Integrated Cooling-Vacuum-Assisted Non-Fractional 1540 nm Erbium:Glass Laser is Effective in Treating Acne Scars

November 2016 | Volume 15 | Issue 11 | Original Article | 1359 | Copyright © November 2016

Yael Politi MD,a Assi Levi MD,b,c and Moshe Lapidoth MDa,b,c

aHerzelia Dermatolgy and Laser Center, Herzelia Pituach, Israel bDepartment of Dermatology, Laser Unit, Rabin Medical Center, Petah-Tikva, Israel cSackler Faculty of Medicine,Tel Aviv University,Tel Aviv, Israel

INTRODUCTION: Acne scars are a common result of in ammatory acne, affecting many patients worldwide. Among which, atrophic scars are the most prevalent form, presenting as dermal depressions caused by inflammatory degeneration of dermal collagen. Mid-infrared laser skin interaction is characterized by its modest absorption in water and nite penetration to the mid-dermis. Since collagen is a desirable laser target, 1540-nm wavelength is amenable for collagen remodeling within the depressed area of atrophic scars. OBJECTIVES: To evaluate the safety and efficacy of acne scars treatment using an integrated cooling-vacuum-assisted 1540 nm Erbium: Glass Laser. PATIENTS AND METHODS: This interventional prospective study included 25 volunteers (10 men, 15 women) with post acne atrophic scars. Patients were treated with a mid-infrared non-fractional 1540 nm Er:Glass laser (Alma Lasers Ltd. Caesarea, Israel) with integrat- ed cooling- vacuum assisted technology. Acne scars were exposed to 3 stacked laser pulses (400-600 mJ/pulse, 4 mm spot size, frequency of 3 Hz). Patients underwent 3-6 treatment sessions with a 2-3 week interval and were followed-up 1 month and 3 months after the last treatment. Clinical photographs were taken by high resolution digital camera before and after treatment. Clinical evaluation was performed by two independent dermatologists and results were graded on a scale of 0 (exacerbation) to 4 (76%-100% improvement). Patients’ and physicians’ satisfaction were also recorded (on a 1-5 scale). Pain perception and adverse effects were evaluated as well. RESULTS: Almost all patients (24/25) demonstrated a moderate to significant improvement. Average improvement was 3.9 and 4.1 points on the quartile scale used for outcome assessment 1 and 3 months following the last session, respectively. Patient satisfaction rate was 4.2. Side effects were minimal and transient: erythema, mild transient vesicles, and mild pain or inconvenience. CONCLUSION Cooling-Vacuum-Assisted mid-infrared non-fractional Er:Glass 1540 nm laser is safe and effective in the treatment of atrophic acne scars. J Drugs Dermatol. 2016;15(11):1359-1363.


Acne vulgaris is a very common condition affecting billions worldwide.1-3 Post acne scars are common sequelae of acne.4 Inflammation is a major factor in their development,5 influenced by acne inflammation severity, extent, and immunological status. Early and proper treatment of active acne is crucial, especially in patients with the tendency of scarring. Despite many available modalities for the treatment of inflammatory acne residual scarring do occur.6The actual extent and incidence of post acne scarring remains unknown, yet one study found acne scars in 1% of adult population.7 Often presents in highly visible areas such as the face, permanent and disfiguring acne scars may significantly decrease self-esteem and well-being.8Acne scars can be divided into two main categories6: atrophic and hypertrophic, the former, appearing much more frequently than the latter. Atrophic scars are characterized by loss of collagen deposition during the wound-healing process. The affected skin has an abnormal contour, with most scars being depressed below the adjacent normal skin. These atrophic scars could be further subdivided into 3 morphological main types9: ice pick like type, boxcar like type, and rolling like type scar.The development of advanced technologies in recent years, brought on a new era in the treatment of acne scars.10 Laser treatments are in constant growing utilization for that purpose,11, 12 alone or in treatment combinations,13 as well as the demand for a minimal downtime following treatment.Non-ablative, fractional photo-thermolysis laser therapy is considered the standard-of-care in various cutaneous conditions such as wrinkles, atrophic and surgical scars, hypo-pigmentation, and others, with high safety profile across all skin types.14-18Fractionation refers to manipulation of a laser beam via a defractive lens in which multiple microscopic laser beams are