A prospective, nonrandomized, open-label study, comparing the efficacy, safety, and tolerability of fractional CO2 laser versus fractional microneedling radio frequency in acne scars

Background: Acne scar is a distressing psychosocial problem, and it has a negative effect on the quality of life. Although variety of approaches are available, demand of less invasive and more effective ways for their treatment is needed. Objective: This study aimed to assess and compare the clinical safety, efficacy, and tolerability of fractional carbon dioxide (FCO2) laser versus fractional microneedling radio frequency (MNRF) in the management of acne scars. Materials and Methods: This study was a prospective, observational, nonrandomized, open-labeled study of total 50 patients selected according to Goodman and Baron global qualitative acne scar grading, and they were divided into two groups of 25 each, having Fitzpatrick skin type III-V. A total of four sessions were given for both the groups at an interval of 2 months. The assessment was done by the treating physician as well as by the blinded physician. Both the subjective and the objective assessment was done at the last follow up given at second month of the fourth session. Results: The mean score of 25 patients in each group of FCO2 and fractional MNRF, decreased from 29.24 to 10.7 (i.e., 63.41%) and from 33.24 to 13.04 (i.e., 60.72%), respectively, as calculated by Goodman and Baron quantitative grading assessed by the treating physician (P = 0.0001). Grade 4 (>75%) improvement was shown by four patients and Grade 3 improvement (51%-75%) was shown by 14 patients among FCO2 group, and similarly Grade 4 (>75%) improvement was shown by three patients and Grade 3 improvement (51%-75%) was shown by 12 patients among MNRF group, as observed by a blinded physician (P = 0.689). Conclusion: Both modalities are equally effective in the treatment of acne scars; however, fractional MNRF having lesser down time and Post inflammatory hyperpigmentation (PIH) among darker skin shades, with good patient satisfaction score, makes it an efficient and safer treatment option as compared to FCO2.