A PROSPECTIVE STUDY TO COMPARE RESURFACING OF FACIAL ACNE SCARS IN ADULTS USING FRACTIONAL CO2 LASER AS MONOTHERAPY VS FRACTIONAL CO2 LASER WITH TOPICAL VITAMIN C SERUM IN A TERTIARY HEALTH CARE CENTRE

Abstract

Background: Dark skin type has a high inclination to acne scarring and is frequently complicated by persistent erythema or pigmentation. Fractional CO2 Laser injures the collagen with a monochromatic light beam, resulting in neocollagenesis, leading to resurfacing atrophic acne scars; however, prolonged erythema and post-inflammatory hyperpigmentation limit its usefulness, particularly in coloured skin. Vitamin C is famous for its antioxidant, anti-pigmentary, and wound healing properties. Laser-assisted drug delivery achieves greater penetration of topical agents. Recent literature demonstrates that ablative lase therapy and topical Vitamin C serum would optimize clinical outcomes in atrophic acne scars. Objectives: The primary objective was to assess the efficacy and safety of Fractional CO2 Laser as Monotherapy and Fractional CO2 Laser in combination with Topical Vitamin C Serum in treating Atrophic Facial Acne Scars. Secondary objectives were to assess post-laser adverse effects and healing. Material and Methods: The study was a double-blinded randomized trial among 76 subjects; 38 in Fractional CO2 laser monotherapy (Group1) and 38 in the Fractional CO2 Laser in combination with Vitamin C serum within 2 minutes immediately after Laser and daily for four months (Group 2). Patients with facial atrophic acne scar belonging to both sexes, within an age group of 18 -40 years, with moderate to severe scar, and willing to undergo treatment and follow up were included in the study. Participants underwent serial photography of the xv lesions at baseline, 1 month, 2 months, 3 months, and 4 months from the first treatment session. The visual analog scale (scoring from 0 to 10) was used to record adverse events (erythema and edema) as perceived by participants. The final assessment was made subjectively by a single observer at the last follow-up visit, and a quartile grading scale was used to assess the response objectively. Data were entered into a Microsoft Excel datasheet and was analysed using SPSS 22 version software. Categorical data was represented in the form of Frequencies and proportions. The Chi-square test or Fischer’s exact test (for 2x2 tables only) was used as a test of significance for qualitative data. Continuous data were represented as mean and standard deviation. MS Excel and MS word were used to obtain various graphs. Pvalue of <0.05 was considered statistically significant after assuming all the rules of statistical tests. Results: A statistically significant difference (p<0.001) was found between the groups with respect to improvement in the appearance of scars after six months. 42.1% and 52.6% of Group 2 patients had >75% and 50-75% of improvement. 21.1% and 31.6% of patients in Group 1 had >75%, and 50- 75% of improvement. >80% of patients were either satisfied or very satisfied in both groups. A statistically significant difference (p<0.001) was found between the groups regarding erythema and edema on Day 7 after the CO2 laser therapy session. With a P-value of 0.016, a statistically significant difference was observed between the groups concerning side effects. xvi Conclusion: The combination of using an ablative fractional CO2 laser and Vitamin C serum in the treatment of atrophic scars has a synergistic effect on their inherent properties in up-regulating new collagen synthesis to improve atrophic scars. Erythema, edema, and post-laser downtime are significantly reduced, with diminished risk of adverse effects.