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    Scar treatment dependent on technique

     

    Combining ablative fractional laser therapy with enhanced topical corticosteroid delivery presents the potential to combine two valuable scar therapies in a simple, cost-effective strategy.”

    FRACTIONAL ABLATIVE CO2 LASER FOR HYPERTROPHIC SCARS

    The first prospective study included 15 patients with hypertrophic scars treated with three to five laser treatment sessions at two- to three-month intervals using fractional ablative CO2 laser followed by immediate postoperative topical application of triamcinolone acteonide suspension at a concentration of 10 or 20 mg/mliv.

    Based on a 0-3 point scale, average overall improvement was assessed to be 2.73/3.0. The highest average overall improvement score was 3.00, which 11 of 15 patients attained. Improvement was observed in appearance, dyschromia, degree of hypertrophy, and texture; most improvement was noticed in texture and the least improvement in dyschromia.

    TREATING VACCINATION-RELATED KELOIDS

    The final prospective studyinvolved 10 patients with keloids on the shoulder as a result of BCG vaccination. All lesions were first treated using an erbium-YAG laser. Following laser therapy, all lesions were divided in two with one half treated with an intralesional injection of triamcinolone acetonide (10 mg/ml) and the other half treated with topical desoxymethasone 0.25% ointment under occlusion for 3-hours. Patients received four treatment sessions, six weeks apart.

    Treatment outcomes were evaluated using the Vancouver Scar Scale (VSS ). The mean score before treatment was 8.59 ± 1.23 for the corticosteroid injection site and 8.31 ± 2.09 for the topical site. After treatment, VSS decreased on both sides of the lesion by approximately 50%  ̶̶̶̶  4.56 ± 1.09 and 5.02 ± 0.87, respectively (P > 0.05).

    TAKE-A-WAYS

    Lead author of the review Rawaa Almukhtar, Ph.D., resident in training in dermatology at Louisiana State University Health Sciences Center in New Orleans, said the studies included in the review all showed that “laser-assisted topical steroid delivery was well tolerated in patients with minimum pain and minimum adverse events observed."  Dr. AlmukhtarDr. Almukhtar

    “Studies suggest that fractional laser-assisted delivery of topical steroid can offer an efficient, safe, and effective treatment option for the management of hypertrophic scars and keloids,” she said. “Combination of fractional laser and topical steroid therapy optimizes dispersion of steroid molecules with minimal discomfort.”  But she added that more research is needed to determine the optimal treatment parameters and steroid dosing.

    “Studies are also needed to directly compare laser-assisted steroid delivery to ablative fractional laser therapy on one hand and to intralesional steroid therapy on the other hand,” she said.

     


    REFERENCES

    1. Cavalié M, Sillard L, Montaudié H, Bahadoran P, Lacour J-P, Passeron T. Treatment of keloids with laser-assisted topical steroid delivery: a retrospective study of 23 cases. Dermatol Ther. 2015 Mar-Apr;28(2):74-8. doi: 10.1111/dth.12187. Epub 2014 Dec 4.
    2. Almukhtar R, Lee B, LeBlanc K. Use of Laser-assisted Topical Steroid Delivery for Treatment of Hypertrophic Scars and Keloids. Annual Meeting of the American Society for Dermatologic Society, Chicago, 5-8 October 2017. Page 172.
    3. Cavalié M, Sillard L, Montaudié H, Bahadoran P, Lacour J-P, Passeron T. Treatment of keloids with laser-assisted topical steroid delivery: a retrospective study of 23 cases. Dermatol Ther. 2015 Mar-Apr;28(2):74-8. doi: 10.1111/dth.12187. Epub 2014 Dec 4.
    4. Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med. 2013 Mar;45(3):135-40. doi: 10.1002/lsm.22120. Epub 2013 Mar 4. PMID: 23460557
    5. Park, J.H., Chun, J.Y. & Lee, J.H. Laser-assisted topical corticosteroid delivery for the treatment of keloids. Lasers Med Sci 2017: 32: 601. https://doi.org/10.1007/s10103-017-2154-5

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