Efficacy of Fractional CO2 Laser in Management of Acne Scars: Systematic Review and Meta-Analysis

Author(s):

Bushra Mohammad Albluwi, Mohammed Ali Alanka, Yassmeen Hmoud Alblowi, Mohammed Abdullah Albesher, Hadi Adnan Mohammed, Saad Abdulrahman Alotaibi, Faisal Abdullah Alghubaywi, Nawaf Ammash Alsubaie, Abdulrahman Fahad Alotaibi and Rana Abdullhadi Bugshan

Background: Different types of lasers, both ablative and non-ablative, are used to treat acne scars. Non-ablative lasers stimulate dermal fibroblasts to make new collagen (NdYAG and Diode lasers), while ablative lasers target water and vaporize injured scar tissue. Aim: This work aims to determine the efficacy and safety of fractional CO2 laser in the management of patients with acne scars. Methodology: A systematic search was performed over different medical databases to identify Dermatology studies, which studied the outcome of the CO2-laser group versus the Non-CO2-laser group of acne scar patients. We conducted a meta-analysis process on improved observer assessment, and satisfied patient assessment as primary outcomes, and on post-inflammatory hyperpigmentation (PIH) as a secondary outcome. Eight studies were identified involving 288 patients, with 144 patients in the CO2-laser group, and 144 patients in the Non-CO2-laser group. Our meta-analysis process showed revealed a highly significant increase in improved observer assessment in the CO2-laser group compared to the Non-CO2-laser group (p=0.016). But, there was a non-significant difference regarding both satisfied patient assessment and PIH (p>0.05) respectively. Conclusion: To conclude, fractional CO2 laser had a significant contribution in improving observer assessment along with clinical improvement, but PIH is still the most common side effect of laser therapy, and further studies are needed to assess the safety of CO2 laser in the management of patients with acne scars.