MIAMI Nonablative fractional resurfacing with an erbium-doped 1,550-nm laser device can safely and effectively improve acne scarring among patients with skin types IV-VI, Dr. Wendy E. Roberts said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.
"Treatment of acne scars with ablative lasers in skin types IV-VI has been limited because of hypopigmentation and depigmentation risks," she said. This significant risk of hypopigmentation, in particular, has limited laser resurfacing for distensible and nondistensible acne scars in skin types other than I-III.
In search of better results, researchers assessed nonablative fractional photothermolysis in 40 patients with skin types IV through VI. Dr. Roberts presented the findings on behalf of the lead investigator, Dr. Vic A. Narurkar, a dermatologist in San Francisco who was unable to attend the meeting.
"This study was motivated by the fact that most laser and light-based technologies are risky in skin types IV-VI, especially for hypopigmentation. And if they are safe, they are generally ineffective," Dr. Narurkar said in a follow-up interview.
Dr. Narurkar and his associates, Dr. Joely Kaufman and Dr. Zakia Rahman, enrolled patients with moderate to severe acne scarring from three clinical sites. Presentations included distensible, nondistensible, ice pick, and box-type scars. Participants were treated with an erbium-doped 1,550-nm Fraxel laser (Reliant Technologies) at 4- to 6-week intervals.
"Resurfacing, particularly for acne scars, has, until the development of the Fraxel laser, not been a viable option for darker skin with traditional lasers," said Dr. Narurkar, who is a consultant for Reliant. Dr. Roberts reported no conflict of interest related to the company.
A nontreating physician scored photographs taken at baseline and at 6 months or longer after completion of the three to five treatment sessions. Every participant showed some improvement, so there were no patients classified as grade 0 (no improvement). Six percent were grade 1 (up to 25% improvement); 34% were grade 2 (26%-50%); 42% were grade 3 (51%-75%); and 18% were grade 4 (76% or greater).
"The majority of patients showed a 50% or greater improvement in acne scars," said Dr. Roberts, a dermatologist in Rancho Mirage, Calif., who also is with the department of medicine at Loma Linda (Calif.) University Medical Center.
Because of the risk of adverse events, use of nonablative fractional resurfacing can be more challenging for patients with ethnic skin. "You really have to not know what you are doing with this to cause any damage in skin types I-III. But it does get tricky in skin types IV-VI. If your laser settings are not conservative, you can get edema and postinflammatory hyperpigmentation," Dr. Roberts said at the meeting, which was also sponsored by Howard University.
In the study, 22% of patients experienced transient postinflammatory hyperpigmentation (PIH) and 28% had acne flares. "We can work through the flares and treat the PIH," Dr. Roberts said. "There was no hypopigmentation, which is quite remarkable."
"We were most impressed with the fact that there were no permanent adverse effects, and even the postinflammatory hyperpigmentation eventually resolved," Dr. Narurkar said. "Future studies include the use of pre- and posttreatment regimens for Fraxel to speed up the recovery and reduce both PIH and acne flares."
A patient is shown at baseline (left) and after undergoing five treatments with an erbium-doped 1,550-nm laser. Photos courtesy Dr. Zakia Rahman