Comparison of a 1064‐nm neodymium‐doped yttrium aluminum garnet picosecond laser using a diffractive optical element vs. a nonablative 1550‐nm erbium‐glass laser for the treatment of facial acne scarring in Asian patients: a 17‐week prospective, randomized, split‐face, controlled trial

Abstract

Background Novel picosecond lasers using a diffractive optical element (P‐DOE) have been available for skin resurfacing with distinct mechanisms. However, there are limited data directly comparing P‐DOE and conventional fractional lasers for the treatment of atrophic acne scarring. Objectives We sought to compare the efficacy and safety of a 1064‐nm neodymium‐doped yttrium aluminium garnet P‐DOE and a non‐ablative fractional laser (NAFL) in the treatment of acne scarring. Methods A prospective, randomized, split‐face, controlled trial was performed. One randomly assigned half‐side of each patient’s face (n = 25) was treated with four consecutive sessions of P‐DOE at 3‐week intervals and the other side with NAFL, with subsequent follow‐up for 8 weeks after the final sessions. The efficacy and safety of the two lasers were determined by the Echelle d'Evaluation Clinique des Cicatrices d'acné (Scale of Clinical Evaluation of Acne Scars; ECCA) grading scale, Investigator’s Global Assessment (IGA) score and patients’ reports at the final visit. Histologic analysis was also performed. Results The P‐DOE‐treated side achieved a significantly better improvement in acne appearance (ECCA per cent reduction: 55% vs. 42%) with less severe pain (4.3 vs. 5.6) (P < 0.05). The IGA score and subjective satisfaction were consistent with ECCA score results. Occurrences of treatment‐related side‐effects were also lower in the group treated with P‐DOE (P < 0.05). Histologic analysis revealed elongation and increased density of neocollagen fibres, elastic fibres and mucin throughout the dermis from both sides. Conclusions Compared with NAFL, P‐DOE afforded better clinical outcomes and fewer side‐effects in the treatment of acne scarring in Asian patients.