Erbium YAG Laser Resurfacing versus Trichloroacetic Acid 35% Peeling in the Treatment of Atrophic Fa
Journal of Pan-Arab League of Dermatologists
Vol. 19, No. 2, June 2008 Page 19- 31
Erbium YAG Laser Resurfacing versus Trichloroacetic Acid 35% Peelingin the Treatment of Atrophic Facial Acne Scars
Hanan M Saleh*, Enas AS Attia* and Reham R Mounir**
Departments of Dermatology and Venereology, Faculty of Medicine*, Ain Shams University, and Egyptian Railway
Hospital**, Cairo, Egypt
Abstract
Background: Various methods of skin resurfacinghave been used for decades to correct theacne damaged skin. One of the familiar methodsis chemical peeling. However, with the advancesin the knowledge of laser, laserresurfacingtechniques became available. Comparedto CO2 laser and short- pulsed Erbiumlasers, Long-pulsed Erbium: Yttrium AluminiumGarnet (Er:YAG) laser produces more heat intissues, and larger zones of residual thermaldamage, and so better collagencontraction andsubsequent remodeling, thus improving skinscars.
Objective: to compare the clinical response tolong-pulsed Er:YAG laser 2940 nm versus trichloroaceticacid (TCA) 35% peeling in thetreatment of different typesof atrophic acnescars, and to correlate the pre-treatment clinicalevaluation of acne scars with the therapeuticresponse.
Methods: 20 patients with atrophic acne scarringwere included and divided into 2 groups(10 patients each). Group I had long-pulsed Er:YAG laser treatmentand group II had TCA 35%peeling treatment. Clinical evaluation using astandard improvement score and photographicdocumentation were performed at baselineand3 months after the end of therapy. Postoperativerecovery was monitored and the rate of complicationsrecorded.
Results: The overall improvement was equal inboth groups (60%). However, the degree of improvementwas better with Er:YAG laser thanwith TCA peeling.Nearly equal responses in icepick scars were achieved in both groups (fair togood), while better response to Er:YAG laserwas observed in rolling and shallowboxcarscars (good to excellent with laser compared tofair with peeling). Deep boxcar scars showedbad response to both modalities. In both groups,distensibleacne scars showed better degree ofimprovement than non-distensible scars. Hyperpigmentationand acne flare were recorded inboth groups, but prolongederythema and hypertrophicscarring were seen only withEr:YAG resurfacing. In both groups, complicationswere more in patients with skin type IVthan with type III.
Conclusion: Each of long- pulsed Er: YAG laserand TCA 35% is relatively safe and effectivemodality in treatment of distensible icepick,rolling, and shallowboxcar atrophic acnescars. However, further studies on larger scaleof patients are needed to confirm our results
Journal of Pan-Arab League of Dermatologists
Vol. 19, No. 2, June 2008 Page 19- 31
Erbium YAG Laser Resurfacing versus Trichloroacetic Acid 35% Peelingin the Treatment of Atrophic Facial Acne Scars
Hanan M Saleh*, Enas AS Attia* and Reham R Mounir**
Departments of Dermatology and Venereology, Faculty of Medicine*, Ain Shams University, and Egyptian Railway
Hospital**, Cairo, Egypt
Abstract
Background: Various methods of skin resurfacinghave been used for decades to correct theacne damaged skin. One of the familiar methodsis chemical peeling. However, with the advancesin the knowledge of laser, laserresurfacingtechniques became available. Comparedto CO2 laser and short- pulsed Erbiumlasers, Long-pulsed Erbium: Yttrium AluminiumGarnet (Er:YAG) laser produces more heat intissues, and larger zones of residual thermaldamage, and so better collagencontraction andsubsequent remodeling, thus improving skinscars.
Objective: to compare the clinical response tolong-pulsed Er:YAG laser 2940 nm versus trichloroaceticacid (TCA) 35% peeling in thetreatment of different typesof atrophic acnescars, and to correlate the pre-treatment clinicalevaluation of acne scars with the therapeuticresponse.
Methods: 20 patients with atrophic acne scarringwere included and divided into 2 groups(10 patients each). Group I had long-pulsed Er:YAG laser treatmentand group II had TCA 35%peeling treatment. Clinical evaluation using astandard improvement score and photographicdocumentation were performed at baselineand3 months after the end of therapy. Postoperativerecovery was monitored and the rate of complicationsrecorded.
Results: The overall improvement was equal inboth groups (60%). However, the degree of improvementwas better with Er:YAG laser thanwith TCA peeling.Nearly equal responses in icepick scars were achieved in both groups (fair togood), while better response to Er:YAG laserwas observed in rolling and shallowboxcarscars (good to excellent with laser compared tofair with peeling). Deep boxcar scars showedbad response to both modalities. In both groups,distensibleacne scars showed better degree ofimprovement than non-distensible scars. Hyperpigmentationand acne flare were recorded inboth groups, but prolongederythema and hypertrophicscarring were seen only withEr:YAG resurfacing. In both groups, complicationswere more in patients with skin type IVthan with type III.
Conclusion: Each of long- pulsed Er: YAG laserand TCA 35% is relatively safe and effectivemodality in treatment of distensible icepick,rolling, and shallowboxcar atrophic acnescars. However, further studies on larger scaleof patients are needed to confirm our results