痤疮疤痕存在于11%-14%的成年人群中，无论年龄、种族或性别，都会影响患者。痤疮疤痕有多种成熟的治疗方法，包括激光换肤、化学换肤、针刺、磨皮和皮下切除。10600nm CO2剥脱激光（ ablative laser）是痤疮疤痕最广泛使用的治疗选择之一，已被证明是治疗痤疮疤痕最有效的激光之一。585nm或595nm脉冲染料激光（PDL）靶向氧合血红蛋白，可用于治疗红斑、萎缩、肥大和瘢痕疙瘩。剥脱激光通常被认为可以最大限度地改善萎缩性瘢痕，而非剥脱激光则可以在临床改善和不良反应之间取得折衷。非剥脱激光通常用于治疗增生性、红斑性或轻度萎缩性瘢痕。激光模式的组合也可用于改善结果，如以下情况所示。
案例报告
一名18岁的Fitzpatrick IV型男性患者因痤疮和红斑滚动、冰痛和棚车痤疮疤痕病史就诊于皮肤科诊所。除了治疗活动性痤疮外，他还接受了三次PDL（7mm斑点；8-9mJ；6ms）、非剥脱CO2激光（FCL；15-20W；斑点间距：600-800；停留时间：600-1000；1次通过）和三氯乙酸（TCA）CROS（50%）治疗，间隔四至八周。治疗后，患者的痤疮消失了，疤痕的数量和深度都消失了，所有相关的红斑都消失了。
五年文献回顾
在过去的五年里，治疗痤疮疤痕的激光选择取得了一些进展，包括现有激光和痤疮疤痕替代品的比较、新的潜在辅助疗法，以及关于异维甲酸和激光治疗联合使用的证据。重要的是，最近的大多数进展都是在有色人种皮肤方面，2016年至2021年间发表的32项研究中有25项、21项和8项分别明确包括III型、IV型和V型皮肤。
现有激光设备
在一项前瞻性队列研究中，FCL被证明可以将ECCA评分降低45.4%。在一项前瞻性试验中，使用手动非剥脱的超脉冲CO2激光在每两个月治疗一到四次后，将ECCA评分降低了32%。在另一项针对酒渣鼻痤疮疤痕的前瞻性试验中，非剥脱性1440nm点阵激光在三个月的治疗后将ECCA评分降低了30分。在另一项前瞻性研究中，根据FAQoL问卷评分，1064nm Nd:YAG皮秒激光在三次治疗后平均改善了85%患者的瘢痕形成，平均改善了三分。
一项针对亚洲患者的随机分面试验显示，使用衍射光学元件的1064nm Nd:YAG皮秒激光治疗使ECCA评分降低了54.6%，明显高于1550nm铒玻璃分段激光组的41.9%。在一项随机分体式面部试验中，经过四个月的治疗后，Nd:YAG皮秒激光和1550nm分段铒光纤激光分别将ECCA评分降低了38.89%和33.33%。重要的是，皮秒激光观察到更多的精确出血，而铒光纤激光的疼痛评分更高。在一项针对16名患者的随机分面试验中，755nm皮秒亚历山大石激光在每四周进行三次治疗后，将ECCA评分降低了24.7%。在另一项随机分体式面部试验中，FCL或点阵皮秒1064nm激光治疗导致皮肤质地和萎缩的医生改善分数相当，而FCL组经历了更多的炎症后色素沉着。最后，在一项随机试验中，2940nm Er:YAG激光在微激光剥离模式、部分剥脱模式和组合模式下均显著降低了ECCA评分，其中组合模式的评分降低幅度最大。
激光替代品
在一项试验中，与三次点阵射频治疗和一次FCL治疗相比，四次FCL间隔四周的治疗在更大程度上降低了ECCA评分。在另一项研究中，每四周注射一次自体脂肪干细胞与三次FCL治疗在减少痤疮疤痕面积方面相当。在一项随机试验中，使用点阵Er:YAG激光进行两个月的治疗比使用双极射频联合二极管激光两个月治疗更能降低ECCA评分。在另一项随机试验中，与微针相比，点阵Er:YAG导致更多患者的临床改善，疼痛评分较低，尽管停机时间较长。在另一项研究中，射频微针（FMR）比1450nm二极管激光更能改善受试者对痤疮疤痕的主观评价。
此外，另一项研究发现，虽然FMR和剥脱性分段Er:YAG激光都能有效治疗痤疮疤痕，但FMR的恢复期往往更短，患者的耐受性更好。
辅助疗法
一项利用Antera评分系统的随机分体式试验确定，与单独使用FCL相比，FCL联合皮内富血小板血浆（PRP）可使更多患者获得良好或极好的改善。另一项研究发现，与单独使用FCL相比，FCL联合皮内PRP在5分研究者全球评估（IGA）和ECCA评分方面有更大的改善。第三项研究确定，与单独使用FCL相比，FCL和冻干PRP治疗可提高皮肤质地、色素沉着和毛孔径的改善率。另一项随机分面研究发现，FCL和皮内PRP在医生评估中比单独使用FCL更能改善痤疮疤痕外观。最后，在一项比较FCL与皮内PRP或非交联透明质酸配对的试验中，两种辅助疗法同样提高了Goodman和Baron的分级系统评分。在另一项试验中，FCL后局部脂肪组织干细胞衍生的外泌体比单独使用FCL更能降低ECCA评分。在另一项随机分面研究中，发现1550nm铒玻璃点阵激光在随后进行FMR时，比单独使用激光更能提高ECCA评分。
一项随机分面试验确定，830/590nm发光二极管低强度光疗（LED-LLLT）缩短了FCL后治疗后红斑的平均持续时间。
两项随机分体式面部试验确定，激光治疗后使用MAS063DP或含有5%泛醇、madecassoide和铜锌锰的保湿霜在减少停机时间方面与0.02%曲安奈德相当。
在一项随机分体式面部试验中，使用Er:YAG激光治疗后使用的硅胶，与安慰剂相比，并没有改善医生或患者对痤疮疤痕严重程度的评估，尽管它确实通过Visioscan测量改善了皮肤粗糙度。在FCL或1565nm非剥脱点阵激光后的分体式面部试验中，葡聚糖在激光后第7天改善了血红蛋白指数、皮肤水合指数和经皮失水。
最后，一项随机对照试验显示，在2940nm Er:YAG激光照射后，0.05%ECa 233凝胶（一种积雪草提取物）降低了平均红斑指数，以及医生对红斑、结痂和伤口外观的评分。一项随机对照试验比较了FCL后7天的夫西地酸乳膏和红霉素软膏，发现在8周和12周时，夫西地酸组的色素沉着过度活动和严重程度指数（HASI）评分较低。
激光治疗和同时使用异维甲酸
在一项对服用0.2-0.3mg/kg/天异维甲酸的患者的观察性研究中，用650微秒1064nm Nd:YAG激光治疗痤疮疤痕，导致IGA评分降低72.2%，皮肤病生活质量指数（DLQI）降低72.3%，同时患者耐受良好，没有形成新的疤痕。在一项随机分体式研究中，接受10mg/天异维甲酸治疗的患者接受了三次1550nm非剥脱性分段激光治疗，这导致萎缩性瘢痕外观的改善，并且通常有轻微的副作用，包括短暂的红斑和水肿。然而，没有观察到额外的疤痕形成。另一项随机分体式研究确定，在完成一个低剂量口服异维甲酸疗程后的一个月内，使用1550nm掺铒光纤激光治疗，医生对瘢痕外观的改善以及正常伤口愈合进行了评分，没有增生性瘢痕或瘢痕疙瘩的形成。
近期进展
重要的是，大多数研究分析了有色皮肤的激光治疗，有色皮肤在激光治疗后更容易出现炎症后色素沉着过度。过去五年为额外的激光和替代品提供了证据，特别是皮秒激光和FMR，可以安全有效地用于治疗痤疮疤痕。此外，尽管需要更多的数据，但早期证据表明，与某些非剥脱激光同时使用和最近使用异维甲酸都是安全有效的。有证据表明辅助治疗，特别是皮内PRP的益处，以及局部类固醇的新潜在替代品，过去五年在改善临床结果方面取得了进展，同时减少了停机时间并最大限度地减少了副作用。
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