Treatment of Surgical Scars With Combination Pulsed Dye and Fractional Nonablative Laser

Abstract

To assess the effectiveness and safety of combined pulsed-dye laser (PDL) and NAFL for treatment of surgical scars. Summary Background Data: PDL and NAFL have not been compared to healing by time alone. Methods: Randomized controlled, single-blinded clinical trial at an urban, university hospital. Healthy adults' status post skin surgery with primary closure were randomized to either 3 sessions of combination PDL and NAFL every 2 to 8 weeks, or control of no treatment. At baseline and 36-week follow-up, Patient and observer Scar Assessment Scale and Scar Cosmesis Assessment and Rating were completed by participants and blinded physicians. The primary outcome was scar improvement, as measured by the score difference over time. Results: Of 76 participants, 52 completed the study (July 2017 to June 2019). No severe adverse events were reported. Patient and observer Scar Assessment Scale assessments demonstrated improvement in total score in the laser group compared to controls, as reported by patients [mean difference (standard deviation), laser: 12.86 (6.91) vs control: 7.25 (6.34); P = 0.004] and blinded physicians [18.32 (8.69) vs 13.08 (9.63); P = 0.044]. Patients observed a greater improvement in scar thickness [3.68 (2.04) vs 1.88 (1.85); P = 0.002] and stiffness [3.57 (2.78) vs 1.50 (2.11); P = 0.004] with lasers, and physicians reported greater improvement in vascularity [3.71 (1.98) vs 1.71 (1.52); P = 0.0002]. The live Scar Cosmesis Assessment and Rating subscore for erythema improved significantly with lasers [1.04 (0.79) vs 0.42 (0.50); P = 0.001]. Conclusions and Relevance: Combined PDL and NAFL resulted in scar improvement. Scar thickness, stiffness, and erythema were improved. Trial Registration: ClinicalTrials.gov (NCT03057964).

Effect of Laser and Energy-based Device Therapies to Minimize Surgical Scar Formation: A Systematic Review and Network Meta-analysis

“…LLLT is postulated to modulate the inflammatory and proliferative phases of wound healing through a process known as photobiomodulation ( 18 ). In contrast, PDL relies on selective photothermolysis to target the scar’s microvasculature, inducing localized hypoxaemia and consequently influencing collagen production ( 25 ). Our understanding suggests that the mechanisms of action employed by LLLT and PDL in the treatment of mature scars are fundamentally rooted in the principles applicable to early scar interventions.…”

“…Thirteen RCTs focused on the effects of the interventions to prevent surgical scars and reported VSS measurements(3,5,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The other 7 RCTs were conducted on effects of the interventions to prevent surgical scars and depicted the OSAS measurements(3,17,(23)(24)(25)(26)(27). Two RCTs reported results in both VSS and OSAS score(3,17) (Table…”