CASE STUDY | ACNE SCARRING |
COMBINATION OF FULL AND FRACTIONAL CO2 RESURFACING FOR
ATROPHIC ACNE SCARRING Dr. Didac Barco discusses using a combinational approach on a 31-year-old female patient suffering from acne scars
ABSTRACT Classic CO2 resurfacing is considered to be the gold standard technique for the treatment of acne scarring due to its efficacy. However, it may be related to a considerable number of side-effects, which limit its application on a regular basis. Fractional CO2 resurfacing has a safer profile, but with less favourable results in terms of efficacy. A combination of both techniques is proposed to take advantage of the high efficiency of the classic CO2 resurfacing limiting its use in the most severely affected areas and preserving the safety of a fractional CO2 laser as applied in a wider fashion to the full extent of skin where acne scars are located.
DIDAC BARCO, MD, Corium Dermatology, Barcelona, Spain email dermatologiabcn.com@gmail.com
KEYWORDS Acne scarring, fractional CO2, Resurfacing
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CNE VULGARIS REPRESENTS AN ACUTELY PREVALENT condition. In Spain, according to the AEDV (Spanish Academy for Dermatology and Venerology), up to 80% of young people aged between 12–18 suffer from this condition. Among those in their 30s, 3% of males and 11–12% of women, also have acne vulgaris. This is an inflammatory process localised to the pilosebaceous units, mainly in the face, chest, upper arms, and back1. Acne affects the face in most of the cases, with many patients experiencing some degree of scarring, the severity of which correlates to the acne grade2. Acne scars are the result of an altered wound healing response to cutaneous inflammation, with inflammatory cell infiltrates found in 77% of atrophic scars3. We can find different scar types typically on the same person: Ice pick scars comprise 60 to 70% of atrophic scars. These narrow, less-than-2 mm, ‘v’- shaped epithelial tracts have a sharp margin that extends vertically to the deep dermis or subcutaneous tissue. Depth of involvement makes ice pick scars resistant to conventional skin resurfacing options. Boxcar scars comprise 20 to 30% of atrophic scars. These scars are wider, 1.5-4.0 mm, round-to-oval depressions with sharply demarcated vertical edges. Shallow boxcar scars (0.1–0.5 mm) are amenable to skin resurfacing treatments, whereas deep boxcar scars (≥0.5 mm) are resistant. Finally, rolling scars comprise 15 to 25% of atrophic scars. These scars are the widest and may reach up to 5 mm in diameter. Treatment of generalised atrophic acne scars involves several techniques as well as other medical approaches. Among these techniques and treatments, we can find lasers, drugs, chemical peels, dermabrasion, micro-needling and radiofrequency.
Mechanism of action The options for laser treatment for acne scarring have expanded in recent years and have gained in popularity given their results. Lasers for acne scarring fall under two
January/February 2020 | prime-journal.com