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Efficacy of fractional CO2 laser therapy combined with hyaluronic acid dressing for treating facial atrophic acne scars: a systematic review and meta-analysis of randomized controlled trials

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Abstract

The present work aimed to systematically identify the efficacy and safety of fractional carbon dioxide (CO2) laser plus hyaluronic acid (HA) dressing in dealing with facial atrophic acne scars. Randomized controlled trials (RCTs) concerning fractional CO2 laser in combination with HA dressing for treating atrophic acne scars were screened in 8 electronic databases (containing PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, Sinomed as well as VIP). Besides, for the purpose of evaluating the risk of bias of the enrolled RCTs, the Cochrane Collaboration tool was adopted. Statistical analysis was completed using Revman5.3 software and Stata 14.0 software. Meanwhile, the quality of evidence was assessed by the GRADE system. Finally, 6 studies involving 623 patients were enrolled. According to the findings in this study, compared with fractional CO2 laser alone, fractional CO2 laser therapy combined with HA dressing reduced the scores of ECCA (échelle d’évaluation clinique des cicatrices d’acné) grading scale (MD=-3.37,95% CI [-5.03, -1.70], P<0.0001), shortened the time of crust formation (MD=-0.42,95% CI [-0.80, -0.04], P=0.03) and the time of crust removal(MD=-1.31,95% CI [-1.67, -0.95], P<0.00001), enhanced patient satisfaction (RR=1.85, 95% CI [1.44, 2.38], P<0.00001). All the reported adverse events including hyperpigmentation, erythema, edema, mild itching, and slight burning pain were controllable. In addition, fractional CO2 laser combined with HA dressing therapy had a lower incidence of hyperpigmentation than fractional CO2 laser alone (RR=0.37, 95% CI [0.23, 0.61], P<0.0001). The level of evidence for outcomes was classified to be low to moderate. According to our findings, fractional CO2 laser combined with HA dressing is efficacious and safe option for facial atrophic acne scars. Nevertheless, more high-quality trials are required for further verification in the future.

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Funding

This work was supported by the Tianjin Municipal Health Commission-Research Projects in Key Areas of Traditional Chinese Medicine (grant no.2019002), Tianjin Municipal Health Commission Health Science and Technology Project (grant no. zc20127).

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Authors and Affiliations

  1. Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China

    Jianfeng Zhang, Yi Hu, Qifeng Meng & Peng Lin

  2. Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, 300120, China

    Fan Xu, Yuxiao Ma & Yu Zhang

  3. Graduate School, Tianjin Medical University, Tianjin, 300070, China

    Haiyue Lin

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Contributions

Jianfeng Zhang and Yu Zhang contributed to the conception and design of the study. Data collection, analyses, and manuscript preparation were performed by Jianfeng Zhang, Fan Xu, Haiyue Lin, Yuxiao Ma, Yi Hu, Qifeng Meng, and Peng Lin. Jianfeng Zhang wrote the first draft of the manuscript. All the authors commented on previous editions of the manuscript. All authors read and approved the final manuscript.

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Zhang, J., Xu, F., Lin, H. et al. Efficacy of fractional CO2 laser therapy combined with hyaluronic acid dressing for treating facial atrophic acne scars: a systematic review and meta-analysis of randomized controlled trials. Lasers Med Sci 38, 214 (2023). https://doi.org/10.1007/s10103-023-03879-y

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