A meta-analysis of the efficacy of fractional CO2 laser combined with acupuncture for acne scars

Background: To systematically evaluate the efficacy of fractional carbon dioxide (CO2) laser combined with acupuncture in acne scars based on the available evidence. Methods: China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Chinese Biomedical Database, China Science and Technology Journal Database, PubMed, Embase, the Cochrane Library, Web of Science databases were searched for published articles on fractional CO2 laser combined with acupuncture for acne scars from their inception to March 22, 2024. Meta-analysis of the articles was performed using Stata/SE 15.0 software after an independent screening of the articles by 2 evaluators, extraction of data and then cross-checking, and quality evaluation of the included articles. Results: A total of 6 articles, involving 468 patients with acne scars, were included. According to a meta-analysis, fractional CO2 laser combined with acupuncture (the treatment group) significantly reduced Echelle d’Evaluation Clinique des Cicatrices d’Acne scores compared to fractional CO2 laser alone (the control group), the efficacy was considerably better than that of fractional CO2 laser alone (relative risk (RR) = ‐3.02, 95% confidence interval [CI] [‐4.47, ‐1.58], P = .000; RR = 1.31, 95% CI [1.14, 1.51], P = .000). The 2 groups did not differ significantly in patient satisfaction or adverse effects (persistent erythema and hyperpigmentation) (RR = 1.74, 95% CI [0.69, 4.36], P = .238; RR = 1.25, 95% CI [0.51, 3.07], P = .627; RR = 0.93, 95% CI [0.59, 1.47], P = .760). Conclusions: Based on the available studies, the efficacy of fractional CO2 laser combined with acupuncture for acne scars is significantly better than fractional CO2 laser alone, and there is no increase in the occurrence of side effects. However, we still need more rigorously designed, large-scale multicenter randomized controlled trials to verify this result.