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Mahmoud A Rageh,1 Shady Mahmoud Attia Ibrahim,1 Noha Abdallah,2 Abeer Attia Tawfik2 1Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 2Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences, Cairo University, Giza, EgyptCorrespondence: Mahmoud A Rageh, Department of Dermatology, Faculty of Medicine, Al-Azhar University, Al-Darrasah, Cairo, 11633, Egypt, Email dr.mahmoudrageh@gmail.comBackground: Atrophic acne scarring is a widely prevalent condition and one of the most distressing complications of acne vulgaris. Numerous options with variable outcomes are available for the treatment of acne scarring. Laser is considered a first‐line therapy for acne scars, and recently there has been a growing interest in using stem cells and their derivatives for treating acne scars. In addition, combined therapeutic modalities often achieve more satisfactory results than a single treatment.Objective: We tried to evaluate the role of nanofat and fractional CO2 laser as a combined treatment approach for atrophic acne scarring.Methods: Twenty-five patients with atrophic acne scarring were enrolled. They received a single session of intradermal nanofat injection, at different points 1 cm apart, for acne scars. Two weeks later, they were treated with three sessions of fractional CO2 laser at monthly intervals. Patients were evaluated three months after the last session using the quantitative Goodman and Baron scoring system. Pain, side effects, and patients’ satisfaction were also evaluated.Results: There were two males and 23 females with a mean age of 25.96 years. Their skin type ranged between Fitzpatrick skin type III, IV, and V. Boxcar scars were the most common scar type in 13 patients (52%). After treatment, there was a significant reduction (p < 0.05) in the quantitative Goodman and Baron scores. The improvement was more evident in rolling scars. Seven patients reported significant improvement, and 12 reported marked improvement.Conclusion: This study showed that combining nanofat and fractional CO2 laser is a safe and effective treatment modality for atrophic acne scars.Keywords: acne scars, fractional laser, fat grafting, nanofat

Abeer Attia Tawfik,1 Maha Fathy,2 Ashraf Badawi,1,3 Noha Abdallah,1 Hisham Shokeir1 1Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt; 2Al-Houd Al Marsoud Hospital, Cairo, Egypt; 3Dermatology and Allergology Department, University of Szeged, Szeged, Hungary Background: Topical 5 fluorouracil (5-FU) has been reported as one of the standard treatments for hypertrophic scars (HTS). Ablative fractional laser was found to have promising results in the delivery of topical drugs into the skin by creating vertical channels through which the drugs can penetrate the skin. So far there have been no comparative studies performed to compare both modalities in the same patient and same anatomical region, especially in severe HTS.Objective: The aim of this study was to compare the effectiveness of topical 5-FU and combined topical 5-FU and laser in treating severe HTS.Patients and methods: Twenty-four severe HTS lesions were treated by 5-FU monotherapy and 5-FU combined with ablative fractional erbium YAG laser. Each lesion was divided into two parts. One part was treated with topical 5-FU twice weekly for 8 months. The other part was treated with combined topical 5-FU and ablative fractional erbium YAG laser once per month for 8 months. The scars’ improvement was evaluated by Vancouver scar scale (VSS) and skin analysis camera.Results: The assessment by VSS showed a significant reduction in the mean height, pliability, and vascularity of the lesions which were treated with combined approaches compared to 5-FU monotherapy. Pain and ulceration occurred at a higher rate in the combination therapy group.Conclusion: Treatment of severe HTS with combined 5-FU and ablative fractional erbium YAG laser is more effective than 5-FU alone. Keywords: hypertrophic scars, fractional erbium YAG laser, 5-FU, transcutaneous drug delivery, scar management, fractional lasers, skin ablation, wound healing