Early laser intervention to reduce scar formation – a systematic review

Abstract

The ability of laser treatment to affect wound healing and subsequently minimize scar formation has been investigated in recent years. However, no systematic review links these clinical trials. The aim of this study was to systematically review and evaluate clinical evidence for early laser intervention to reduce scar formation in studies where laser treatment was introduced less than 3 months after wounding. We searched PubMed using relevant keywords in June 2017. Titles, abstracts and articles were sorted according to inclusion and exclusion criteria. Methodological quality was evaluated according to Cochrane Collaborations risk-of-bias assessment guideline by two independent authors. Twenty-five articles met the inclusion criteria. In total, 22 of 25 studies were controlled studies, and 17 of 25 studies compared laser treatment vs. untreated control scars. The following laser devices have been investigated: pulsed dye laser (PDL), potassium-titanyl-phosphate (KTP) laser, fractional erbium:glass 1540 nm/1550 nm, fractional/full ablation erbium-doped yttrium aluminium garnet (Er:YAG) laser or fractional CO laser. Eighteen studies applied laser treatments 2-4 times with 2- to 8-week intervals, while seven studies applied only one laser treatment. Follow-up time ranged from 1 to 12 months with 18 studies using a follow-up time ≤3 months. In general, laser-treated wounds and scars showed benefit from laser intervention, though not always reaching significance. Significant scar improvement was found in three of four studies using laser treatment in inflammation phase, in six of 16 studies with laser initiated in the proliferation phase and in two of five studies in the remodelling phase. High risk of bias was found in randomization and allocation concealment, and low risk of bias with regard to blinding of outcome assessment and lost to follow-up. In conclusion, laser intervention when introduced in inflammation, proliferation or remodelling phase has the potential to reduce cutaneous scar formation. Further, high-quality studies are needed before standard protocols can be implemented in clinical practice.

Laser treatments in early wound healing improve scar appearance: a randomized split-wound trial with nonablative fractional laser exposures vs. untreated controls

“…Particular strengths of this study are the randomized, allocation‐concealed, controlled and blinded split‐wound study setup with internal controls, an aspect that is unprecedented in the field of early laser intervention to reduce scar formation . Furthermore, the detailed and validated POSAS as the primary outcome measure enabled detection of differences in scar characteristics such as relief, thickness, pliability and overall scar appearance that would have been overlooked by VSS.…”

Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus Recommendations

“…These were among the first utilized to treat traumatic (including burn) scars, and can help reduce erythema, and improve scar pliability and hypertrophy . Although more efficacious if utilized earlier in the healing process , they have shown efficacy in scars of varying duration contingent in the presence of erythema . A consensus algorithm for the treatment of burn scars included the use of vascular lasers early in the treatment course .…”

“…Accumulating evidence suggests that lasers can treat the sequelae of existing traumatic scars, and importantly they may also have the potential to proactively modulate the early wound healing process to mitigate traumatic scars and contractures as they form. A systematic review of 25 articles by Karmisholt et al in 2018 detailed the clinical outcomes of laser intervention within 3 months of wounding (primarily post‐surgical scars) . There was an overall trend toward improvement with early laser treatment, and statistically significant scar improvement was found in 3 of 4 studies when laser was initiated in the inflammatory phase of wound healing, in 6 of 16 studies when initiated in the proliferative phase, and in 2 of 5 studies when performed in the remodeling phase.…”

Randomized, Controlled Early Intervention of Dynamic Mode Fractional Ablative CO2 Laser on Acute Burn Injuries for Prevention of Pathological Scarring

“…Ablative fractional lasers (AFLs), both CO 2 and Erbium:YAG (Er:YAG), have shown to be powerful tools in the treatment of mature burn and traumatic scars , but young scars are less well‐studied. Karmisholt et al published a review of early laser intervention in different phases of wound healing and the impact on scar formation. The conclusion supports increased efficacy with early intervention but several studies had flaws including primary use of surgical scars, which often improve sufficiently without intervention , exclusion of keloid scarring , and 3 months or less of follow‐up .…”