A novel therapy of combination Fractional CO2 Laser with topical insulin for treating atrophic acne scar: Single arm study
Keywords:
novel therapy, atrophic scar, laser co2 fractional, topical insulin, palembangAbstract
Introduction Atrophic acne scars pose significant cosmetic and psychological challenges for individuals. Various treatment modalities have been explored, including fractional CO2 laser therapy and topical insulin, which have shown promising efficacy in scar remodelling and tissue regeneration. The objective of the study is to evaluate the effectiveness and safety of a novel therapy utilizing a combination of fractional CO2 laser and topical insulin in treating atrophic acne scars. Methods A total of 19 patients with atrophic acne scars in Palembang were enrolled in this study. The treatment regimen included a combination of fractional CO2 laser therapy and topical insulin application. Treatment sessions were performed once every two weeks for two months. Scar severity was assessed using validated scales, and patient satisfaction and adverse events were recorded. Results The combination of fractional CO2 laser and topical insulin therapy demonstrated promising results in treating atrophic acne scars with significant developments in all outcome variables (Goodman and Baron score, visual analog scale, and quality of life index in dermatology). Significant improvements in scar severity and patient satisfaction scores were observed at the end of the treatment period (at six weeks), with minimal reported adverse events. There is no significant result for random blood sugar with topical insulin influencing blood sugar systemic. Conclusion A combination of fractional CO2 laser and topical insulin therapy has been proven effective in treating acne atrophic scars. This treatment option shows promise for managing acne atrophic scars due to its effectiveness and safety.References
Goh C, Cheng C, Agak G, Zaenglein A, Graber E, Thiboutot M. Acne vulgaris. In: Kang S, Amagai M, Bruckner A, Enk AH D, Margolis McMichael A, Orringer J, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw-Hill Education; 2019. p. 1391–1412.
Arsiwala N, Inamadar A, Adya K. A comparative study to assess the efficacy of fractional carbon dioxide laser and combination of fractional carbon dioxide laser with topical autologous platelet-rich plasma in post-Acne atrophic scars. J Cutan Aesthet Surg. 2020;13(1):11–7.
Layton AM, Thiboutot D, Tan J. Reviewing the global burden of acne: how could we improve care to reduce the burden?. Br J Dermatol. 2021;184(2):219–25.
Utley C, Gold M. Treating acne scars in 2020: Use of lasers. Dermatological Rev. 2021;2(1):4– 10.
Fabbrocini G, Annunziata MC, D’Arco V, De Vita V, Lodi G, Mauriello MC, et al. Acne scars: Pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010(1).
Roh MR, Chung KY. Acne scars: how they form and fow to undo them. In: Ogawa R, editor. Total scar management: from lasers to surgery for scars, keloids, and scar contractures. Tokyo: Springer; 2019. p. 97–8.
Kraeva E, Ho D, Jagdeo J. Successful treatment of keloid with fractionated carbon dioxide (CO2) laser and laser-assisted drug delivery of triamcinolone acetonide ointment in an African-American man. J Drugs Dermatol. 2017;16(9):925–7.
Goodarzi A, Behrangi E, Ghassemi M, Nobari NN, Sadeghzadeh-Bazargan A, Roohaninasab, M. Acne scar; A review of classification and treatment. J Crit Rev. 2020;7(7):1108–14.
Wang J, Xu J. Effects of Topical Insulin on Wound Healing: A Review of Animal and Human Evidences. Diabetes Metab Syndr Obes. 2020; 13: 719-27
Pawar M, Singh M. Microneedling with autologous platelet-rich plasma versus microneedling with topical insulin in the treatment of post-acne atrophic scars: A simultaneous split-face comparative study. J Am Acad Dermatol. 2021;85(6):1-4.
Clark AK, Saric S, Sivamani RK. Acne scars: how do we grade them? Am J Clin Dermatol. 2018;19:139–44.
Majid, I. and Imran, S. ‘Fractional Co2 Laser resurfacing as monotherapy in the treatment of atrophic facial acne scars’, Journal of Cutaneous and Aesthetic Surgery. 2014, 7(2), p. 87. doi:10.4103/0974-2077.138326.
Sadick N, Cardona A. Laser treatment for facial acne scars: a review. Journal of Cosmetic and Laser Therapy. 2018, 20: 424-435.
Lanoue J, Goldenberg G. Acne scarring: a review of cosmetic therapies. 2015, Cutis, 95: 276-81.
Annabathula A, Sekar CS, Srinivas CR. Fractional carbon dioxide, long pulse Nd:YAG and pulsed dye laser in the management of keloids. J Cutan Aesthet Surg. 2017;10:76–80.
Wang J, Xu J. Effects of Topical Insulin on Wound Healing: A Review of Animal and Human Evidences. Diabetes Metab Syndr Obes. 2020; 13: 719-27
Wang L, Yang B, Jiang H, et al. The molecular mechanism study of insulin in promoting wound healing under high-glucose conditions. J Cell Biochem. 2019;120(9):16244–16253.
Liu Y, Dhall S, Castro A, Chan A, Alamat R, Martins-Green M. Insulin regulates multiple signaling pathways leading to monocyte/macrophage chemotaxis into the wound tissue. Biol Open. 2018;7:1.
Rezvani O, Shabbak E, Aslani A et al. A randomized, double-blind, placebo-controlled trial to determine the effects of topical insulin on wound healing. Ostomy/Wound Management. 2009, 55: 22-28.
Pawar M, Singh M. Microneedling with autologous platelet-rich plasma versus microneedling with topical insulin in the treatment of post-acne atrophic scars: A simultaneous split-face comparative study. J Am Acad Dermatol. 2021;85(6):1-4.
Amer, A.M., Goda, A.-S.A.-T. and Khattab, F.M. ‘Topical insulin and fractional laser in management of ACNE SCARS: Review article’, The Egyptian Journal of Hospital Medicine. 2023, 91(1), pp. 4323–4326. doi:10.21608/ejhm.2023.296386.
