Comparative study between fractional CO laser (10,600 nm) and microneedling in treatment of morphea: dermoscopic and histopathological evaluation.

Morphea is a chronic inflammatory fibrosing disorder. Since fibrosis is the hallmark of both scars and morphea, our attention was raised for the possible use of Fractional Ablative CO lasers and microneedling as treatment modalities for morphea. To compare the efficacy and safety of Fractional Ablative CO lasers and microneedling in the treatment of morphea. This comparative cross-sectional study was conducted on 30 patients with morphea, diagnosed clinically and histopathologically. These patients were divided into two groups; Group 1 (n = 15) received treatment with Fractional Ablative CO laser, and Group 2 (n = 15) received microneedling treatment. Each patient in both groups underwent a total of three sessions, one session per month. Treatment assessment was performed 1 month after the last session using Photographic documentation, clinical evaluation with the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT), dermoscopic imaging and histopathological evaluation with Hematoxylin and Eosin (H&E) and Masson's Trichrome stains. Additionally, patient satisfaction and side effects were evaluated at the end of treatment. A statistically significant decrease in the clinical score (LoSCAT) of morphea was observed in both the Fractional CO laser and microneedling groups at the end of treatment. Furthermore, the histopathological score significantly improved in both groups regarding dermal vasculature, infiltrate, epidermal and dermal changes, and adnexal and periappendiceal fat. A high degree of satisfaction was reported among patients in both groups. Both factional CO and microneedling are safe, effective, and well-tolerated modalities for the treatment of morphea.