An Analytical Comparative Study to Evaluate the Efficacy and Safety of Fractional CO₂ Laser versus Dermaroller Therapy in the Treatment of Post-Acne Atrophic Scars

Background: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit and is frequently followed by permanent scarring, particularly after inflammatory lesions. Post-acne atrophic scars pose a therapeutic challenge due to their variable morphology and depth. Fractional carbon dioxide (CO₂) laser resurfacing and microneedling using dermarollers are commonly employed modalities aimed at collagen remodelling and scar improvement. Aim: To compare the efficacy and safety of fractional CO₂ laser resurfacing and dermaroller therapy in the management of post-acne atrophic scars. Materials and Methods: This prospective, analytical, comparative study was conducted on 100 patients with moderate to severe post-acne atrophic scars. Patients were randomly divided into two groups of 50 each. Group A was treated with fractional CO₂ laser resurfacing, while Group B received dermaroller therapy. Six treatment sessions were performed at four-week intervals. Treatment response was evaluated using Goodman and Baron’s quantitative global acne scarring grading system and a 5-point visual analogue scale. Adverse effects were documented. Results: Both treatment modalities showed statistically significant improvement in acne scar scores from baseline. Dermaroller therapy demonstrated comparable efficacy with a slightly higher proportion of very good responses, whereas fractional CO₂ laser therapy showed a higher incidence of post-inflammatory hyperpigmentation. Pain was more frequently reported with dermaroller therapy, while erythema was universal but transient in both groups. Conclusion: Fractional CO₂ laser resurfacing and dermaroller therapy are both effective and safe for the treatment of post-acne atrophic scars. Dermaroller therapy offers comparable clinical improvement with fewer pigmentary adverse effects, making it a suitable alternative, especially in darker skin types.