Atrophic acne scar: a novel 4-step treatment approach using the ultra-pulse fractional CO₂ laser

Ultra-pulse fractional CO₂ laser is regarded as an effective modality for treating atrophic acne scar. In this study, we described a novel 4-step treatment approach, which combined a manual fractional thermal contraction technology (MFTCT) and ablation mode of conventional CO₂ laser, with deep and superficial mode of fractional laser for treating atrophic acne scars. This study evaluated the efficacy and safety of the novel 4-step treatment using the ultra-pulse fractional CO₂ laser in patients with atrophic acne scars. 20 patients with Fitzpatrick skin type III-IV and facial acne scars were treated with 4-step treatment approach. All patients completed 6 treatment sessions at 8-week intervals. Two blinded dermatologists evaluated the pre- and post-treatment photographs with a 4-point global assessment scale and ECCA grading scale (échelle d'évaluation clinique des cicatrices d'acné). Patients also provided self-assessment of satisfaction and adverse effects. Three of 20 patients showed more than 75% improvement, 14 patients showed 51%-75% improvement, and 3 patients showed 25%-50%. The mean ECCA scores decreased from 109.75 ± 15.26 to 58.75 ± 17.08, with an improvement rate of 46%, and the change was significant (P < 0.01). All patients were either "very satisfied" or "satisfied" with the outcome of the treatments. There were no obvious adverse events after treatments. Only one developed post-inflammatory hyperpigmentation (PIH) for 3 months after the last treatment. This 4-step treatment is an effective and safe treatment modality for atrophic acne scars with an excellent cosmetic outcome and low complication rates.