New Delhi: Acne today affects most of the teenagers and adults and poses a therapeutic challenge for dermatologists. Acne scars can occur early in acne development and may affect up to 14 per cent of patients with this disease, which can be more serious if there is a delay in the treatment.
The most common type of acne scarring is atrophic, which includes: ice pick, rolling scars and boxcar scars. One of the many treatments used for atrophic scars is resurfacing procedure that includes chemical peels, dermabrasion and laser treatments. Studies in the area have shown promising results for the treatment of acne scars with fractional laser.
However, only few studies have examined the role of fractional lasers in individual acne scars (ice-pick, box car, rolling) using objective assessment tools in darkly pigmented skin.
Though, therapies combining various modalities and comparative studies have examined overall acne scar topography, but an understanding of the basic fact that which type of atrophic acne scar responds best to a particular fractional laser technology is lacking. Furthermore, the dose and settings does not consider the tissue effect and depth of fractional lasers, which depend on various factors such as dose, density, passes, stacking, and pulse duration to create sufficient tissue response to ameliorate acne scars.
With this idea in mind, Dr Kabir Sardana, professor, dermatology and nodal officer, STD, Maulana Azad Medical College, New Delhi along with his team conducted a study to evaluate the fractional 1,540-nm laser in the treatment of atrophic scar types using an objective assessment tool based on histologic data in conjunction with acne scar depth.
The other members of the team were – Dr Vijay K Garg, director, professor and head, department of dermatology and STD; Dr Mukesh Manjhi and Dr Vivek Sagar, both former residents.
Dr Kabir Sardana told India Medical Times, “The primary objective of the study was to assess the effect of fractional laser treatment on acne scars, while at the same time to assess objective improvement using a self-devised colour score and the side effects in a darkly pigmented population.”
According to the study, the parameters were tuned to take into consideration the depth and the width of microthermal treatment zones (MTZ) to maximize results.
The study was conducted using a 1,540-nm fractional laser on 35 patients by the department of dermatology, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, from October 2009 to March 2011, after due ethical approval.
Six sessions were performed with four passes per session and a dose varying from 70 to 100 mJ to maximize the depth-to-width ratio (DWR). A self-devised objective assessment tool with dose settings to optimize the DWR and a visual analogue scale (VAS) were used to count individual atrophic scars. Final results were assessed six months after the final laser treatment.
The results showed that the boxcar scars (52.9%) responded better than the rolling (43.1%) and ice-pick scars (25.9%), with statistically significant improvement seen in boxcar scars after four sessions. An erbium-doped glass laser was found to improve atrophic acne scars, markedly so for boxcar and rolling scars.
Dr Sardana said, “Though the new fractional lasers have been around for some time but most users have not understood which type of scars respond to a particular laser technology hence the results vary.”
“In a pilot study published in the American journal Dermatologic Surgery, we have shown that only the rolling and boxcar scars respond while the deep ice pick scars do not respond. Thus a more realistic outcome can be expected from using laser technology while treating different type of atrophic scars,” he said.
“We thought this work could get publicity to balance the laser companies’ one pointed agenda of promoting lasers for all types of scars,” Dr Sardana added.
by Vidhi Rathee