Dermatology: Practical and Conceptual


Research Letter | Dermatol Pract Concept. 2022;12(1):e2022024 1

Ablative Fractional Erbium:YAG Laser Resurfacing: 
A Treatment Option for Acne

Stefania Guida1, Nicola Lippolis1, Matteo Giovani1, Gioia Pedroni1, Giacomo Giovanni 
Urtis2, Giovanni Pellacani1,3, Francesca Farnetani1, Marco Manfredini1

1 Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and 

Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy

2 Cliniche Diventa, Milano-Roma-Como, Italy

3 Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome,  

Rome, Italy 

Key words: acne, laser, erbium:YAG, active acne

Citation: Guida S, Lippolis N, Giovani M, et al. Ablative fractional erbium:yag laser resurfacing: a treatment option for acne.  
Dermatol Pract Concept. 2022;12(1):e2022024. DOI: https://doi.org/10.5826/dpc.1201a24

Accepted: May 26, 2021; Published: January 2022

Copyright: ©2022 Guida et al. This is an open-access article distributed under the terms of the Creative Commons  
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted 
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Dr Nicola Lippolis, Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with 
Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.  
E-mail: lippolisnicola@yahoo.it

Introduction

Acne vulgaris is a disease of the pilosebaceous unit, charac-

terized by a hyper keratinization process, comedo formation, 

and inflammatory reactions [1]. The use of lasers for the 

treatment of acne has been described, but the role of resur-

facing lasers for active acne has not been clarified yet.

Case Presentation

We present the cases of 3 women with noninflammatory 

and inflammatory acne lesions. They received laser therapy 

because they refused prolonged topical treatments or other 

systemic acne therapies. No treatment was given to the pa-

tients in the previous 6 months prior to laser treatment. The 

patients gave informed consent to mild laser rejuvenation 

therapy with ablative fractionated erbium:YAG laser, (Xlase 

plus; Biotec Italia srl, Dueville, VI). 

These patients were treated using the standard protocol 

for mild resurfacing and rejuvenation. Employed parameters 

were 1.5 ms, 3.5 mJ/cm2, 5 Hz on the cheeks and the chin, 

and the rest of the face was treated with 1.0 ms, 2.8 mJ/cm2, 

6 Hz. One laser session per month for 3 months was per-

formed for each patient. Overlapping pulses were performed 

over inflammatory lesions. After the laser sessions, the pa-

tients were instructed to apply sunscreen SPF 50+ and a 
hydrating cream for 30 days. All 3 patients tolerated the 

treatment without any reported side effects. They showed a 

visible improvement of the skin texture and a reduction of 

active acne. 

Dermatology Practical & Conceptual



2 Research Letter | Dermatol Pract Concept. 2022;12(1):e2022024

The average value for the Investigator Global Assessment 

scale (IGA) was indicative of a mild-moderate acne at base-

line (IGA 1-2) and decreased consistently to the almost-clear 

stage (IGA 0-1) at the last follow-up visit 3 months after the 

last laser session (Figures 1 and 2).

One paper describes the application of multiple sessions 

of erbium:YAG laser treatment for active acne on 2 patients 

with inflamed cystic acne [2]. Singh et al hypothesized that 

the mechanism of action of this laser source might be related 

to the photothermal effect acting on follicular hyperkeratosis 

and contributing to skin microbe modulation. 

The short follow-up period of our patients represents 

a limitation of this case report. Further studies are needed 

to investigate the anti-acne effect of erbium: YAG laser and 

its mechanism of action with respect to comedogenesis and 

inflammation.

Conclusions

Acne is one of the most common skin diseases. Many ther-

apeutic approaches are currently available for active acne, 

including laser treatments. However, the role of resurfacing 

Figure 1. Clinical pictures of a 34-year-old woman. (A) Before the last erbium:YAG laser session. (B) 3 months after the last 

 erbium:YAG laser session, showing the reduction of active acne lesions.

Figure 2. Clinical pictures of a 25-year-old woman. (A) Before the last erbium:YAG laser session. (B) 3 months after the 

last erbium:YAG laser session, highlighting a consistent reduction of both inflammatory and noninflammatory acne skin 

lesions.



Research Letter | Dermatol Pract Concept. 2022;12(1):e2022024 3

with erbium:YAG laser has not been clarified yet. Results 

from clinical practice, such as in the cases presented herein, 

highlight the importance of further investigations in 

this field.

Informed consent: Written informed consent for publication 

of their clinical details and clinical images was obtained from 

all patients.

References

1. Manfredini M, Greco M, Farnetani F, et al. In vivo monitoring 

of topical therapy for acne with reflectance confocal microscopy. 

Skin Res Technol. 2017;23:36–40. DOI: 10.1111/srt.12298. 

PMID: 27273850.

2. Singh MZ, Singh SI, Basra PS. Erbium:YAG laser resurfacing 

in patients with inflamed cystic acne. J Cosmet Laser Ther. 

2006;8(4):163-166. DOI: 10.1080/14764170601034711. PMID:  

19839167.