Abstract:
Background
Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit prevalent in adolescent population. Acne can manifest as inflammatory or non-inflammatory lesions. Inflammatory acne can produce permanent scarring which causes low academic performance, unemployment, depression and suicide.
Although challenging to treat, various modalities both non-energy based and energy based can be used for acne scars. However, the introduction of fractional carbon dioxide laser and platelet-rich plasma therapy for atrophic scars has opened up new avenues for management of acne scars
Objective
To evaluate the efficacy of fractional carbon dioxide laser alone and in combination with topical platelet rich plasma in treating post acne atrophic scars.
Method
A hospital based prospective, double blinded, randomized, comparative study was conducted. A total of 33 cases of post acne atrophic scars of moderate to severe grade attending outpatient department of tertiary care hospital were included in the study. The enrolled patients were allotted into 2 groups. Detailed history and clinical examination were performed and recorded and score of acne scars using Goodman and Baron qualitative grading and quantitative scoring chart was calculated. Patients in GROUP A were treated with fractional carbon dioxide laser ablation followed by topical platelet-rich plasma. Patients in GROUP B were treated with fractional carbon dioxide laser ablation only. Baseline investigations and clinical photographs were taken. Three laser sessions were performed 4 weeks apart and patient were assessed (clinical photographs, scar score, adverse effects,VAS) at every visit. At the end of 12 weeks, baseline and post treatment photographs were compared for final assessment.
Results
Out of the 33 patients enrolled in the study, 25 patients completed the study.
Mean change in score at the end of the study was higher in subjects of Group A (4.17) when compared to those in Group B (3.15) which was statistically insignificant. The mean scar score in Group A reduced from 11.5 to 4 and in Group B from 12 to 3. This reduction of scar score in both groups was highly significant (P<0.0001).
Mean VAS for patient’s assessment of improvement was higher in subjects in Group A (4.08) when compared to those in Group B (3.46). The change in scar score irrespective of treatment was the highest in patients with rolling scars with a mean of 4.2 followed by boxcar scars with a mean of 3.89 and the lowest in ice-pick scars with a mean of 2.33 which was highly significant. Erythema, erythema with oedema, pain and hyperpigmentation was more in subjects in Group B.
Conclusion
Combination therapy with platelet rich plasma is more efficacious in reducing the appearance of scars, reducing adverse effects of laser therapy and better patient satisfaction by the means of subjective improvement as compared to monotherapy with fractional carbon dioxide laser. Fractional carbon dioxide laser gives better response for rolling and boxcar scars as compared to ice pick scars.
