Comparison of 1550nm Fractional Laser Alone Versus in Combination With Microneedling for the Treatment of Acne Scars
Comparison of 1550nm Fractional Laser Alone Versus in Combination With Microneedling for the Treatment of Acne Scars
Acne scarring is an unfortunate consequence of inflammatory acne vulgaris that often leads to
 significant cosmetic and psychosocial impacts. Although there have been many advances in the
 treatment of acne scarring, it remains one of the greatest challenges in cosmetic and laser
 dermatology.

 There have been a multitude of studies establishing the efficacy of non-ablative fractional
 laser therapy for the treatment of atrophic acne scars, and it is widely regarded as one of
 the best available treatments. More recently, there has been a renewed interest in
 controlled, non-thermal dermal injury via microneedling devices in the treatment of atrophic
 acne scars.

 Where there is a gap in the literature, however, is in the evaluation of the combination of
 non-ablative fractional laser resurfacing with microneedling in the treatment of atrophic
 acne scars.

 The investigators' study will compare the safety and efficacy of using non-ablative
 fractional laser versus a combination of microneedling and non-ablative fractional laser for
 atrophic acne scars using a randomized, double-blind, split-face study.

 The investigators' aim is to further elucidate the pathogenesis of acne scarring and the best
 approaches for treatment. In doing so, the investigators will study a combination approach to
 this complex problem in order to better serve future patients.
Acne vulgaris is a highly prevalent dermatologic disorder that affects up to 90% percent of
 the population at some point in their lives to varying degrees. Acne scarring is an
 unfortunate complication of the inflammation that results if acne is not sufficiently
 treated. Classically, acne scarring has been described as either atrophic, hypertrophic,
 keloidal, or pigmented. Atrophic is by far the most common type of acne scarring and is
 subdivided into boxcar, rolling, and icepick subtypes. The presence of acne scarring has been
 associated with a significant decrease in patient well-being and has many psychosocial
 implications. Although the understanding of the pathogenesis, prevention, and treatment of
 acne scarring has come a long way, there are limitations to the current treatment options and
 the search for a cure continues.

 One of the greatest advances in the treatment of acne scarring came with the advent of
 non-ablative fractional lasers, which work through the theory of fractional photothermolysis.
 Fractional photothermolysis relies on the principle of creating thousands of microthermal
 injury zones in the skin while allowing the surrounding intact skin to expedite wound
 healing. The relative sparing of the epidermis while facilitating collagen remodeling in the
 dermis underlies the use of non-ablative fractional laser therapy in the treatment of
 atrophic scars.

 The erbium-doped 1,550-nm non-ablative fractional laser has been extensively studied in the
 treatment of atrophic acne scars with good efficacy and safety.

 The concept of using needle subcision for the treatment of depressed surgical scars was first
 described by Orentreich et al in 1995. The first microneedling device, a drum-shaped roller
 was subsequently developed by Fernandes et al in the early 2000s. Several studies have
 validated the use of microneedling for acne scarring with a similar mechanism of creating
 microchannels in the dermis that allow for collagen remodeling. Furthermore, microneedling
 has been demonstrated to induce a specific cytokine profile including fibroblast-like growth
 factor, vascular endothelial growth factor, epidermal growth factor, and transforming growth
 factor-beta3 which are associated with favorable wound healing.

 More recently, experts have advocated for the use of electric-powered microneedling devices
 which allow for more controlled injury at a set depth, density, and speed for the treatment
 of atrophic acne scars with good results.

 To the investigators' knowledge, this study will be the first of its kind to compare the
 efficacy and safety of a combination of 1,550-nm erbium-doped fractional laser and
 microneedling with the SkinPenTM device to 1,550-nm erbium-doped fractional laser alone in
 the treatment of atrophic acne scars.

 Both treatment modalities in this study are already FDA approved treatment modalities for
 acne scarring.
Inclusion Criteria:

 -  All gender patients

 -  Age older than 18 years

 -  Fitzpatrick skin types I-III

 -  Facial acne scarring of grades III-IV

 -  Both sides of the face should have similar amount and severity of acne scarring

 Exclusion Criteria:

 -  History of keloidal scarring

 -  Localized or active infection in the treatment region

 -  Immunodeficiency disorders

 -  Porphyria or light sensitivity

 -  Connective tissue disorders.

 -  Pregnant or nursing

 -  Recent isotretinoin use within the past 6 months

 -  Renal Disease

 -  Allergies to lidocaine, tetracaine, valacyclovir