Comparative outcome study of various chemical peels and surgical procedures in the management of acne scarring

Abstract

Background: Acne scarring is an unfortunate, permanent complication of acne vulgaris, which may be associated with significant psychological distress. The most common type of acne scarring is atrophic (ice pick, rolling scars, and box scars). Numerous treatment options exist for acne scarring such as chemical peeling, surgical procedures, lasers, and so on. This study is being done utilizing chemical agents (glycolic acid, trichloroacetic acid [TCA]) and simple surgical procedures such as microneedling and subcision. Objective: To assess and compare the efficacy, side effects, and safety of chemical peels with simple surgical modalities in the treatment of atrophic acne scars. Materials and Methods: Of the 80 included patients of atrophic acne scars, patients were randomly allotted to four groups of 20 patients. Group A: Glycolic acid peel (35%–70%), Group B: 95% TCA CROSS, Group C: Microneedling, Group D: Subcision. On the basis of a modified scoring system, all the patients were evaluated at their enrollment and further evaluated at 3, 6, and 9 months. Result: Of the 80 patients, 62.5% (50) of the patients belonged to 21–30 years, 44 men and 36 women. Box scar was the most common type. Overall maximum improvement in acne scarring was found in Group C (59%), followed by Group D (51%), Group B (TCA 48%), and Group A (37%). Prolonged erythema and hematoma were common in surgical treatment whereas pigmentary changes were seen mostly with chemical peels. Conclusion: Rolling scars were better managed with microneedling and subcision, box scars and icepick scars with TCA CROSS. On subjective evaluation, maximum patient satisfaction was found with microneedling whereas glycolic acid was the least satisfactory. Overall, surgical treatment showed better improvement compared with chemical treatment.