Adverse effects associated with ablative lasers when treating common dermatologic conditions: a systematic review of 946 patients

Submitted: 26 November 2023
Accepted: 4 December 2023
Published: 21 December 2023
Abstract Views: 1299
PDF: 5
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CO2 and Er:YAG are the two most common types of ablative lasers in use today. Ablative lasers are known for their superior efficacy in penetrating deeper through the skin layers when compared to non-ablative lasers. This review compares the outcomes and adverse events associated with CO2 and Er: YAG lasers, in conjunction with other therapeutic modalities, in the treatment of common skin conditions. A PRISMA-compliant systematic review of PubMed and Embase databases was conducted from January 2012 to December 2022. Study types that were eligible for this review included clinical trials, randomized controlled trials, case reports, case series, cohort studies, and meta-analyses. The study protocol was registered (PROSPERO 2022: CRD42022348569). The search strategy produced 27 studies comprising 946 patients who were treated for acne scars, postacne hyperpigmentation, solar lentigines, facial rejuvenation, refractory vitiligo, and epidermal verrucous nevi. Erythema, pain, and hyperpigmentation were the most commonly reported adverse effects. A higher rate of adverse events was observed in CO2 laser therapies (n=610, 64.5%) when compared to Er: YAG and other laser cohorts (n=40, 4.2%). Both CO2 and Er: YAG lasers demonstrate similar efficacy in the treatment of benign cutaneous conditions. Further research is needed for parallel comparison of CO2 and Er: YAG lasers.



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Ciocon DH, Doshi D, Goldberg DJ. Non-ablative lasers. Curr Probl Dermatol 2011;42:48-55. DOI:
Riggs K, Keller M, Humphreys TR. Ablative laser resurfacing: high-energy pulsed carbon dioxide and erbium:yttrium-aluminum-garnet. Clin Dermatol 2007;25:462-473. DOI:
Verma N, Yumeen S, Raggio BS. Ablative laser resurfacing. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
Zaresharifi S, Robati RM, Dadkhahfar S, et al. Efficacy and safety of cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in the treatment of seborrheic keratosis. Dermatol Ther 2021;34:e15083. DOI:
Xu Y, Deng Y. Ablative fractional CO2 laser for facial atrophic acne scars. Facial Plast Surg 2018;34:205-219. DOI:
Raulin Ch, Grema H. Psoriasis vulgaris. Indikation für den Laser? [Psoriasis vulgaris. An indication for lasers?]. Hautarzt 2003;54:242-247. DOI:
Lodhi A, Huzaira M, Khatri KA. Erbium:YAG laser skin resurfacing: a Pakistani experience. J Cosmet Laser Ther 2003;5:43-49. DOI:
Manuskiatti W, Iamphonrat T, Wanitphakdeedecha R, Eimpunth S. Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians. Dermatol Surg 2013;39:111-20. DOI:
Faghihi G, Nouraei S, Asilian A, et al. Efficacy of punch elevation combined with fractional carbon dioxide laser resurfacing in facial atrophic acne scarring: a randomized split-face clinical study. Indian J Dermatol 2015;60:473-8. DOI:
Ahmed R, Mohammed G, Ismail N, Elakhras A. Randomized clinical trial of CO2 laser pinpoint irradiation technique versus chemical reconstruction of skin scars (cross) in treating ice pick acne scars. J Cosmet Laser Ther 2014;16:8-13. DOI:
Zhang Z, Fei Y, Chen X, et al. Comparison of a fractional microplasma radio frequency technology and carbon dioxide fractional laser for the treatment of atrophic acne scars: a randomized split-face clinical study. Dermatol Surg 2013;39:559-566. DOI:
Sirithanabadeekul P, Tantrapornpong P, Rattakul B, et al. Comparison of fractional picosecond 1064-nm laser and fractional carbon dioxide laser for treating atrophic acne scars: a randomized split-face trial. Dermatol Surg 2021;47:e58-e65. DOI:
Galal O, Tawfik AA, Abdalla N, Soliman M. Fractional CO2 laser versus combined platelet-rich plasma and fractional CO2 laser in treatment of acne scars: image analysis system evaluation. J Cosmet Dermatol 2019;18:1665-1671. DOI:
Nilforoushzadeh MA, Faghihi G, Jaffary F, et al. Fractional carbon dioxide laser and its combination with subcision in improving atrophic acne scars. Adv Biomed Res 2017;6:20. DOI:
Emam AAM, Nada HA, Atwa MA, Tawfik NZ. Split‐face comparative study of fractional ER:YAG laser versus microneedling radiofrequency in treatment of atrophic acne scars, using optical coherence tomography for assessment. J Cosmet Dermatol 2022;2:227-236. DOI:
Abdel Aal AM, Ibrahim IM, Sami NA, Abdel Kareem IM. Evaluation of autologous platelet-rich plasma plus ablative carbon dioxide fractional laser in the treatment of acne scars. J Cosmet Laser Ther 2018;20:106-113. DOI:
Zhou B-rong, Zhang T, Bin Jameel AA, et al. The efficacy of conditioned media of adipose-derived stem cells combined with ablative carbon dioxide fractional resurfacing for atrophic acne scars and skin rejuvenation. J Cosmet Laser Ther 2016;18:138-148. DOI:
Abdallah MA, Gobrial CK, Gomah SG. Whole area versus focal acne scar treatment (FAST) of post acne-scars by fractional CO2 laser: a comparative study. QJM- Int J Med 2020;113 Suppl 1. DOI:
Yang Z, Jiang S, Zhang Y, et al. Self‐contrast study of pinprick therapy combined with super pulse fractional Co2 laser for the treatment of atrophic acne scars. J Cosmet Dermatol 2021;20:481-490. DOI:
Al Taweel AAI, Al Refae AAAS, Hamed AM, Kamal AM. Comparative study of the efficacy of platelet‐rich plasma combined with carboxytherapy vs its use with fractional carbon dioxide laser in atrophic acne scars. J Cosmet Dermatol 2019;18:150-155. DOI:
Helou J, Korkomaz J, Stephan F, Soutou B. Searching predictive factors of efficacy and safety in a fractional CO2 laser. Dermatol Ther 2020;33. DOI:
Elcin G, Yalici-Armagan B. Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation. Laser Med Sci 2017;32:2047-2054. DOI:
Lee SJ, Kang JM, Chung WS, et al. Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians. Lasers Med Sci 2014;29:615-9. DOI:
Wang B, Wu Y, Luo YJ, et al. Combination of intense pulsed light and fractional CO(2) laser treatments for patients with acne with inflammatory and scarring lesions. Clin Exp Dermatol 2013;38:344-51. DOI:
Ochi H, Tan L, Tan WP, Goh CL. Treatment of facial acne scarring with fractional carbon dioxide laser in Asians, a retrospective analysis of efficacy and complications. Dermatol Surg 2017;43:1137-1143. DOI:
Tatlıparmak A, Aksoy B, Shishehgarkhaneh LR, et al. Use of combined fractional carbon dioxide laser and fractional microneedle radiofrequency for the treatment of acne scars: a retrospective analysis of 1‐month treatment outcome on scar severity and patient satisfaction. J Cosmet Dermatol 2020;19:115-121. DOI:
Fang F, Yang H, Liu X, et al. Treatment of acne scars with fractional carbon dioxide laser in Asians: a retrospective study to search for predicting factors associated with efficacy. Laser Med Sci 2022;37:2623-2637. DOI:
Osman MAR, Kassab AN. Carbon dioxide laser versus erbium:YAG laser in treatment of epidermal verrucous nevus: a comparative randomized clinical study. J Dermatolog Treat 2017;28:452-457. DOI:
Feily A, Seifi V, Ramirez-Fort MK. Fractional CO2 laser pretreatment to autologous hair transplantation and phototherapy improves perifollicular repigmentation in refractory vitiligo: a randomized, prospective, half-lesion, comparative study. Dermatol Surg 2016;42:1082-8. DOI:
Tawfic SO, Abdel Hay R, Salim H, Elmasry MF. Tranexamic acid versus fractional carbon dioxide laser in post-acne hyperpigmentation. Dermatol Ther 2021;34:e15103. DOI:
Cameli N, Mariano M, Serio M, Ardigò M. Preliminary comparison of fractional laser with fractional laser plus radiofrequency for the treatment of acne scars and photoaging. Dermatol Surg 2014;40:553-61. DOI:
Vachiramon V, Panmanee W, Techapichetvanich T, Chanprapaph K. Comparison of Q-switched Nd: YAG laser and fractional carbon dioxide laser for the treatment of solar lentigines in Asians. Lasers Surg Med 2016;48:354-9. DOI:
Hui Q, Chang P, Guo B, et al. The clinical efficacy of autologous platelet-rich plasma combined with ultra-pulsed fractional CO2 laser therapy for facial rejuvenation. Rejuv Res 2017;20:25-31. DOI:
Maninder K, Richa R, Dinesh AP, Suman P. Factors affecting the outcome of fractional carbon dioxide laser resurfacing of various types of scars in skin of color. J Cosmet Dermatol 2021;21:3842-3847. DOI:

How to Cite

Ghani, H., Khan, S., Podwojniak, A., Mirza, F. N., Richards, E., Ekeh, O., … Khatri, K. (2023). Adverse effects associated with ablative lasers when treating common dermatologic conditions: a systematic review of 946 patients. Laser Therapy, 30(2).