Department of Dermatology, R.D. Gardi Medical College and C.R. Gardi Hospital, Ujjain, India.
Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.
Am J Clin Dermatol. 2018 Aug;19(4):459-477. doi: 10.1007/s40257-018-0358-5.
Modalities for atrophic acne scarring can be classified depending upon the needs they satisfy; that is, resurfacing, lifting/volumization, tightening, or surgical removal/movement of tissue that is required for correction. A plethora of treatment options have resulted from the need to treat various acne scar types, variability of responses noted in various skin types, and increasing popularity of minimally invasive modalities. Still, there is a lack of consensus guidelines on treatment or combination therapies for various clinical scenarios.
This systematic review includes a critical evaluation of the evidence relevant to these modalities and various multimodality therapies.
We performed a systematic literature search in Medline and EMBASE databases for studies on acne scar management. Also, we checked the reference lists of included studies and review articles for further studies. A total of 89 studies were included in our quality of evidence evaluation.
The efficacy of lasers and radiofrequency in atrophic acne scarring is confirmed by many comparative and observational studies. Other modalities can be used as an adjunct, the choice of which depends on the type, severity, and number of atrophic scars. Minimally invasive procedures, such as fractional radiofrequency and needling, provide good outcomes with negligible risks in patients with dark or sensitive skin types.
There is a lack of high-quality data. Fractional lasers and radiofrequency offer significant improvement in most types of atrophic acne scars with minimal risks and can be combined with all other treatment options. Combination therapies typically provide superior outcomes than solo treatments.
萎缩性痤疮瘢痕的治疗方式可以根据其满足的需求进行分类，即磨皮、提升/填充、紧致或切除/移动组织以进行矫正。由于需要治疗各种痤疮瘢痕类型、各种皮肤类型的反应差异以及微创治疗方式的日益普及，产生了大量的治疗选择。尽管如此，对于各种临床情况的治疗或联合治疗仍缺乏共识指南。
本系统评价包括对这些治疗方式以及各种多模态治疗的相关证据的批判性评估。
我们在 Medline 和 EMBASE 数据库中进行了一项系统的文献检索，以寻找有关痤疮瘢痕管理的研究。此外，我们还检查了纳入研究和综述文章的参考文献列表，以寻找进一步的研究。共有 89 项研究纳入了我们的证据质量评估。
许多比较性和观察性研究证实了激光和射频在萎缩性痤疮瘢痕中的疗效。其他治疗方式可以作为辅助手段，选择取决于瘢痕的类型、严重程度和数量。对于深色或敏感皮肤类型的患者，微创治疗，如微针射频和微针，风险极小，可提供良好的效果。
高质量数据缺乏。分束激光和射频可显著改善大多数类型的萎缩性痤疮瘢痕，风险极小，可与所有其他治疗选择联合使用。联合治疗通常比单一治疗提供更好的效果。
