Topical Antioxidant Serum May Be Effective in Treating Atrophic Acne Scars

New findings suggest a newly-developed topical antioxidant combination of vitamins C and E with ferulic acid may increase wound healing speed and reduce common post-laser complications following ablative CO₂ treatment for those with atrophic acne scars.1

These data were authored by several investigators, including Wei Zhang, MD, the chief physician at the Shanghai Skin Disease Hospital. Zhang and coauthors’ analysis pointed to previous clinical research on a combination treatment of acne scars using vitamin C, vitamin E, and ferulic acid.2

However, the investigative team noted a lack of post-laser recovery data with this formulation in previous studies. They sought to expand upon their findings with this analysis.

“To address this gap, this trial aims to assess the postoperative reparative effects of an antioxidant serum, known as CE Ferulic serum, after ablative fractional CO2 laser treatment in the Chinese population with atrophic acne scars compared with a placebo comparator (normal saline),” Zhang and colleagues wrote.1

Study Design

Using a randomized, investigator-blinded, split-face controlled study design, the investigative team set out to assess post–laser wound recovery among patients using this topical antioxidant serum. Enrollment of participants in the trail occurred over a 60-day period between December 2020 - January 2021, with Zhang et al recruiting adults between 18 - 50 years of age who presented with moderate-to-severe atrophic facial acne scarring.

Scar severity was determined by the investigators via the échelle d’évaluation clinique des cicatrices d’acné (ECCA) system of grading. This classification system features a range of scores, with 16 - 45 being considerate moderate and 46 - 80 being considered severe. Participants deemed eligible were randomly assigned in a split-face design to receive CE Ferulic on 1 side of the face and normal saline on the opposite side. This process took place immediately following ablative CO₂ laser resurfacing.

Application of both of these treatments were applied by Zhang and colleagues for a total duration of 14 days, with the investigators assessing outcomes being blinded to treatment allocation. Those taking part were additionally stratified into subgroups with the team based on application frequency. Some of these subjects received the assigned product once-per-day and others received the treatment twice daily. All throughout the 14-day follow-up period, they assessed multiple parameters related to wound healing and skin barrier function.

The primary marker of acne wound recovery was determined to be scabbing status at the 7-day mark. In their secondary assessments, Zhang and coauthors looked into shifts in erythema index (EI), melanin index (MI), transepidermal water loss (TEWL), and hydration of the skin. They did not aim to directly assess improvement in acne scar appearance. There were 64 patients included by the investigative team in the final analysis.

Findings on Topical Antioxidant Treatment

At Day 7, complete scab detachment was significantly increased in the topical antioxidant–treated side compared with the saline-treated control side of patients’ faces. Specifically, rates were 60.9% versus 34.4%, respectively (P = .0026). Erythema and pigmentation reductions were consistently greater on the intervention side, as evidenced by significantly lower EI and MI values at the 3, 7, and 14-day marks (P < .0001 for all comparisons). By Day 14, the CE Ferulic–treated skin also was shown to have superior ability to retain moisture and preserve its barrier integrity. This, Zhang et al highlighted, suggested significantly improved skin hydration (P = .0367) and reduced TEWL (P = .0246) compared with the control side.

“In conclusion…[we] found that a combination of vitamin C, E, and ferulic acid helped to improve wound healing, reduce erythema and melanin levels, and maintain skin barrier function following ablative fractional CO2 laser treatment compared with normal saline, suggesting its potential to promote skin repair and prevent post-inflammatory hyperpigmentation,” they concluded.1

References

1. Shi Y, Xu S, Zhang W. Reparative Effects of a Topical Antioxidant Serum Containing Vitamin C, Vitamin E, and Ferulic Acid After Ablative Fractional CO2 Laser Treatment for Atrophic Acne Scars: A Randomized, Investigator-Blinded, Split-Face, Controlled Trial. J Cosmet Dermatol. 2026 Jan;25(1):e70634. doi: 10.1111/jocd.70634. PMID: 41521693; PMCID: PMC12793811.

2. Lin FH, Lin JY, Pinnell SR, et al. Ferulic acid stabilizes a solution of vitamins C and E and doubles its photoprotection of skin. J Invest Dermatol. 2005 Oct;125(4):826-32. doi: 10.1111/j.0022-202X.2005.23768.x. PMID: 16185284.