF with FMR or NAF alone , with a 4-week interval between each session . Although both sides demonstrated significant decreases in the échelle d ’ évaluation clinique des cicatrices d ’ acné ( ECCA ) score , the facial side treated using the combination regimen demonstrated greater improvement in ECCA score regarding degree and onset time than the NAF-treated side . Histopathological and immunohistochemical results confirmed the clinical findings . This study demonstrated that a combination regimen involving NAF and FMR could be a viable option with satisfactory efficacy .
Key words : acne scar ; fractional photothermolysis ; laser surgery ; radiofrequency .
Accepted May 16 , 2017 ; Epub ahead of print May 17 , 2017 Acta Derm Venereol 2017 ; 97 : 947 – 951 .
Corr : Gyeong-Hun Park , MD , PhD , Department of Dermatology , Dongtan Sacred Heart Hospital , Hallym University College of Medicine , 7 , Keunjaebong-gil , Hwaseong-si , Gyeonggi-do 18450 , Republic of Korea . E-mail : borelalgebra @ gmail . com and Jae Yoon Jung , MD , MS , Oaro Dermatology Clinic , 507 , Nohaero , Nowongu , Seoul 01695 , Republic of Korea . E-mail : jaeyoon007 @ hanmail . net
Facial atrophic acne scarring , a permanent sequelae of acne vulgaris , may be a socially disabling and psychologically devastating disease ( 1 , 2 ). Among a multitude of treatment options , recent application of various devices based on ‘ fractional photothermolysis ( FP ) technology ’ has brought remarkable advances and broadened therapeutic options ( 3 , 4 ). However , there are still no guidelines regarding the selection of fractional devices from the perspective of maximum efficacy and minimal downtime . Although ablative FP may be more efficacious in fewer treatments , patients tend to experience more downtime and a higher risk of various side effects including pain , pigmentation , scarring , and prolonged healing , especially in patients with darker skin ( 5 , 6 ).
In that sense , non-ablative fractional lasers ( NAF ) or radiofrequency ( RF ) devices have been actively applied to minimize treatment-related adverse effects ( 7 ). NAF such as a 1,550-nm erbium-glass fractional laser has been proven to deliver effective improvements to scarred skin with low complication rates ( 8 , 9 ). It results in shorter downtime than ablative lasers , and re-epithelialization is complete within one day ( 8 ). Fractional micro-needling radiofrequency ( FMR ) delivers bipolar RF directly to the dermis using an array of microneedles ( 10 ). FMR has been recently reported to improve skin laxity , wrinkles , and acne scarring ( 11 , 12 ). Given its association with epidermal preservation and a rapid recovery time , it has become popular recently .
Despite the advantages of non-ablative fractional devices , previous studies have rarely evaluated whether combination treatments involving these devices have advantageous effects from the perspective of efficacy and potential side effects for the treatment of acne scarring . In this study , we aimed to evaluate whether the sequential application of NAF and FMR has a synergistic effect on the efficacy and safety of atrophic acne scar treatments , as compared with conventional NAF alone during 3 consecutive sessions through a prospective , randomized split-face comparison study .
METHODS Study design and subjects
This study was conducted based on a 16-week , prospective , randomized split-face protocol that compared clinical and histological aspects between two facial sides either receiving sequential application of NAF and FMR or NAF alone for atrophic acne scar . It was carried out in accordance with the Declaration of Helsinki and approved by the Institutional Review Board . Informed consents were acquired from all subjects prior to enrollment . Treatments of each side were scheduled to receive 3 consecutive sessions at 4-week intervals , with a follow-up visit 8 weeks after the final third treatment . Twenty-eight Korean subjects ( 15 men and 13 women , aged 21 – 38 years , 15 Fitzpatrick skin type III and 13 type IV ) with atrophic and / or hypertrophic acne scars were enrolled . Participants whose échelle d ’ évaluation clinique des cicatrices d ’ acné ( ECCA ) score was higher than 50 were eligible for inclusion ( 13 ). A simple random allocation sequence was created using computer-based random number generators to assign the treatment modality of each side . Randomization codes were secured in a safe until all data analyses were finished . Two dermatologists evaluating the scar improvement were blinded
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2017 Acta Dermato-Venereologica . doi : 10.2340 / 00015555-2701 Acta Derm Venereol 2017 ; 97 : 947 – 951