Atrophic acne scar: a novel 4-step treatment approach using the ultra-pulse fractional CO laser.

Ultra-pulse fractional CO laser is regarded as an effective modality for treating atrophic acne scar. In this study, we described a novel 4-step treatment approach, which combined a manual fractional thermal contraction technology (MFTCT) and ablation mode of conventional CO laser, with deep and superficial mode of fractional laser for treating atrophic acne scars. This study evaluated the efficacy and safety of the novel 4-step treatment using the ultra-pulse fractional CO laser in patients with atrophic acne scars. 20 patients with Fitzpatrick skin type III-IV and facial acne scars were treated with 4-step treatment approach. All patients completed 6 treatment sessions at 8-week intervals. Two blinded dermatologists evaluated the pre- and post-treatment photographs with a 4-point global assessment scale and ECCA grading scale (échelle d'évaluation clinique des cicatrices d'acné). Patients also provided self-assessment of satisfaction and adverse effects. Three of 20 patients showed more than 75% improvement, 14 patients showed 51%-75% improvement, and 3 patients showed 25%-50%. The mean ECCA scores decreased from 109.75 ± 15.26 to 58.75 ± 17.08, with an improvement rate of 46%, and the change was significant (P < 0.01). All patients were either "very satisfied" or "satisfied" with the outcome of the treatments. There were no obvious adverse events after treatments. Only one developed post-inflammatory hyperpigmentation (PIH) for 3 months after the last treatment. This 4-step treatment is an effective and safe treatment modality for atrophic acne scars with an excellent cosmetic outcome and low complication rates.