Network Meta-analysis Of Different Lasers For Atrophic Acne Scar In Asian Patients

Objectives Network meta-analys is applied to compare the efficacy and safety of four therapeutic mesures for atrophic acne scar in Asian patients including CO2 ablative fractional laser（CO₂FL）,Erbium-Doped Yttrium Aluminum Garnet fractional laser（EYFL）,Erbium:glass fractional laser（EGFL）,picosecond laser（PL）.In order to provide scientific evidence for clinical decision-making.Methods We searched Pub Med,Cochrane Library,Embase databases,CNKI,CQVIP and Wanfang CSPD,the retrieval time was set for the establishment of the database to December 2020,and all the randomized controlled trials on the treatment of atrophic acne scar were searched.The literature was screened independently by two researchers.The quality evaluation and data extraction of the documents that meet the inclusion criteria were carried out according to the requirements of Cocharane system Evaluation Handbook5.0.Echelle d’Evaluation Clinique des Cicatrices d’acne（ECCA）,pain visual score（VAS）and post-inflammatory hyperpigmentation（PIH）incidence were used as the outcome index,and the mean difference（MD）and 95%Confidence interval（CI）were used as the effect indexs for the Continuous variables.The odds ratio（OR）and 95%CI were used as the effect indexes for the dichotomous variables.Review Manager 5.4 and Stata MP 16software were used for data analysis.Results A total of 15 RCTs studies were included,all of which were double-arm trials,including 10 Chinese articles and 5 English articles.A total of 862 asian patients with atrophic acne scar were included,of which 217 were self-control.The sample size of the studies ranged from 16 to 220.there were four intervention measures:CO₂FL,EYFL,EGFL and PL.Results of network Meta-analysis showed that:1 after treatment,the decreasing degree of ECCA score of CO₂FL was better than that of EYFL and EGFL（EYFLvs CO₂FL:MD=-4.64;EGFLvs CO₂FL:MD=-26.23）,but there was no significant difference between CO₂FL and PL,EYFL and EGFL,EYFL and PL,EGFL and PL.According to the SUCRA chart,the results showed that CO₂FL（SUCRA=96.8）>EYFL（SUCRA=58.0）>PL（SUCRA=41.6）>EGFL（SUCRA=3.6）.The ranking results show that the effect of CO₂FL in the treatment of atrophic acne scar may be better than the other three schemes.2 after treatment,in terms of pain score,EYFL and PL were lower than CO₂FL,PL were lower than EGFL.（EYFLvs CO₂FL:MD=-1.85;PLvs CO₂FL:MD=-2.07;PLvs EGFL:MD=-1.09）,and the difference was statistically significant（P<0.05）.There was no significant difference between EGFL and CO₂FL,EGFL and EYFL,PL and EYFL.According to the SUCRA chart,the results showed that:PL（SUCRA=87.4）>EYFL（SUCRA=77.0）>EGFL（SUCRA=34.7）>CO₂FL（SUCRA=0.8）.The ranking results showed that the pain caused by PL in the treatment of atrophic acne scar may be weaker than the other three schemes.3.Comparison of the post-inflammatory hyperpigmentation（PIH）:after treatment,the incidence of PIH in PL was lower than that in CO₂FL and EYFL（PLvs CO₂FL:OR=0.09;PLvs EYFL:OR=0.19）,and the difference was statistically significant.There was no significant difference between EYFL and CO₂FL,EGFL and CO₂FL,EGFL and EYFL,PL and EGFL.According to the SUCRA chart,the results showed that:PL（SUCRA=98.3）>EGFL（SUCRA=54.5）>EYFL（SUCRA=44.8）>CO₂FL（SUCRA=2.5）.The ranking results show that the incidence of PIH caused by PL in the treatment of atrophic acne scar may be lower than that of the other three regimens.Conclusions 1 In terms of reducing the ECCA score of atrophic acne scar in Asian patients:the effect of CO₂FL may be better than the other three schemes.2 in terms of VAS of pain and the incidence of PIH:the pain intensity and risk of pigmentation caused by CO₂FL treatment of atrophic acne scar in Asian patients may be higher than those of the other three schemes,while the pain intensity and risk of pigmentation caused by PL may be lower than those of the other three schemes.3 PL can be recommended for patients with mild illness or seeking less pain and lower risk of complications.Figure20;Table7;Reference 140...