A Systematic Review Of Fractional CO₂ Laser Combined With PRP In The Treatment Of Acne Scar

Object: Acne is a common chronic inflammatory disease of hair follicles and sebaceous glands in adolescent men and women.However,acne scar after acne is a common disease in acne patients,which not only affects the appearance of patients but also affects the psychological and life of patients.Ablative Fractional carbon dioxide laser systems（CO₂ AFL）has been proved to be an effective method for the treatment of acne scars.In recent years,the efficacy and safety of CO₂ AFL combined with Autologous platelet-rich plasma（PRP）and CO₂ AFL alone have been compared.This system evaluated the effectiveness and safety of CO₂ AFL combined with PRP in the treatment of acne scar through the retrieval and collection of relevant literature,to further guide the treatment of patients with acne scar.Methods: Computer retrieval of Web of Science,Pub Med,EMBASE,Vip database,Chinese National Knowledge Infrastructure（CNKI）and Wanfang database was conducted until November 2019.All randomized controlled and nonrandomized controlled studies of CO₂ AFL combined with PRP and CO₂ AFL in the treatment of acne scar were searched,and references that had been included in the study were searched for screening to prevent omission.Literature was screened according to the preset inclusion and exclusion criteria,method quality evaluation and data extraction were conducted for the final included literature,and meta-analysis was conducted for the data with Revman5.3 system evaluation software.Results: Nine studies were included in this meta-analysis,including 8 randomized controlled trials and 1 non-randomized controlled trial,with a total of 357 patients.The results are as follows:1.Clinical improvement score: in a total of 6 studies,the clinical improvement score is significantly higher in the experimental group than in the control group,with a statistically significant difference（MD=0.51,95%CI [0.32,0.70],P< 0.000001）.2.Clinical improvement rate >75%: in a total of 4 studies,patients with clinical improvement rate greater than 75% were significantly higher in the experimental group than in the control group,with statistically significant difference（OR=4.12,95%CI [1.93,8.79],P=0.0003）;Clinical improvement rate > 50%: in a total of 5 studies,patients with clinical improvement rate greater than 50% in the experimental group were significantly higher than those in the control group,with statistically significant difference（OR=2.77,95%CI [1.62,4.71],P=0.0002）.Clinical improvement rate > 25%: a total of 4 studies showed that patients with a clinical improvement rate greater than 25% were significantly higher in the experimental group than in the control group,with statistically significant differences（OR=2.77,95%CI [1.32,5.82],P=0.007）.3.Patient satisfaction: in a total of 7 studies,the number of patients satisfied with treatment was significantly higher in the experimental group than in the control group,with a statistically significant difference（OR=3.61,95%CI [2.26,5.75],P< 0.00001）.4.Scab stage after treatment: there were two studies,and the scab time was significantly shorter in the experimental group than in the control group,with a statistically significant difference（MD=-1.04,95%CI [-1.56,-0.52],P< 0.0001）.5.Incidence of adverse reactions: a total of 5 studies recorded the incidence of pigmentation after treatment.The results of the metaanalysis showed that the incidence of pigmentation was significantly lower in the experimental group than in the control group,with a statistically significant difference（OR=0.27,95%CI [0.11,0.66],P=0.004）.A total of three studies recorded the incidence of erythema.The results of the meta-analysis showed that the incidence of erythema was significantly lower in the experimental group than in the control group,with a statistically significant difference（OR=0.27,95%CI [0.10,0.71],P=0.008）.A total of 2 studies recorded the number of cases of edema.The results showed that the number of cases of edema was significantly lower in the test group than in the control group,with a statistically significant difference（OR=0.21,95%CI [0.05,0.80],P=0.02）.Acne outbreak: two studies recorded the number of cases of acne outbreak,with no significant difference between the two groups（OR=0.36,95%CI [0.12,1.10],P=0.07）.6.Duration of adverse reactions: a total of 3 studies recorded the duration of erythema after treatment,and there was no significant difference between the two groups（MD=-1.07,95%CI [-2.39,0.25],P=0.11）.The duration of edema was recorded in three studies,with no significant difference between two groups（MD=-0.53,95%CI [-1.73,0.67],P=0.39）.7.Pain score: three studies recorded the pain score of patients after treatment,and there was no significant difference between the two groups（MD=1.03,95%CI [-1.58,3.64],P=0.44）.Conclusions: The results of this meta-analysis showed that CO₂ AFL combined with PRP was more effective and safer than CO₂ AFL alone in the treatment of acne scars.1.Patients in the CO₂ AFL combined with the PRP treatment group showed higher clinical improvement and higher patient satisfaction than those in the CO₂ AFL group alone.2.The incidence of erythema,edema,pigmentation and other adverse reactions in patients treated with CO₂ AFL combined with PRP was lower than those treated with CO₂ AFL alone,and the crusting stage was shorter after treatment.