A network meta-analysis of the safety of carbon dioxide fractional laser combined with other non-surgical therapy in the treatment of atrophic acne scars
Objective To systematically review the safety of carbon dioxide fractional laser combined with other non-surgical treatments on patients with acne scars.Methods PubMed,EMbase,the Cochrane Library,WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials(RCTs)on the safety of carbon dioxide fractional laser and carbon dioxide fractional laser combined with other non-surgical treatments on patients with acne scars from inception to June 2023.Two reviewers inde-pendently screened the literature,extracted data and assessed the risk of bias in included studies.The network meta-analysis was then performed using Stata 16.0 software.Results A total of 55 RCTs involving 4779 patients were included.The results of network meta-analysis showed that the probability order of the treatments on pigmentation incidence was:fractional CO2 laser+platelet-rich plasma(PRP;79.9%)>fractional CO2 laser+epidermal growth factor dressing(70.2%)>fractional CO2 laser+silicone gel(64.3%)>fractional CO2 laser+collagen dressing(58.0%)>fractional CO2 laser+hyaluronic acid dressing(56.6%)>fractional CO2 laser+recombinant basic fi-broblast growth factor(55.6%)>fractional CO2 laser+asiaticoside cream ointment(51.8%)>fractional CO2 laser+fruit acid(38.8%)>frac-tional CO2 laser+microneedling(23.4%)>fractional CO2 laser(1.3%).In terms of lost time,the probability order of the treatments was:fractional CO2 laser+PRP(97.0%)>fractional CO2 laser+epidermal growth factor dressing(72.8%)>fractional CO2 laser+silicone gel(68.7%)>fractional CO2 laser+asiaticoside cream ointment(40.7%)>fractional CO2 laser+collagen dressing(20.7%)>fractional CO2 laser(0).In the term of edema incidence,the probability order of the treatments was:fractional CO2 laser+PRP(73.5%)>fractional CO2 laser+epidermal growth factor dressing(70.4%)>fractional CO2 laser+collagen dressing(68.8%)>fractional CO2 laser+hyaluronic acid dressing(63.8%)>fractional CO2 laser+fruit acid(51.0%)>fractional CO2 laser+silicone gel(36.0%)>fractional CO2 laser(19.9%)>fractional CO2 laser+recombinant basic fibroblast growth factor(16.4%).In terms of infection incidence,the probability order of the treatments was:frac-tional CO2 laser+PRP(75.6%)>fractional CO2 laser+epidermal growth factor dressing(71.7%)>fractional CO2 laser(33.3%)>fractional CO2 laser+microneedling(19.4%).Conclusion The current evidence shows that carbon dioxide fractional laser combined with PRP is the safest treatment among carbon dioxide fractional laser combined with other non-surgical treatments,which effectively reduces pigmen-tation incidence,lost time,edema incidence,and infection incidence induced by fractional CO2 laser in patients with acne scars,as well as improve patient compliance.
Acne scarFractional CO2 laserSafetyNetwork meta-analysis
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