Kalsoom Jawaid
Punjab Medical College Faisalabad, Pakistan
Scientific Tracks Abstracts: Surgery Curr Res
Introduction: Treatment of acne scars in the pigmented skin has always been challenging, for which many of the procedures have been tried, among them, the most advanced technique now is the fractional CO2 laser. Its results have been varied with different technical expertise and are complicated by post-inflammatory hyperpigmentation. We have tried high fluence targeted ablation of individual acne scars of all types. Objective: To obtain maximum possible effacement of all types of acne scars in the pigmented skin with 2 step approach i.e high intensity fractional CO2 laser ablation specifically targeted to the individual acne scars followed by low intensity resurfacing of the whole of the involved area for blending purposes. Materials and Methods: 20 patients with inactive acne and mixed types of scars underwent 3 sessions of fractional CO2 phothermolysis at 6 weeks intervals. The severity of the scarring was graded from 0 to 10 by an independent dermatologist on the visual analog scale. A Korean high power 30W fractional CO2 laser was used. After topical anesthesia with EMLA under occlusion for 30 minutes, fractional CO2 laser therapy (150-200 mg/cm2, 20-30% coverage, 3-5 passes) precisely targeted to the individual acne scars to get clinical end-point of about 90% scar effacement followed by low intensity (30-50 MJ/cm2, 25% coverage, single pass) resurfacing of the whole of the involved area to blend the scars??? edges with the surrounding skin. Post-operative antiviral prophylaxis was given and polyfax skin ointment was advised until the crusting clears. Daily bedtime application of Hydroquinone 2% plus Glycolic acid 1% combination was started on the 10th day after the procedure for prevention of post-inflammatory hyperpigmentation. Results: Objective mean improvement of 55% (range 40 to 70%) was seen on visual analog in all patients 3 months after the last session. Serosanguinous exudation, crusting, and erythema followed by transient hyperpigmentation were the most common but predictable side effects noted. Conclusion: High energy, multiple passes, deep ablation of individual deep acne scars to get immediate maximum scar effacement combined with superficial, low intensity, resurfacing of the whole of the anatomical zone is good option to balance the efficacy and safety of fractional CO2 laser resurfacing in pigmented skin. It leads to significant improvement even in ice pick and boxcar scars but associated with frequent, but transient, postprocedural hyperpigmentation, which can be managed to much extent with topical depigmenting agents.
E-mail: dr.klsmjwd@gmail.com
