LASER ACNE SCAR TREATMENT

Laser treatment for acne scar resurfacing

ACNE SCAR LASER TREATMENT

Despite its prevalence, acne scar treatment has been notoriously difficult. Traditionally, dermatologists have used excision, punch grafts, dermabrasion and chemical peels as acne scar treatment. But the results of these therapies were limited, and additional acne scar could potentially occur. Over the past several years, dermatologists have worked with pulsed laser technology, which has assumed an increasingly important and indispensable role in the acne scar treatment procedures.

Speaking at the American Academy of Dermatology's Academy '97 Meeting, at the New York Hilton and Towers, Tina S. Alster, MD, Washington Institute of Dermatologic Laser Surgery and Georgetown University, reported on the increased use of the pulsed lasers in acne scar treatment

In the late 1980s, experiments using pulsed dye lasers were initiated on thickened, overgrown scars. Dr. Alster and her colleagues reported prolonged improvement in the appearance of most scars after pulsed dye laser treatment. "Clinical assessments and skin surface texture analyses using a computer image analyzer showed that the laser-irradiated acne scar approximated normal skin characteristics," noted Dr. Alster.

Clinical research over the years has led to textural improvements of both thickened and deeply colored red acne scar. "After one or two pulsed dye laser treatments, a 57% to 83% improvement was observed. Facial acne scar have been very responsive to this treatment," said Dr. Alster.

Research has shown that combining the use of the pulsed dye technology with carbon dioxide laser vaporization was found to provide improvement in non-reddened, minimally thickened scars. Atrophic acne scar where there is a breakdown of the skin, have been found to respond most favorably to carbon dioxide laser resurfacing. The number of acne scar treatment rounds necessary depends on the type of lesion and each individual's collagen and wound healing response. Usually two or more rounds of acne scar treatment are needed for hypertrophic (thick) acne scars.

"We have had great success with these laser acne scar treatments, but it is often difficult to categorize scars where several clinical features overlap. A careful preoperative patient evaluation is very important in order to decide the most appropriate procedure to perform," Dr. Alster said.

The pulsed dye laser procedure is typically performed on an outpatient basis without general anesthesia. Local anesthesia is usually administered with a topical anesthetic cream, intralesional injections or nerve blocks. Adjacent, nonoverlapping laser pulses are delivered over the scars. The immediate result may produce a purplish coloring. The treated scars are then evaluated 6-8 weeks later, where another treatment, at the same or slightly higher strength may be necessary.

Local, regional nerve block, or intravenous sedation may be required for CO2 laser resurfacing of atrophic acne scars depending on the extent of damage. Follow-up examinations and skin cleanings are scheduled often during the first postoperative week and patients are encouraged to keep the area moistened with healing ointments and/or cooled compresses. Early evaluation and intervention are important in order to prevent long-term scarring.

"Great strides have been made in the treatment of acne scarring. Pulsed dye lasers are now the preferred treatment for red or thick scars, whereas carbon dioxide laser resurfacing for atrophic scars is now surpassing the results obtained from dermabrasion and chemical peels. Future laser technologic advances coupled with other treatments may even further enhance clinical results," Dr. Alster said.

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