Fractional CO2 laser augmented by polynucleotide and exosome-mimetic nanovesicles in atrophic acne scars: randomised comparative trial.

INTRODUCTION: Atrophic acne scars impose a significant physical and psychological burden. Fractional CO2 laser treatment is hindered by delayed healing and pigmentation. Exosome-mimetic nanovesicles (EMNV) may optimise outcomes through increasing collagen remodelling, accelerating the healing process, and inhibiting inflammation. AIM: The aim to the study was to assess combination therapy (CO2 laser + topical exosome-mimetic nanovesicles (EMNV) and polynucleotide) vs. CO2 laser monotherapy on clinical and patient-centred outcomes. MATERIAL AND METHODS: A comparative randomised study assessed CO2 laser alone versus combination therapy in 100 participants with atrophic acne scars. Cases were treated 3 times in a 4-week period. Baseline and 3-month outcomes were assessed by Clinical Evaluation Scale for Acne Scars (ECCA) score reduction as primary outcome, and scars characterization subtype improvement, patient satisfaction, treatment sessions required, and adverse events (hyperpigmentation, erythema, post-treatment pain) were the secondary outcomes. RESULTS: Combination therapy enhanced CO2 laser performance, leading to better ECCA reduction (47.3% vs. 35.9%, p < 0.001), significantly improved scar characterization subtype, ice-pick (68% vs. 42%), boxcar (76% vs. 50%), and rolling scars (72% vs. 48%), as well as fewer cases of post-inflammatory hyperpigmentation (10% vs. 24%, p = 0.04) and fewer cases of prolonged erythema (14% vs. 30%, p = 0.03). Patients had fewer sessions (1.8 vs. 2.3, p < 0.001), were more satisfied (90% vs. 70%, p = 0.003), and continued to improve at 3 months (92% vs. 76%, p = 0.02). CONCLUSIONS: Combination therapy demonstrates superior efficacy, safety, and greater clinical healing as well as significantly improved patient satisfaction. It is a useful innovation as it focuses on both clinical performance and psychological comfort.