Ablative Fractional Resurfacing Appears Effective for Acne Scars in Asians

Ablative fractional resurfacing appears to be safe and effective in Asians with mild to moderate atrophic acne scarring, according to a study of 13 patients.

While 12 of the 13 patients experienced some postinflammatory hyperpigmentation, this resolved in all patients in an average of 5 weeks.

The Asian patients underwent three sessions of ablative fractional resurfacing (AFR) with the Ellipse Juvia 15-W CO2 laser, wrote Dr. Woraphong Manuskiatti and colleagues of Mahidol University, Bangkok. All patients had skin phototype IV. Intervals between treatments averaged 7 weeks. All patients were followed for 6 months after the third treatment.

Independent physicians blinded to the order in which clinical photos had been taken judged the improvement in scarring to be excellent in 8% of the patients, good in 38.5% of them, fair in 38.5%, and slight in 15%. None of the patients worsened (J. Am. Acad. Dermatol. 2010;63:274-83).

By the patients’ own evaluations, 46% judged their overall improvement to be fair, 23% judged it to be good, and 31% judged it to be excellent. In both physician and patient evaluations, “slight” was defined as less than 25% improvement, “fair” as 25%-50% improvement, good as 51%-75% improvement, and excellent as 76%-100% improvement.

Postinflammatory hyperpigmentation (PIH) was the most common side effect, seen in 12 of the 13 (92%) patients and after 20 of the 39 (51%) treatment sessions. All cases of PIH were graded as mild except for one that was graded as moderate. After treatment with 4% hydroquinone cream once daily, PIH resolved in all patients within 2-16 weeks (average 5 weeks).

Other adverse events were acneiform eruptions in four patients, allergic contact dermatitis in two patients, and herpes simplex infection in one patient.

Each treatment consisted of a full-face single-pass treatment with a 5-7 ms pulse width. Investigators adjusted the laser to deliver 49 microthermal zones (MTZs) per square centimeter, with each individual MTZ 500 mcm in diameter. The average percent coverage was 9.6%, and the investigators set the laser to deliver energies between 75-105 mJ/MTZ depending on the severity of scarring.

Although physicians prepared the patients for 1 hour before each treatment with a topical anesthetic applied to the full face with occlusion, on average patients rated their pain as 8.1 on a scale of 1-10. Pain scores tended to decrease for the second and third treatments.

The investigators described AFR as offering a treatment alternative midway between nonablative fractional resurfacing (NAFR) and fractional photothermolysis (FP). “Although NAFR has a patient-friendly advantage,” the investigators wrote, “the outcomes of most NAFR lasers still leave much to be desired in the treatment of photodamaged skin, rhytides, and atrophic scars. ... By depositing a pixelated pattern of microscopic ablative wounds surrounded by healthy tissue in a manner similar to that of [the] NAFR method, AFR combines the increased efficacy of ablative techniques with the safety and reduced downtime associated with FP.”

The investigators declared that they had no conflicts of interest. The study was supported by a research grant from Ellipse A/S, which manufactures the laser used in the study.

Ablative fractional resurfacing appears to be safe and effective in Asians with mild to moderate atrophic acne scarring, according to a study of 13 patients.

While 12 of the 13 patients experienced some postinflammatory hyperpigmentation, this resolved in all patients in an average of 5 weeks.

The Asian patients underwent three sessions of ablative fractional resurfacing (AFR) with the Ellipse Juvia 15-W CO2 laser, wrote Dr. Woraphong Manuskiatti and colleagues of Mahidol University, Bangkok. All patients had skin phototype IV. Intervals between treatments averaged 7 weeks. All patients were followed for 6 months after the third treatment.

Independent physicians blinded to the order in which clinical photos had been taken judged the improvement in scarring to be excellent in 8% of the patients, good in 38.5% of them, fair in 38.5%, and slight in 15%. None of the patients worsened (J. Am. Acad. Dermatol. 2010;63:274-83).

By the patients’ own evaluations, 46% judged their overall improvement to be fair, 23% judged it to be good, and 31% judged it to be excellent. In both physician and patient evaluations, “slight” was defined as less than 25% improvement, “fair” as 25%-50% improvement, good as 51%-75% improvement, and excellent as 76%-100% improvement.

Postinflammatory hyperpigmentation (PIH) was the most common side effect, seen in 12 of the 13 (92%) patients and after 20 of the 39 (51%) treatment sessions. All cases of PIH were graded as mild except for one that was graded as moderate. After treatment with 4% hydroquinone cream once daily, PIH resolved in all patients within 2-16 weeks (average 5 weeks).

Other adverse events were acneiform eruptions in four patients, allergic contact dermatitis in two patients, and herpes simplex infection in one patient.

Each treatment consisted of a full-face single-pass treatment with a 5-7 ms pulse width. Investigators adjusted the laser to deliver 49 microthermal zones (MTZs) per square centimeter, with each individual MTZ 500 mcm in diameter. The average percent coverage was 9.6%, and the investigators set the laser to deliver energies between 75-105 mJ/MTZ depending on the severity of scarring.

Although physicians prepared the patients for 1 hour before each treatment with a topical anesthetic applied to the full face with occlusion, on average patients rated their pain as 8.1 on a scale of 1-10. Pain scores tended to decrease for the second and third treatments.

The investigators described AFR as offering a treatment alternative midway between nonablative fractional resurfacing (NAFR) and fractional photothermolysis (FP). “Although NAFR has a patient-friendly advantage,” the investigators wrote, “the outcomes of most NAFR lasers still leave much to be desired in the treatment of photodamaged skin, rhytides, and atrophic scars. ... By depositing a pixelated pattern of microscopic ablative wounds surrounded by healthy tissue in a manner similar to that of [the] NAFR method, AFR combines the increased efficacy of ablative techniques with the safety and reduced downtime associated with FP.”

The investigators declared that they had no conflicts of interest. The study was supported by a research grant from Ellipse A/S, which manufactures the laser used in the study.

Ablative fractional resurfacing appears to be safe and effective in Asians with mild to moderate atrophic acne scarring, according to a study of 13 patients.

While 12 of the 13 patients experienced some postinflammatory hyperpigmentation, this resolved in all patients in an average of 5 weeks.

The Asian patients underwent three sessions of ablative fractional resurfacing (AFR) with the Ellipse Juvia 15-W CO2 laser, wrote Dr. Woraphong Manuskiatti and colleagues of Mahidol University, Bangkok. All patients had skin phototype IV. Intervals between treatments averaged 7 weeks. All patients were followed for 6 months after the third treatment.

Independent physicians blinded to the order in which clinical photos had been taken judged the improvement in scarring to be excellent in 8% of the patients, good in 38.5% of them, fair in 38.5%, and slight in 15%. None of the patients worsened (J. Am. Acad. Dermatol. 2010;63:274-83).

By the patients’ own evaluations, 46% judged their overall improvement to be fair, 23% judged it to be good, and 31% judged it to be excellent. In both physician and patient evaluations, “slight” was defined as less than 25% improvement, “fair” as 25%-50% improvement, good as 51%-75% improvement, and excellent as 76%-100% improvement.

Postinflammatory hyperpigmentation (PIH) was the most common side effect, seen in 12 of the 13 (92%) patients and after 20 of the 39 (51%) treatment sessions. All cases of PIH were graded as mild except for one that was graded as moderate. After treatment with 4% hydroquinone cream once daily, PIH resolved in all patients within 2-16 weeks (average 5 weeks).

Other adverse events were acneiform eruptions in four patients, allergic contact dermatitis in two patients, and herpes simplex infection in one patient.

Each treatment consisted of a full-face single-pass treatment with a 5-7 ms pulse width. Investigators adjusted the laser to deliver 49 microthermal zones (MTZs) per square centimeter, with each individual MTZ 500 mcm in diameter. The average percent coverage was 9.6%, and the investigators set the laser to deliver energies between 75-105 mJ/MTZ depending on the severity of scarring.

Although physicians prepared the patients for 1 hour before each treatment with a topical anesthetic applied to the full face with occlusion, on average patients rated their pain as 8.1 on a scale of 1-10. Pain scores tended to decrease for the second and third treatments.

The investigators described AFR as offering a treatment alternative midway between nonablative fractional resurfacing (NAFR) and fractional photothermolysis (FP). “Although NAFR has a patient-friendly advantage,” the investigators wrote, “the outcomes of most NAFR lasers still leave much to be desired in the treatment of photodamaged skin, rhytides, and atrophic scars. ... By depositing a pixelated pattern of microscopic ablative wounds surrounded by healthy tissue in a manner similar to that of [the] NAFR method, AFR combines the increased efficacy of ablative techniques with the safety and reduced downtime associated with FP.”

The investigators declared that they had no conflicts of interest. The study was supported by a research grant from Ellipse A/S, which manufactures the laser used in the study.