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