Comparative Analysis of fractional laser resurfacing versus Standard Care in acne vulgaris

Abstract

Background: Atrophic scarring and persistent inflammatory lesions remain the most disfiguring long-term consequences of acne vulgaris, and standard pharmacologic care, topical retinoids, benzoyl peroxide, oral antibiotics, and isotretinoin, treats active disease more reliably than it reverses established dermal damage.

Objective: This review compares fractional laser resurfacing with standard pharmacologic care for acne vulgaris and post-acne scarring, evaluating efficacy for active lesions, efficacy for atrophic scarring, safety, and the role of combined regimens.

Methods: We synthesized randomized and split-face trials, prospective cohorts, and consensus guidelines addressing ablative and non-ablative fractional laser resurfacing, topical and systemic acne pharmacotherapy, and comparative or combination protocols in acne vulgaris and acne scarring.

Findings: Standard regimens remain first-line for controlling lesion counts and preventing new scar formation, while fractional resurfacing produces durable improvement in rolling and shallow boxcar scars that pharmacotherapy alone rarely achieves; non-ablative erbium-glass devices offer shorter recovery than ablative carbon dioxide systems with comparable improvement, and sequencing acne control before staged resurfacing outperforms either modality alone.

Conclusions: Fractional laser resurfacing and standard care are complementary rather than competing strategies; a sequential protocol, disease control first, staged resurfacing once inflammation is quiescent, offers the most consistent combination of safety and long-term cosmetic outcome.