الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
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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.