Study Of Atrophic Acne Scar And The Effect Of Fractional CO₂ Laser On Different Types Of Atrophic Acne Scar

[Background]Acne is a common condition that affects up to 80%of adolescent population to some degree and scarring from acne is most common complication of acne vulgaris.Studies have reported that the incidence of acne scarring in general populations to be 1-11%.There are very few articles on the prevalence and incidence of atrophic acne scar and different types of atrophic acne scar are mostly present on face.Atrophic acne scars are a common complication of severe acne.Many modalities are proposed but each does not yield satisfactory clinical outcomes.The treatment of atrophic acne scars with fractional carbon dioxide(CO2)lasers is gaining increasing impact,but has so far not been compared on which types it is more effective.Adequate laser settings in the treatment of scars using a CO2 fractional laser system have not been established;now fractional CO2 laser systems have been effectively used to treat different atrophic acne scars.[Objectives]1.Study to find which type of atrophic acne scar found on face.2.Study to find which atrophic acne scar is present in different parts.3.Fractional CO2 laser is effective on which atrophic acne scar.[Methods]122 cases of atrophic acne scar patient were selected in which 71 patients were male and 51 patients were female from age 15-45 years.The scarring was quantified according to a lesion count and allocated a score.23 cases of atrophic acne scar patient were selected in which 10 patients were male and 13 patients were female from age between 18-45years.The scarring was quantified according to a lesion count before and after 3rd treatment with fractional CO2 laser.[Result]1.Atrophic acne scar count was recorded from 122 patients.Of the total patients 91.8%had all three types of atrophic acne scar on the all three parts of cheek and 8.2%had other two types atrophic acne scar.From the total scar count 47%of scar was icepick,37%were rolling and 16%were boxcar.There was no statistically significant between male and female while comparing with different atrophic acne scar(p>0.05).Most of the scar was found in cheek area(83.39 ± 37.6)than in forehead,nose,chin(13.34 ± 10.4)which was statistically significant in cheek area(p<0.05).As the cheek part was further divided into 3 parts,in the middle part of cheek,the maximum number of scar seen were 26%icepick,20.6%rolling and 9.60%of boxcar than the other part of cheek.The mean value of icepick scar in male(19.718.4)and female(2319.5)that was statistically significant in the middle part of cheek(p=0.022)and rolling scar(p=0.021)in male(15.518.4)and female(19.419.4).Comparing between the duration of acne with mean atrophic acne scar count,it was found to be statistically significant(p=0.003).This shows that the duration of acne can influence the degree of atrophic acne scarring.2.A11 patients(n = 23)had definite reduction in acne scar count after three treatment sessions that was maintained.Mean reduction in mean atrophic acne scar after treatment is 17.0417.9(p<0.001)and mean reduction in ECCA scores after treatment was 22.39119.9(p<0.05).Percentage reduction in ECCA scores achieved after the third laser sessions was 19.3%.There was a significant reduction in mean boxcar scar count(7.4413.15,p<0.05)and rolling scar count(6.52±3.6,p<0.001)with good improvement on both rolling(60%)and boxcar(58%).There was statistically significant reduction in ECCA scores of mean rolling scar score(9.56± 10.2,p<0.001)and boxcar scar score(10.87±14.7,p=0.002)but not in icepick scar(1.9±5.2,p=0.083).Reduction of scar and ECCA score were statistically significant in both rolling scar and boxcar scar.[Conclusion]1.This study shows that maximum number of scar found was icepick scar and most of the scar was present in middle part of cheek.There was no difference in scar count between male and female but icepick and rolling scar in the middle part of the cheek area was more in female than male.The duration of acne can influence the degree of atrophic acne scarring 2.Using an objective evaluation tool,fractional CO2 laser was found to improved on atrophic acne scars,markedly for boxcar and rolling scars.