Treatment of Atrophic Acne Scars Medical Presentation

Fractional CO2 Laser PowerPoint Presentation

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Published on : Oct 23, 2019 | Views : 3178 | Downloads : 9

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Slide 1-

Comparison of Efficacy of Combined Fractional CO2 Laser with Autologous Platelet Rich Plasma versus Fractional CO2 Laser alone in the Treatment of Atrophic Acne Scars Dr. Sumaira Mushtaq Post-graduate Resident Dermatology Department FJMU/ Sir Ganga Ram Hospital, Lahore
Slide 2-

Introduction Acne --- common inflammatory disorder of pilosebaceous unit 80% adolescents Acne scars --- inflammatory mediators, enzymatic degradation collagen fibers & subcutaneous fat Acne scars --- a cosmetic problem Psychological morbidity --- low self-esteem, poor quality of life
Slide 3-

Introduction (Contd….) Classified into 3 types: Atrophic Hypertrophic Keloid Atrophic scars --- most common
Slide 4-

Introduction (Contd….) Based on shape and depth, three types of atrophic scars: Ice pick Boxcar Rolling
Slide 5-

Types of atrophic scars Ice pick Boxcar Rolling
Slide 6-

Introduction (Contd….) Multiple treatment options: Chemical peeling Dermabrasion Subcision Punch excision & elevation Tissue augmentation with fillers Ablative & non-ablative lasers
Slide 7-

Introduction (Contd….) Fractional CO2 ---- Established & popular modality Initiates healing, collagen synthesis & remodelling Limitations: Longer downtime Post-inflammatory hypo-hyperpigmentation New scarring Secondary infection
Slide 8-

Introduction (Contd….) Autologous PRP --- platelet rich plasma portion of autologous blood Platelet derived growth factors --- tissue remodelling, upregulation collagen & protein synthesis Anti-inflammatory --- reduces side effects of laser
Slide 9-

Objective To compare the efficacy of combined fractional CO2 laser and autologous platelet rich plasma (PRP) with Fractional CO2 laser alone in the treatment of atrophic acne scars
Slide 10-

Hypothesis To investigate potential of PRP to enhance efficacy of Fractional CO2 laser & reduce adverse effects
Slide 11-

Material and Methods Dermatology Department, FJMU/ SGRH, LHR March, 2018 to August, 2018 Sample size 26 (13 each group) 10 males and 16 females Aged 18 to 50 years Patients with moderate to severe acne scars according to Goodman and Baron qualitative scar grade scale
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Exclusion criteria Active acne Chemical peeling, microdermabrasion, dermabrasion in last 1 month Oral and topical retinoid therapy Herpes simplex, Hepatitis B, C & HIV infection Blood dyskrasias Keloidal tendency
Slide 14-

Material and Methods (Contd….) Patients randomly divided into 2 groups: Group A --- fractional CO2 laser alone Group B --- combined fractional CO2 laser and autologous PRP Topical anesthetic cream 60 minutes before treatment Cleansing with 70% isopropyl alcohol Fractional CO2 laser both cheeks
Slide 15-

Materials and Methods (Contd….) PRP --- 15 ml autologous blood drawn Transferred into vial containing 0.5 ml sodium citrate Centrifuged at 1500 RMP ----- 10 mins Buffy coat aspirated, platelet rich plasma, RBC transferred to other vial Centrifugation at 3000 RMP ------ 5 mins Middle platelet rich layer aspirated
Slide 16-

Material and Methods (contd…) Group B --- O.05 ml PRP injected into scars with 2 cm interval Moisturizer --- after treatment Topical antibiotics ---5 days Sun protection Avoid heat exposure, friction and soap 6 sessions at 1 month interval Photographs --- before and after each session
Slide 17-

Clinical response categorized: 2 step upgradation from baseline --- 1 month after last session EFFICACY
Slide 18-

Side Effects Dyschromia Acneiform eruption Secondary infection Persistent erythema New scarring
Slide 19-

Results Data analyzed --- MINITAB Proportion of 2 samples calculated P-value --- <0.01 --- significant
Slide 20-

Results
Slide 21-

Results
Slide 22-

Fractional CO2 alone BEFORE AFTER
Slide 23-

Fractional CO2 with PRP BEFORE AFTER
Slide 24-

Discussion Challenge to treat New techniques fractional CO2 laser & PRP popular This study shows: Efficacy 53% (7) --- Fractional CO2 laser alone Efficacy 85% (11) --- Fractional CO2 laser + PRP
Slide 25-

Discussion (Contd….) PRP combined with Fractional CO2 laser ---significant improvement in scar grading Decreased laser downtime
Slide 26-

Discussion (contd....) Sidhartha D. Shah et al. comparative split face study 30 patients with moderate to severe atrophic acne scars 2 sessions 4 weeks apart Right side ------- Fractional CO2 laser + PRP Left side -------- Fractional CO2 laser + normal saline
Slide 27-

Discussion (Contd….) Response assessment: 4 months after last session Excellent Response --- 33 % with PRP, 13% with control Side effects (edema, persistent erythema , acneiform eruption) --- both sides
Slide 28-

Discussion (Contd….) Faghihi G et al. --- split face comparative study 16 patients with moderate to severe acne scars 2 sessions at 4 weeks apart 1 side of face --- Fractional CO2 laser with intradermal normal saline Other side of face --- Fractional CO2 laser with intradermal PRP
Slide 29-

Discussion (Contd….) Outcome assessment: 4 months after last session Good improvement : 14 (87.5%) ----- Fractional CO2 laser + PRP 11 (68.8%) ----- Fractional CO2 laser + normal saline Longer duration of edema & erythema with PRP
Slide 30-

Conclusion Combined Fractional CO2 Laser with autologous PRP is more efficacious for atrophic acne scars than Fractional CO2 Laser alone