Abstract
Scarring is one of the most esthetically challenging and psychologically burdening aspects following inflammatory acne. While “macular” disease is the scar subtype with the least complicated outcome, its phase can be regarded as the most defining in the ultimate scar appearance. Moreover, with lasers recently gaining much popularity in the scientific community for managing several dermatologic conditions, we aimed to evaluate whether they would lead to significant benefits. For this systematic review, four databases consisting of PubMed, Scopus, Embase, and Web of Science were searched using a comprehensive string, with the data from the relevant yet eligible identified records qualitatively synthesized. After investigating the data obtained from the nine included studies, we found the utilized lasers, namely neodymium-doped yttrium aluminum garnet, fractional carbon dioxide, pulsed dye, erbium:glass, pro-yellow, and high-power optically pumped semiconductor, to be highly effective in managing the erythematous or dyspigmented appearance with the reduced elasticity also significantly improving. Moreover, the adverse events were both bearable and minimal, and transient. However, the degree of improvement each type of scar demonstrated following laser therapy varied based on the laser used. Neodymium-doped yttrium aluminum garnet, fractional carbon dioxide, and pulsed dye are the most commonly investigated lasers for managing macular acne scars, demonstrating eye-catching capabilities in managing either erythema or dyspigmentation. However, we still recommend that further comparative interventional studies be carried out, while the intended outcomes also assessed with objective measures for further clarification.
Similar content being viewed by others
Data availability
The dataset supporting the conclusions of this article (i.e., data extracted from included studies) is available upon request to the corresponding author, Najmeh Ahramiyanpour.
References
Panchaprateep R, Munavalli G (2015) Low-fluence 585 nm Q-switched Nd:YAG laser: a novel laser treatment for post-acne erythema. Lasers Surg Med 47(2):148–155
Kim S, Cho KH (2010) Treatment of facial postinflammatory hyperpigmentation with facial acne in Asian patients using a Q-switched neodymium-doped yttrium aluminum garnet laser. Dermatol Surg 36(9):1374–1380
Zawar VP, Agarwal M, Vasudevan B (2015) Treatment of postinflammatory pigmentation due to acne with Q-switched neodymium-doped yttrium aluminum garnet in 78 Indian cases. J Cutan Aesthet Surg 8(4):222–226
Petrov A, Pljakovska V (2016) Fractional carbon dioxide laser in treatment of acne scars. Open Access Maced J Med Sci 4(1):38–42
Tawfic S O, Abdel Hay R, Salim H, Elmasry MF (2021) Tranexamic acid versus fractional carbon dioxide laser in post‐acne hyperpigmentation. Dermatol Ther 34(6):e15103
Park KY, Ko EJ, Seo SJ, Hong CK (2014) Comparison of fractional, nonablative, 1550-nm laser and 595-nm pulsed dye laser for the treatment of facial erythema resulting from acne: a split-face, evaluator-blinded, randomized pilot study. J Cosmet Laser Ther 16(3):120–123
Yoon HJ, Lee DH, Kim SO, Park KC, Youn SW (2008) Acne erythema improvement by long-pulsed 595-nm pulsed-dye laser treatment: a pilot study. J Dermatol Treat 19(1):38–44
Sarac G, Kapicioglu Y, Cenk H (2021) An evaluation of the efficacy of a single‐session 577 nm pro‐yellow laser treatment in patients with postacne erythema and scarring. Dermatol Ther 34(1):e14611
Wanitphakdeedecha R, Cembrano KAG, Ungaksornpairote C, Kobwanthanakun W, Phothong W, Eimpunth S et al (2020) The efficacy and safety of a 577-nm high-power optically pumped semiconductor laser in the treatment of postacne erythema. J Cosmet Dermatol 19(7):1642–1647
Layton AM, Henderson CA, Cunliffe WJ (1994) A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol 19(4):303–308
Goodman GJ (2000) Management of post-acne scarring. What are the options for treatment? Am J Clin Dermatol 1(1):3–17
Dreno B, Amici JM, Demessant-Flavigny AL, Wright C, Taieb C, Desai SR et al (2021) The impact of acne, atopic dermatitis, skin toxicities and scars on quality of life and the importance of a holistic treatment approach. Clin Cosmet Investig Dermatol 14:623–632
Hayashi N, Miyachi Y, Kawashima M (2015) Prevalence of scars and “mini-scars”, and their impact on quality of life in Japanese patients with acne. J Dermatol 42(7):690–696
Lauermann FT, Almeida HLD Jr, Duquia RP, Souza PRMD, Breunig JDA (2016) Acne scars in 18-year-old male adolescents: a population-based study of prevalence and associated factors. An Bras Dermatol 91(3):291–295
Cunliffe W, Gould D (1979) Prevalence of facial acne vulgaris in late adolescence and in adults. Br Med J 1(6171):1109–1110
Tan J, Kang S, Leyden J (2017) Prevalence and risk factors of acne scarring among patients consulting dermatologists in the USA. J Drugs Dermatol 16(2):97–102
Baum CL, Arpey CJ (2005) Normal cutaneous wound healing: clinical correlation with cellular and molecular events. Dermatol Surg 31(6):674–686
Chivot M, Pawin H, Beylot C, Chosidow O, Dreno B, Faure M, ..., ACNE GE (2006, October) Acne scars: epidemiology, physiopathology, clinical features and treatment. In Annales de Dermatologie et de Venereologie 133(10):813–824
Martin P, Leibovich SJ (2005) Inflammatory cells during wound repair: the good, the bad and the ugly. Trends Cell Biol 15(11):599–607
Fabbrocini G, Annunziata MC, D’Arco V, De Vita V, Lodi G, Mauriello MC et al (2010) Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract 2010:893080
Goodman GJ, Baron JA (2006) Postacne scarring: a qualitative global scarring grading system. Dermatol Surg 32(12):1458–1466
Adamič M, Pavlović MD, Troilius Rubin A, Palmetun-Ekbäck M, Boixeda P (2015) Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology. J Eur Acad Dermatol Venereol 29(9):1661–1678
Husain Z, Alster TS (2016) The role of lasers and intense pulsed light technology in dermatology. Clin Cosmet Investig Dermatol 9:29
Tanzi EL, Lupton JR, Alster TS (2003) Lasers in dermatology: four decades of progress. J Am Acad Dermatol 49(1):1–34
Ahramiyanpour N, Akbari Z, Sarasyabi MS, Aflatoonian M, Saki N, Shafie’ei M (2022) The therapeutic role of lasers in primary localized cutaneous amyloidosis: a systematic review. Lasers Med Sci 37(2):799–813
Bhargava S, Cunha PR, Lee J, Kroumpouzos G (2018) Acne scarring management: systematic review and evaluation of the evidence. Am J Clin Dermatol 19(4):459–477
Husein-ElAhmed H, Steinhoff M (2021) Comparative appraisal with metaanalysis of erbium vs. CO2 lasers for atrophic acne scars. J Dtsch Dermatol Ges 19(11):1559–68
Zhang DD, Zhao WY, Fang QQ, Wang ZC, Wang XF, Zhang MX et al (2021) The efficacy of fractional CO(2) laser in acne scar treatment: a meta-analysis. Dermatol Ther 34(1):e14539
Kalantari Y, Dadkhahfar S, Etesami I (2022) Post‐acne erythema treatment: A systematic review of the literature. J Cosmet Dermatol 21(4):1379–1392
Albluwi BM, Alanka MA, Alblowi YH, Albsher MA, Mohammed HA, Alotaibi SA et al (2021) Efficacy of fractional CO2 laser in management of acne scars: systematic review and meta-analysis. Ann Med Health Sci Res 11:27–31
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, The PRISMA et al (2020) statement: an updated guideline for reporting systematic reviews. BMJ 2021:372
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors) (2022) Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022). Cochrane. https://www.training.cochrane.org/handbook
Team TE. EndNote. EndNote 20 ed. Philadelphia, PA: Clarivate; 2013
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan—a web and mobile app for systematic reviews. Syst Rev 5(1):1–10
Institute JB. Checklist for Quasi-Experimental Studies 2017 [Available from: https://jbi.global/critical-appraisal-tools
Institute JB. Checklist for Randomized Controlled Trials 2017 [Available from: https://jbi.global/critical-appraisal-tools
Alster TS, McMeekin TO (1996) Improvement of facial acne scars by the 585 nm flashlamp-pumped pulsed dye laser. J Am Acad Dermatol 35(1):79–87
Glaich AS, Goldberg LH, Friedman RH, Friedman PM (2007) Fractional photothermolysis for the treatment of postinflammatory erythema resulting from acne vulgaris. Dermatol Surg 33(7):842–846
Author information
Authors and Affiliations
Contributions
All authors participated in designing the protocol. First, all authors participated in the design of the study. Z. A. and M. S. then did the literature search. Z. A. and N. S. selected the studies and extracted the relevant information, then assessed, and confirmed by the senior author, N. A. All authors then participated in synthesizing the data. M. S., Z. A., N. S., and M. J. also wrote the first draft of the paper. N. A. provided critical guidance on the analysis and overall direction of the study. All authors critically revised successive drafts of the paper and approved the final version.
Corresponding author
Ethics declarations
Ethics approval
No ethical approval was required as this manuscript is a review article with no original research data.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Authorship
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Supplementary information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sarvipour, N., Akbari, Z., Shafie’ei, M. et al. Lasers for the treatment of erythema, dyspigmentation, and decreased elasticity in macular acne scars: a systematic review. Lasers Med Sci 37, 3321–3331 (2022). https://doi.org/10.1007/s10103-022-03621-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10103-022-03621-0