Laser resurfacing has beneficial effects for the treatment of several skin conditions. Recently, the pulsed erbium:YAG laser has been shown to be a highly effective treatment for several kinds of pitted facial scars.

The purpose of this study was to assess the efficacy and safety of pulsed erbium:YAG laser skin resurfacing at the setting of low or high energy for pitted acne scars.

65 patients with pitted acne scars were included in this study. All patients had skin types III or IV. All patients were instructed to use tretinoin cream 0.05% nightly for 2-4 weeks prior to the laser treatment. The pulsed erbium:YAG laser with a 2 mm handpiece at the setting of 500 mJ/pulse, 3.5-5 W in 45 patients and 1,000 mJ/pulse, 7-10 W in 20 patients was used. Two weeks after laser treatment, topical application of hydroquinone 4%, tretinoin 0.05%, and hydrocortisone 1% cream was recommended for 2-4 weeks. Facial photographs were obtained at baseline and 2 week intervals postoperatively. The results of treatment were evaluated for the changes of skin texture and color at 1 month, 3 months, and 6 months.

In 45 cases treated with 500 mJ/pulse energy, pitted acne scars were improved about 46.7 % on average and no erythema and postinflammatory hyperpigmentation was observed after 6 months. In 20 cases treated with 1,000 mJ/pulse energy, pitted acne scars were improved about 64% on average and erythema in two patients and postinflammatory hyperpigmentation in one patient were observed after 6 months.

The results of laser treatment for pitted facial acne scars at the setting of high energy are better than those of laser treatment at the setting of low energy.