Atrophic acne scars are the most common type of acne scars and are classified into three main types: icepick, boxcar, and rolling scars. Various procedures and techniques for atrophic acne scarring are discussed in detail, with stronger evidence-based support for lasers (non-fractional, fractional, ablative, and non-ablative), platelet-rich plasma as adjunctive treatment, chemical peels (glycolic acid, trichloroacetic acid, and Jessner's solution), dermal fillers such as hyaluronic acid, and microneedling, and lesser quality evidence for microdermabrasion, subcision, and lipoaspirate grafting. Further research is needed to optimize treatment protocols, assess the efficacy of monotherapies, and establish standardized guidelines for clinicians. This paper will provide a comprehensive review of the evidence-based management of atrophic acne scars, including currently commonly utilized therapies as well as more innovative treatment options.

Superficial chemical peels are one of the most popular skin resurfacing procedures in a dermatologists' clinic today due to quick application process, fast recovery, good patient acceptance, and excellent cosmetic results. The role of various peeling agents like glycolic acid, salicylic acid, trichloroacetic acid, Jessner's solution, retinoic acid, and lactic acid in the management of melasma has been established as that of an additional or maintenance therapy. This article details the current evidence and recommendations for the use of chemical peels in the treatment of melasma, a chronic and recurrent hyperpigmentary disorder.

BACKGROUND: A number of treatments have been used to treat melasma, with varying degrees of success and side effects. OBJECTIVE: We sought to compare the efficacy of a single session of low-power fractional CO2 (10,600 nm) laser followed by Jessner's solution peeling against that of Jessner's solution peeling alone for the treatment of melasma by way of a prospective cohort comparative study performed at Alexandria Main University Hospital in Alexandria, Egypt. This study included 40 Egyptian female patients diagnosed with melasma. Group A received a single session of low-power fractional CO2 laser followed by Jessner's solution peeling for up to six sessions, while Group B received up to six sessions of Jessner's solution peeling alone. Responses were evaluated using the modified Melasma Area and Severity Index (mMASI) score. RESULTS: There was a statistically significant (p≤0.001) difference between mMASI score between before and after treatment in both groups. There was no intergroup significant difference in mMASI score improvements. CONCLUSION: Both low-power fractional CO2 laser combined with Jessner's solution and Jessner's solution peeling alone were safe and effective for the treatment of melasma in patients with different skin types, especially in dark skin types (Fitzpatrick Skin Types III and IV).

1064-nm Q-switched Nd: YAG (neodymium-doped yttrium-aluminium-garnet) laser is widely used for the treatment of Nevus of Ota but multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Modified Jessner's solution has been used for the treatment of facial pigmentation but repetitive chemical peeling can cause irritation and post-inflammatory hyperpigmentation. In this series, we evaluated seven patients who were treated with a combination of 1064-nm Q-switched Nd: YAG laser and Modified Jessner's peel for eight sessions with 85.7% patients showing more than 50% reduction in pigmentation. The added therapeutic benefit of the combination helped to achieve a significant reduction in pigmentation faster with a lesser number of sessions and reduced cost.

Background: Atrophic acne scarring is a permanent complication of acne vulgaris. It has a high prevalence and significant impact on the quality of life. We compared between the efficacy and safety of microneedling (dermapen) and superficial chemical peeling by Jessner's solution for treatment of atrophic acne scars. Materials/Methods: Sixty patients who had atrophic acne scars were divided randomizely into three groups. Group Ι included 20 patients and were treated with dermapen, group ΙΙ included 20 patients and were treated with Jessner's solution peeling, and group ΙΙΙ included 20 patients and were treated with dermapen and Jessner's solution. Clinical assessment of patients was done according to Goodman and Baron scarring global quantitative grading system before and after the end of treatment. Results: There was a significant clinical improvement of acne scars in group ΙIΙ than in group Ι and group ΙΙ, and boxcar scars showed the best clinical improvement in all studied groups. There was statistically negative correlation between the degree of improvement of acne scars and duration of lesions and age of patients. Conclusions: The combined technique (dermapen and Jessner's solution peeling) showed the best clinical improvement with the least number of sessions followed by the microneedling technique and lastly the jessner's solution peeling for treating atrophic acne scars.

Trichloroacetic acid (TCA) is a versatile agent, efficacious in treating a spectrum of facial rhytids and dyschrommias at varying concentrations. TCA is commonly used in a 30%-35% concentration to achieve a medium-depth peel into the upper reticular dermis. The addition of Jessner's solution before the TCA peel application leads to partial removal of epidermis, allowing for deeper penetration of the TCA. This combination is beneficial, as lower concentrations of TCA can be used for the same depth of peel, minimizing complications such as scarring.

Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.