Fractional ablative CO₂ laser and oral isotretinoin—A prospective randomized controlled split‐face trial comparing concurrent versus delayed laser treatment for acne scars

Abstract

BackgroundTherapeutic dogma has been to treat acne scars with ablative fractional laser no less than 6 months after isotretinoin (ITN) cessation.ObjectiveTo evaluate the safety and efficacy of fractional ablative CO2 laser (FACL) in patients treated concurrently with ITN.MethodsWe conducted a prospective split‐face randomized control trial in patients treated with FACL concurrently with ITN versus patients treated with FACL 6 months post‐ITN treatment. Patients received 3 monthly sessions of FACL with concurrent ITN treatment on half of the face; the other side of the face received the same FACL treatment regimen 6 months post‐ITN cessation. Patients were followed for adverse effects up to 6 months post‐FACL treatment. Final cosmesis was scored using the Quantitative Global Acne Scarring Grading System (GASGS) by three independent dermatologists.ResultsThe GASGS of the concurrent ITN‐FACL treated side of the face was significantly lower than the side treated with delayed laser therapy (4.7 ± 2.5 vs. 7.7 ± 2.9, respectively, p < 0.001).LimitationsThe laser's settings were standardized, and not adjusted per patient skin type.ConclusionPer our prospective trial, concurrent treatment of FACL ‐ITN is superior to delayed FACL treatment 6 months post‐ITN cessation.Fractional ablative laser treatment is effective in improving acne scars, which persist despite isotretinoin therapy.

Fractional Radiofrequency and Oral Isotretinoin—A Prospective Randomized Controlled Split‐Face Trial Comparing Concurrent Versus Delayed Fractional Radiofrequency Treatment for Acne Scars

“…Similarly, Hasan et al evaluated RF microneedling and ITN versus ITN alone in the treatment of acne and determined that combination therapy is not only safe and effective but yields a quicker response with less scarring and a reduced risk for recurrence [29]. Lastly, two of the authors of our current paper have previously published research confirming the safety and efficacy of fractional ablative CO 2 laser and oral ITN when used concurrently for the treatment of acne and acne scars [30].…”

Introduction to the 2024 special dermatology plastic surgery issue

“…Authors note no difference in adverse events (including no hypertrophic scars or keloids), raising the question as to whether combination therapy is not only more effective, but safer than previously thought. 2 Remaining in the realm of scars, we present two studies that explore solutions to improve treatment tolerability while maintaining efficacy. Using a patientfriendly alternative to needle injection, Bekkers et al treat 15 patients with >148 recalcitrant keloids with bleomycin and lidocaine delivered intralesionally by electronic pneumatic injection, reporting significantly less pain compared to regular needle injection in addition to clinical improvement.…”