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

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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

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Data Availability

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

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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.

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Correspondence to Samuel J. Lin.

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Supplementary Information

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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)

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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)

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

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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

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