Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars

McGoldrick, Rory; Theodorakopoulou, Evgenia; Azzopardi, Ernest A.; Murison, Maxwell

doi:10.1177/2059513116689805

Cited by 20 publications

(27 citation statements)

References 172 publications

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“… 47 Therefore, surgical excision is not recommended as a monotherapy as it results in high recurrence rates in the range of 45%–100%. 2 , 48 For better postoperative surgical outcomes, surgical excision is often combined with other forms of treatment including radiotherapy, intralesional corticosteroid injections, IFN injection, bleomycin, cryotherapy, pressure therapy and silicone gel or sheeting. 8 , 26 , 49 Successful use of dermal substitutes and epidermal skin grafting with keloid excision has also been reported.…”

Section: Current Treatmentsmentioning

confidence: 99%

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Keloids: Current and emerging therapies

Ojeh

Bharatha

Gaur

et al. 2020

Scars, Burns & Healing

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Keloids are pathological scars that grow over time and extend beyond the initial site of injury after impaired wound healing. These scars frequently recur and rarely regress. They are aesthetically disfiguring, can cause pain, itching, discomfort as well as psychological stress, often affecting quality of life. Many treatment modalities, including surgical and non-surgical, have been explored and have been reported to be beneficial; however, none have been absolutely satisfactory or optimal for the treatment of all keloid subtypes to date. This poses a major challenge to clinicians. Often, a combinational therapeutic approach appears to offer the best results with higher patient satisfaction compared to monotherapy. The aetiopathogenesis of keloids is not fully elucidated; however, with recent advances in molecular biology and genetics, insight is being gained on the complex process of scar formation and hence new therapeutic and management options for keloids. In this paper, we explore the literature and summarise the general concepts surrounding keloid development and review both current (corticosteroids, surgical excision, silicone-based products, pressure therapy, radiotherapy, cryotherapy, laser therapy, imiquimod and 5-fluorouracil) and emerging (stem cell therapy, mitomycin C, verapamil, interferons, bleomycin, botulinum toxin type A and angiotensin-converting enzyme inhibitors) treatments. Increased knowledge and understanding in this area may potentially lead to the discovery and development of novel therapeutic options that are more efficacious for all keloid types. Lay Summary [Formula: see text] Keloids are problematic scars that are difficult to treat and manage. The aetiopathogenesis of keloids is not clear; however, recent advances in molecular biology and genetics are beginning to shed light on the underlying mechanisms implicated in keloid scar formation which will hopefully lead to the development of treatment options for all keloid types. This review summarises current and emerging therapies.

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Section: Current Treatmentsmentioning

confidence: 99%

“… 97 Since then, different systems have been used for the treatment of keloid and hypertrophic scars. 48 , 98 These lasers target skin chromophores like haemoglobin and melanin, based on the principle of selective photothermolysis. 99 Lasers can be classified as ablative and non-ablative.…”

Section: Current Treatmentsmentioning

confidence: 99%

Keloids: Current and emerging therapies

Ojeh

Bharatha

Gaur

et al. 2020

Scars, Burns & Healing

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“…Inflammatory and erythematous scars encountered early are most amenable to treatment with pulsed dye laser. [16][17][18] Ablative fractional lasers typically produce greatest improvement for hypertrophic scars and scars of less than 2-year duration. The penetration of scar is between 400 and 1,000 lm into the dermis; deeper dermis fibrotic components remain untreated.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Fractional CO₂ Laser, Verapamil, and Triamcinolone for the Treatment of Keloid

Srivastava

Kumari

Singh

2019

Advances in Wound Care

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Objective: Scar biology is a territory less understood. The search for ideal treatment of keloid continues. The aim of this study was to compare the role of CO 2 laser, triamcinolone (TAC), and verapamil in the treatment of keloid. Approach: A randomized parallel-group study was conducted in which 60 patients were randomly allocated to three groups from May 2017 to April 2018. First group received fractional CO 2 laser therapy, second group received triamcinolone, and third group received intralesional verapamil. Outcomes were evaluated using Vancouver scar scale score at 3 weekly intervals for 6 months. Results: There was a reduction in scar height, vascularity, and pliability in all the three groups. However, pigmentation was not completely resolved by any of the three modalities. The response was fastest in case of triamcinolone followed by verapamil and laser, which was statistically significant. There was reduction in pain and pruritus in all the three groups and lesser injection site pain with verapamil. There was some amount of charring with CO 2 laser. Innovation: Our study provides evidence that TAC has the fastest response in treating keloids when compared to other modalities. Scar pigmentation is the parameter that is not completely resolved by TAC, verapamil, or CO 2 laser. Conclusion: The study revealed that fractional CO 2 laser and verapamil are as efficient as triamcinolone acetonide (TAC) for treating keloids, except it takes longer for laser and verapamil to act compared to TAC. Verapamil can be used as an alternative treatment modality that is cost-effective with minimal adverse effects.

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“…Laser PDL bekerja mendestruksi pembuluh darah kecil pada kulit sehingga mengurangi asupan oksigen dan terjadi hipoksemia jaringan. 5,12,15 Beberapa studi mengenai penggunaan PDL 585 nm menunjukkan perbaikan ringan-sedang dibandingkan dengan penggunaan injeksi kortikosteroid intralesi. Belum ada konsensus yang menetapkan panjang gelombang pada alat PDL untuk terapi keloid, namun beberapa studi menggunakan panjang gelombang antara 585-595 nm.…”

Section: Proses Penyembuhan Luka Dan Patomekanisme Keloidunclassified

“…Hasil maksimal dilaporkan sekitar 3-4 bulan pascaterapi. 15,16 Sebuah meta-analisis menunjukkan perbaikan skar pada 72% kasus tanpa rekurensi pada penggunaan laser PDL. Selain itu, beberapa studi meta-analisis menunjukkan keunggulan penggunaan PDL dibandingkan laser fractional, CO2 Nd:YAG, dan erbium-doped yttrium garnet (Er:YAG).…”

Section: Proses Penyembuhan Luka Dan Patomekanisme Keloidunclassified

TATA LAKSANA LASER PADA KELOIDi

Bahat

Ade

2019

MDVI

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Keloid merupakan respons abnormal terhadap penyembuhan luka. Keloid disebabkan oleh ketidakseimbangan respons transforming growth factor-beta (TGF-β) dan interleukin dalam sintesis dan degradasi kolagen. Pilihan terapi untuk keloid dapat dibagi menjadi metode bedah atau nonbedah. Terapi laser menggunakan pendekatan nonablatif pulsed dye laser (PDL) dan Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG)], ablatif, dan fractional. PDL terbukti mengurangi ukuran skar sebesar 72% tanpa disertai rekurensi bermakna. Sedangkan laser Nd:YAG dapat mereduksi ukuran keloid ±10% dari ukuran sebelumnya dalam waktu empat minggu. Laser CO2 memiliki efek destruktif pada epidermis dan sebagian dermis dengan memanfaatkan energi kalor sehingga terjadi remodeling jaringan.Sementara itu, laser fractional menunjukkan angka kepuasan pasien sebesar 96,7% dan penguranganVancouver scar scale yang signifikan. Terapi laser dapat dipertimbangkan sebagai salah satu modalitas terapikeloid. Terapi ini memiliki unggul dalam mereduksi keloid dalam waktu singkat dengan efek sampingminimal.

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Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars

Cited by 20 publications

References 172 publications

Keloids: Current and emerging therapies

Keloids: Current and emerging therapies

Comparison of Fractional CO₂ Laser, Verapamil, and Triamcinolone for the Treatment of Keloid

TATA LAKSANA LASER PADA KELOIDi

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Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars

Cited by 20 publications

References 172 publications

Keloids: Current and emerging therapies

Keloids: Current and emerging therapies

Comparison of Fractional CO2 Laser, Verapamil, and Triamcinolone for the Treatment of Keloid

TATA LAKSANA LASER PADA KELOIDi

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Product

Resources

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Comparison of Fractional CO₂ Laser, Verapamil, and Triamcinolone for the Treatment of Keloid