Introduction: Isotretinoin is an approved drug from the United States (US) Food and Drug Administration (FDA) for the treatment of severe recalcitrant nodular acne. Based on reports of poor wound healing and scarring, many practitioners believe that the majority of cutaneous laser treatments should be delayed at least six to 12 months after a patient discontinues isotretinoin treatment. The purpose of this study was to investigate the safety and the efficacy of fractional carbon dioxide laser combined with the low (6mg/day), medium (18mg/day) or high dose (30mg/day) of isotretinoin for the treatment of acne and acne scars and, investigation of the factor associated with the synchronous use of isotretinoin and fractional CO2 laser.
Settings and Design: The study was retrospective, non- randomized, single-centre, open case series performed in our private clinic. A retrospective chart review was conducted for all patients registered at our private clinic for assessment of acne from April 2016 through March 2018.
Materials and Methods: In this study, 80 patients with acne scarring were treated with 10,600nm fractional CO2 laser. Out of eighty, 60 patients in three experimental groups received different dose of isotretinoin (n=20, low dose: 6mg/day; n=20, medium dose: 18mg/day; n=20, high-dose: 30mg/day) prior to the initial fractional CO2 laser treatment. 20 patients with acne scarring who was treated only with the fractional CO2 laser served as control. Acne scars improvement, healing period and presence of keloids formation was taken in account as outcome measured after 6 months follow-up.
Statistical analysis: Comparisons of differences in the demographic profile, efficacy and healing period among four groups was done by Kruskal–Wallis test. Multiple comparisons were performed using Kruskal-Wallis test followed by the p-value was adjusted using the Holm-Bonferroni sequential correction “P” to identify independent factors associated with synchronous use.
Results: In the fractional CO2 laser with medium-dose isotretinoin group, all patients demonstrated normal wound healing also satisfactory acne scar improvement. Moreover, no hypertrophic scars or keloids were observed in patients from this group. Grade of acne, doses of isotretinoin, No of the treatment session, % of MTZ applied during the session, level of MTZ and passes per session were an independent factor that significantly correlated synchronous use of with isotretinoin and fractional CO2 laser.
Conclusion: Based on findings the author concluded that synchronous use of a medium dose of isotretinoin and the fractional CO2 laser was an excellent choice for the future treatment regime.
Keywords: Acne, Acne improvement, Healing period, Isotretinoin, Microthermal damage zone, Treatment sessions.
