Laser resurfacing for facial acne scars: Cochrane systematic review

Abstract

Assessed as up to date: 2000/03/14

Background

Most people have acne at some stage during their life, with about one per cent being left with permanent acne scars. Recent laser techniques are thought to be more effective than chemical peels and dermabrasion.

Objectives

To assess the effects of laser resurfacing for treating facial acne scars.

Search methods

We searched MEDLINE (1966 to April 1999), EMBASE (1980 to April 1999), Science Citation Index (1981 to April 1999), the Cochrane Controlled Trials Register (April 1999), DARE (April 1999), INAHTA (April 1999), NHS HTA Internet site (April 1999). Dermatological Surgery (1995 to March 1999) and the British Journal of Dermatology (1995 to September 1999) were handsearched. We searched the reference lists of relevant articles and contacted experts and commercial laser manufacturers.

Selection criteria

Randomised controlled trials which compare different laser resurfacing techniques for treating patients with facial acne scars, or compare laser resurfacing with other resurfacing techniques or no treatment.

Data collection and analysis

Two reviewers independently selected studies, assessed the quality of studies and extracted data.

Main results

No randomised controlled trials where laser treatment was compared to either placebo or a different type of laser were found. Most of the 27 studies uncovered were poor quality case series with small numbers of acne-scarred patients.

Authors' conclusions

The lack of good quality evidence does not enable any conclusions to be drawn about the effectiveness of lasers for treating atrophic or ice-pick acne scars. Well designed randomised controlled comparisons of carbon dioxide versus Erbium:YAG laser are urgently needed.

Author(s)

Jordan Rachel, Cummins Carole CL, Burls Amanda, Seukeran Daron DC

Summary

Laser treatment for acne scars

Acne (acne vulgaris) is caused by a combination of excess skin oil, bacteria and other tissue leading to blockage of the pores. Inflamed spots usually appear on the face, chest, shoulders or upper arms. Permanent physical scarring may result. Treatment of scars includes using steroids, chemical and mechanical resurfacing techniques (such as dermabrasion), or surgery to fill the scarred area with fat, skin or collagen. Laser resurfacing has the potential to be more precise than other techniques in the treatment of some facial scars, but is expensive and may have adverse effects. The review found no trials of laser resurfacing. There is not enough evidence to show whether laser resurfacing is worthwhile for acne scars.

Reviewer's Conclusions

Implications for practice

There is unmet patient need and demand for the treatment of acne scars, particularly in publicly-funded health care systems, so the evaluation of the effectiveness of laser treatments is important. At the moment laser treatment for acne scars is only funded sporadically by health authorities in the UK National Health Service. It is possible that there is some benefit from treatment, but this cannot be quantified with the available evidence. The cost per treatment in the UK is about £1000 for a localised area or £3000 for a full face for either Erbium YAG or carbon dioxide laser (1998 UK costs). If there is benefit, it is assumed that this will be permanent. If lasers were found to be clinically effective, they may well also be cost-effective from a health care perspective in publicly funded health care systems, particularly if we also assume that removal of acne scars improves patients' psychological status and quality of life. The current evidence, however, is insufficient to support or reject laser treatment.

Implications for research

Further primary research in the form of randomised controlled trials (which must include validated quality of life measures) is needed in order to quantify the benefits and harms and to compare lasers with different gain mediums, ideally:

Study design
A randomised controlled trial (either right to left comparison or a randomised parallel group).

Population
Adults with atrophic or ice-pick acne scars, stratified by severity. A standard scale should be identified and used with baseline psychological or quality of life measurements.

Intervention
Carbon dioxide laser compared with Erbium:YAG laser or either laser compared with no treatment.

Blinding
Observers should be blinded to the treatment allocated.

Outcomes
Clinical scar improvement measured by optical profilometry; patient satisfaction measured by accepted quality of life scoring system; side effects. Long-term outcomes should be measured; ideally at least one year after treatment.

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