Energy-based devices for the treatment of Acne Scars: 2022 International consensus recommendations.

BACKGROUND AND OBJECTIVES: Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs. STUDY DESIGN/MATERIALS AND METHODS: An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence. RESULTS: The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome. CONCLUSION: Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.

Evaluation of the safety and efficacy of the dual wavelength picosecond laser for the treatment of benign pigmented lesions in Asians.

BACKGROUND AND OBJECTIVES: Cutaneous pigmentary disorders are both more common and more difficult to treat in patients with skin color given the higher melanin content in the epidermis. Although Q-switched lasers are widely considered to be the standard treatment for both epidermal and dermal pigmentary conditions, a very high risk of post-inflammatory hyperpigmentation (PIH) of up to 25% is seen in patients with skin of color. Recently, the novel picosecond laser with pulse durations operating at sub-nanosecond domains has been shown to be effective in tattoo removal and in the treatment of acne scars. The objective of this study is to examine the safety and efficacy of the dual wavelength picosecond laser for the treatment of benign pigmented skin lesions in Asian patients. METHODS: Twelve subjects with benign pigmentary disorders and Fitzpatrick skin types III to IV were recruited in a prospective clinical study to examine the safety and efficacy of the dual wavelength picosecond laser. Patients were treated at approximately 2-6 week intervals depending of the type of lesion. The primary efficacy endpoint is the global percent of clearance which was evaluated by blinded observers using post treatment photographs compared to baseline photographs. Safety was evaluated before and after each laser treatment and patients were asked to rate the level of pain according to the Visual Analog Scale after each treatment session. Patient satisfaction was assessed at the completion of treatment with questionnaires. All patients were followed up at 4, 8, and 12 weeks after the last treatment session. RESULTS: The pigmentary conditions treated included melasma, freckles, lentiginies, café au lait macules, and Hori's macules. Three months after treatment, 53.8% of all pigments achieved excellent response (75-94% lightening,) 30.8% of pigments achieved good response (50-74% lightening,) and 7.7% of pigments achieved both fair (25-49% lightening) and poor responses (0-24% lightening), respectively. The average number of treatment sessions required to reach at least 50% clearance was 4.5 for melasma, 1 for freckles, 1.5 for lentigines and 1 for café au lait. The patient with Hori's macules did not reach 50% clearance after a total of six treatments. Sixty three percent of patients reported satisfaction in the subjective assessment, while 27.3% were neutral and 9.1% were very dissatisfied. The post inflammatory hyperpigmentation rate was 4.8% and 6.5% of subjects developed blistering as a side effect of treatment. CONCLUSION: The dual wavelength picosecond laser is a safe and effective treatment of benign pigmentary conditions in patients with skin of color. In particular, superior clinical efficacy is demonstrated for treatment of freckles and lentigines with a low risk of PIH. Lasers Surg. Med. 51:14-22, 2019. © 2018 Wiley Periodicals, Inc.