Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Editorial Department of Chinese Journal of Dermatovenereology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Lasers Surg Med. 2023 Apr;55(4):359-371. doi: 10.1002/lsm.23646. Epub 2023 Mar 1.
Acne scars are common in patients with moderate to severe acne. Isotretinoin is the first-line treatment for those patients, but whether oral isotretinoin can improve acne scar is not clear. Picosecond lasers (FxPico) has been reported to improve acne scars. In the present study, we evaluated the clinical efficacy of low-dose isotretinoin with or without FxPico treatment for acne scars.
A total of 48 patients with acne scars were enrolled and were randomly assigned to receive low dose oral isotretinoin or not. For all the patients in both treatment groups, one side of face were randomly assigned to be treated with picosecond laser. Assessments, including photos, échelle d'évaluation clinique des cicatrices d'acné (ECCA) and Global Acne Grading System (GAGS) score, the number of lesions, melanin and erythema indexes, transepidermal water loss were assessed at 0, 1, 2, and 3 month. Side effects, Dermatology Life Quality Index (DLQI) and satisfaction were recorded before and after the study.
A total of 44 patients completed the study (24 received oral low dose isotretinoin and 20 did not). Low dose oral isotretinoin treated group showed significant improvement on ECCA (from 112.5 [50-180] to 105 [50-160]), GAGS score (from 12.6 ± 3.3 to 10.1 ± 3.0), the count of papules (from 4.3 ± 3.7 to 1.0 ± 1.5) than the blank group, and higher improvement were noticed after isotretinoin combined with FxPico. All the side effects were temporary and tolerable, no adverse effects were observed. Higher DLQI and patients' satisfaction were achieved by oral isotretinoin alone and isotretinoin combined with FxPico.
This is the first paper showing the improvement of scars by early low dose-isotretinoin intervention with or without the combination of picosecond laser. Early intervention with oral low-dose isotretinoin is effective for the treatment and prevention of acne scars, the combined therapy with FxPico can achieve better outcome.
痤疮瘢痕在中重度痤疮患者中较为常见。对于这些患者，异维 A 酸是一线治疗药物，但口服异维 A 酸是否能改善痤疮瘢痕尚不清楚。皮秒激光（FxPico）已被报道可改善痤疮瘢痕。本研究评估了低剂量异维 A 酸联合或不联合 FxPico 治疗痤疮瘢痕的临床疗效。
共纳入 48 例痤疮瘢痕患者，随机分为口服低剂量异维 A 酸组或不治疗组。对于两组患者，一侧面部随机接受皮秒激光治疗。在 0、1、2 和 3 个月时评估照片、痤疮瘢痕临床评估量表（ECCA）和全球痤疮分级系统（GAGS）评分、皮损数量、黑素和红斑指数、经表皮水分丢失。记录研究前后的不良反应、皮肤病生活质量指数（DLQI）和满意度。
共有 44 例患者完成了研究（24 例接受口服低剂量异维 A 酸治疗，20 例未治疗）。与空白组相比，口服低剂量异维 A 酸治疗组 ECCA（从 112.5[50-180]降至 105[50-160]）、GAGS 评分（从 12.6±3.3 降至 10.1±3.0）和丘疹计数（从 4.3±3.7 降至 1.0±1.5）均有显著改善，异维 A 酸联合 FxPico 治疗后改善更明显。所有不良反应均为暂时性且可耐受，未观察到不良反应。单独口服异维 A 酸和异维 A 酸联合 FxPico 治疗均可获得更高的 DLQI 和患者满意度。
这是第一篇报道早期低剂量异维 A 酸干预联合或不联合皮秒激光治疗痤疮瘢痕的改善情况。早期口服低剂量异维 A 酸治疗对痤疮瘢痕的治疗和预防有效，联合 FxPico 治疗可获得更好的效果。
