Comparison of the effects of short- and long-pulse durations when using a 585-nm pulsed dye laser in the treatment of new surgical scars

Treatment of Cutaneous Leishmaniasis with Intense Pulsed Light: Is it Effective?

Background

Cutaneous leishmaniasis (CL) is a common parasitic disorder that is endemic in many countries. There is no completely effective treatment for this condition, but pentavalent antimony compounds are regarded as the main treatment. Different laser types have been used for treatment of CL with variable success but to our best knowledge, there is no published paper regarding use of intense pulsed light (IPL) for treatment of CL.

Materials and Methods

In this randomized, single-blind clinical trial study, we compared the efficacy of intralesional glucantime alone versus intralesional glucantime plus weekly IPL for treatment of 54 patients with confirmed cutaneous leishmaniasis for a maximum of eight weeks as a randomized, clinical trial.

Results

Although it was not statistically significant, combination treatment was more effective than intralesional glucantime alone (P > 0.05). However, the velocity of healing was significantly higher in the IPL plus intralesional glucantime alone versus glucantime alone. No side effect was observed in both groups.

Discussion

To better evaluate the efficacy of IPL, more studies with a higher number of patients and using various IPL filters are recommended.

Analysis of the Utility of CO2 and Pulse-Dye Lasers Together and Separately in the Treatment of Hypertrophic Burn Scars

INTRODUCTION

Hypertrophic burn scars (HTBSs) remain a significant source of morbidity. Contemporary treatment has evolved to use CO2 lasers and/or pulse-dye lasers (PDLs) to reduce scar thickness (ST) and erythema. This study seeks to compare treatment efficacy with CO2 or PDL individually and in combination.

METHODS

Patients undergoing laser treatments for HTBSs were enrolled. Three 3 × 3 cm squares of HTBSs were randomized to receive treatment with CO2 laser, PDL or CO2 + PDL. Patients underwent 3 treatments, 4 to 6 weeks apart and were followed up over 3 to 6 months. Scar assessments occurred at each visit before treatment and consisted of photographs, ultrasound, colorimetry, and the Patient and Observer Scar Assessment Score.

RESULTS

Twenty-five patients were enrolled. Twenty completed 2 treatments (80%) and 11 completed all 3 treatments (44%). Median initial ST was 0.3 cm. Median time since injury was 8 months. Hypertrophic burn scars treated with CO2 or PDL showed a significant decrease in Patient and Observer Scar Assessment Scale score from visit 1 to 3 (P = 0.01 and 0.01, respectively). When separated by ST, thick scars (≥0.3 cm) showed a significant decrease in thickness between visit 1 and 2 using all laser modalities (CO2 + PDL, P = 0.01; CO2, P = 0.02; PDL, P = 0.03). Thin scars (<0.3 cm) showed a reduction in thickness by visit 3 after CO2 + PDL or PDL alone (P = 0.01 and 0.04, respectively). Separating scars by age, younger scars (<9 months) showed a significant reduction in thickness between visit 1 and 2 for CO2 treatment (P = 0.04), and between visit 2 and 3 for CO2 + PDL treatment (P = 0.04). Hypertrophic burn scars treated with PDL did not demonstrate a significant reduction in thickness until visit 3 (P = 0.002). Older scars (≥9 months) showed a significant reduction in thickness between visit 1 and 2 only after CO2 + PDL (P = 0.01).

CONCLUSIONS

Hypertrophic burn scars of varying ages, etiologies, and thicknesses were examined in this study with greater degree of early reduction seen in thicker scars using all laser modalities of CO2, PDL or in combination. However, there was no clinically meaningful benefit found with combination as compared with individual treatment. These data support the use of laser to improve HTBS but does not support one modality or combination of modalities over another.

Treatment of keloids and hypertrophic scars. Position statement of the Brazilian expert group GREMCIQ

Keloids (K) and hypertrophic scars (HS) are abnormal responses to wound healing that occur as the result of dermal inflammation. Despite the advances on their treatment, many patients still suffer from the negative effects of excessive scarring; its approach is impaired by the lack of objective data on different treatments and the large genetic variability among patients and the difficulties in producing multicentre studies. Their incidence among the Brazilian population is high, as the result of an admixture of Amerindians, Europeans and Africans ancestral roots. With the aim of producing multicentre studies on K and HS, a panel of senior Brazilian dermatologists focused on their treatment was invited to contribute with the K and HS Treatment Brazilian Guidelines. In the first part of this study, different treatment modalities for keloids and HS are fully reviewed by the panel. The second part of the study presents a consensus recommendation of treatment for different types of lesions. More than a literature review, this article aims to show the pitfalls and pearls of each therapeutic option, as well as a therapeutic approach by the Panel of Experts on keloids and Scars on a highly mixed population, providing simple guidelines.

Evaluating outcomes of pulsed dye laser therapy combined with intralesional triamcinolone injection after surgical removal of hypertrophic cesarean section scars

BACKGROUND

Recently, pulsed dye laser (PDL) combined with triamcinolone intralesional injection (TAILI) has been introduced for surgical scar prevention. However, little is known about this procedure's effectiveness in preventing hypertrophic scar following surgical scar removal.

OBJECTIVES

This study aimed to evaluate the outcome of early intervention using PDL combined with TAILI after surgical removal of hypertrophic cesarean section (CS) scars.

METHODS

The medical records of 35 patients who underwent early intervention using PDL and TAILI after removal of hypertrophic CS scars were retrospectively reviewed. The scars' average Vancouver Scar Scale (VSS) scores before scar removal and 3 months after the final treatment were compared.

RESULTS

The patients received 4.23 treatments on average and were followed up for a mean period of 7.74 months. The mean final VSS was 3.11 ± 1.52 and was significantly lower than that of the previous VSS (9.29 ± 1.74, p = 0.000). VSS of the previous CS scar, and the presence or absence of keloid formation in other areas, was associated with treatment outcome (p = 0.003 and 0.008, respectively).

CONCLUSIONS

Early intervention using PDL combined with TAILI could prevent the recurrence or progression of hypertrophic CS scarring after surgical scar removal.

Vascularity and Thickness Changes in Immature Hypertrophic Scars Treated With a Pulsed Dye Laser

BACKGROUND AND OBJECTIVES

Growth of capillaries is an essential process after a dermal injury. An immature scar with robust growth of capillaries tends to be hypertrophic. Pulsed dye laser (PDL) causes damage to microvascular structures and is increasingly used for early erythematous scars to limit scar growth. To have a better understanding of the impact of PDL on scar vascularity and to optimize the clinical use of PDL for managing hypertrophic scars, this study aimed to explore changes in scar erythema, blood perfusion, and thickness of immature hypertrophic scars in Asian patients who received PDL treatments at an early stage.

STUDY DESIGN/MATERIALS AND METHODS

This was a 3-month, assessor-blinded, clinical study. There were two groups of patients, the PDL group and the control group, who had hypertrophic scars less than 1-year post-injury. Patients in the PDL group received three PDL sessions at 4-week intervals. A total of three assessments were performed, at baseline, 1 and 3 months, consisting of the Patient and Observer Scar Assessment Scale (POSAS) and objective measurements of scar erythema, blood perfusion, and scar thickness.

RESULTS

A total of 45 patients were enrolled, 22 in the PDL group and 23 in the control group. After the 3-month treatment, parameters of scar vascularity (P = 0.003), pigmentation (P = 0.026), color (P < 0.001), thickness (P < 0.05), and overall scores (P < 0.01) on the POSAS significantly decreased in the PDL group. Moreover, objective measurements of scar erythema and blood perfusion showed significant improvements in the PDL group (P = 0.009 and P = 0.022, respectively) but not in the control group (P = 0.296 and P = 0.115, respectively). A stable scar thickness was maintained in the PDL group from baseline to 3 months (0.21 cm vs. 0.22 cm, P > 0.05), whereas scar thickness significantly increased in the control group (0.22 cm vs. 0.32 cm, P < 0.01).

CONCLUSION

Use of PDL at an early stage controls vascularity of immature hypertrophic scar by improving its poor blood perfusion that further limits scar thickness growth and promotes scar maturation. Lasers Surg. Med. 00:00-00, 2020. © 2020 Wiley Periodicals LLC.

Evaluating the efficacy and safety of vascular IPL for treatment of acute cutaneous leishmaniasis: a randomized controlled trial

Treatment of cutaneous leishmaniasis (CL) continues to be a health concern, and alternative therapies with fewer side effects are substantially needed. This study aimed to determine the efficacy of intense pulsed light (IPL) with wavelength spectrum affecting vascular lesions on acute cutaneous leishmaniasis. In this randomized clinical trial study, 30 patients with acute CL were enrolled. Baseline clinical and demographic data were recorded in the checklist after obtaining written informed consent. Patients were randomly allocated to receive either IPL fortnightly (intervention group) or intralesional meglumine antimoniate (MA) weekly (control group) over 10 weeks. Patients were assessed every 2 weeks to determine the size of induration and improvement rate of lesions. Follow-up visits were arranged at 3rd and 6th months. Overall, 15 patients (21 lesions) in the intervention group and 15 patients (22 lesions) in the control group were studied. The size of lesions in the control group was significantly higher at the baseline (P = 0.014) and the second week (P = 0.034), and significantly lower in the eighth week (P = 0.009), compared with the intervention group. The size of lesions in the control group changed during the study (P < 0.001), whereas changes were not significant in the intervention group. The trend of changes in size of lesions was faster in the control group (P < 0.001). More patients in the control group had higher improvement rate at the sixth (P = 0.005) and tenth (P < 0.001) weeks. At the end of study, the cure rate was 35% (7 out of 20 lesions) in intervention group and 81.8% (18 out of 22 lesions) in the control group. Complete response happened earlier in the control group (P < 0.001). None of the lesions that were cured before the tenth week relapsed after 6 months. The frequency of blistering was significantly higher in intervention group (P = 0.001). Our results indicated that IPL with wavelength spectrum affecting vascular lesions was inferior to intralesional MA in treatment of CL. However, it can be considered as a second-line option, especially in patients with limitations for use of MA. Trial registry:  https://www.irct.ir/trial/34246 IRCT20140414017271N5.

Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis

Objective: The aim of this systematic review with meta-analysis was to describe the status on the effects of physical scar treatments on pain, pigmentation, pliability, pruritus, scar thickening, and surface area.

Design: Systematic review and meta-analysis.

Subjects: Adults with any kind of scar tissue.

Interventions: Physical scar management versus control or no scar management.

Outcome measures: Pain, pigmentation, pliability, pruritus, surface area, scar thickness.

Results: The overall results revealed that physical scar management is beneficial compared with the control treatment regarding the management of pain (p = 0.012), pruritus (p < 0.001), pigmentation (p = 0.010), pliability (p < 0.001), surface area (p < 0.001), and thickness (p = 0.022) of scar tissue in adults. The observed risk of bias was high for blinding of participants and personnel (47%) and low for other bias (100%).

Conclusions: Physical scar management demonstrates moderate-to-strong effects on improvement of scar issues as related to signs and symptoms. These results show the importance of specific physical management of scar tissue.

Keloids: Current and emerging therapies

Keloids are pathological scars that grow over time and extend beyond the initial site of injury after impaired wound healing. These scars frequently recur and rarely regress. They are aesthetically disfiguring, can cause pain, itching, discomfort as well as psychological stress, often affecting quality of life. Many treatment modalities, including surgical and non-surgical, have been explored and have been reported to be beneficial; however, none have been absolutely satisfactory or optimal for the treatment of all keloid subtypes to date. This poses a major challenge to clinicians. Often, a combinational therapeutic approach appears to offer the best results with higher patient satisfaction compared to monotherapy. The aetiopathogenesis of keloids is not fully elucidated; however, with recent advances in molecular biology and genetics, insight is being gained on the complex process of scar formation and hence new therapeutic and management options for keloids. In this paper, we explore the literature and summarise the general concepts surrounding keloid development and review both current (corticosteroids, surgical excision, silicone-based products, pressure therapy, radiotherapy, cryotherapy, laser therapy, imiquimod and 5-fluorouracil) and emerging (stem cell therapy, mitomycin C, verapamil, interferons, bleomycin, botulinum toxin type A and angiotensin-converting enzyme inhibitors) treatments. Increased knowledge and understanding in this area may potentially lead to the discovery and development of novel therapeutic options that are more efficacious for all keloid types.

LAY SUMMARY

Keloids are problematic scars that are difficult to treat and manage. The aetiopathogenesis of keloids is not clear; however, recent advances in molecular biology and genetics are beginning to shed light on the underlying mechanisms implicated in keloid scar formation which will hopefully lead to the development of treatment options for all keloid types. This review summarises current and emerging therapies.

Early laser intervention to reduce scar formation in wound healing by primary intention: A systematic review

BACKGROUND

Hypertrophic scars frequently follow primary closure of surgical wounds. Laser application at or shortly after suture may be associated with a reduction in scar formation, although the respective study results vary.

AIM

The objective was to evaluate the efficacy of early laser applied within the first six months after surgery to reduce scar formation compared to no treatment.

METHODS

We searched the databases MEDLINE and CENTRAL on 14 January 2019 and included randomized controlled trials (RCTs). Primary outcome was the Vancouver Scar Scale (VSS). Measure of treatment effect was the mean difference from baseline.

RESULTS

Seventeen relevant RCTs randomized 430 scars (413 assessed) and compared laser versus no treatment. Fourteen studies applied a split-scar and three applied a simple parallel design. Three studies with a split-scar design favored the laser group on VSS, and one study had indifferent findings. Considerable heterogeneity I² = 86% did not justify a meta-analysis. The remaining 13 studies did not report appropriate data.

CONCLUSION

On the basis of the currently available evidence, we are uncertain whether early laser can reduce scar formation, and more high-quality research is needed for a definitive conclusion.

Nonvascular uses of pulsed dye laser in clinical dermatology

Lasers are fast becoming the vogue of dermatology ranging from ablative, nonablative, fractional photothermolysis to vascular lasers. There are a range of vascular lasers including potassium titanyl phosphate (KTP 532 nm), pulsed dye laser (PDL -595 nm), diode (810 nm), and Nd:YAG (1064 nm). PDL is a laser that emits yellow light using Rhodamine dye as it is lasing medium. Typical vascular lesions which are treated by PDL include port wine stain, hemangioma, telangiectasia, spider angioma, and rosacea. This article focuses on the use of PDL beyond primary vascular conditions. We review the evidence, or lack thereof, of the use of PDL in acne vulgaris, scars, striae, warts, molluscum, psoriasis, rejuvenation, basal cell carcinoma (BCC), and miscellaneous dermatological sequelae.

The Spectrum of Scarring in Craniofacial Wound Repair

Fibrosis is intimately linked to wound healing and is one of the largest causes of wound-related morbidity. While scar formation is the normal and inevitable outcome of adult mammalian cutaneous wound healing, scarring varies widely between different anatomical sites. The spectrum of craniofacial wound healing spans a particularly diverse range of outcomes. While most craniofacial wounds heal by scarring, which can be functionally and aesthetically devastating, healing of the oral mucosa represents a rare example of nearly scarless postnatal healing in humans. In this review, we describe the typical wound healing process in both skin and the oral cavity. We present clinical correlates and current therapies and discuss the current state of research into mechanisms of scarless healing, toward the ultimate goal of achieving scarless adult skin healing.

Early laser intervention to reduce scar formation - a systematic review

The ability of laser treatment to affect wound healing and subsequently minimize scar formation has been investigated in recent years. However, no systematic review links these clinical trials. The aim of this study was to systematically review and evaluate clinical evidence for early laser intervention to reduce scar formation in studies where laser treatment was introduced less than 3 months after wounding. We searched PubMed using relevant keywords in June 2017. Titles, abstracts and articles were sorted according to inclusion and exclusion criteria. Methodological quality was evaluated according to Cochrane Collaborations risk-of-bias assessment guideline by two independent authors. Twenty-five articles met the inclusion criteria. In total, 22 of 25 studies were controlled studies, and 17 of 25 studies compared laser treatment vs. untreated control scars. The following laser devices have been investigated: pulsed dye laser (PDL), potassium-titanyl-phosphate (KTP) laser, fractional erbium:glass 1540 nm/1550 nm, fractional/full ablation erbium-doped yttrium aluminium garnet (Er:YAG) laser or fractional CO2 laser. Eighteen studies applied laser treatments 2-4 times with 2- to 8-week intervals, while seven studies applied only one laser treatment. Follow-up time ranged from 1 to 12 months with 18 studies using a follow-up time ≤3 months. In general, laser-treated wounds and scars showed benefit from laser intervention, though not always reaching significance. Significant scar improvement was found in three of four studies using laser treatment in inflammation phase, in six of 16 studies with laser initiated in the proliferation phase and in two of five studies in the remodelling phase. High risk of bias was found in randomization and allocation concealment, and low risk of bias with regard to blinding of outcome assessment and lost to follow-up. In conclusion, laser intervention when introduced in inflammation, proliferation or remodelling phase has the potential to reduce cutaneous scar formation. Further, high-quality studies are needed before standard protocols can be implemented in clinical practice.

Cutaneous Scarring: Basic Science, Current Treatments, and Future Directions

Significance: Scarring of the skin from burns, surgery, and injury constitutes a major burden on the healthcare system. Patients affected by major scars, particularly children, suffer from long-term functional and psychological problems. Recent Advances: Scarring in humans is the end result of the wound healing process, which has evolved to rapidly repair injuries. Wound healing and scar formation are well described on the cellular and molecular levels, but truly effective molecular or cell-based antiscarring treatments still do not exist. Recent discoveries have clarified the role of skin stem cells and fibroblasts in the regeneration of injuries and formation of scar. Critical Issues: It will be important to show that new advances in the stem cell and fibroblast biology of scarring can be translated into therapies that prevent and reduce scarring in humans without major side effects. Future Directions: Novel therapies involving the use of purified human cells as well as agents that target specific cells and modulate the immune response to injury are currently undergoing testing. In the basic science realm, researchers continue to refine our understanding of the role that particular cell types play in the development of scar.

Pathophysiologic Mechanisms and Current Treatments for Cutaneous Sequelae of Burn Wounds

Burn injuries are a pervasive clinical problem. Extensive thermal trauma can be life-threatening or result in long-lasting complications, generating a significant impact on quality of life for patients as well as a cost burden to the healthcare system. The importance of addressing global or systemic issues such as resuscitation and management of inhalation injuries is not disputed but is beyond the scope of this review, which focuses on cutaneous pathophysiologic mechanisms for current treatments, both in the acute and long-term settings. Pathophysiological mechanisms of burn progression and wound healing are mediated by highly complex cascades of cellular and biochemical events, which become dysregulated in slow-healing wounds such as burns. Burns can result in fibroproliferative scarring, skin contractures, or chronic wounds that take weeks or months to heal. Burn injuries are highly individualized owing to wound-specific differences such as burn depth and surface area, in addition to patient-specific factors including genetics, immune competency, and age. Other extrinsic complications such as microbial infection can complicate wound healing, resulting in prolonged inflammation and delayed re-epithelialization. Although mortality is decreasing with advancements in burn care, morbidity from postburn deformities continues to be a challenge. Optimizing specialized acute care and late burn outcome intervention on a patient-by-patient basis is critical for successful management of burn wounds and the associated pathological scar outcome. Understanding the fundamentals of integument physiology and the cellular processes involved in wound healing is essential for designing effective treatment strategies for burn wound care as well as development of future therapies. Published 2018. Compr Physiol 8:371-405, 2018.

[Therapy of scars with lasers]

Scar formation is the consequence of trauma to the skin that affects the deep parts of the dermis. Different scar types like immature, mature, atrophic, hypertrophic, or keloid scars can develop depending on factors like age, anatomic localization, cause of trauma, the course of the healing process, and individual predispositions. Keloids and hypertrophic scars are often associated with itching, pain, tautness of the skin, and functional impairments, thus, leading to significantly reduced quality of life in some patients. However, even seemingly physiologically healed scars can cause tremendous psychological strain as is the case with self-harm scars. Despite increased research efforts, the exact pathomechanisms of excessive scarring are still scarcely understood, and dependably effective treatment options are often lacking. However, through continually improving scientific progress, scar treatment paradigms for a variety of scar types, thus far often dominated by conventional treatment methods, are increasingly complemented by new laser technologies and wavelengths.

A clinical review of phototherapy for psoriasis

Psoriasis is an autoimmune inflammatory skin disease. In the past several decades, phototherapy has been widely used to treat stable psoriatic lesions, including trunk, scalp, arms and legs, and partial nail psoriasis. A variety of light/lasers with different mechanisms of action have been developed for psoriasis including ultraviolet B (UVB), psoralen ultraviolet A (PUVA), pulsed dye laser (PDL), photodynamic therapy (PDT), intense pulsed light (IPL), light-emitting diodes (LED), and so on. Because light/laser each has specific therapeutic and adverse effects, it is important to adequately choose the sources and parameters in management of psoriasis with different pathogenic sites, severities, and duration of the disorder. This review aims at providing most updated clinic information to physicians about how to select light/laser sources and individual therapeutic regimens. To date, UV light is primarily for stable plaque psoriasis and PDL for topical psoriatic lesions with small area, both of which are safe and effective. On the other hand, PUVA has better curative effects than UVB for managing refractory psoriasis plaques, if its side effects can be better controlled. PDL provides optimal outcomes on nail psoriasis compared with other lasers. Although the trails of low-level light/laser therapy (LLLT) are still small, the near infrared (NIR) and visible red light with low energy show promise for treating psoriasis due to its strong penetration and encouraging photobiomodulation. IPL is rarely reported for psoriasis treatment, but PDT-IPL has been found to offer a moderate effect on nail psoriasis. In brief, various phototherapies have been used either in different combinations or as monotherapy. The modality has become a mainstay in the treatment of mild-to-moderate psoriasis without systemic adverse events in today's clinical practice.

Treatment of keloid scars using light-, laser- and energy-based devices: a contemporary review of the literature

Keloid scars are common and have a predilection for young, ethnic skin often with a family history. Keloids can be painful and pruritic and cause significant emotional distress when particularly visible or prominent. In this article, we review the evidence underlying the use of laser- and energy-based devices for treatment of keloid scars, either as monotherapy or in conjunction with other therapies such as corticosteroids, surgery and silicone gel in the treatment of keloid scars.

A 1-Year Follow-Up of Post-operative Scars After the Use of a 1210-nm Laser-Assisted Skin Healing (LASH) Technology: A Randomized Controlled Trial

BACKGROUND

Laser therapies are used prophylactically for excessive scar formation. The Laser-Assisted Skin Healing treatment induces a controlled heat stress that promotes tissue regeneration. This comparative trial is the first to evaluate the performance of a new automated 1210-nm laser system, compatible with all Fitzpatrick scale phototypes.

METHODS

Forty women undergoing bilateral breast reduction were enrolled in this double-blinded randomized controlled trial. The horizontal sutured incision of one breast was treated with the portable 1210-nm laser while in the operating theatre. The other breast was used as the study control. Objective measurements, subjective clinical assessments and safety evaluation were carried out over 1 year by both clinicians and patients.

RESULTS

Six weeks following surgery, better overall appearance and modified OSAS scores were reported for the laser-treated scars when compared to the control group (p = 0.024 and p = 0.079). This supports an early effect of the laser treatment during the inflammatory stage of the healing process. After a post-treatment period of 6 months, there continued to be a strong tendency in favour of the laser treatment based on the subjective scores and corroborated by the objective improvement of the treated scar volume (p = 0.038). At 1 year, the laser-treated scars continued to improve compared to the control ones in terms of volume (p = 0.004), surface (p = 0.017) and roughness (p = 0.002), and these comparatively better results were strengthened with the blind expression of patients' preference for their laser-treated scar (p = 0.025).

CONCLUSIONS

This new 1210-nm laser treatment, used as a single session performed immediately after surgery, provides significant objective and subjective improvements in scar appearance. These data can be useful when preparing patients to undergo their surgical procedure.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Combination Approach to Surgical Scars

BACKGROUND

Scar formation from surgical procedures is an unavoidable risk. Despite measures taken by both the surgeon and patient during the perioperative and postoperative periods to maximize cosmesis, some patients will wish to pursue surgical or laser scar revision.

OBJECTIVE

The authors propose a treatment algorithm to assist in approaching surgical scar revision with combination treatments.

MATERIALS AND METHODS

A PubMed search was performed on various surgical scar revision techniques. The authors augment these findings with their own personal experiences.

RESULTS

Reports of surgical excision, intralesional corticosteroid injection, intralesional 5-fluorouracil injection, pulse dye laser treatment, nonablative fractional laser resurfacing, ablative fractional laser resurfacing, and microneedling and fractional needle radiofrequency, used in isolation or combination, were found. The authors also provide clinical photographs documenting improvement in appearance of surgical scars using these treatments.

CONCLUSION

Surgical scars are best treated with a combination approach to address various features of the scar. The authors propose a treatment algorithm with multiple treatment options and how to combine them safely and effectively.

Successful treatment of traumatic scars with combined nonablative fractional laser and pinpoint technique of standard CO2 laser

To evaluate the use of a pinpoint irradiation technique followed by nonablative fractional technique in treatment of traumatic scars. Thirteen patients with traumatic sacrs were treated with pinpoint technique of CO2 laser using traditional headpiece activating laser at a frequency (50 Hz) to deliver pulsed mode with power of 1 W using the focusing technique followed by 3-5 passes of the nonablative 1540 nm fractional Er:glass laser. An independent physician evaluator assessed the treatment outcomes using Vancouver scar scale (VSS) and 5-point grading scale (grade 0, no improvement; grade 1, 1-25%; grade 2, 26-50%; grade 3, 51-75%; grade 4, 76-100% improvement). After the final treatment, average percentage changes of VSS were 41.5%. Improvement was evident in terms of vascularity, pigmentation, and height, while insignificant in terms of Pliability. Based on physician's global assessment, mean grade of 2.5 was achieved. Patient's subjective satisfaction scores paralleled the physician's objective evaluation. Pinpoint irradiation technique by CO2 laser followed by nonablative fractional laser is a safe and effective modality in treatment of scars.

The effect of 595 nm pulsed dye laser on connective tissue growth factor (CTGF) expression in cultured keloid fibroblasts

OBJECTIVE

To investigate the effect of pulsed dye laser (PDL 595 nm) on the proliferation and expression of connective tissue growth factor (CTGF) in cultured keloid fibroblasts.

MATERIALS AND METHODS

Cultured keloid fibroblasts were exposed to pulsed dye laser irradiation at fluences of 6, 8, and 10 J/cm(2) , with pulse durations of 1.5, 3, and 10 ms. The viability of keloid fibroblasts was measured with CCK-8 at 72, 24, and 12 hours prior to irradiation. Subsequently, viability was measured at 12, 24, and 72 hours post-irradiation. Additionally, the fibroblast cell cycle and apoptosis rate were measured by flow cytometry. Finally, keloid fibroblasts underwent real-time polymerase chain reaction (PCR) and Western blot to investigate the CTGF mRNA and protein expression after PDL irradiation. The untreated cultured keloid fibroblasts served as controls.

RESULTS

The proliferation of keloid fibroblasts was significantly inhibited after PDL irradiation. Both CTGF mRNA and protein expression were significantly down-regulated in 1.5, 3, and 10 ms pulse duration groups, in a dose dependent manner (P < 0.05). However, there was no statistically significant difference between groups of different pulse duration in 6, 8, and 10 J/cm(2) fluence ranges (P > 0.05).

CONCLUSIONS

Within certain fluence ranges, pulsed dye laser can effectively suppress the growth of keloids and significantly down-regulate CTGF mRNA and CTGF expression.

Effects of the combined PDL/Nd:YAG laser on surgical scars: vascularity and collagen changes evaluated by in vivo confocal microscopy

The aim of this study was to investigate the efficacy of the sequential combined 585 nm PDL and the 1064 nm neodymium:yttrium-aluminium-garnet laser (PDL/Nd:YAG) in the treatment of surgical scars and to evaluate the short-term effects by in vivo confocal microscopy (RCM) and the long-term effects by clinical assessment of the scars. Twenty-five patients were enrolled with 39 postoperative linear scars; each scar was divided into two fields. One half was treated with the combined PDL/Nd:YAG laser, whereas the other half remained untreated. Each scar was treated three times at monthly intervals. Scars were evaluated by an independent examiner, using the Vancouver Scar Scale. The combined PDL/Nd:YAG laser significantly improved the appearance of the scars. In order to study the short-term effects of combined laser treatment, six additional patients were enrolled with 7 postoperative linear scars. One half of scars was treated once with the combined PDL/Nd:YAG laser. One week after this laser treatment, both the treated and the nontreated parts of the scars were examined by dermoscopy and RCM. The dermoscopic pictures revealed improvements even in treated areas. In conclusion, the combined PDL/Nd:YAG laser was found to be effective in improving the quality and appearance of the surgical scars.

Treatment of surgical scars using a 595-nm pulsed dye laser using purpuric and nonpurpuric parameters: a comparative study

BACKGROUND

Many studies have examined laser treatment of scars, but cosmetic results have been variable. Although no studies have examined the effect of purpura on scar improvement using the pulsed dye laser (PDL), many clinicians believe inducing purpura results in better and quicker improvement.

OBJECTIVE

To determine whether PDL treatment of fresh surgical scars with purpura-inducing settings improves clinical appearance more than non-purpura-inducing settings or no treatment.

METHODS

Twenty-six subjects with surgical scars enrolled in this prospective study. Scars were divided into three equal segments; treatment was randomized: 595-nm PDL with purpuric (1.5 ms) or nonpurpuric (10 ms) settings or no treatment. Fluences were adjusted to Fitzpatrick skin type. Scars were treated three times, 1 month apart, beginning at suture removal. Outcome measures included Vancouver Scar Scale (VSS) and blind clinical ratings.

RESULTS

The nonpurpuric condition showed significant improvement on the VSS total score, vascularity, and pliability ratings. The purpuric condition demonstrated a trend for improvement on the VSS total. According to blind observer ratings, all conditions improved, without differences between groups.

CONCLUSION

Nonpurpuric settings on the PDL resulted in significant improvements in the appearance of fresh surgical scars for vascularity, pliability, and VSS total scores, although all scar segments improved over time.

Prospective ex-vivo study on thermal effects in human skin phototypes II, IV and VI: a comparison between the 808, 1064, 1210 and 1320-nm diode laser

BACKGROUND

Laser Assisted Skin Healing (LASH) was first introduced in 2001 by Capon and Mordon to prevent keloids and hypertrophic scars. LASH requires homogenous heating throughout the full thickness of the skin around the wound. However, LASH therapy with 808-nm diode laser is deemed to be only applicable for phototype I-IV due to melanin absorption. This prospective ex-vivo study aims to evaluate the thermal effects of different wavelengths (808, 1064, 1210 and 1320 nm) on human skin phototype II, IV and VI.

MATERIAL AND METHODS

Laser shots were applied on skin explants phototypes II, IV and VI. The following laser settings were used: 808, 1064, 1210 and 1320-nm diode laser, Spot size 20 × 3.7 mm, Power 3 W, Irradiance 4 W/cm², 50 shots for each phototype and wavelength. The surface temperature at 2 and 4-mm depth respectively was evaluated by an infrared camera and a low inertia micro thermocouple.

RESULTS

For the 1064, 1210 and 1320-nm wavelengths, the temperature gradient between the surface and 2-mm depth after an irradiation time of 15 s was less than 4.0°C for each phototype. For the 808 nm, the gradient was 0.8°C and 4.4°C in phototype II and IV respectively, but reached 17.2°C in phototype VI. Strong absorption by melanin of skin phototype VI induced unwanted temperature increases at the dermis-epidermis junction, making this wavelength unsuitable for LASH therapy for this phototype. Among the three other wavelengths, the discussion section indicates strong blood absorption at 1064 nm and presents both 1210 and 1320 nm as excellent compromises for LASH therapy across the whole range of phototypes.

CONCLUSION

Being poorly absorbed by melanin, both 1210 and 1320-nm wavelengths ensure homogeneity of temperature throughout the full skin explant thickness. Their possible utilization for efficient LASH therapy should now be confirmed by prospective in vivo studies.

Pulse dye and other laser treatments for vocal scar

PURPOSE OF REVIEW

Vocal fold scar is a challenging clinical problem, resulting in a spectrum of voice-related complaints. While there are a variety of treatment options available, it is rare to obtain outcomes similar to the perfectly normal voice. The pulsed dye and other lasers are an emerging treatment option for cutaneous scar and have shown promise for the treatment of vocal fold scarring. The purpose of this review is to summarize the theory, and describe clinical outcomes from both cutaneous and vocal fold scarring treated with lasers.

RECENT FINDINGS

There are a growing number of papers in the literature substantiating the use of pulsed dye and other lasers used to treat cutaneous scars. Some experimental models describe potential mechanisms of laser effect, which include the development of a sub-basement membrane cleavage plane, as well as up-regulation of proteins which may actively modulate continued fibrosis. One prospective pilot study of 11 patients with vocal fold scarring treated with the pulsed dye laser has also shown statistically significant improvement in subjective and objective voice measures, as well as laryngeal stroboscopy findings after treatment.

SUMMARY

The pulsed dye and other lasers have shown effectiveness and potential in treating cutaneous and vocal scarring.