Efficacy and safety of pulsed dye laser for the treatment of surgical scars: a systematic review and meta-analysis

Evaluating the combination and comparison of ablative fractional lasers (CO2, Erbium-YAG) with pulsed dye laser (PDL) for treating hypertrophic scars: a systematic review

The aim of this study is to compare pulsed dye laser (PDL) and ablative fractional lasers (CO2, Erbium-YAG) in the treatment of hypertrophic scars in a systematic review. Databases including Web of Science, Science Direct, Google Scholar and PubMed were searched for clinical trials up to December 1, 2022; focusing on the role of ablative fractional lasers and pulsed dye lasers in treating hypertrophic scars, using comprehensive keywords and search syntaxes. Key data extracted included type of scars, the assessment indexes, treatment modalities, side effects and the final conclusion of each article. We found no significant difference between the PDL and the ablative fractional laser in the treatment of hypertrophic scars, and both showed significant improvement. The average number of treatment sessions in the group receiving ablative fractional laser was 3.43 sessions, in the group receiving PDL, 3.68 sessions, and in the group receiving the combination of the two lasers, 1.5 sessions. Ablative fractional laser was 57.5% effective in VSS scoring and 40.4% effective in POSAS scoring, while PDL laser was 49.4% effective in VSS scoring and 35.5% effective in POSAS scoring, also the combination of both methods may lead to better results and higher efficacy with no severe adverse reactions noted. More high-quality trials are needed to fully confirm the effectiveness of laser therapy. Ablative fractional laser and PDL are both effective in treating hypertrophic scars and there was no significant difference between them. However, studies investigating the combination of these two lasers have reported greater effectiveness than each method alone.

Efficiency of Early Sequential Laser Treatment for Facial Linear Scars in Cross-Sectional Regions

BACKGROUND

Long linear scars in cross-sectional regions can adversely affect facial aesthetics and functionality, leading to substantial psychological distress. Early intervention with carbon dioxide ablative fractional laser (CO2-AFL) and 595-nm pulsed dye laser (PDL) has shown promise in mitigating post-surgical scarring. However, the effectiveness of this treatment for extensive facial scars across different areas remains unclear.

METHODS

We reviewed medical records of 39 patients with long scars from facial trauma between January 2022 and October 2023. Treatment commenced with two sessions of PDL and three sessions of CO2-AFL 1 week post-suture removal. Outcomes were assessed using Antera 3D imaging and the Patient and Observer Scar Assessment Scale (POSAS 3.0). Quality of life improvements were measured using the Short Form-36 Health Survey (SF-36).

RESULTS

All patients completed five sessions of laser treatment. Significant reductions were noted in Patient and Observer scores on the POSAS (p < 0.05). Antera 3D analysis revealed substantial improvements in average roughness, depression depth, and elevation depth across facial regions. The significance of improvements in color variation, texture elevation span, melanin hyperconcentration, and hemoglobin hyperconcentration varied by area. Patients also showed significant improvements in SF-36 scores for physical role limitations, social functioning, and emotional well-being compared to pre-treatment levels (p < 0.05).

CONCLUSIONS

Early sequential treatment with PDL and CO2-AFL effectively improves long scars in various facial areas.

Efficacy and safety of phototherapies for upper lip scars in cleft lip patients: a systematic review and meta-analysis

OBJECTIVE

Cleft lip is a prevalent congenital developmental defect, and its surgical repair often results in scarring that adversely impacts facial esthetics, function, and mental health. Numerous studies have examined the efficacy and safety of phototherapy for scar treatment. However, definitive evidence is lacking. This study aims to evaluate the effectiveness and safety of phototherapies for treating upper lip scars in cleft lip patients.

METHODS

The authors searched PubMed, Cochrane Library, Embase, and Web of Science databases using specific search terms. The authors collected clinical trials on laser or other phototherapy treatments for upper lip scars after cleft lip surgery published up to the end of March 2024. Two researchers independently screened the literature, extracted data, and assessed quality based on inclusion and exclusion criteria. The data were analyzed by using RevMan 5.4 statistical software.

RESULTS

A total of nine studies were included. 1 Analysis of the clinical efficacy rate between the control group (routine care) and the intervention group (phototherapy) showed that laser or intense pulsed light (IPL) treatment significantly reduced total VSS scores ( P <0.0001). 2 Analysis of the Pretest-Post-test cohort showed that total VSS scores were significantly reduced after phototherapy ( P <0.00001). 3 Timing of phototherapy intervention analysis: early postoperative phototherapy intervention had a better effect. None of the literature reported permanent complications, nor were there any serious adverse events, only localized temporary erythema or blisters.

CONCLUSION

Phototherapy can effectively improve the total VSS scores of upper lip scars after cleft lip surgery (including skin color, vascular distribution, softness, and thickness) with no apparent adverse reactions or serious complications. Early phototherapy intervention for upper lip scars has a better effect.

Timing of Laser Intervention on Facial Scars: A 3D Imaging and Scar Scale Analysis in a Retrospective Study

OBJECTIVES

Scars resulting from injuries or surgical procedures often present both physical and aesthetic challenges. Recent studies have indicated promising results in improving postoperative scar outcomes through the combined use of specific laser technologies. Nevertheless, there remains a crucial need for further exploration to ascertain the optimal timing for initiating such treatments.

METHODS

In this retrospective investigation, a cohort of 47 adult patients who did not require hospitalization was analyzed. These patients were divided into two distinct groups: Group A, which received intervention beginning 2 weeks after their respective operations, and Group B, which commenced intervention 4 weeks postoperation. Each group underwent a comprehensive treatment protocol consisting of five laser sessions. Initially, patients underwent three sessions of V-beam pulsed-dye laser (PDL) therapy followed by two sessions of ablative fractional CO2 laser (AFL) therapy. Evaluation of outcomes was conducted using advanced imaging techniques such as Antera 3D imaging, in conjunction with established scar assessment tools including the Vancouver Scar Scale (VSS) and the University of North Carolina "4P" Scar Scale (UNC4P).

RESULTS

All patients successfully completed the full course of five treatment sessions, with no dropouts and no reported adverse events. Baseline cosmetic assessments of scars were equivalent across both groups. In Group A, the mean VSS scores decreased from 7.04 before treatment to 5.29 at 3 months posttreatment and further to 4.33 at 6 months posttreatment. Meanwhile, in Group B, scores decreased from 7.52 to 6.83 at 3 months and 6.17 at 6 months. There were no statistically significant differences in baseline VSS scores between the two groups (p = 0.34). At both the 3- and 6-month follow-up points, mean VSS scores were significantly lower in Group A compared to Group B (p < 0.05). Similar trends were observed in UNC4P scores. Statistically significant differences were noted across all time points (baseline, 3 months, and 6 months posttreatment) for both VSS and UNC4P scores (p < 0.05). Subset analysis revealed greater improvements in texture and depression volume at 3 months posttreatment, while improvements in depression area, depth, elevation variation, and area were more pronounced at the 6-month mark.

CONCLUSIONS

Early intervention using the combined 595-nm pulse dye laser and CO2 ablative fractional laser (AFL) 2- and 4-weeks post-surgery proves to be an effective and safe method for improving scar outcomes, particularly for facial surgical scars when treatment starts 2 weeks after surgery. However, further research is needed to refine our understanding and address potential study limitations.

Advances in Photoelectric Therapy for the Early Intervention and Treatment of Traumatic Scars

Traumatic scar is a disease that affected approximately tens of millions of patients worldwide. According to the histological and morphological properties of scars, the traumatic scar typically includes superficial scar, atrophic scar, hypertrophic scar, and keloid. Its formation is a natural consequence of wound healing, regardless of whether the wound was caused by trauma or surgery. However, the production of scars has considerable impacts on the physical and mental health of patients, even causing substantial aesthetic and functional impairments. Prevention or early treatment of scars is the most suitable therapeutic method, including surgical and non-surgical procedures; nevertheless, the benefits of non-operative therapies for scars are quite limited, and surgical treatments are always hard to achieve satisfying outcomes. Through the application of innovative technologies such as lasers, intense pulsed light, and radiofrequency, significant progress has been made in the treatment of traumatic scars. This review highlights the current advancements of photoelectric therapy for the prevention and treatment of various traumatic scars, which may throw light on innovative therapeutic options for scar therapies.

The Efficacy of Fractional Carbon Dioxide Laser in Surgical Scars Treatment: A system Review and Meta-analysis

BACKGROUND

Surgical scars seriously affect a patient's quality of life, and they have a strong impact on individuals. Many studies have reported the results of using fractional carbon dioxide (CO₂) laser to treat surgical scars and have generally found it to be effective.

OBJECTIVES

We conducted a meta-analysis with the objective of evaluating and proving the efficacy of fractional CO₂ laser therapy for surgical scars.

METHODS

We performed a search of databases including PubMed, Web of Science, Embase and the Cochrane Library. The outcomes of the meta-analysis were overall scores on the Vancouver Scar Scale (VSS) and its four dimensions (pigmentation, vascularity, pliability and height). Statistical analysis was performed using RevMan 5.4 software.

RESULTS

A total of ten studies were included in this meta-analysis, including six randomized controlled trials (RCTs) and four nonrandomized controlled trials (N-RCTs). In the meta-analysis of RCTs and N-RCTs, similar results were obtained, and fractional CO₂ laser irradiation significantly decreased VSS scores (P < 0.00001). In addition, fractional CO₂ laser irradiation also had a significant effect on scores on the pigmentation (P = 0.08), vascularity (P = 0.001), flexibility (P = 0.005) and height (P = 0.008) dimensions. Except for mild pain during treatment and temporary erythema after treatment, most patients had no obvious adverse reactions.

CONCLUSION

Our study found that fractional CO₂ laser exhibits excellent efficacy and safety in terms of surgical scar treatment. Thus, we hope it becomes more widely available to patients with surgical scars.

LEVEL OF EVIDENCE III

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 .

Local vasoregulative interventions impact drug concentrations in the skin after topical laser-assisted delivery

INTRODUCTION

The ability of ablative fractional lasers (AFL) to enhance topical drug uptake is well established. After AFL delivery, however, drug clearance by local vasculature is poorly understood. Modifications in vascular clearance may enhance AFL-assisted drug concentrations and prolong drug dwell time in the skin. Aiming to assess the role and modifiability of vascular clearance after AFL-assisted delivery, this study examined the impact of vasoregulative interventions on AFL-assisted 5-fluorouracil (5-FU) concentrations in in vivo skin.

METHODS

5-FU uptake was assessed in intact and AFL-exposed skin in a live pig model. After fractional CO₂ laser exposure (15 mJ/microbeam, 5% density), vasoregulative intervention using topical brimonidine cream, epinephrine solution, or pulsed dye laser (PDL) was performed in designated treatment areas, followed by a single 5% 5-FU cream application. At 0, 1, 4, 48, and 72 h, 5-FU concentrations were measured in 500 and 1500 μm skin layers by mass spectrometry (n = 6). A supplemental assessment of blood flow following AFL ± vasoregulation was performed using optical coherence tomography (OCT) in a human volunteer.

RESULTS

Compared to intact skin, AFL facilitated a prompt peak in 5-FU delivery that remained elevated up to 4 hours (1500 μm: 1.5 vs. 31.8 ng/ml [1 hour, p = 0.002]; 5.3 vs. 14.5 ng/ml [4 hours, p = 0.039]). However, AFL's impact was transient, with 5-FU concentrations comparable to intact skin at later time points. Overall, vasoregulative intervention with brimonidine or PDL led to significantly higher peak 5-FU concentrations, prolonging the drug's dwell time in the skin versus AFL delivery alone. As such, brimonidine and PDL led to twofold higher 5-FU concentrations than AFL alone in both skin layers by 1 hour (e.g., 500 μm: 107 ng/ml [brimonidine]; 96.9 ng/ml [PDL], 46.6 ng/ml [AFL alone], p ≤ 0.024), and remained significantly elevated at 4 hours (p ≤ 0.024). A similar pattern was observed for epinephrine, although trends remained nonsignificant (p ≥ 0.09). Prolonged 5-FU delivery was provided by PDL, resulting in sustained drug deposition compared to AFL alone at both 48 and 72 hours in the superficial skin layer (p ≤ 0.024). Supporting drug delivery findings, OCT revealed that increases in local blood flow after AFL were mitigated in test areas also exposed to PDL, brimonidine, or epinephrine, with PDL providing the greatest, sustained reduction in flow over 48 hours.

CONCLUSION

Vasoregulative intervention in conjunction with AFL-assisted delivery enhances and prolongs 5-FU deposition in in vivo skin.

A prospective study to evaluate the treatment effect of pulsed dye laser on thyroidectomy hypertrophic scars using 3D imaging analysis

OBJECTIVES

The pulsed dye laser (PDL) is an effective modality for preventing and improving hypertrophic scars (HSs). However, the heterogeneity of the parameter settings of the laser and subjective scar assessment methods used in most studies resulting in uncertainty with treatment plans. Therefore, we investigated the treatment effect of the PDL (V-beam; Candela Laser Corporation) on HSs in post-thyroidectomy patients using three-dimensional imaging analysis and intended to provide a systemic and optimal treatment protocol.

METHODS

Nineteen patients with HS after thyroidectomy underwent eight treatment sessions with the 595 nm PDL (with the dose gradually increased by 0.5 J/cm² ) at 4- to 6-week intervals. Patients with an elevated lesion also received intralesional corticosteroid (ICS) treatment. After every two treatment sessions, we assessed the patients' HS using the Vancouver Scar Scale (VSS), a patient satisfaction questionnaire, and with a three-dimensional (3D) skin imaging device (Antera 3D™; Miravex Limited).

RESULTS

In repeated-measures analysis of variance, the mean VSS and patient satisfaction significantly improved (p < 0.001), with significant differences in these values observed until the sixth and eighth treatment sessions, respectively. In the quantitative analysis using Antera 3D™, the mean height, pigmentation, and vascularity scores were observed to be significantly improved (p < 0.001). Significant differences in these values were observed until the fourth, second, and eighth treatment sessions, respectively. Subgroup analysis according to ICS treatment showed no significant differences in scar characteristics between those with and without ICS treatment.

CONCLUSIONS

In this study, we found that the PDL was effective in reducing scar height, vascularity, and pigmentation in patients with thyroidectomy HS using 3D imaging analysis. Furthermore, we have suggested a cost-effective treatment plan with the 595 nm PDL.