Skip to main content

Advertisement

SpringerLink
Log in

Laser Therapy in Hypertrophic and Keloid Scars: A Systematic Review and Network Meta-analysis

  • Review
  • Non-Surgical Procedures
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Laser therapy has emerged as a promising treatment modality for improving the appearance and symptoms associated with hypertrophic and keloid scars. In this network meta-analysis, we aimed to evaluate the efficacy of different laser types in treating hypertrophic and keloid scars.

Methods

A comprehensive search of four databases was conducted to identify relevant studies published up until July 2023. Data were extracted from eligible studies and pooled as mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous data in a network meta-analysis (NMA) model, using R software.

Results

A total of 18 studies, comprising 550 patients, were included in the analysis. Pooling our data showed that fractional carbon dioxide (FCO2) plus 5-fluorouracil (5-FU) was superior to control in terms of Vancouver Scar Scale (VSS), pliability score, and thickness; [MD = − 5.97; 95% CI (− 7.30; − 4.65)], [MD = − 2.68; 95% CI (− 4.03; − 1.33)], [MD = − 2.22; 95% CI (− 3.13; − 1.31)], respectively. However, insignificant difference was observed among FCO2 plus 5-FU compared to control group in terms of erythema, vascularity, redness and perfusion, and pigmentation [MD = − 0.71; 95% CI (− 2.72; 1.30)], [MD = − 0.44; 95% CI (− 1.26; 0.38)], respectively.

Conclusion

Our NMA found that the FCO2 plus 5-FU was the most effective intervention in decreasing the VSS and thickness, while FCO2 plus CO2 was the most effective intervention in decreasing the pliability score. Further research is needed to determine the optimal laser parameters and long-term efficacy of laser therapy in hypertrophic and keloid scars.

Level of Evidence IV

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

Data Availability

On reasonable request, the supporting data of this study's findings can be provided by the corresponding author.

References

  1. Eming SA, Paul Martin MTC (2014) Wound repair and regeneration: Mechanisms, signaling, and translation Sabine. Sci Transl Med. https://doi.org/10.1126/scitranslmed.3009337

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gupta S, Sharma VK (2011) Standard guidelines of care: Keloids and hypertrophic scars. Indian J Dermatol Venereol Leprol 77(1):94–100. https://doi.org/10.4103/0378-6323.74968

    Article  PubMed  Google Scholar 

  3. Ogawa R (2020) Mechanobiology of cutaneous scarring. In Téot L, Mustoe TA, Middelkoop E, Gauglitz GG (eds) Textbook on scar management: state of the art management and emerging technologies. Springer, Cham, pp 11–18

    Chapter  Google Scholar 

  4. Leszczynski R, da Silva CA, Pinto ACPN, Kuczynski U, da Silva EM (2022) Laser therapy for treating hypertrophic and keloid scars. Cochrane database Syst Rev 9(9):CD011642. https://doi.org/10.1002/14651858.CD011642.pub2

    Article  PubMed  Google Scholar 

  5. Oosterhoff TCH, Beekman VK, van der List JP, Niessen FB (2021) Laser treatment of specific scar characteristics in hypertrophic scars and keloid: a systematic review. J Plast Reconstr Aesthet Surg 74(1):48–64. https://doi.org/10.1016/j.bjps.2020.08.108

    Article  PubMed  Google Scholar 

  6. de Alas JMG, las, Siripunvarapon AH, Dofitas BL. (2012) Pulsed dye laser for the treatment of keloid and hypertrophic scars: a systematic review. Expert Rev Med Devices 9(6):641–650. https://doi.org/10.1586/erd.12.56

    Article  CAS  PubMed  Google Scholar 

  7. Page MJ, McKenzie JE, Bossuyt PM, The PRISMA et al (2020) statement: An updated guideline for reporting systematic reviews. BMJ 2021:372. https://doi.org/10.1136/bmj.n71

    Article  Google Scholar 

  8. Al-Mohamady AESAEH, Ibrahim SMA, Muhammad MM (2016) Pulsed dye laser versus long-pulsed Nd:YAG laser in the treatment of hypertrophic scars and keloid: a comparative randomized split-scar trial. J Cosmet Laser Ther 18(4):208–212. https://doi.org/10.3109/14764172.2015.1114648

    Article  PubMed  Google Scholar 

  9. Azzam OA, Bassiouny DA, El-Hawary MS, El Maadawi ZM, Sobhi RM, El-Mesidy MS (2016) Treatment of hypertrophic scars and keloids by fractional carbon dioxide laser: a clinical, histological, and immunohistochemical study. Lasers Med Sci 31(1):9–18. https://doi.org/10.1007/s10103-015-1824-4

    Article  CAS  PubMed  Google Scholar 

  10. Bowes LE, Nouri K, Berman B et al (2002) Treatment of pigmented hypertrophic scars with the 585 nm pulsed dye laser and the 532 nm frequency-doubled Nd:YAG laser in the Q-switched and variable pulse modes: a comparative study. Dermatol Surg 28(8):714–719. https://doi.org/10.1046/j.1524-4725.2002.01058.x

    Article  PubMed  Google Scholar 

  11. Choi JE, Oh GN, Kim JY, Seo SH, Ahn HH, Kye YC (2014) Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers. J Dermatolog Treat 25(4):299–303. https://doi.org/10.3109/09546634.2013.782090

    Article  CAS  PubMed  Google Scholar 

  12. Elgarhy LH, El-Tatawy RA, Abdelaziz D, Dogheim NN (2021) Pulsed dye laser versus ablative fractional CO2 laser in treatment of old hypertrophic scars: clinicopathological study. Wound Repair Regen 29(3):417–424. https://doi.org/10.1111/wrr.12904

    Article  PubMed  Google Scholar 

  13. El-Zawahry BM, Sobhi RM, Bassiouny DA, Tabak SA (2015) Ablative CO2 fractional resurfacing in treatment of thermal burn scars: an open-label controlled clinical and histopathological study. J Cosmet Dermatol 14(4):324–331. https://doi.org/10.1111/jocd.12163

    Article  PubMed  Google Scholar 

  14. El-Azhary EAEH, Al-Salam FMA, Abd HS, El-Hafiz MHM (2022) Fractional carbon dioxide (CO2) laser alone versus fractional CO2 laser combined with triamcinolone acetonide or trichloroacetic acid in keloid treatment: a comparative clinical and radiological study. Dermatol Pract Concept 12(2):1–9. https://doi.org/10.5826/dpc.1202a72

    Article  Google Scholar 

  15. Khedr MM, Mahmoud WH, Sallam FA, Elmelegy N (2020) Comparison of Nd:YAG laser and combined intense pulsed light and radiofrequency in the treatment of hypertrophic scars: a prospective clinico-histopathological study. Ann Plast Surg 84(5):518–524. https://doi.org/10.1097/SAP.0000000000002086

    Article  CAS  PubMed  Google Scholar 

  16. Kono T, Erçöçen AR, Nakazawa H, Nozaki M (2005) Treatment of hypertrophic scars using a long-pulsed dye laser with cryogen-spray cooling. Ann Plast Surg 54(5):487–493. https://doi.org/10.1097/01.sap.0000155276.93061.93

    Article  CAS  PubMed  Google Scholar 

  17. Lee JH, Seo CE, Song WJ et al (2021) Combination treatment utilizing fractional ablative and continuous wave CO2 lasers for hypertrophic burn scars. Burns 47(5):1084–1093. https://doi.org/10.1016/j.burns.2020.10.015

    Article  PubMed  Google Scholar 

  18. Manuskiatti W, Fitzpatrick RE, Goldman MP (2001) Energy density and numbers of treatment affect response of keloidal and hypertrophic sternotomy scars to the 585-nm flashlamp-pumped pulsed-dye laser. J Am Acad Dermatol 45(4):557–565. https://doi.org/10.1067/mjd.2001.116580

    Article  CAS  PubMed  Google Scholar 

  19. Omranifard M, Mehdi R (2007) Comparing the effects of conventional method, pulse dye laser and erbium laser for the treatment of hypertrophic scars in Iranian patients. J Res Med Sci 12(6)

  20. Ouyang HW, Li GF, Lei Y, Gold MH, Tan J (2018) Comparison of the effectiveness of pulsed dye laser vs pulsed dye laser combined with ultrapulse fractional CO2 laser in the treatment of immature red hypertrophic scars. J Cosmet Dermatol 17(1):54–60. https://doi.org/10.1111/jocd.12487

    Article  PubMed  Google Scholar 

  21. Rahman SHA, Mohamed MS, Hamed AM (2021) Efficacy and safety of Nd:YAG laser alone compared with combined Nd:YAG laser with intralesional steroid or botulinum toxin A in the treatment of hypertrophic scars. Lasers Med Sci 36(4):837–842. https://doi.org/10.1007/s10103-020-03120-0

    Article  PubMed  Google Scholar 

  22. Ramadan H, Saber M, Salah M, Samy N (2021) The effectiveness of long pulsed Nd:YAG Laser alone for treatment of keloids and hypertrophic scars versus its combination with bleomycin. J Cosmet Dermatol 20(12):3899–3906. https://doi.org/10.1111/jocd.14509

    Article  PubMed  Google Scholar 

  23. Radmanesh M, Mehramiri S, Radmanesh R (2021) Fractional CO2 laser is as effective as pulsed dye laser for the treatment of hypertrophic scars. J Dermatolog Treat 32(6):576–579. https://doi.org/10.1080/09546634.2019.1687821

    Article  CAS  PubMed  Google Scholar 

  24. Sabry HH, Abdel Rahman SH, Hussein MS, Sanad RR, Abd El Azez TA (2019) The efficacy of combining fractional carbon dioxide laser with verapamil hydrochloride or 5-fluorouracil in the treatment of hypertrophic scars and keloids: a clinical and immunohistochemical study. Dermatol Surg 45(4):536–546. https://doi.org/10.1097/DSS.0000000000001726

    Article  CAS  PubMed  Google Scholar 

  25. Yan D, Zhao H, Li C et al (2022) A clinical study of carbon dioxide lattice laser–assisted or microneedle-assisted 5-aminolevulinic acid–based photodynamic therapy for the treatment of hypertrophic acne scars. Photodermatol Photoimmunol Photomed 38(1):53–59. https://doi.org/10.1111/phpp.12716

    Article  CAS  PubMed  Google Scholar 

  26. Monstrey S, Middelkoop E, Vranckx JJ et al (2014) Updated scar management practical guidelines: non-invasive and invasive measures. J Plast Reconstr Aesthet Surg 67(8):1017–1025. https://doi.org/10.1016/j.bjps.2014.04.011

    Article  PubMed  Google Scholar 

  27. Bouzari N, Davis SC, Nouri K (2007) Laser treatment of keloids and hypertrophic scars. Int J Dermatol 46(1):80–88. https://doi.org/10.1111/j.1365-4632.2007.03104.x

    Article  CAS  PubMed  Google Scholar 

  28. Nunez JH, Strong AL, Comish P et al (2023) A review of laser therapies for the treatment of scarring and vascular anomalies. Adv Wound Care 12(2):68–84. https://doi.org/10.1089/wound.2021.0045

    Article  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  30. Li K, Nicoli F, Cui C et al (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):1–11. https://doi.org/10.1038/s41598-020-78738-9

    Article  CAS  Google Scholar 

  31. Jin R, Huang X, Li H et al (2013) Laser therapy for prevention and treatment of pathologic excessive scars. Plast Reconstr Surg 132(6):1747–1758. https://doi.org/10.1097/PRS.0b013e3182a97e43

    Article  CAS  PubMed  Google Scholar 

  32. Yang S, Luo YJ, Luo C (2021) Network meta-analysis of different clinical commonly used drugs for the treatment of hypertrophic scar and keloid. Front Med. https://doi.org/10.3389/fmed.2021.691628

    Article  PubMed  PubMed Central  Google Scholar 

  33. Choi KJ, Williams EA, Pham CH et al (2021) Fractional CO2 laser treatment for burn scar improvement: a systematic review and meta-analysis. Burns 47(2):259–269. https://doi.org/10.1016/j.burns.2020.10.026

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We sincerely thank Victor Joao, affiliated with the Universidad De La Republica Uruguay for his help as the active librarian for this project. He helped with creating search strategies and gathering the search results for this manuscript.

Funding

Not applicable.

Author information

Author notes

  1. Jose A. Foppiani and Abdulrhman Khaity are co-first author.

Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, USA

    Jose A. Foppiani, Daniela Lee & Samuel J. Lin

  2. 1st Faculty of Medicine, Charles University, Prague, Czech Republic

    Jose A. Foppiani

  3. Faculty of Medicine, Elrazi University, Khartoum, Sudan

    Abdulrhman Khaity

  4. Faculty of Medicine, Fayoum University, Fayoum, Egypt

    Nada Mostafa Al-Dardery

  5. Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Mohammed Tarek Hasan, Omar A. Abdelwahab & Aya Ehab Abd-Alwahed

  6. Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Mohamed El-Samahy

  7. Faculty of Dentistry, Sinai University, Sinai, Egypt

    Huzifa Marwan Khitti

  8. Faculty of Medicine, The Hashemite University, Zarqa, Jordan

    Khaled Albakri

Authors
  1. Jose A. Foppiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abdulrhman Khaity
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nada Mostafa Al-Dardery
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammed Tarek Hasan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohamed El-Samahy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniela Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Omar A. Abdelwahab
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Aya Ehab Abd-Alwahed
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Huzifa Marwan Khitti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Khaled Albakri
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Samuel J. Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel J. Lin.

Ethics declarations

Conflict of interest

Author A discloses royalties from McGrawHill.

Not applicable.

Ethical Approval

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

266_2024_4027_MOESM1_ESM.jpg

Supplementary Figure 1. The risk of bias summary graph according to Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB2) (JPG 119 KB)

266_2024_4027_MOESM2_ESM.xlsx

Supplementary Table 1. Quality assessment results of the observational studies according to the Newcastle-Ottawa scale (NOS) (XLSX 9 KB)

266_2024_4027_MOESM3_ESM.xlsx

Supplementary Table 2. Head-to-head comparison of all included interventions in terms of Vancouver Scar Scale (VSS) (XLSX 12 KB)

Supplementary Table 3. Head-to-head comparison of all included interventions in terms of pliability score (XLSX 10 KB)

266_2024_4027_MOESM5_ESM.xlsx

Supplementary Table 4. Head-to-head comparison of all included interventions in terms of Erythema, Vascularity, Redness and Perfusion (V) (XLSX 10 KB)

266_2024_4027_MOESM6_ESM.xlsx

Supplementary Table 5. Head-to-head comparison of all included interventions in terms of Hight or thickness (mm) (XLSX 10 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Foppiani, J.A., Khaity, A., Al-Dardery, N.M. et al. Laser Therapy in Hypertrophic and Keloid Scars: A Systematic Review and Network Meta-analysis. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-04027-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00266-024-04027-9

Keywords

Search

Navigation