Fractional carbon dioxide laser versus trichloroacetic acid peel in the treatment of pseudo‐acanthosis nigricans

Abstract Background Treatment of acanthosis nigricans (AN) is challenging, and new modalities are being explored continuously to increase the therapeutic efficacy. Aim To evaluate the efficacy and safety of fractional CO2 laser compared to trichloroacetic acid (TCA) peel in the treatment of pseudo‐acanthosis nigricans (pseudo‐AN). Methods The study included 40 patients with pseudo‐AN on the neck and axilla allocated into two groups each containing 20 patients. Group (A) was treated with TCA 20% peel applied on the pigmented area while group (B) received fractional CO2 laser. Both treatments were performed till complete clearance or for a maximum of four treatment sessions. Patients with excellent response were further followed up for 6 months after the end of treatment. Results Both modalities were effective in the treatment of pseudo‐AN; however, the therapeutic response was significantly higher in the fractional CO2 laser group compared to the TCA peel group ( p < 0.01). Marked to excellent response (51%–100% clearance of AN lesions) was achieved in 85% of the patients in the fractional laser group versus 10% of the patients in the TCA group. Adverse effects, for example, persistent erythema, post‐inflammatory hyperpigmentation, and burning sensation, were also statistically higher in the TCA group compared to the laser group ( p = 0.04). Conclusion Fractional CO2 laser is a promising effective and well‐tolerated treatment modality for pseudo‐acanthosis nigricans.