Evaluating the Pros and Cons of Fractional CO2 Laser Versus Microneedling in Atrophic Acne Scars in the Skin of Color: A Split Face Study.

Background: Post-acne scarring causes severe physical and psychological distress. Multiple treatment modalities are available with no single gold standard treatment.

Aim and objectives: To assess and compare the efficacy and safety of fractional CO2 laser and microneedling in atrophic acne scars and corelate with variables like scar type, duration, and Fitzpatrick skin types.

Materials and methods: Thirty patients (aged 20-40 years) with facial post-acne atrophic scars with the same Goodman and Baron (GB) grade on both sides of the face were included in the study after written informed consent. After priming skin, four monthly sessions of fractional CO2 laser on the right and microneedling on the left side were performed with 2 months follow-up.

Results: GB (3.53 to 2.37) grade and patient's subjective score (8.63 to 4.37) showed 32.9% and 49.4% improvement over the fractional CO2 laser side and 9.3% (3.53 to 3.20) and 19.7% (8.63 to 6.93) improvement over the microneedling side, respectively, and the difference between the two modalities being statistically significant. Rolling (42.90% vs. 16.18%) and boxcars (36.18% vs. 3.74%) also showed more improvement with fractional CO2 laser. Ice-pick scars responded the least with both modalities. Scars of less than 10 years duration responded better to both modalities with sustained improvement during the study. However, postinflammatory hyperpigmentation (30% vs. 6.67%) was greater with fractional CO2 laser (more in higher Fitzpatrick skin types).

Limitations: Small sample size, short follow-up period, and subjective assessment methods.

Conclusion: Both microneedling and fractional CO2 laser improve the overall appearance of atrophic post-acne scars. The latter was more effective than the former but with a slightly longer healing time and greater post-procedure hyperpigmentation.