Combined Fractional Microneedle Radiofrequency With Ablative Fractional Laser for Acne Treatment

acne scars on a man's face
Close-up acne and scars on asian man face, isolated white background
Findings from the first effort to assess the effects of FMRF/AFL combination treatment as well as the use of FMRF with concomitant isotretinoin therapy.

Fractional microneedle radiofrequency (FMRF) combined with traditional ablative fractional laser (AFL) was demonstrated to be safe and efficacious for the treatment of inflammatory acne and acne scars, according to study data published in Dermatologic Surgery.

Investigators conducted a retrospective review of electronic patient medical records at Severance Hospital, Yonsei University Health System in Seoul, Korea. Adult patients who underwent combination FMRF and AFL for acne or acne scars from January 2015 to December 2017 were eligible for inclusion. Efficacy endpoints included changes in acne scarring severity per the Scar Global Assessment Scale (SGA) and inflammatory lesion count. Textural improvement was assessed using a global improvement score system, in which grade 0 represented a worsening of skin and grade 4 represented >75% improvement. Treatment-emergent adverse events were extracted from medical records. The Wilcoxon signed-rank test was used to identify significant improvements between baseline and after 3 sessions.

The electronic records of 71 patients with inflammatory acne and acne scars were included in analyses. Mean age was 24.8 years (range, 19-38 years), and 38 patients (53.5%) were women. A total of 43 patients were receiving concomitant low-dose isotretinoin or had completed isotretinoin within the 3 weeks prior to first FMRF/AFL session. Mean SGA score decreased from 3.14 ± 0.76 at baseline to 1.58 ± 0.70 after 3 sessions (P <.05). Among 30 patients who had >5 active inflammatory lesions at baseline, lesion count decreased to a mean value of 1.2 ± 0.41 after 3 sessions (P <.05). Mean change in SGA score was greater in  patients with isotretinoin exposure (n=43) vs unexposed patients (n=28) (P <.05). Patients with isotretinoin also experienced nominally better improvement in skin texture compared with untreated patients (3.23 ± 0.70 vs 2.91 ± 0.69). Combined FMRF/AFL was well-tolerated by patients; no sedation was required other than topical anesthesia. No patient reported delayed wound healing or post-procedure adverse events. Three patients developed clinical signs of acral dermatitis related to isotretinoin, but these signs did not delay healing of the treated regions. All patients reported erythema and edema immediately after treatment, but these symptoms resolved within hours to days after each session.

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Study limitations include the small cohort size and absence of a control group.

These data support the efficacy of combination FMRF and AFL for the treatment of acne and acne scars in adults. Although previous studies have confirmed the efficacy of each individual modality, the current study represents the first effort to assess the effects of FMRF/AFL combination treatment. Although post-procedure erythema and edema were unavoidable, these symptoms resolved quickly. No significant adverse events were observed. Patients with isotretinoin exposure experienced generally greater improvements than patients not taking systemic retinoids. Further study is necessary to elucidate the molecular mechanisms which underlie the efficacy of FMRF/AFL, particularly in combination with systemic isotretinoin.

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Kim J, Lee YI, Kim J, Jung JY, Lee WJ, Lee JH. Safety of combined fractional microneedle radiofrequency and CO2 as an early intervention for inflammatory acne and scarring treated with concomitant isotretinoin [published online March 13, 2020]. Dermatol Surg. doi: 10.1097/DSS.0000000000002364