Efficacy and safety of erbium-doped yttrium aluminium garnet fractional resurfacing laser for treatment of facial acne scars.

BACKGROUND: Treatment of acne scars with ablative fractional laser resurfacing has given good improvement. But, data on Indian skin are limited. A study comparing qualitative, quantitative, and subjective assessments is also lacking. AIM: Our aim was to assess the improvement of facial acne scars with Erbium-doped Yttrium Aluminium Garnet (Er:YAG) 2940 nm fractional laser resurfacing and its adverse effects in 25 patients at a tertiary care teaching hospital. METHODS: All 25 patients received four treatment sessions with Er:YAG fractional laser at 1-month interval. The laser parameters were kept constant for each of the four sittings in all patients. Qualitative and quantitative assessments were done using Goodman and Barron grading. Subjective assessment in percentage of improvement was also documented 1 month after each session. Photographs were taken before each treatment session and 1 month after the final session. Two unbiased dermatologists performed independent clinical assessments by comparing the photographs. The kappa statistics was used to monitor the agreement between the dermatologists and patients. RESULTS: Most patients (96%) showed atleast fair improvement. Rolling and superficial box scars showed higher significant improvement when compared with ice pick and deep box scars. Patient's satisfaction of improvement was higher when compared to physician's observations. No serious adverse effects were noted with exacerbation of acne lesions forming the majority. CONCLUSION: Ablative fractional photothermolysis is both effective and safe treatment for atrophic acne scars in Indian skin.Precise evaluation of acne scar treatment can be done by taking consistent digital photographs.

A clinico-epidemiological study of adult acne: is it different from adolescent acne?

BACKGROUND: Although acne is usually recognized as an adolescent skin disorder, the prevalence of adults with acne is increasing. There is surprisingly a paucity of data on the prevalence and clinical features of postadolescent acne in the adult Indian population. AIMS: The clinical and epidemiological data of adult acne were evaluated with a view to establishing possible contributing etiological factors and observing whether clinical features differ from adolescent acne. METHODS: Patients over the age of 25 years presenting with acne in a tertiary care hospital were included in the study. A detailed history and examination was carried out, with a stress on aggravating factors. Hormonal imbalances were investigated in females with alopecia, obesity, hirsutism and menstrual irregularity. Severity of acne and complications like scarring and psychological stress were included. RESULTS: Out of 280 patients included in the study 82.1% were women and 17.9% were men. The mean age of the patients was 30.5 years. Persistent acne was observed in 73.2%, while it was late onset in 26.8%. Majority of the patients had inflammatory papular acne (55%), whereas comedonal acne was the least common (6%). Most common predominant site of involvement was cheek (81%), followed by chin (67%), and mandibular area (58.3%). Family history of acne was present in 38.6%. Premenstrual flare was seen in 11.7% of female patients, obesity in 6.4%, hirsutism in 5.7% and alopecia in 1.8%, but raised laboratory markers of hyperandrogenism were observed in only 3.08%. Scarring was observed in a majority of patients (76.4%) and psychological stress in 52.8% patients. CONCLUSION: Adult acne is predominant in women, and as compared to adolescent acne is more inflammatory, with involvement of the cheeks and lower half of the face, while comedones are rare. Facial scarring occurs in a majority and stress is common, which emphasizes that adult acne should not be neglected.