Shedding Light on Acne Scars: A Comprehensive Review of CO2 vs. Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser Therapy

Abstract

Acne scars pose a significant cosmetic concern and can have a profound impact on individuals' self-esteem and quality of life. Laser therapy has emerged as a promising treatment modality for improving the appearance of acne scars by promoting collagen remodeling and tissue regeneration. This comprehensive review compares two commonly used laser modalities, CO2 and erbium-doped yttrium aluminum garnet (Er:YAG), focusing on their mechanisms of action, efficacy, safety profiles, and patient outcomes. While CO2 lasers offer deeper tissue penetration and the potential for more significant improvement in severe acne scars, Er:YAG lasers provide a gentler approach with a lower risk of post-inflammatory hyperpigmentation. Recommendations for clinical practice include tailoring treatment approaches to individual patient characteristics, educating patients about treatment expectations and post-treatment care, considering combination therapies for enhanced outcomes, and implementing regular follow-up care. Areas for further research include long-term outcome studies, investigation of laser therapy in ethnically diverse populations, exploration of combination therapies, and evaluation of emerging laser technologies. This review aims to provide clinicians and patients with valuable insights to inform treatment decisions and optimize outcomes in managing acne scars.

Clinical use of lasers and energy-based devices in selected skin diseases

“…Patients with concave scars benefit from fractional CO2 laser treatment as it improves skin texture and accelerates healing by stimulating collagen. [24] One of the comparative studies referenced in this review demonstrated that fractional CO2 laser therapy significantly surpassed Er:YAG laser treatment for acne scars, as indicated by higher subjective satisfaction and physician assessment scores. [24,25] Combination therapy is also used to treat acne scars.…”

“…[24] One of the comparative studies referenced in this review demonstrated that fractional CO2 laser therapy significantly surpassed Er:YAG laser treatment for acne scars, as indicated by higher subjective satisfaction and physician assessment scores. [24,25] Combination therapy is also used to treat acne scars. [26] Platelet-rich plasma (PRP) is an autologous blood product derived from an individual's own blood, distinguished by elevated platelet concentrations compared to normal levels, and comprising growth factors typically associated with platelets.…”

“…This is a very common problem, as the prevalence of acne is estimated at over 90% in teenagers and in approximately 12-14% of them it persists into adulthood. [23,24] Clinical and histopathological studies have demonstrated the effectiveness of CO2 laser resurfacing in treating atrophic facial acne scars, showing an improvement of 50-80%. To qualify for CO2 laser resurfacing, patients must meet several criteria: they should not be in the active phase of acne, must have abstained from oral isotretinoin for at least one year, and should not have experienced a herpes virus skin infection in the six months prior to treatment.…”