Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of cosmetic dermatology, Friendship Plastic Surgery Hospital, Nanjing Medical University, Nanjing, China.
J Cosmet Dermatol. 2022 May;21(5):1989-1997. doi: 10.1111/jocd.14868. Epub 2022 Feb 25.
This study was performed to analyze the efficacy, adverse reactions of fractional CO laser for atrophic acne scars, and related clinical factors.
The clinical data of 121 patients with atrophic acne scars treated with ultra-pulsed fractional CO laser in the Cosmetic Dermatology from August 2014 to March 2020 were retrospectively analyzed. The efficacy and adverse reactions of atrophic acne scar after fractional CO laser therapy were statistically analyzed. The clinical factors related to efficacy and adverse reactions after the first therapy session were analyzed by multivariate logistic regression.
A total of 121 patients received 206 sessions of fractional CO laser therapy, with an average of 1.7 sessions. Moderate to excellent improvement rate reached 50.4% after the first session. Multivariate logistic regression analysis indicated that rolling scars responded better to fractional CO laser treatment than icepick scars (OR = 7.3, 95% CI [1.2, 43.4], p = 0.029), and scar improvement was more significant in the high-energy laser group than in the low-energy laser group (OR = 10.9, 95% CI [1.1, 106.8], p = 0.041). The main adverse reactions after fractional laser surgery were pigmentation, skin sensitivity, persistent erythema, and acneiform eruption. Multivariate logistic analysis revealed that the longer the scar duration, the higher incidence of postoperative adverse reactions (OR = 1.3, 95% CI [1.1, 1.5], p = 0.008). Compared with icepick scars, rolling scars (OR = 10.4, 95% CI [2.3, 47.7], p = 0.003) and boxcar scars (OR = 12.0, 95% CI [3.3, 44.0], p < 0.001) had higher risk of developing adverse reactions. The incidence of postoperative adverse reactions was also higher in the combined mode group (DeepFX mode + ActiveFX mode) than in the single-mode group (OR = 7.8, 95% CI [2.4, 25.5], p < 0.001).
Fractional CO laser was effective in the treatment of atrophic acne scars, without serious adverse reactions. Scar type and laser energy were independent clinical factors affecting its efficacy. Scar course, scar type, and fractional laser mode were independent clinical factors affecting its adverse reactions.
分析超脉冲 CO 2 点阵激光治疗萎缩性痤疮瘢痕的疗效、不良反应及相关临床因素。
回顾性分析 2014 年 8 月至 2020 年 3 月在我科行超脉冲 CO 2 点阵激光治疗的 121 例萎缩性痤疮瘢痕患者的临床资料。对患者行超脉冲 CO 2 点阵激光治疗后萎缩性痤疮瘢痕的疗效及不良反应进行统计学分析。采用多因素 logistic 回归分析首次治疗时与疗效及不良反应相关的临床因素。
121 例患者共接受 206 次超脉冲 CO 2 点阵激光治疗，平均 1.7 次/例。首次治疗后，中度至极好改善率达 50.4%。多因素 logistic 回归分析表明，滚轮样瘢痕较冰锥样瘢痕对 CO 2 点阵激光治疗的反应更好（OR=7.3，95%CI[1.2，43.4]，p=0.029），高能激光组较低能激光组瘢痕改善更显著（OR=10.9，95%CI[1.1，106.8]，p=0.041）。CO 2 点阵激光术后主要不良反应为色素沉着、皮肤敏感、持续性红斑和痤疮样疹。多因素 logistic 分析显示，瘢痕病程越长，术后不良反应发生率越高（OR=1.3，95%CI[1.1，1.5]，p=0.008）。与冰锥样瘢痕相比，滚轮样瘢痕（OR=10.4，95%CI[2.3，47.7]，p=0.003）和箱车型瘢痕（OR=12.0，95%CI[3.3，44.0]，p<0.001）发生不良反应的风险更高。联合模式（DeepFX 模式+ActiveFX 模式）组术后不良反应发生率高于单一模式组（OR=7.8，95%CI[2.4，25.5]，p<0.001）。
CO 2 点阵激光治疗萎缩性痤疮瘢痕疗效确切，无严重不良反应。瘢痕类型和激光能量是影响疗效的独立临床因素。瘢痕病程、瘢痕类型和 CO 2 点阵激光模式是影响不良反应的独立临床因素。
