Abstract

Objectives: This case series aims to evaluate the efficacy and safety of combination CO2 laser treatment with topical polydeoxyribonucleotide (PDRN) for acne scars in Filipino patients, and to compare its outcomes with other established post-laser agents, such as exosomes and topical poly-L-lactic acid, in terms of scar improvement and treatment tolerance. Introduction: Fractional CO2 laser is a widely used modality for scar remodeling, but is often limited by prolonged downtime and adverse effects. Post-laser adjuvant treatments, such as skin boosters, have been evaluated to address these concerns. Polydeoxyribonucleotide (PDRN), a regenerative and anti-inflammatory agent, is a potential post-laser treatment, often administered intradermally. This case series is first to evaluate its use as a topical agent via laser-assisted drug delivery using CO2 laser for acne scars, comparing its efficacy with established skin boosters. Materials / method: This is a case series consists of 3 patients with chronic atrophic acne scars who underwent fractional CO2 laser combined with topical PDRN in split-face designs. Patient 1 is a 24-year-old female treated with CO2 laser alone on one side of the face, and the other combined with PDRN applied post-CO2 laser. Patient 2 is a 28-year-old female, and did a split-face study comparing CO2 laser + exosomes vs. CO2 laser + PDRN. Patient 3 is a 30-year-old female, who underwent split-face treatment with CO2 laser + topical poly-L-lactic acid vs. CO2 laser + PDRN. Results: After completing 3-4 sessions, all patients noted improvement of acne vulgaris, post-inflammatory pigmentation, and atrophic scars, with greater benefit on PDRN-treated sides. Compared with other topical agents, PDRN performed better than topical PLLA for addressing PIH and PIE, and was comparable with exosomes. Conclusion: The combination of CO2 treatment and PDRN demonstrated greater efficacy than either modality alone, offering comparable, if not superior, results to other topical skin boosters. Since PDRN is commonly administered via intradermal injection, its use as a topical agent post-laser provides a non-invasive, more comfortable option while maintaining therapeutic benefits. This synergistic approach offers an effective alternative for optimizing scar treatment outcomes while reducing side effects traditionally associated with CO2 laser therapy.