Fractional picosecond laser for atrophic acne scars: A meta-analysis

Abstract

Background: Conventional fractional lasers (FLs) are well-established treatments for acne scars with some inevitable adverse events. Fractional picosecond laser (FPL) is increasingly used for acne scars. Aims: To compare the efficacy and safety of FPL with non-picosecond FLs for acne scars. Methods: PubMed, Embase, Ovid, Cochrane Library, and Web of Science databases were searched. We also searched ClinicalTrials, WHO ICTRP, and ISRCTN websites. A meta-analysis was conducted to assess the clinical improvement and adverse events after FPL compared with other FLs. Results: Overall, seven eligible studies were included. Three physician evaluation systems showed no difference between FPL and other FLs in clinical improvement of atrophic acne scars (MD = 0.64, 95% CI:−9.67 to 10.94; MD = −0.14, 95% CI:-0.71 to 0.43; RR = 0.81, 95% CI:0.32 to 2.01). Patient-assessed effectiveness was also not significantly different between FPL and other FLs (RR = 1.00, 95% CI:0.69 to 1.46). Although temporary pinpoint bleeding was more common after FPL (RR = 30.33, 95% CI:6.14 to 149.8), the incidence of post-inflammatory hyperpigmentation (PIH) and pain level were lower for FPL (RR = 0.16, 95% CI:0.06 to 0.45; MD = −1.99, 95% CI:−3.36 to −0.62). Additionally, edema severity after treatment did not differ between the two groups (MD = −0.35, 95% CI:−0.72 to 0.02). As for the duration of erythema, no difference between FPL and nonablative FL groups (MD = −1.88, 95% CI:−6.28 to 2.51). Conclusions: FPL seems similar to other FLs regarding clinical improvement of atrophic acne scars. With lower PIH risk and pain scores, FPL is more suitable for acne scar patients prone to PIH or sensitive to pain.