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Keloid and Hypertrophic Scars Treatment

  • Original Articles
  • Basic Science/Experimental
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Abstract

Background

Hypertrophic scars are contained within the site of injury and may regress over time, while keloids spread beyond the borders of the initial injury and do not regress. On histologic examination, hypertrophic scars tend to have collagen in a wavy, regular pattern, whereas keloids have no distinct pattern of collagen.

Objective

To retrospectively analyze improvement in keloid and hypertrophic scars characteristics following treatment with Ablative 10600 nm and a non-Ablative 1570 nm Hybrid Laser Device.

Methods

Treatment parameters with the ProScan Hybrid Mode were 40 W/1.3–1.5 ms for the CO2 and 12 W/4 ms for the 1570 nm in a 1:1 ratio. Outcomes were assessed based on physician scar grading as measured by the Vancouver Scar Scale and patient-reported satisfaction. Excel was used for data analysis, and a p value < 0.05 was considered statistically significant. Adverse events and patient pain were also recorded.

Results

A total of 31 hypertrophic scars and 30 keloid scars were treated. There was a significant reduction in Vancouver Scar Scale scores for both hypertrophic and keloid scars (62% ± 8% and 58% ± 7%; p = 2.6E-17 and p = 8.29E-26, respectively). In a scar-based comparison, a statistically significant difference was observed for all measures reflecting favorable outcomes for hypertrophic scars (VSS, p = 1.1E-05; satisfaction, p = 0.0112; pain, p = 0.00081). Only one adverse event was reported, a superficial burn treated with topical antibiotics.

Conclusions

The device was found to be safe and effective, with promising results for the treatment of hypertrophic and keloid scars.

Level of Evidence II

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.

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References

  1. Berman B, Maderal A, Raphael B (2017) Keloids and hypertrophic scars: pathophysiology, classification, and treatment. Dermatol Surg 43(Suppl 1):S3–S18. https://doi.org/10.1097/DSS.0000000000000819

    Article  CAS  PubMed  Google Scholar 

  2. Eming S, Krieg T, Davidson J (2007) Inflammation in wound repair: molecular and cellular mechanisms. J Invest Dermatol 127(3):514–525. https://doi.org/10.1038/SJ.JID.5700701

    Article  CAS  PubMed  Google Scholar 

  3. Koh T, DiPietro L (2011) Inflammation and wound healing: the role of the macrophage. Expert Rev Mol Med 13:e23. https://doi.org/10.1017/S1462399411001943

    Article  PubMed Central  PubMed  Google Scholar 

  4. Ogawa R (2017) Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci 18(3):606. https://doi.org/10.3390/IJMS18030606

  5. Carswell L, Borger J (2023) Hypertrophic scarring keloids. In: StatPearls Publishing LLC. https://www.ncbi.nlm.nih.gov/books/NBK537058/

  6. Arno A, Gauglitz G, Barret J, Jeschke M (2014) Up-to-date approach to manage keloids and hypertrophic scars: a useful guide. Burns 40(7):1255–1266. https://doi.org/10.1016/j.burns.2014.02.011

    Article  PubMed Central  PubMed  Google Scholar 

  7. Lee HJ, Jang YJ (2018) Recent understandings of biology, prophylaxis and treatment strategies for hypertrophic scars and keloids. Int J Mol Sci 19(3):711. https://doi.org/10.3390/ijms19030711

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. González N, Goldberg DJ (2019) Update on the treatment of scars. J Drugs Dermatol 18(6):550–555

    PubMed  Google Scholar 

  9. Puri N, Talwar A (2009) The efficacy of silicone gel for the treatment of hypertrophic scars and keloids. J Cutan Aesthet Surg 2(2):104–106. https://doi.org/10.4103/0974-2077.58527

    Article  PubMed Central  PubMed  Google Scholar 

  10. Ogawa R (2022) The Most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago. Plast Reconstr Surg 149(1):79e–94e. https://doi.org/10.1097/PRS.0000000000008667

    Article  CAS  PubMed  Google Scholar 

  11. Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG, Stella M, Téot L, Wood FM, Ziegler UE; International Advisory Panel on Scar Management (2002) International clinical recommendations on scar management. Plast Reconstr Surg 110(2):560–571. https://doi.org/10.1097/00006534-200208000-00031

  12. Khatri KA, Mahoney DL, McCartney MJ (2011) Laser scar revision: a review. J Cosmet Laser Ther 13(2):54–62. https://doi.org/10.3109/14764172.2011.564625. (PMID: 21401378)

    Article  PubMed  Google Scholar 

  13. Paasch U, Said T (2020) Stimulation of collagen and elastin production in-vivo using 1,540 nm Er: glass laser: assessment of safety and efficacy. J Cosmet Laser Ther 22(2):77–83. https://doi.org/10.1080/14764172.2020.1728339

    Article  PubMed  Google Scholar 

  14. Goldberg DJ (2003) Lasers for facial rejuvenation. Am J Clin Dermatol 4(4):225–234. https://doi.org/10.2165/00128071-200304040-00002

    Article  PubMed  Google Scholar 

  15. Park J, Koh Y, Shin S (2022) Review of scar assessment scales. Med Lasers 11(1):1–7. https://doi.org/10.25289/ML.2022.11.1.1

  16. Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ (1990) Rating the burn scar. J Burn Care Rehabil 11(3):256–260. https://doi.org/10.1097/00004630-199005000-00014

    Article  CAS  PubMed  Google Scholar 

  17. da Costa PTL, Echevarría-Guanilo ME, Gonçalves N, Girondi JBR, Gonçalves ADC (2021) Subjective tools for burn scar assessment: an integrative review. Adv Skin Wound Care 34(6):1–10. https://doi.org/10.1097/01.ASW.0000749732.09228.a9

    Article  PubMed  Google Scholar 

  18. Clapham PJ, Pushman AG, Chung KC (2010) A systematic review of applying patient satisfaction outcomes in plastic surgery. Plast Reconstr Surg 125(6):1826–1833. https://doi.org/10.1097/PRS.0b013e3181d51276

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Chen SX, Cheng J, Watchmaker J, Dover JS, Chung HJ (2022) Review of lasers and energy-based devices for skin rejuvenation and scar treatment with histologic correlations. Dermatol Surg 48(4):441–448. https://doi.org/10.1097/DSS.0000000000003397

    Article  CAS  PubMed  Google Scholar 

  20. Li K, Nicoli F, Cui C, Xi WJ, Al-Mousawi A, Zhang Z, Balzani A, Neill L, Sorge R, Tong Y, Zhang Y (2020) Treatment of hypertrophic scars and keloids using an intralesional 1470 nm bare-fibre diode laser: a novel efficient minimally-invasive technique. Sci Rep 10(1):21694. https://doi.org/10.1038/s41598-020-78738-9

    Article  ADS  CAS  PubMed Central  PubMed  Google Scholar 

  21. Barone N, Safran T, Vorstenbosch J, Davison PG, Cugno S, Murphy AM (2021) Current advances in hypertrophic scar and keloid management. Semin Plast Surg 35(3):145–152. https://doi.org/10.1055/s-0041-1731461

    Article  PubMed Central  PubMed  Google Scholar 

  22. Sheng M, Chen Y, Li H, Zhang Y, Zhang Z (2023) The application of corticosteroids for pathological scar prevention and treatment: current review and update. Burns Trauma 11:tkad009. https://doi.org/10.1093/burnst/tkad009.

  23. Wang F, Li X, Wang X, Jiang X (2020) Efficacy of topical silicone gel in scar management: a systematic review and meta-analysis of randomised controlled trials. Int Wound J 17(3):765–773. https://doi.org/10.1111/iwj.13337

    Article  PubMed Central  PubMed  Google Scholar 

  24. O'Brien L, Jones DJ (2013) Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev 9:CD003826. https://doi.org/10.1002/14651858.CD003826.pub3

  25. Chowdhury B, Kassir M, Salas-Alanis J, Nistico S, Galadari H, Fritz K, Salavastru C, Blicharz L, Goldust M (2021) Laser in surgical scar clearance: an update review. J Cosmet Dermatol 20(12):3808–3811. https://doi.org/10.1111/jocd.14325

    Article  PubMed  Google Scholar 

  26. Seago M, Shumaker PR, Spring LK, Alam M, Al-Niaimi F, Rox Anderson R, Artzi O, Bayat A, Cassuto D, Chan HH, Dierickx C, Donelan M, Gauglitz GG, Leo Goo B, Goodman GJ, Gurtner G, Haedersdal M, Krakowski AC, Manuskiatti W, Norbury WB, Ogawa R, Ozog DM, Paasch U, Victor Ross E, Tretti Clementoni M, Waibel J (2020) Laser treatment of traumatic scars and contractures: 2020 international consensus recommendations. Lasers Surg Med 52(2):96–116. https://doi.org/10.1002/lsm.23201

    Article  PubMed  Google Scholar 

  27. Anderson RR, Donelan MB, Hivnor C, Greeson E, Ross EV, Shumaker PR, Uebelhoer NS, Waibel JS (2014) Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report. JAMA Dermatol 150(2):187–193. https://doi.org/10.1001/jamadermatol.2013.7761

    Article  PubMed  Google Scholar 

  28. Nisticò SP, Bennardo L, Zingoni T, Pieri L, Fusco I, Rossi F, Magni G, Cannarozzo G (2022) Synergistic sequential emission of fractional 10.600 and 1540 nm lasers for skin resurfacing: an ex vivo histological evaluation. Medicina (Kaunas) 58(9):1308. https://doi.org/10.3390/medicina58091308.

  29. Chitgopeker P, Goettsche L, Landherr MJ, Ye A, Johnson-Jahangir H, Ferguson N, VanBeek M (2020) 1550-nm nonablative fractional laser versus 10,600-nm ablative fractional laser in the treatment of surgical and traumatic scars: a comparison study on efficacy and treatment regimen. Dermatol Surg 46(6):780–788. https://doi.org/10.1097/DSS.0000000000002152

    Article  CAS  PubMed  Google Scholar 

  30. Waibel J, Wulkan AJ, Lupo M, Beer K, Anderson RR (2012) Treatment of burn scars with the 1,550 nm nonablative fractional Erbium Laser. Lasers Surg Med 44(6):441–446. https://doi.org/10.1002/lsm.22038

    Article  PubMed  Google Scholar 

  31. Haedersdal M, Moreau KE, Beyer DM, Nymann P, Alsbjørn B (2009) Fractional nonablative 1540 nm laser resurfacing for thermal burn scars: a randomized controlled trial. Lasers Surg Med 41(3):189–195. https://doi.org/10.1002/lsm.20756

    Article  PubMed  Google Scholar 

  32. Taudorf EH, Danielsen PL, Paulsen IF, Togsverd-Bo K, Dierickx C, Paasch U, Haedersdal M (2015) Non-ablative fractional laser provides long-term improvement of mature burn scars–a randomized controlled trial with histological assessment. Lasers Surg Med 47(2):141–147. https://doi.org/10.1002/lsm.22289

    Article  PubMed  Google Scholar 

  33. Snast I, Lapidoth M, Levi A (2022) Clinical and histological evaluation of a dual sequential application of fractional 10,600 nm and 1570 nm lasers, compared to single applications in a porcine model. Lasers Med Sci 37(3):1983–1992. https://doi.org/10.1007/s10103-021-03460-5

    Article  PubMed  Google Scholar 

  34. Belletti S, Madeddu F, Amoruso GF, Provenzano E, Nisticò SP, Fusco I, Bennardo L (2023) An innovative dual-wavelength laser technique for atrophic acne scar management: a pilot study. Medicina (Kaunas) 59(11):2012. https://doi.org/10.3390/medicina59112012

    Article  PubMed  Google Scholar 

  35. Mezzana P, Valeriani M, Valeriani R (2016) Combined fractional resurfacing (10600 nm/1540 nm): tridimensional imaging evaluation of a new device for skin rejuvenation. J Cosmet Laser Ther 18(7):397–402. https://doi.org/10.1080/14764172.2016.1202417

    Article  PubMed  Google Scholar 

  36. Belletti S, Madeddu F, Brando A, Provenzano E, Nisticò SP, Fusco I, Bennardo L (2023) Laser Impacts on skin rejuvenation: the use of a synergistic emission of co2 and 1540 nm wavelengths. Medicina (Kaunas) 59(10):1857. https://doi.org/10.3390/medicina59101857

    Article  PubMed  Google Scholar 

  37. Shanina NA, Patrushev AV, Zorman A (2021) Histological and immunohistochemical changes in facial skin treated with combined ablative and non-ablative laser therapy. J Cosmet Dermatol 20(11):3509–3516. https://doi.org/10.1111/jocd.14023

    Article  PubMed Central  PubMed  Google Scholar 

  38. Waibel S, Pozner J, Robb C, Tanzi E (2018) Hybrid fractional laser: a multi-center trial on the safety and efficacy for photorejuvenation. J Drugs Dermatol 17(11):1164–1168 (PMID: 30481954)

    PubMed  Google Scholar 

  39. Belletti S, Pennati BM, Madeddu F (2023) A sequential CO2 and 1540 nm laser for the treatment of neck skin laxity. Skin Res Technol. 29(9):e13469. https://doi.org/10.1111/srt.13469

    Article  PubMed Central  PubMed  Google Scholar 

  40. Tsur Shenhav L, Shehade W, Muravnik G, Horovitz T, Artzi O (2023) The safety and efficacy of a dual CO 2 and 1570-nm hybrid laser for periorbital rejuvenation. Dermatol Surg 49(5):479–482. https://doi.org/10.1097/DSS.0000000000003750

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Fiorentini F, Fusco I (2023) Synergistic sequential emission of fractional 1540 nm and 10600 lasers for abdominal postsurgical scar management: a clinical case report. Am J Case Rep. 14(24):e938607. https://doi.org/10.12659/AJCR.938607

    Article  Google Scholar 

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Authors and Affiliations

  1. The Department of Adult and Pediatric Plastic, Aesthetic and Reconstructive Surgery, Shamir Medical Center Be’er Ya’akov, Shamir Medical Center Assaf Harofeh, Tel Aviv, Israel

    Shaked Menashe & Lior Heller

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  1. Shaked Menashe
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  2. Lior Heller
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Correspondence to Shaked Menashe.

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Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Human and Animal Rights

Retrospective data collection in this study was conducted following the approval of the ethic committee of Shamir Medical Center, Israel (approval number ASF-0092-23) and in accordance with the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

This is a retrospective collection of anonymized data from previously recorded routine assessments and does not present risk of exposure of personal data of patients. Waiving informed consent will not adversely affect the rights and welfare of the subjects. Consequently, informed consent is not required, in agreement with the Israel Ministry of Health (MoH) Pharmaceutical Division Procedure 14 Part 1(02) clause 4.3.2.10.

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Menashe, S., Heller, L. Keloid and Hypertrophic Scars Treatment. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-03869-7

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