الفهرس | Only 14 pages are availabe for public view |
Abstract Facial scars have a profound psychosocial impact on patients of all ages. Surgical reconstruction is sometimes advised, but the most favorable outcome for improving skin texture is achieved by fractional resurfacing following subcision. Carbon dioxide resurfacing following subcision is the gold standard for treating atrophic scars. This study included 50 patients with atrophic acne scars. They were collected from outpatient Clinic of Dermatology, Andrology & STDS Department in Menoufia University. An informed consent was obtained from all participants in this research. Acne patients from both sex ≥ 18 years with any types and any grade of atrophic post-acne scars, not receiving any treatment in the last 6 months for their scars. group (A): including 25 patients who were submitted to fractional CO2 laser CO2 laser with varying energy, pulse durations and number of passes. group (B): including 25 patients who were subjected to subcision followed by fractional laser each of enrolled patients will be assessed before each session and in the 3 follow up visits for evaluation. All patients were assessed objectively by means of clinical photography using. Oppo mobile camera 20 mega pixel resolution before starting treatment, at each session, and three months after the last session. using identical lighting situation and patient positioning Clinical assessment was fulfilled via calculating the score of scar by qualitative grading system proposed by Goodman and Baron. SUMMARY 95 Patients were assessed before each session and four weeks after last session, On objective lines, an improvement of scarring by two grades or more was labeled as ‘excellent’ response; a ‘good’ response meant improvement by a single grade and the response was labeled as ‘poor’ where scar grading remained the same after completion of treatment. Side effects were all reported including prolonged erythema (erythema more than 3 days), pain (graded as mild, moderate and severe), and swelling, infection, hyperpigmentation or hypopigmentation and sub dermal nodules formation. . The skin texture of the acne scar and depressed scar group improved per treatment session. After completion of treatment there was a statistically significant difference for all dermatologists in their assessment of the improvement of skin texture for both scar groups. In group A the types of scar were 5 Ice Pick, 16were Rolling and 18were Box scar. In group, B types were 4Ice Pick, 18Rolling and 18Box scar. No statistical significant difference found by comparison between two patients groups as regards type of scar. In group A grade 3 were most common 44% and least common was grade 2 (20%). In group B, grade 3 was most common 48% and least common was grade 4 (24%). No statistical significant difference found between both groups as regard grading in pre-intervention. In group A grade 2 were most common (30.4%) and least common was grade 1 (21.7%). In group B, grade 1 was most common 63.24% and least common was grade 3(9.09%). There were statistical significant differences between both groups as regard grading in post-intervention. There were statistical significant differences between both groups in pre SUMMARY 96 and post-intervention (p-value˂0.05). Excellent Satisfaction was 17.39% in group A and 50% in group B. Poor Satisfaction was least common in group B 18.18% versus group A 60.87%. There was statistical significant difference found by comparison between two patients groups as patient satisfaction (p-value=0.010). Side effects were slightly higher in group B than group A with no statistical significant difference found between two patients groups as patient satisfaction (p-value=0.684). Atrophic acne scars with photothermolysis resurfacing CO2 fractional laser, demonstrated statistically significant improvement in skin texture and atrophy. Fractional lasers are effective in treating superficial textural irregularity and color variation but have limited ability to improve scars that are deep. Subcision is a valuable method, but as it has a high risk of recurrence, the effectiveness of this method is considered low to medium. For more effectiveness, it can be combined with other methods such as laser. Our findings were in line with several studies that confirmed value of combined therapy: Rolling scars were seen to respond the best while icepick pitted scars responded the least to treatment in the study population. This observation carries a lot of therapeutic importance as simple fractional laser resurfacing monotherapy is unlikely to take care of pitted scars. Thus, if pits or ice-pick scars are the predominant scar type in any individual patient, the patient is unlikely to be satisfied with fractional laser resurfacing monotherapy alone. The average recovery rate and satisfaction of patients in the combined method was significantly more than fractional CO2 laser alone. |