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Evaluation of nonablative fractional laser treatment in scar reduction

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Abstract

Fractional lasers have been used for the improvement of scar tissue in the recent years but there has not been extensive research on their impact. The purpose of this study was to evaluate the efficacy of nonablative fractional laser (NAFL) on acne, burn, and surgery/traumatic scar. The scars were also categorized as atrophic, hypertrophic, and keloid, and treatment efficacy was investigated accordingly. This is a retrospective, single-center study. Scar tissues were treated using a nonablative fractional 1550-nm Erbium glass laser in high-energy parameters at 4-week interval for 4–8 sessions. The scar regression score (SRS) was used to determine the decrease in scar appearance. Forty-six patients with acne (n:18), burn (n:13), or surgery/traumatic (n:15) scar were included. The number of sessions was higher for burn patients while SRS in burn patients was lower than in patients with acne or a surgical/traumatic scar. Evaluation according to scar types showed that atrophic scars had a significantly better response to NAFL treatment. This study indicates that NAFL treatment with the high-energy parameters has better outcomes in atrophic acne scars, while the success rate is considerably low in post-burn and keloid scars.

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References

  1. Lupton JR, Alster TS (2002) Laser scar revision. Dermatol Clin 20:55–65

    Article  PubMed  Google Scholar 

  2. Dreno B, Khammari A, Orain N, Noray C et al (2007) ECCA grading scale: an original validated acne scar grading scale for clinical practice in dermatology. Dermatology 214:46–51

    Article  CAS  PubMed  Google Scholar 

  3. Alster TS, Handrick C (2000) Laser treatment of hypertrophic scars, keloids, and striae. Semin Cutan Med Surg 19:287–292

    Article  CAS  PubMed  Google Scholar 

  4. Cohen BE, Brauer JA, Geronemus RG (2016) Acne scarring: a review of available therapeutic lasers. Lasers Surg Med 48:95–115

    Article  PubMed  Google Scholar 

  5. Fife D (2016) Evaluation of acne scars: how to assess them and what to tell the patient. Dermatol Clin 34:207–213

    Article  CAS  PubMed  Google Scholar 

  6. Sardana K, Manjhi M, Garg VK, Sagar V (2014) Which type of atrophic acne scar (ice-pick, boxcar, or rolling) responds to nonablative fractional laser therapy? Dermatol Surg 40:288–300

    Article  CAS  PubMed  Google Scholar 

  7. Berman B, Maderal A, Raphael B (2017) Keloids and hypertrophic scars: pathophysiology, classification, and treatment. Dermatol Surg 43:3–18

  8. Ogawa R, Ono S, Akaishi S, Dohi T et al (2016) Reconstruction after anterior chest wall keloid resection using internal mammary artery perforator propeller flaps. Plast Reconstr Surg Glob Open 4:1049

    Article  Google Scholar 

  9. Anthonissen M, Daly D, Janssens T, Van den Kerckhove E (2016) The effects of conservative treatments on burn scars: a systematic review. Burns 42:508–518

    Article  PubMed  Google Scholar 

  10. Manstein D, Herron GS, Sink RK, Tanner H et al (2004) Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 34:426–438

    Article  PubMed  Google Scholar 

  11. Saedi N, Petelin A, Zachary C (2011) Fractionation: a new era in laser resurfacing. Clin Plast Surg 38:449–461

    Article  PubMed  Google Scholar 

  12. Carniol PJ, Hamilton MM, Carniol ET (2015) Current status of fractional laser resurfacing. JAMA Facial Plast Surg 17:360–366

    Article  PubMed  Google Scholar 

  13. Naouri M, Atlan M, Perrodeau E, Georgesco G et al (2011) High-resolution ultrasound imaging to demonstrate and predict efficacy of carbon dioxide fractional. Dermatol Surg 37:596–603

    Article  CAS  PubMed  Google Scholar 

  14. Finlay V, Burrows S, Kendell R, Berghuber A et al (2017) Modified Vancouver Scar Scale score is linked with quality of life after burn. Burns 43:741–746

    Article  PubMed  Google Scholar 

  15. Duncan JA, Bond JS, Mason T, Ludlow A et al (2006) Visual analogue scale scoring and ranking: a suitable and sensitive method for assessing scar quality? Plast Reconstr Surg 118:909–918

    Article  CAS  PubMed  Google Scholar 

  16. Bijlard E, Uiterwaal L, Kouwenberg CA, Mureau MA et al (2017) A systematic review on the prevalence, etiology, and pathophysiology of intrinsic pain in dermal scar tissue. Pain Physician 20:1–13

    PubMed  Google Scholar 

  17. Akaishi S, Ogawa R, Hyakusoku H (2008) Keloid and hypertrophic scar: neurogenic inflammation hypotheses. Med Hypotheses 71:32–38

    Article  CAS  PubMed  Google Scholar 

  18. Goldman MP, Fitzpatrick RE (1995) Laser treatment of scars. Dermatol Surg 21:685–687

    Article  CAS  PubMed  Google Scholar 

  19. Waibel J, Wulkan AJ, Lupo M, Beer K et al (2012) Treatment of burn scars with the 1,550 nm nonablative fractional erbium laser. Lasers Surg Med 44:441–446

    Article  PubMed  Google Scholar 

  20. Morton LM (2014) The evolution of laser surgery for acne and other scarring processes. Semin Cutan Med Surg 33:169–175

    Article  PubMed  Google Scholar 

  21. Tan JK (2004) Psychosocial impact of acne vulgaris: evaluating the evidence. Skin Therapy Lett 9:1–3

    CAS  PubMed  Google Scholar 

  22. Fife D (2011) Practical evaluation and management of atrophic acne scars: tips for the general dermatologist. J Clin Aesthet Dermatol 4:50–57

    PubMed  PubMed Central  Google Scholar 

  23. Patel PA, Bailey JK, Yakuboff KP (2012) Treatment outcomes for keloid scar management in the pediatric burn population. Burns 38:767–771

    Article  CAS  PubMed  Google Scholar 

  24. Kim HS, Lee JH, Park YM, Lee JY (2012) Comparison of the effectiveness of nonablative fractional laser versus ablative fractional laser in thyroidectomy scar prevention: a pilot study. J Cosmet Laser Ther 14:89–93

    Article  PubMed  Google Scholar 

  25. Park SH, Kim DW, Jeong T (2012) Skin-tightening effect of fractional lasers: comparison of non-ablative and ablative fractional lasers in animal models. J Plast Reconstr Aesthet Surg 65:1305–1311

    Article  PubMed  Google Scholar 

  26. Bogdan Allemann I, Kaufman J (2010) Fractional photothermolysis—an update. Lasers Med Sci 25:137–144

    Article  PubMed  Google Scholar 

  27. Alster TS, West TB (1997) Treatment of scars: a review. Ann Plast Surg 39:418–432

    Article  CAS  PubMed  Google Scholar 

  28. Bloom BS, Brauer JA, Geronemus RG (2013) Ablative fractional resurfacing in topical drug delivery: an update and outlook. Dermatol Surg 39:839–848

    Article  CAS  PubMed  Google Scholar 

  29. Cavalie M, Sillard L, Montaudie H, Bahadoran P et al (2015) Treatment of keloids with laser-assisted topical steroid delivery: a retrospective study of 23 cases. Dermatol Ther 28:74–78

    Article  PubMed  Google Scholar 

  30. Connolly KL, Chaffins M, Ozog D (2014) Vascular patterns in mature hypertrophic burn scars treated with fractional CO2 laser. Lasers Surg Med 46:597–600

    Article  PubMed  Google Scholar 

  31. Bach DQ, Garcia MS, Eisen DB (2012) Hyperpigmented burn scar improved with a fractionated 1550 nm non-ablative laser. Dermatol Online J 18:12

    PubMed  Google Scholar 

  32. Jensen JD, Keane C, Huang CC, Northington ME (2014) Ablative fractionated CO2 resurfacing yields excellent result for severely atrophic traumatic scar on the face. J Drugs Dermatol 13:861–862

    PubMed  Google Scholar 

  33. Shumaker PR, Kwan JM, Landers JT, Uebelhoer NS (2012) Functional improvements in traumatic scars and scar contractures using an ablative fractional laser protocol. J Trauma Acute Care Surg 73:116–121

    Article  Google Scholar 

  34. Uebelhoer NS, Ross EV, Shumaker PR (2012) Ablative fractional resurfacing for the treatment of traumatic scars and contractures. Semin Cutan Med Surg 31:110–120

    Article  CAS  PubMed  Google Scholar 

  35. Weiss ET, Chapas A, Brightman L, Hunzeker C et al (2010) Successful treatment of atrophic postoperative and traumatic scarring with carbon dioxide ablative fractional resurfacing: quantitative volumetric scar improvement. Arch Dermatol 146:133–140

    Article  PubMed  Google Scholar 

  36. Brightman LA, Brauer JA, Anolik R, Weiss E et al (2009) Ablative and fractional ablative lasers. Dermatol Clin 27:479–489

    Article  CAS  PubMed  Google Scholar 

  37. Hsiao FC, Bock GN, Eisen DB (2012) Recent advances in fractional laser resurfacing: new paradigm in optimal parameters and post-treatment wound care. Adv Wound Care 1:207–212

    Article  Google Scholar 

  38. Chan HH, Manstein D, Yu CS, Shek S et al (2007) The prevalence and risk factors of post-inflammatory hyperpigmentation after fractional resurfacing in Asians. Lasers Surg Med 39:381–385

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Minal Caliskan and Samuel W. Baker for their inputs in analyzing the data and interpreting the results.

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Authors and Affiliations

  1. Department of Dermatology, Koç University School of Medicine, Davutpasa Cad, No:4, Topkapı, 34010, Istanbul, Turkey

    Hilal Gokalp

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  1. Hilal Gokalp
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Correspondence to Hilal Gokalp.

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Gokalp, H. Evaluation of nonablative fractional laser treatment in scar reduction. Lasers Med Sci 32, 1629–1635 (2017). https://doi.org/10.1007/s10103-017-2303-x

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  • DOI: https://doi.org/10.1007/s10103-017-2303-x

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