Fractional Carbon Dioxide Laser: Optimizing Treatment Outcomes for Pigmented Atrophic Acne Scars in Skin of Color

Shehnaz Z Arsiwala, Swasti R Desai, Shehnaz Z Arsiwala, Swasti R Desai

Abstract

Dark skin type has high propensity to acne scarring and is often complicated by persistent erythema or pigmentation at the base. Fractional lasers are available for the longest period and are able to improve most atrophic acne scars. Often pigmented scar bases and dark skin types limit the use of aggressive laser parameters. Long pulse mode is preferred over short pulse to prevent epidermal damage; low fluence is chosen versus high fluence and low density versus high density. Repeated treatments are needed to minimize complications and optimize results; all these must be achieved through a controlled stage of inflammation. Interventional priming with chemical peels and laser toning before ablative fractional carbon dioxide laser helps to reduce photodamage, recent tan, and pigment at scar base, thus minimizing the risk of post-inflammatory hyperpigmentation. Multiple recent literature evidence validates the combinations to optimize outcomes in atrophic acne scars as discussed in this review article.

Keywords: Combination therapies; fractional ablative lasers; pigmented atrophic acne scars; skin of color.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Pigmented macular atrophic acne scars
Figure 2
Figure 2
Pigmented atrophic acne scars (grade 2)
Figure 3
Figure 3
Erythematous acne scars (grade 3) with few active acne lesions. (A and B) before, (C and D) after peels and AFRCL
Figure 4
Figure 4
(A, B) Pigmented erythematous acne scars before. (C, D) Pigmented erythematous acne scars after nonablative quasi pulse Nd:YAG laser with AFRCL
Figure 5
Figure 5
(A, B) Erythematous acne scars grade 3, with few active acne lesions. (C, D) Erythematous acne scars grade 3 after peels and AFRCL
Figure 6
Figure 6
(A, B) Pigmented acne scars grade 3. (C, D) Pigmented acne scars after AFRCL with PRP
Chart 1
Chart 1
Algorithm for treating pigmented acne scars
Chart 2
Chart 2
Algorithm for acne scars with AFRCL and PRP
Chart 3
Chart 3
Algorithm for combining with subcision and PRP

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