Clinical Outcomes of Long-Pulsed 1064-nm Nd:YAG Laser Therapy for Facial Acne Scars: A Prospective Before-and-After Study

Vollständiger Abstract

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Background: Facial acne scarring is a common sequela of acne vulgaris and is frequently associated with long-term psychosocial burden. Long-pulsed 1064-nm Nd:YAG laser therapy provides deep dermal penetration with a favorable safety profile, particularly in darker skin phototypes; however, prospective real-world data remain limited. Objective: To evaluate within-subject changes in facial acne scar severity and treatment tolerability following long-pulsed 1064-nm Nd laser therapy in patients with Fitzpatrick skin types III and IV. Methods: This prospective, single-arm before-and-after study enrolled 98 adult patients with facial acne scars treated at a tertiary dermatology center. Participants received six sessions of long-pulsed 1064-nm Nd:YAG laser therapy at two-week intervals, applied unilaterally to standardize treatment exposure. Scar severity was assessed at baseline and six months after treatment using the Goodman and Baron acne scar grading system and the Scar Severity Scale (SCAR-S). Scar morphologies and treatment-related pain were also evaluated. Results: Following treatment, statistically significant reductions in acne scar severity were observed across both outcome measures. The median Goodman and Baron score decreased from 8.0 (IQR: 3.0) at baseline to 5.5 (IQR: 2.0) after treatment, with a median change of −2.0 (IQR: 2.0; Z = −8.025, p<0.001; effect size r = 0.81). The median SCAR-S score decreased from 3.0 (IQR: 2.0) to 2.0 (IQR: 1.0), with a median change of −1.0 (IQR: 1.0; Z = −7.072, p<0.001; effect size r = 0.71). Improvement was observed in 85.7% and 58.2% of participants according to the Goodman and Baron and SCAR-S measures, respectively. Significant score reductions were detected across all major atrophic scar subtypes, including ice-pick, boxcar, and rolling scars (all p<0.001). Treatment-related pain was generally mild, and no clinically evident post-inflammatory hyperpigmentation or serious adverse events were observed during routine clinical follow-up. Conclusion: Long-pulsed 1064-nm Nd laser therapy was associated with statistically significant reductions in facial acne scar severity and demonstrated good tolerability in patients with Fitzpatrick skin types III and IV. The observed score changes were accompanied by large statistical effect sizes; however, their clinical meaningfulness should be interpreted cautiously in the absence of an established minimally clinically important difference for the outcome measures used. Because this was an uncontrolled before-and-after study, the observed changes cannot be attributed definitively to the intervention. Controlled comparative studies are needed to establish treatment efficacy.