Efficacy of a Combination Treatment of Ablative Fractional Carbon Dioxide Laser Therapy and Recombinant Human Epidermal Growth Factor for Atrophic Acne Scars

Abstract

Background: Atrophic acne scars (AAS) are disfiguring and permanent changes caused by inflammatory acne. Fractional carbon dioxide is a common ablative device used to treat this condition. However, issues such as unclear effectiveness, frequent treatments, and potential side effects exist. In recent years, recombinant human epidermal growth factor (rhEGF) has also been frequently reported for its application in the treatment of acne scars.

Objective: To explore the potential synergistic effect of fractional carbon dioxide laser combined with rhEGF in AAS treatment.

Methods: We enrolled 15 patients with AAS. They received fractional carbon dioxide laser treatment and were then randomly assigned to receive either rhEGF or a placebo on one side of the face. The procedure was repeated three times, and the results were evaluated using the échelle d'évaluation clinique des cicatrices d'acné (ECCA) score and analyzed using the CBS camera system, 3D analysis (3DMD). Reflectance confocal microscopy (RCM) examination was also conducted.

Results: Both sides exhibited significant improvement in the appearance of the acne scars after treatment, as confirmed by the ECCA score, 3DMD data, and CBS texture score. On the rhEGF-treated side, the pore number and epidermal pigment area significantly improved as compared to the control side, whereas no significant differences were observed in the other data. Under RCM, a significant increase in epidermal thickness and appearance of reticular collagen fibers in the dermal layer after treatment was observed.

Conclusion: Compared to the sole use of laser, the combination of fractional carbon dioxide laser and rhEGF does not significantly enhance scar therapeutic effects. However, it does shorten the recovery period after laser treatment and improves the pore appearance.

Keywords: atrophic acne scar; fractional carbon dioxide laser; recombinant human epidermal growth factor.

FIGURE 1

Clinical photographs of AAS patients taken at baseline (upper row) and at 3 months after the third treatment (lower row) show clinical improvements on both the treatment (R) and control (L) sides. AAS, atrophic acne scar.

FIGURE 2

ECCA scores, number of pores, texture score, and epidermal pigment area calculated by using the CBS system at baseline and at 3 months after the third treatment for the rhEGF‐treated and control sides. ECCA, échelle d'évaluation clinique des cicatrices d'acné; rhEGF, recombinant human epidermal growth factor.

FIGURE 3

CBS images of a 27‐year‐old male taken preoperatively (upper row) and 3 months after the final treatment session (lower row) are presented. The patient's left side received rhEGF treatment, while the right side served as the control. The images were captured using polarization mode and red area analysis, and pore and smoothness analyses were conducted. The results demonstrate an improvement in the patient's AAS, characterized by a reduction in the red area, a decrease in the number of pores, and an enhancement in smoothness. AAS, atrophic acne scar; rhEGF, recombinant human epidermal growth factor.

FIGURE 4

RCM images reveal a honeycomb‐like structure in the epidermal layer, with a small amount of highly refractive melanin (a), the dermal layer contained coarse collagen fibers before treatment (b), whereas after treatment, a reticular arrangement of fibers became visible (c). RCM, reflectance confocal microscopy.

FIGURE 5

Following the analysis of 3DMD data, (a) illustrates the preoperative data of localized AAS, (b) presents a comparative chart depicting the difference between 3 months postoperatively and preoperatively. AAS, atrophic acne scar.