Acne

Acne scarring treatment recommendations released for lasers and energy-based devices


Dermatologists and plastic surgeons have developed treatment recommendations  acne scars with energy-based devices (EBDs).

The international panel listed 22 evidence-based and opinion-based recommendations for using vascular lasers, ablative fractional lasers (AFLs), non-AFLs and radiofrequency devices in an international consensus statement after “unanimously” agreeing EBDs play an important role in scar management.

In a key recommendation, the panel suggested EBDs be used as a first-line treatment for acne-related macular discolouration, mild and moderate atrophic scarring and erythematous flat scars.

It also suggested “patients with active acne and acne scars should be treated with EBD and topical or systemic medications [such as isotretinoin and antibiotics] in parallel” to “reduce the severity and/or duration of inflammation and scarring potential” and enhance the medications’ effectiveness.

The panel supported the use of “multiple EBD platforms and other treatment modalities in the same treatment session”, as treatment plans can vary based on patients’ scar types, co-existing conditions, prior treatments and responses, skin type and degree of melanisation, and tolerance for pain and downtime.

In the absence of contraindications, clinicians should “continue laser treatment until the desired effect is achieved, or improvement plateaus, rather than adhere to a predetermined number of treatments”, the statement advised.

The recommendations for “safe and efficacious EBD treatment” are designed to help fill the gap between treatment guidelines, advances and clinical practices, the statement read.

“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 centres,” the authors wrote.

This may also reflect the vast array of patient factors that can affect treatment choices for “each individual scar” and the lack of high-quality clinical studies supporting these mono- and combination therapies’ efficacy and safety.

In light of these challenges, the panel generated treatment recommendations based on available literature and expert opinion.

It hoped future research would provide fodder for evidence-based practice and that international guidelines and reimbursement schemes would soon be updated to reflect current evidence and improve treatment access.

It noted that acne scars are “not only aesthetically displeasing, but can also result in significant social and societal burden”, being a risk factor for suicide, depression, anxiety, poor-self esteem, low academic performance and unemployment.

“Given the impact of acne scarring on the overall psychosocial as well as quality of life, a new more inclusive treatment paradigm is required. Indeed, early intervention with EBDs should be adopted and informed consent should include a discussion of these options,” it concluded.

The full recommendations are available in Lasers in Surgery and Medicine

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