BC08 Effective treatment of papular acne scarring with combined full-field and fractional Er:YAG laser resurfacing: a case report

Abstract Papular acne scars present as raised, cobblestone-like lesions; they are usually found on the chin or trunk and are skin coloured or hypopigmented. They present a therapeutic challenge – traditional treatments including chemical peels, microneedling and subcision often yield suboptimal results. Laser resurfacing has demonstrated efficacy in improving acne-related scarring, promoting controlled tissue ablation and collagen remodelling (Gozali MV, Zhou B. Effective treatments of atrophic acne scars. J Clin Aesthet Dermatol 2015; 8: 33–40). Er:YAG laser treatment offers precise ablation with minimal thermal damage, facilitating effective scar reduction and improved skin texture. Research supports its effectiveness in both full-field and fractional resurfacing for atrophic scars, although evidence on use in papular acne scars remains limited (Lee SJ, Kim JM, Kim YK et al. The pinhole method using an Er:YAG laser for the treatment of papular acne scars. Dermatol Ther 2017; 30: e12512). A 27-year-old woman presented with multiple persistent papular acne scars located on the chin. She had no active acne or dermatological conditions. Given the limitations of traditional therapies, a combined laser-based resurfacing approach was selected, targeting both the raised scar tissue and surrounding skin irregularities. The procedure was performed under topical anaesthesia, using the Er:YAG laser. Initially, single-spot ablation was carried out on protuberant lesions, progressively shaving 25 μm per pass until the lesion surface was flush with surrounding skin. Then followed three passes of fractional resurfacing at 11% density, with depths of 750 μm, 600 μm and 450 μm, respectively, without coagulation. The patient followed a postprocedure regimen involving emollients, photoprotection and wound care measures. The patient exhibited significant improvement in response to a combination of full and fractional resurfacing using the Er:YAG laser, with a marked reduction in scar prominence and overall smoother skin texture. Re-epithelialization was completed within 7 days, with erythema and oedema resolving within 2 weeks. No adverse effects were observed. The treatment was well tolerated, and healing was uneventful, requiring a single follow-up review 2 months postprocedure. This case supports the effectiveness of combining full-field ablation (for precise lesion removal) with fractional resurfacing to enhance skin texture in papular acne scarring. The safety and efficacy profile observed corresponds with existing literature on Er:YAG resurfacing in acne-related scarring and suggests its utility in papular acne. Few studies discuss the use of the Er:YAG laser in the management of papular acne. This case confirms that a combined approach using full-field and fractional Er:YAG laser resurfacing was an effective and well-tolerated treatment for papular acne scarring. Further research is warranted to validate broader application.