Facial acne is a common skin disease characterized by chronic inflammation of the facial sebaceous glands and hair follicles. When the primary rash gradually subsides, the patient’s face is often left with acne scars, mainly atrophic scars. Carbon dioxide fractional laser and gold microneedle, two completely different instruments, are often used to treat acne scars. Which instrument has a better treatment effect? ​​How should we choose?

Acne mechanism

Acne is a common chronic inflammatory skin disease involving the hair follicles and sebaceous glands. Its pathogenesis is not yet fully understood, but most scholars believe that its main causes include excessive sebum secretion, excessive keratinization of the hair follicle infundibulum and formation of keratin plugs, excessive proliferation of Propionibacterium acnes and inflammatory response. Propionibacterium acnes is considered to be a key link in the pathogenesis. Some patients may have scars after acne is cured, which is more common in patients with severe acne.\

Principles and methods of acne scar treatment
According to the “Chinese Expert Consensus on Acne Scar Treatment (2021 Edition)”, in the early stage of scarring, anti-inflammatory repair is used to prevent further skin necrosis and the formation of obvious scars. Active intervention in early scars is recommended. It is recommended to use intense pulsed light and 560 nm, 590 nm treatment filters or 500 ~ 600 nm mixed spectrum intense pulsed light equipment in low energy mode for continuous treatment every day until the inflammatory erythema of the skin lesions improves or subsides. In the mature stage of scars, for atrophic scars, it is recommended to use ablative fractional lasers such as CO2 and Er: YAG fractional lasers for treatment. Microneedle radiofrequency or traditional Chinese medicine plum blossom needle rolling can also be used for treatment. Mild atrophic scars can also be treated with plasma therapy or ablative fractional lasers. For hypertrophic scars, a drug combined with photoelectric treatment mode should be used, such as long-acting glucocorticoid intralesional injection combined with laser peeling treatment. For some patients who form keloids, drug treatment, photoelectric combined with radiotherapy, or surgery combined with radiotherapy is recommended.

CO2 fractional laser VS gold microneedle

1.How effective is it in treating acne scars?

A study selected 64 patients and divided them into an observation group and a control group with 32 cases in each group by random envelope method. There was no statistically significant difference in gender, age, course of disease, scar severity, and scar classification between the two groups. The control group was treated with CO2 fractional laser. The lesion area was anesthetized with compound chamomile lidocaine gel before surgery, and the treatment area was cleaned about 1 hour later. Deep or Fusion mode was selected according to the severity of the patient’s scar. The DEEP mode selected a coverage rate of 5% and an energy of 60~70 mJ; the Fusion mode selected a coverage rate of 30% and an energy of 50~60 mJ. The laser treatment shape was selected as a rectangle or hexagon, and the spot size was selected according to the patient’s skin lesion area. A total of 3 treatments were performed, with an interval of 2~3 months between each treatment. The observation group used the gold microneedle radiofrequency treatment device, and selected the microneedle length (1.0~1.5 mm) and radiofrequency power (6~12 W) according to the patient’s treatment site and tolerance, and the radiofrequency output time was 100~150 ms; the vertical operation method with an upright handle was used, and the treatment head was evenly arranged in the treatment area; the repair mask was applied immediately after the treatment for about 20 minutes; a total of 3 treatments were performed, with an interval of 2~3 months between each treatment.The results showed that when the time indicators related to treatment of the two groups of patients were compared, the inflammatory exudation time, healing time, scab shedding time and erythema duration of the observation group were significantly shorter than those of the control group.

2.Mechanism of treating acne scars

CO2 fractional laser is based on the theory of selective photothermal decomposition. Through laser, tiny holes are evenly punched on the skin, which can form three areas of thermal exfoliation, thermal coagulation and thermal effect in the skin layer, and stimulate the skin to produce a series of biochemical reactions, such as new collagen synthesis and epidermal re-epithelialization, which are beneficial to skin self-repair and ultimately improve skin quality and repair scars.On the one hand, gold microneedle technology uses tiny needles to penetrate the skin, causing pinhole damage deep into the papillary layer, which plays a mechanical stimulation role; on the other hand, radio frequency energy is emitted through the needle tip to generate radio frequency thermal stimulation and biological effects, thereby activating the skin repair system. It can not only promote microcirculation and improve the microenvironment, but also stimulate collagen growth and reconstruction and promote skin metabolism. It can also selectively destroy apocrine glands and hair follicle sebaceous glands, which is beneficial to activate the self-anti-inflammatory repair system and reduce local inflammatory reactions.The mechanical stimulation of gold microneedles and the thermal effect of radio frequency treatment have a synergistic effect, and the patient’s skin regeneration and trauma repair ability are enhanced; on the other hand, gold microneedle therapy can reduce sebaceous gland secretion, increase collagen expression, and reduce inflammatory reactions, so it may have better efficacy.