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Wilk LS, Doppegieter M, van der Beek N, van Leeuwen TG, Aalders MCG. Modeling pulsed dye laser treatment of psoriatic plaques by combining numerical methods and image-derived lesion morphologies. Lasers Surg Med 2024; 56:508-522. [PMID: 38576388 DOI: 10.1002/lsm.23781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/27/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES Knowledge of the physical effects of pulsed dye laser (PDL) treatment of psoriatic lesions is essential in unraveling the remedial mechanisms of this treatment and hence also in maximizing in its disease-modifying potential. Therefore, the main objective of this study was to provide estimates of these physical effects (for laser wavelengths of 585 and 595 nm), with the aim of identifying pathogenic processes that may be affected by these conditions. METHODS We modeled the laser light propagation and subsequent photothermal heating by numerically solving the transient diffusion and heat equations simultaneously. To this end, we used the finite element method in conjunction with an image-derived psoriatic lesion morphology (which was defined by segmenting blood vessels from a confocal microscopy image of a fluorescently labeled section of a 3 mm punch biopsy of a psoriatic lesion). The resulting predictions of the generated temperature field within the lesion were then used to assess the possibility of stalling or arresting some suspected pathogenic processes. RESULTS According to our results, it is conceivable that perivascular nerves are thermally denatured, as almost all locations that reach 60°C were found to be within 18 µm (at 585 nm) and 11 µm (at 595 nm) of a blood vessel wall. Furthermore, activation of TRPV1 and TRPV2 channels in perivascular neuronal and immune cells is highly likely, since a critical temperature of 43°C is generated at locations within up to 350 µm of a vessel wall (at both wavelengths) and sustained for up to 700 ms (at 585 nm) and 40 ms (at 595 nm), while a critical temperature of 52°C is reached by locations within 80 µm (at 585 nm) and 30 µm (at 595 nm) of a vessel wall and sustained for up to 100 ms (at 585 nm) and 30 ms (at 595 nm). Finally, we found that the blood vessel coagulation-inducing temperature of 70°C is sustained in the vascular epithelium for up to 19 and 5 ms at 585 and 595 nm, respectively, rendering partial or total loss of vascular functionality a distinct possibility. CONCLUSIONS The presented approach constitutes a useful tool to provide realistic estimates of the photothermal effects of PDL treatment of psoriatic plaques (as well as other selective photothermolysis-based treatments), yielding information that is essential in guiding future experimental studies toward unraveling the remedial mechanisms of these treatments.
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Affiliation(s)
- Leah S Wilk
- Amsterdam UMC, location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Co van Ledden Hulsebosch Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Meagan Doppegieter
- Amsterdam UMC, location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Nick van der Beek
- ZBC MultiCare, Independent Treatment Center for Dermatology, Hilversum, The Netherlands
| | - Ton G van Leeuwen
- Amsterdam UMC, location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrythmias, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Maurice C G Aalders
- Amsterdam UMC, location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Co van Ledden Hulsebosch Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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2
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Xu W, Sinaki DG, Tang Y, Chen Y, Zhang Y, Zhang Z. Acne-induced pathological scars: pathophysiology and current treatments. BURNS & TRAUMA 2024; 12:tkad060. [PMID: 38585341 PMCID: PMC10998535 DOI: 10.1093/burnst/tkad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 04/09/2024]
Abstract
Acne is a common chronic inflammatory dermatosis that can lead to pathological scars (PSs, divided into hypertrophic scars and keloids). These kinds of abnormal scars seriously reduce the quality of life of patients. However, their mechanism is still unclear, resulting in difficult clinical prevention, unstable treatment effects and a high risk of recurrence. Available evidence supports inflammatory changes caused by infection as one of the keys to abnormal proliferation of skin fibroblasts. In acne-induced PSs, increasing knowledge of the immunopathology indicates that inflammatory cells directly secrete growth factors to activate fibroblasts and release pro-inflammatory factors to promote the formation of PSs. T helper cells contribute to PSs via the secretion of interleukin (IL)-4 and IL-13, the pro-inflammatory factors; while regulatory T cells have anti-inflammatory effects, secrete IL-10 and prostaglandin E2, and suppress fibrosis production. Several treatments are available, but there is a lack of combination regimens to target different aspects of acne-induced PSs. Overall, this review indicates that the joint involvement of inflammatory response and fibrosis plays a crucial role in acne-induced PSs, and also analyzes the interaction of current treatments for acne and PS.
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Affiliation(s)
- Wanyu Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Dorsa Gholamali Sinaki
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Yuchen Tang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Yunsheng Chen
- Department of Burns and Plastic Surgery, Shanghai Institute of Burns Research, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Zheng Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
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3
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Doppegieter M, van der Beek N, Bakker ENTP, Neumann MHA, van Bavel E. Effects of pulsed dye laser treatment in psoriasis: A nerve-wrecking process? Exp Dermatol 2023. [PMID: 37083107 DOI: 10.1111/exd.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
Pulsed dye laser (PDL) therapy can be effective in treating psoriasis, with a long duration of remission. Although PDL therapy, albeit on a modest scale, is being used for decades now, the underlying mechanisms responsible for the long-term remission of psoriasis remain poorly understood. The selective and rapid absorption of energy by the blood causes heating of the vascular wall and surrounding structures, like perivascular nerves. Several studies indicate the importance of nerves in psoriatic inflammation. Interestingly, denervation leads to a spontaneous remission of the psoriatic lesion. Among all dermal nerves, the perivascular nerves are the most likely to be affected during PDL treatment, possibly impairing the neuro-inflammatory processes that promote T-cell activation, expression of adhesion molecules, leukocyte infiltration and cytokine production. Repeated PDL therapy could cause a prolonged loss of innervation through nerve damage, or result in a 'reset' of neurogenic inflammation after temporary denervation. The current hypothesis provides strong arguments that PDL treatment affects nerve fibres in the skin and thereby abrogates the persistent and exaggerated inflammatory process underlying psoriasis, causing a long-term remission of psoriasis.
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Affiliation(s)
- Meagan Doppegieter
- Department of Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nick van der Beek
- ZBC MultiCare, Independent Treatment Center for Dermatology, Hilversum, The Netherlands
| | - Erik N T P Bakker
- Department of Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martino H A Neumann
- ZBC MultiCare, Independent Treatment Center for Dermatology, Hilversum, The Netherlands
| | - Ed van Bavel
- Department of Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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4
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Abo-Saif MA, Ragab AE, Ibrahim AO, Abdelzaher OF, Mehanyd ABM, Saber-Ayad M, El-Feky OA. Pomegranate peel extract protects against the development of diabetic cardiomyopathy in rats by inhibiting pyroptosis and downregulating LncRNA-MALAT1. Front Pharmacol 2023; 14:1166653. [PMID: 37056985 PMCID: PMC10086142 DOI: 10.3389/fphar.2023.1166653] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Pyroptosis is an inflammatory programmed cell death accompanied by activation of inflammasomes and maturation of pro-inflammatory cytokines interleukin-1β (IL-1β) and IL-18. Pyroptosis is closely linked to the development of diabetic cardiomyopathy (DC). Pomegranate peel extract (PPE) exhibits a cardioprotective effect due to its antioxidant and anti-inflammatory properties. This study aimed to investigate the underlying mechanisms of the protective effect of PPE on the myocardium in a rat model of DC and determine the underlying molecular mechanism.Methods: Type 1 diabetes (T1DM) was induced in rats by intraperitoneal injection of streptozotocin. The rats in the treated groups received (150 mg/kg) PPE orally and daily for 8 weeks. The effects on the survival rate, lipid profile, serum cardiac troponin-1, lipid peroxidation, and tissue fibrosis were assessed. Additionally, the expression of pyroptosis-related genes (NLRP3 and caspase-1) and lncRNA-MALAT1 in the heart tissue was determined. The PPE was analyzed using UPLC-MS/MS and NMR for characterizing the phytochemical content.Results: Prophylactic treatment with PPE significantly ameliorated cardiac hypertrophy in the diabetic rats and increased the survival rate. Moreover, prophylactic treatment with PPE in the diabetic rats significantly improved the lipid profile, decreased serum cardiac troponin-1, and decreased lipid peroxidation in the myocardial tissue. Histopathological examination of the cardiac tissues showed a marked reduction in fibrosis (decrease in collagen volume and number of TGF-β-positive cells) and preservation of normal myocardial structures in the diabetic rats treated with PPE. There was a significant decrease in the expression of pyroptosis-related genes (NLRP3 and caspase-1) and lncRNA-MALAT1 in the heart tissue of the diabetic rats treated with PPE. In addition, the concentration of IL-1β and caspase-1 significantly decreased in the heart tissue of the same group. The protective effect of PPE on diabetic cardiomyopathy could be due to the inhibition of pyroptosis and downregulation of lncRNA-MALAT1. The phytochemical analysis of the PPE indicated that the major compounds were hexahydroxydiphenic acid glucoside, caffeoylquinic acid, gluconic acid, citric acid, gallic acid, and punicalagin.Conclusion: PPE exhibited a cardioprotective potential in diabetic rats due to its unique antioxidant, anti-inflammatory, and antifibrotic properties and its ability to improve the lipid profile. The protective effect of PPE on DC could be due to the inhibition of the NLRP3/caspase-1/IL-1β signaling pathway and downregulation of lncRNA-MALAT1. PPE could be a promising therapy to protect against the development of DC, but further clinical studies are recommended.
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Affiliation(s)
- Mariam Ali Abo-Saif
- Department of Biochemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Amany E. Ragab
- Department of Pharmacognosy, Faculty of Pharmacy, Tanta University, Tanta, Egypt
- *Correspondence: Amany E. Ragab, ; Maha Saber-Ayad,
| | - Amera O. Ibrahim
- Department of Biochemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | | | | | - Maha Saber-Ayad
- Department of Clinical Sciences, College of Medicine and Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Pharmacology, College of Medicine, Cairo University, Giza, Egypt
- *Correspondence: Amany E. Ragab, ; Maha Saber-Ayad,
| | - Ola A. El-Feky
- Department of Biochemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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Nunez JH, Strong AL, Comish P, Hespe GE, Harvey J, Sorkin M, Levi B. A Review of Laser Therapies for the Treatment of Scarring and Vascular Anomalies. Adv Wound Care (New Rochelle) 2023; 12:68-84. [PMID: 35951024 DOI: 10.1089/wound.2021.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Significance: Laser use has become part of the gold standard of treatment as an effective adjuvant in multimodal therapy for pathologic scarring caused by burns, trauma, acne, and surgery, as well as vascular anomalies. Understanding indications and applications for laser therapy is essential for physicians to improve patient outcomes. Recent Advances: Since the 1980s, the medical use of lasers has continuously evolved with improvements in technology. Novel lasers and fractionated technologies are currently being studied in the hopes to improve treatment efficacy, while reducing complications. Recent advancements include acne treatment with novel picosecond lasers, new hypertrophic scar therapies with simultaneous laser and intense pulsed light use, and novel systems such as lasers with intralesional optical fiber delivery devices. In addition, optimizing the timing of laser therapy and its use in multimodal treatments continue to advance the field of photothermolysis. Critical Issues: Selecting the correct laser for a given indication is the fundamental decision when choosing a laser balancing effective treatment with minimal complications. This article covers the principles of laser therapy, the preferred lasers used for the treatment of scarring and vascular anomalies, and discusses the current evidence behind these laser choices. Future Directions: To optimize laser therapy, larger randomized control trials and split scar studies are needed. Continued advancement through better randomized controlled studies will help to improve patient outcomes on a broader scale.
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Affiliation(s)
- Johanna H Nunez
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Comish
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geoffrey E Hespe
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jalen Harvey
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Altunisik N, Turkmen D, Sener S. Evaluation of the effect of 577-nm pro-yellow laser on demodex intensity. J COSMET LASER THER 2022; 23:221-224. [PMID: 35786293 DOI: 10.1080/14764172.2022.2075898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The skin disease of the pilosebaceous unit created by demodex mites is called demodicosis. Recently, it has been brought to the agenda that laser therapies can be effective in reducing the intensity of demodex parasite. With this study, we aimed to evaluate the effect of pro-yellow laser applied to the face on the intensity of demodex parasite. Twenty-five patients who had referred to the dermatology polyclinic with a complaint of rash on the face and who had been given proyellow laser therapy during the past year were included in the study. Average pre-laser therapy demodex number per cm2 was 3.9 ± 5.0, while average post-therapy demodex number per cm2 was 2.6 ± 4.9 (p = .117). The 577-nm pro-yellow laser caused a change in demodex density. We found that the number of demodex following laser therapy decreased in some patients, while it increased in some others.
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Affiliation(s)
- Nihal Altunisik
- Department of Dermatology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Dursun Turkmen
- Department of Dermatology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Serpil Sener
- Department of Dermatology, Faculty of Medicine, Inonu University, Malatya, Turkey
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7
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Drozhdina MB, Bobro VA, Sennikova YA, Kornilova EI. Post-acne symptom complex. Approaches to therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Postacne-persistent skin changes that appear as a result of long-term acne, inadequate therapy and manipulations performed in the management of this group of patients. The post-acne symptom complex is stable skin changes that appear as a result of long-term acne inadequate therapy and manipulations performed during the management of this group of patients. The pathogenetic mechanisms underlying the launch of acne currently look as follows: androgens cause hyperseborrhea, sebum lipids activate innate immunity; pathological keratinization due to the production of IL-1 inflammatory mediator and androgen hyperproduction; Cutibacterium acnes activate innate immune responses through toll-like receptors and metalloproteinases, stimulate the production of antimicrobial peptides and sebum production. The subsequent rupture of the follicles activates the wound healing process. Depending on the genetically determined features of the course of the inflammatory process, various individual postacne changes of the skin will prevail in different patients. The article highlights the main factors influencing the formation of post-acne, pathogenetic mechanisms underlying the formation of these changes, systematizes modern data on the classification, morphological and pathohistological characteristics of scars. Quantitative and qualitative scales of assessment of post-acne scars for determining the severity of the pathological process are presented, differentiated approaches to modern methods of therapy are discussed in detail, including the advantages and disadvantages of the most common methods of treating patients based on the principles of evidence-based medicine using a number of personalized methods.
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8
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Schaffrick L, Ding J, Kwan P, Tredget EE. Molecular Features of Hypertrophic Scars After Thermal Injury: Is There a Biologic Basis for Laser Therapy? Adv Wound Care (New Rochelle) 2022; 11:163-178. [PMID: 34663086 DOI: 10.1089/wound.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Hypertrophic scars (HTS) and keloids are common after thermal injuries and other trauma to deep regions of dermis of the skin. These abnormal scars can cause contractures and the thick masses of scar tissue that result in functional and cosmetic impairment. Management of these dermal fibrotic conditions includes a wide range of medical and surgical treatments, which can be time consuming, only partially effective, and often uncomfortable for patients. Recent Advances: The molecular pathophysiology of HTS has become more understood over the past two decades, where thermal injury to the reticular dermis results in an inflammatory response, fibrogenic growth factor release, and the formation of a dermal scar with increased collagen and proteoglycan composition in an abnormal morphology. Lasers are becoming a widely used form of treatment for these types of scars; however, the evidence for the beneficial effects of laser treatments and the understanding of their mechanism of action are still evolving. Critical Issues: Paradoxically, laser delivery of thermal energy to the skin is suggested to improve scar remodeling and wound healing, yet HTS is a well-recognized complication of excessive thermal energy delivered by laser treatments. This review aims to examine the current evidence for the use of lasers for HTS, and to investigate the molecular mechanisms where re-injury of a burn scar from laser treatment could result in overall improvements in scar quality. Future Directions: Improved design of clinical trials for the treatment of scarring in the future will evolve from new methodology and models of HTS in animals and humans.
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Affiliation(s)
- Lindy Schaffrick
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Edward E. Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
- Department of Surgery, Division of Critical Care, University of Alberta, Edmonton, Canada
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9
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Nast A, Gauglitz G, Lorenz K, Metelmann HR, Paasch U, Strnad V, Weidmann M, Werner RN, Bauerschmitz J. S2k‐Leitlinie Therapie pathologischer Narben (hypertrophe Narben und Keloide) –
Update
2020. J Dtsch Dermatol Ges 2021; 19:312-327. [PMID: 33586893 DOI: 10.1111/ddg.14279_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Alexander Nast
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM)
| | - Gerd Gauglitz
- Praxis Dermatologie München-Neuhausen, München.,Klinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Kerstin Lorenz
- Klinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle, Halle/Saale
| | - Hans-Robert Metelmann
- Klinik und Poliklinik für Mund-Kiefer-Gesichtschirurgie und Plastische Operationen, Universitätsmedizin Greifswald
| | - Uwe Paasch
- Hautärzte Paasch, Praxis Gotha, Jesewitz OT Gotha
| | | | | | - Ricardo Niklas Werner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM)
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10
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Combination of 1,064-nm Neodymium-doped Yttrium Aluminum Garnet Laser and Steroid Tape Decreases the Total Treatment Time of Hypertrophic Scars: An Analysis of 40 Cases of Cesarean-Section Scars. Dermatol Surg 2021; 46:1062-1067. [PMID: 31702591 DOI: 10.1097/dss.0000000000002235] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (Cutera, Inc., Brisbane, CA) and steroid tape (fludroxycortide tape) have been used to treat keloids and hypertrophic scars. OBJECTIVE To evaluate the efficacy of contact-mode 1,064-nm Nd:YAG laser therapy and steroid tape for hypertrophic cesarean-section scars versus conservative therapy (steroid tape only). MATERIALS AND METHODS A medical record review identified 40 consecutive Japanese patients who had hypertrophic scars (total Japan Scar Workshop Scar Scale [JSS] 2015 evaluation scores of 9 to 12) for more than 1 year after a vertical cesarean section and who were treated at our scar-specialist clinic from July 2015 to December 2017. All 40 patients continued treatment until the total JSS score dropped below 3. Recurrence was defined as a ≥1-point increase in the total JSW score 6 months after achieving a total JSS score <3. RESULTS The patients had a mean age of 34.2 years. The test (n = 25) and control (n = 15) groups took on average 16.9 and 24.3 months to achieve a total JSS score <3, respectively (p < .01). In the following 6 months, none of the scars recurred. CONCLUSION Nd:YAG laser treatment effectively decreased the total treatment time of hypertrophic cesarean-section scars. An algorithm for treating mild and severe hypertrophic cesarean-section scars is proposed.
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11
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Deng H, Tan T, Luo G, Tan J, Li-Tsang CWP. Vascularity and Thickness Changes in Immature Hypertrophic Scars Treated With a Pulsed Dye Laser. Lasers Surg Med 2020; 53:914-921. [PMID: 33289116 DOI: 10.1002/lsm.23366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/28/2020] [Accepted: 11/18/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Growth of capillaries is an essential process after a dermal injury. An immature scar with robust growth of capillaries tends to be hypertrophic. Pulsed dye laser (PDL) causes damage to microvascular structures and is increasingly used for early erythematous scars to limit scar growth. To have a better understanding of the impact of PDL on scar vascularity and to optimize the clinical use of PDL for managing hypertrophic scars, this study aimed to explore changes in scar erythema, blood perfusion, and thickness of immature hypertrophic scars in Asian patients who received PDL treatments at an early stage. STUDY DESIGN/MATERIALS AND METHODS This was a 3-month, assessor-blinded, clinical study. There were two groups of patients, the PDL group and the control group, who had hypertrophic scars less than 1-year post-injury. Patients in the PDL group received three PDL sessions at 4-week intervals. A total of three assessments were performed, at baseline, 1 and 3 months, consisting of the Patient and Observer Scar Assessment Scale (POSAS) and objective measurements of scar erythema, blood perfusion, and scar thickness. RESULTS A total of 45 patients were enrolled, 22 in the PDL group and 23 in the control group. After the 3-month treatment, parameters of scar vascularity (P = 0.003), pigmentation (P = 0.026), color (P < 0.001), thickness (P < 0.05), and overall scores (P < 0.01) on the POSAS significantly decreased in the PDL group. Moreover, objective measurements of scar erythema and blood perfusion showed significant improvements in the PDL group (P = 0.009 and P = 0.022, respectively) but not in the control group (P = 0.296 and P = 0.115, respectively). A stable scar thickness was maintained in the PDL group from baseline to 3 months (0.21 cm vs. 0.22 cm, P > 0.05), whereas scar thickness significantly increased in the control group (0.22 cm vs. 0.32 cm, P < 0.01). CONCLUSION Use of PDL at an early stage controls vascularity of immature hypertrophic scar by improving its poor blood perfusion that further limits scar thickness growth and promotes scar maturation. Lasers Surg. Med. 00:00-00, 2020. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Huan Deng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Teresa Tan
- Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jianglin Tan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University, Chongqing, China
| | - Cecilia W P Li-Tsang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
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12
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Nast A, Gauglitz G, Lorenz K, Metelmann HR, Paasch U, Strnad V, Weidmann M, Werner RN, Bauerschmitz J. S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids) - Update 2020. J Dtsch Dermatol Ges 2020; 19:312-327. [PMID: 33015930 DOI: 10.1111/ddg.14279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Alexander Nast
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM)
| | - Gerd Gauglitz
- Dermatological Practice München-Neuhausen, Munich.,Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle, Halle/Saale
| | - Hans-Robert Metelmann
- Department and Clinic for Oral and Maxillofacial Surgery and Plastic Surgery, University Hospital Greifswald
| | - Uwe Paasch
- Dermatological Practice Paasch, Gotha, Jesewitz OT Gotha
| | | | | | - Ricardo Niklas Werner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM)
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Ekstein SF, Wyles SP, Moran SL, Meves A. Keloids: a review of therapeutic management. Int J Dermatol 2020; 60:661-671. [PMID: 32905614 DOI: 10.1111/ijd.15159] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/20/2022]
Abstract
Keloid scar formation arises from a disorganized fibroproliferative collagen response that extends beyond the original wound margins because of excessive production of extracellular matrix (ECM). Despite treatment options for keloid scars including medical and surgical therapies, such as intralesional steroid injection and surgical excision, the recurrence rate remains high. Herein we consolidate recently published narrative reviews, systematic reviews, and meta-analyses to provide an overview of updated treatment recommendations for keloidal scar formation. PubMed search engine was used to access the MEDLINE database to investigate updates regarding keloid incidence and treatment. More than 100 articles were reviewed. Keloid management remains a multimodal approach. There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however, the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser-based devices in combination with intralesional steroids, or 5-fluorouracil (5-FU) in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell-based therapies) for keloid management. This review article provides updated treatment guidelines for keloids and discusses insight into management to assist patient-focused, evidence-based clinical decision making.
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Affiliation(s)
- Samuel F Ekstein
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Steven L Moran
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Rosenthal A, Kolli H, Israilevich R, Moy R. Lasers for the prevention and treatment of hypertrophic scars: a review of the literature. J COSMET LASER THER 2020; 22:115-125. [PMID: 32576064 DOI: 10.1080/14764172.2020.1783451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite the increasing knowledge about wound healing mechanisms and the advancements made in laser technology, hypertrophic scars remain difficult to manage. This review intends to discuss the laser devices studied in the prevention and treatment of HS, arising from trauma, surgery, and burns, detail their mechanisms of action, and emphasize those devices with the most promising effects. Most of the suggested mechanisms and explanations for the use of lasers in treating hypertrophic scars are based on selective photothermolysis, in which the light energy emitted from a laser is absorbed by its intended target, thereby disrupting existing collagen and altering the cycle of neocollagenesis. Through our literature review, we have determined that combination therapies, utilizing more than one laser target demonstrate enhanced clinical efficacy. Further, early use of laser devices has been shown to enhance the cosmetic result of sutured wounds and may play a role in preventing the development of hypertrophic scars.
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Affiliation(s)
- Amanda Rosenthal
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine , Miami, FL, USA.,Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
| | - Hiren Kolli
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
| | - Rachel Israilevich
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
| | - Ronald Moy
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
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15
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Zhang S, Zhao ZM, Xue HY, Nie FF. Effects of photoelectric therapy on proliferation and apoptosis of scar cells by regulating the expression of microRNA-206 and its related mechanisms. Int Wound J 2019; 17:317-325. [PMID: 31850679 DOI: 10.1111/iwj.13272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 12/28/2022] Open
Abstract
Human skin fibroblast (HSF) cells were irradiated with different energy lasers to detect cell proliferation, apoptosis, and expression of microRNA-206 and protein, and to further summarise the therapeutic effect of laser on scar cells. Human scar cell line HSF cells were cultured in three groups. The control group was not irradiated by laser, the low-energy group was irradiated by 10 J/cm2 laser, and the high-energy group was irradiated by 20 J/cm2 laser. After irradiation, HSF cells were cultured for 20 hours. Cell proliferation was detected by MTT assay. Cell cycle and apoptosis were detected by flow cytometry. Transwell migration assay was used to detect cell migratory ability. Reverse transcription polymerase chain reaction (RT-PCR) was used to detect miR-206 and mTOR gene levels. The levels of MMP-9, Bax, Bcl-2, cyclin D1, and mTOR signalling pathway proteins were detected by Western blotting assays. The results showed that after laser irradiation, the proliferation of cells decreased, and the difference between the control group and the experimental group was significant (P < .05). The higher the energy was, the greater the upregulation of apoptosis was. Apoptosis and cell migration increased (P < .05). The expressions of microRNA-206, MMP-9, and Bax were upregulated, while the expressions of mTOR, Bcl-2, and cyclin D1 were downregulated. To sum up, laser irradiation can significantly inhibit the proliferation of HSF cells, affect cell cycle, and increase cell apoptosis and migratory ability.
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Affiliation(s)
- Song Zhang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Zhen-Min Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Hong-Yu Xue
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Fang-Fei Nie
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
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16
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High-resolution ultrasound for keloids and hypertrophic scar assessment. Lasers Med Sci 2019; 35:379-385. [DOI: 10.1007/s10103-019-02830-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/11/2019] [Indexed: 11/26/2022]
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17
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Lin L, Guo P, Wang X, Huo R, Li Q, Yin S, Cao Y. Effective treatment for hypertrophic scar with dual-wave-length PDL and Nd:YAG in Chinese patients. J COSMET LASER THER 2018; 21:228-233. [PMID: 30260709 DOI: 10.1080/14764172.2018.1516889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Li Lin
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Peng Guo
- Tuina Department, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Xining Wang
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Ran Huo
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Qiang Li
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Siyuan Yin
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Yongqian Cao
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
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18
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Ertaş R, Yaman O, Akkuş MR, Özlü E, Avcı A, Ulaş Y, Ozyurt K, Atasoy M. The rapid effect of pulsed dye laser on demodex density of facial skin. J COSMET LASER THER 2018; 21:123-126. [PMID: 29883220 DOI: 10.1080/14764172.2018.1481509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Recently, treatment with acaricides, which is aimed at reducing excessive proliferation of demodex mites, has gained popularity due to its providing a significant improvement in the symptoms of diseases, such as rosacea, seborrhoeic dermatitis, and perioral dermatitis. The effect of IPL on demodex mites was reported in skin biopsy specimens in three patients; however, to the best of our knowledge, no study exists to date, which evaluates the effect of pulsed dye laser (PDL) on demodex density (Dd) in larger patient group. We aim here in to observe the Dd before and after PDL therapy with two different skin biopsy techniques. MATERIAL AND METHODS Thirty-one patients diagnosed with rosacea were included in the study who received PDL treatment. Dds which were measured by using both the SSSB (standardized skin surface biopsy) and CTM (cellophane tape method) techniques before and after 3 weeks of PDL therapy were evaluated. RESULTS AND DISCUSSION The Dd of patients before PDL treatment was 13.0 (interquartile range (IQR): 5.0-28.0) and after 3 weeks of PDL treatment it was 6.0 (IQR: 3.0-12.0) with SSSB. After PDL treatment, the Dd was significantly lower than pretreatment the Dd (p = 0.002). The present study shows that PDL significantly reduced Dd in facial skin with one session.
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Affiliation(s)
- Ragıp Ertaş
- a Kayseri Health Training and Research Center, Dermatology Clinic , Health Sciences University , Kayseri , Turkey
| | - Ozan Yaman
- b Kayseri Health Training and Research Center, Parasitology Clinic , Health Sciences University , Kayseri , Turkey
| | - M Reşat Akkuş
- a Kayseri Health Training and Research Center, Dermatology Clinic , Health Sciences University , Kayseri , Turkey
| | - Emin Özlü
- c School of Medicine, Department of Dermatology , Düzce University , Düzce , Turkey
| | - Atıl Avcı
- a Kayseri Health Training and Research Center, Dermatology Clinic , Health Sciences University , Kayseri , Turkey
| | - Yılmaz Ulaş
- a Kayseri Health Training and Research Center, Dermatology Clinic , Health Sciences University , Kayseri , Turkey
| | - Kemal Ozyurt
- a Kayseri Health Training and Research Center, Dermatology Clinic , Health Sciences University , Kayseri , Turkey
| | - Mustafa Atasoy
- a Kayseri Health Training and Research Center, Dermatology Clinic , Health Sciences University , Kayseri , Turkey
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Rerknimitr P, Tekacharin N, Panchaprateep R, Wititsuwannakul J, Tangtanatakul P, Hirankarn N, Asawanonda P. Pulsed-dye laser as an adjuvant treatment for discoid lupus erythematosus: a randomized, controlled trial. J DERMATOL TREAT 2018; 30:81-86. [DOI: 10.1080/09546634.2018.1468063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Pawinee Rerknimitr
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Nucharin Tekacharin
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Ratchathorn Panchaprateep
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Jade Wititsuwannakul
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Pattarin Tangtanatakul
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Center of Excellence in Immunology and Immune-mediated Diseases, Chulalongkorn University, Bangkok, Thailand
| | - Nattiya Hirankarn
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Center of Excellence in Immunology and Immune-mediated Diseases, Chulalongkorn University, Bangkok, Thailand
| | - Pravit Asawanonda
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
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20
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Abstract
Psoriasis is an autoimmune inflammatory skin disease. In the past several decades, phototherapy has been widely used to treat stable psoriatic lesions, including trunk, scalp, arms and legs, and partial nail psoriasis. A variety of light/lasers with different mechanisms of action have been developed for psoriasis including ultraviolet B (UVB), psoralen ultraviolet A (PUVA), pulsed dye laser (PDL), photodynamic therapy (PDT), intense pulsed light (IPL), light-emitting diodes (LED), and so on. Because light/laser each has specific therapeutic and adverse effects, it is important to adequately choose the sources and parameters in management of psoriasis with different pathogenic sites, severities, and duration of the disorder. This review aims at providing most updated clinic information to physicians about how to select light/laser sources and individual therapeutic regimens. To date, UV light is primarily for stable plaque psoriasis and PDL for topical psoriatic lesions with small area, both of which are safe and effective. On the other hand, PUVA has better curative effects than UVB for managing refractory psoriasis plaques, if its side effects can be better controlled. PDL provides optimal outcomes on nail psoriasis compared with other lasers. Although the trails of low-level light/laser therapy (LLLT) are still small, the near infrared (NIR) and visible red light with low energy show promise for treating psoriasis due to its strong penetration and encouraging photobiomodulation. IPL is rarely reported for psoriasis treatment, but PDT-IPL has been found to offer a moderate effect on nail psoriasis. In brief, various phototherapies have been used either in different combinations or as monotherapy. The modality has become a mainstay in the treatment of mild-to-moderate psoriasis without systemic adverse events in today's clinical practice.
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Evidence-Based Scar Management: How to Improve Results with Technique and Technology. Plast Reconstr Surg 2017; 138:165S-178S. [PMID: 27556757 DOI: 10.1097/prs.0000000000002647] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear. METHODS A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention. RESULTS For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae. CONCLUSION Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.
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Abstract
Hypertrophic scar and contracture in burn patients is a complex process. Contributing factors include critical injury depth and activation of key cell subpopulations, including deep dermal fibroblasts, myofibroblasts, fibrocytes, and T-helper cells, which cause scarring rather than regeneration. These cells influence each other via cellular profibrotic and antifibrotic signals, which help to determine the outcome. These cells also both modify and interact with extracellular matrix of the wound, ultimately forming hypertrophic scar. Current treatments reduce hypertrophic scar formation or improve remodeling by targeting these pathways and signals.
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Affiliation(s)
- Peter O Kwan
- 2A Plastic Surgery, Kaye Edmonton Clinic, University of Alberta, 11400 University Avenue, Edmonton, Alberta T6G 1Z1, Canada
| | - Edward E Tredget
- Department of Surgery, University of Alberta, 2D2.28 WMHSC, 8440-112 Street Northwest, Edmonton, Alberta T6G 2B7, Canada.
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23
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Geraghty LN, Rahman Z. Treatment of Surgical Scars with Laser Therapy. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Comparison of 532 nm Potassium Titanyl Phosphate Laser and 595 nm Pulsed Dye Laser in the Treatment of Erythematous Surgical Scars: A Randomized, Controlled, Open-Label Study. Dermatol Surg 2016; 42:70-6. [PMID: 26673432 DOI: 10.1097/dss.0000000000000582] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The pulsed dye laser (PDL) has long been used for treatment of erythematous and hypertrophic scars. Its effectiveness has been attributed in large part to its vascular-specificity. The vascular-specific potassium titanyl phosphate (KTP) laser has also been reported to be clinically effective for scars, but has not been compared to the PDL. OBJECTIVE To compare the safety and clinical efficacy of a 532-nm KTP laser versus a 595-nm PDL in improving the appearance of erythematous surgical scars. METHODS Twenty patients with matched bilateral erythematous surgical scars or a single linear erythematous scar measuring longer than 5 cm were enrolled in the study. Single scars were divided into equal halves with each half randomized to receive 3 successive treatments at 6-week intervals with either a 532-nm KTP laser (Excel V; Brisbane, CA) or a 595-nm PDL (Cynergy; Cynosure Inc., Chelmsford, MA) at equivalent laser parameters. Bilateral matched scars were similarly randomized to receive three 532-nm KTP or 595-nm PDL treatments. Clinical efficacy was evaluated 12 weeks after the third (final) laser treatment by independent, blinded photographic scar assessments. Secondary evaluations included final investigator and subject treatment/satisfaction assessments, Vancouver scar scale (VSS) scores, subject scar symptoms, intraoperative pain scores, and incidence of side effects. RESULTS Clinical improvement of erythematous surgical scars was observed with both 532-nm KTP and 595-nm PDL systems. No statistically significant differences between the 2 treatment arms were noted in the independent, blinded photographic scar assessments, investigator and subject treatment/satisfaction assessments, subject scar symptoms, and intraoperative pain scores. The KTP arm produced statistically significant improvement for the vascularity component of the VSS only. Side effects were limited to mild treatment discomfort and minimal transient post-treatment erythema and purpura. No vesiculation, infection, scarring or other adverse events were experienced. Subject satisfaction surveys mirrored the observed clinical effects. CONCLUSION The-532 nm KTP laser is comparable in efficacy and safety to the 595-nm PDL laser in the treatment of erythematous surgical scars.
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Kim HT, Baizhumanova AS. Is recurrent respiratory papillomatosis a manageable or curable disease? Laryngoscope 2015; 126:1359-64. [PMID: 26608928 DOI: 10.1002/lary.25795] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Recurrent respiratory papillomatosis (RRP) is a relatively rare disease with potentially devastating consequences for the patient. The purpose of this study was to evaluate the patterns of recurrence of RRP after surgery and determine the effectiveness of combined concurrent adjuvant therapy. METHODS A total of 86 patients were diagnosed with and operated on for RRP. The clinical characteristics of 29 of the 86 patients who had undergone operations at other hospitals and who were followed up for >2 years were evaluated retrospectively. A combined concurrent adjuvant therapy was performed with microlaryngeal surgery, 585-nm pulsed dye laser (PDL) application, and an intralesional cidofovir injection. To evaluate the recurrence pattern, the larynx was divided into 10 subsites, and patients were investigated for the frequency of recurrence at the subsites after the operation. RESULTS Twenty-nine subjects required a mean of 3.0 operations to achieve complete remission for 2 years. The most common subsites for recurrence were the anterior commissure, subglottis, and epiglottis according to increasing number of operations. The subsites of recurrence tended to be closely correlated with the laryngeal submucosal glandular density distribution. A complete en-bloc layer excision, including the submucosal glands, using cold instruments decreased the recurrence rate of RRP. Applying PDL minimized scarring and provided significant posttreatment voice-quality improvement. CONCLUSIONS The results of the recurrent pattern analysis suggest that a combined concurrent adjunctive treatment might be promising as a cure for RRP and restoration of vocal function after treatment. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1359-1364, 2016.
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Affiliation(s)
- Hyung-Tae Kim
- Yeson Voice Center, Institute of Performing Art Medicine, Seoul, South Korea
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Philandrianos C, Bertrand B, Andrac-Meyer L, Magalon G, Casanova D, Kerfant N, Mordon S. Treatment of keloid scars with a 1210-nm diode laser in an animal model. Lasers Surg Med 2015; 47:798-806. [PMID: 26437851 DOI: 10.1002/lsm.22428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE A temperature increase can improve wound healing by activation of heat shock protein 70 and stimulation of fibroblasts. Since keloids are a dysfunction of collagen fiber synthesis and organization, this study aimed to evaluate if a 1,210 nm diode laser could have effects in a new animal model of keloid scars. STUDY DESIGN/MATERIALS AND METHODS A total of 39 nude mice were used for this study. Phototypes IV and V human keloids were grafted into their backs and after 1 month of healing, the mice were divided into four groups: Control, Laser, Resection, Resection/Laser. In the Laser group, the keloids were treated with a 1,210-nm diode-laser with the following parameters: 4 W; 10 seconds; fluence: 51 J/cm(2) ; spot: 18.9 × 3.7 mm(2) . In the Resection group, surgical intra-lesional excision was performed. In the Resection/Laser group, keloids were treated with the 1,210-nm laser-diode after surgical intra-lesional excision. Temperature measurements were made during the laser treatment. Clinical examination and histological study were performed on the day of treatment and 1 month, 2 months, and 3 months later. RESULTS Mean temperature measurement was of 44.8°C (42-48°) in the Laser groups. No healing complications or keloid proliferation was observed in any group. Keloid histologic characters were confirmed in all grafts. No histologic particularity was observed in the laser groups in comparison with the Control and Resection groups. CONCLUSION First, this keloid animal model appears to be adapted for laser study. Secondly, the 1,210-nm diode laser does not induce keloid thermal damage in vivo. Further studies with different 1,210-nm laser diode parameters should be performed in order to observe significant effects on keloids.
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Affiliation(s)
| | - Baptiste Bertrand
- Department of Plastic Surgery, AP-HM, Marseille, 13915, France.,Aix-Marseille University, Marseille, France
| | - Lucile Andrac-Meyer
- Aix-Marseille University, Marseille, France.,Department of Pathology, AP-HM, Marseille, 13915, France
| | - Guy Magalon
- Department of Plastic Surgery, AP-HM, Marseille, 13915, France
| | - Dominique Casanova
- Department of Plastic Surgery, AP-HM, Marseille, 13915, France.,Aix-Marseille University, Marseille, France
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28
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Lee DE, Trowbridge RM, Ayoub NT, Agrawal DK. High-mobility Group Box Protein-1, Matrix Metalloproteinases, and Vitamin D in Keloids and Hypertrophic Scars. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e425. [PMID: 26180726 PMCID: PMC4494495 DOI: 10.1097/gox.0000000000000391] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/23/2015] [Indexed: 01/16/2023]
Abstract
Keloids and hypertrophic scars represent excessive wound healing involving high production of collagen by skin fibroblasts. This review focuses on the role of high-mobility group box protein-1 (HMGB-1), matrix metalloproteinases (MMPs), and vitamin D in these conditions. Although the role of HMGB-1 in keloids and hypertrophic scars is unclear, the effect of HMGB-1 on fibroblasts suggests a profibrotic role and a potential contribution to excessive scarring. MMPs contribute extensively to wound healing and characteristically degrade the extracellular matrix. MMP-1 is decreased in keloids and hypertrophic scars. However, other MMPs, including MMP-2, have been found to be increased and are thought to possibly contribute to keloid expansion through peripheral extracellular matrix catabolism. Many novel therapeutic approaches to keloids and hypertrophic scars target MMPs and aim to increase their levels and catabolic activity. The higher prevalence of keloids in darker skin types may partially be due to a tendency for lower vitamin D levels. The physiologically active form of vitamin D, 1,25(OH)2D3, inhibits the proliferation of keloid fibroblasts, and correlations between vitamin D receptor polymorphisms, such as the TaqI CC genotype, and keloid formation have been reported. Additionally, vitamin D may exert an antifibrotic effect partially mediated by MMPs. Here, we critically discuss whether keloid and hypertrophic scar formation could be predicted based on vitamin D status and vitamin D receptor polymorphisms. Specifically, the findings identified HMGB-1, MMPs, and vitamin D as potential avenues for further clinical investigation and potentially novel therapeutic approaches to prevent the development of keloids and hypertrophic scars.
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Affiliation(s)
- Dylan E. Lee
- From the Center for Clinical and Translational Science, Creighton University School of Medicine, Omaha, Neb.; Brigham and Women’s Hospital, Boston, Mass.; and Westfield Plastic Surgery Center, Omaha, Neb
| | - Ryan M. Trowbridge
- From the Center for Clinical and Translational Science, Creighton University School of Medicine, Omaha, Neb.; Brigham and Women’s Hospital, Boston, Mass.; and Westfield Plastic Surgery Center, Omaha, Neb
| | - Nagi T. Ayoub
- From the Center for Clinical and Translational Science, Creighton University School of Medicine, Omaha, Neb.; Brigham and Women’s Hospital, Boston, Mass.; and Westfield Plastic Surgery Center, Omaha, Neb
| | - Devendra K. Agrawal
- From the Center for Clinical and Translational Science, Creighton University School of Medicine, Omaha, Neb.; Brigham and Women’s Hospital, Boston, Mass.; and Westfield Plastic Surgery Center, Omaha, Neb
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29
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Hsu CK, Tzeng SY, Yang CC, Lee JYY, Huang LLH, Chen WR, Hughes M, Chen YW, Liao YK, Tseng SH. Non-invasive evaluation of therapeutic response in keloid scar using diffuse reflectance spectroscopy. BIOMEDICAL OPTICS EXPRESS 2015; 6:390-404. [PMID: 25780731 PMCID: PMC4354586 DOI: 10.1364/boe.6.000390] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/15/2014] [Accepted: 01/02/2015] [Indexed: 05/31/2023]
Abstract
The pathogenesis and ideal treatment of keloid are still largely unknown, and it is essential to develop an objective assessment of keloid severity to evaluate the therapeutic response. We previously reported that our diffuse reflectance spectroscopy (DRS) system could assist clinicians in understanding the functional and structural condition of keloid scars. The purpose of this study was to understand clinical applicability of our DRS system on evaluating the scar severity and therapeutic response of keloid. We analyzed 228 spectral data from 71 subjects with keloid scars. The scars were classified into mild (0-3), moderate (4-7) and severe (8-11) according to the Vancouver scar scale. We found that as the severity of the scar increased, collagen concentration and water content increased, and the reduced scattering coefficient at 800 nm and oxygen saturation (SaO2) decreased. Using the DRS system, we found that collagen bundles aligned in a specific direction in keloid scars, but not in normal scars. Water content and SaO2 may be utilized as reliable parameters for evaluating the therapeutic response of keloid. In conclusion, the results obtained here suggest that the DRS has potential as an objective technique with which to evaluate keloid scar severity. In addition, it may be useful as a tool with which to track longitudinal response of scars in response to various therapeutic interventions.
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Affiliation(s)
- Chao-Kai Hsu
- Department of Dermatology, National Cheng Kung University College of Medicine and Hospital, Tainan 701,
Taiwan
- Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan 701,
Taiwan
- International Research Center of Wound Repair and Regeneration, National Cheng Kung University, Tainan 701,
Taiwan
- These authors contributed equally to this work and should be considered co-first authors
| | - Shih-Yu Tzeng
- Department of Photonics, National Cheng-Kung University, Tainan 701,
Taiwan
- Advanced Optoelectronic Technology Center, National Cheng-Kung University, Tainan 701,
Taiwan
- These authors contributed equally to this work and should be considered co-first authors
| | - Chao-Chun Yang
- Department of Dermatology, National Cheng Kung University College of Medicine and Hospital, Tainan 701,
Taiwan
- Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan 701,
Taiwan
- International Research Center of Wound Repair and Regeneration, National Cheng Kung University, Tainan 701,
Taiwan
| | - Julia Yu-Yun Lee
- Department of Dermatology, National Cheng Kung University College of Medicine and Hospital, Tainan 701,
Taiwan
- International Research Center of Wound Repair and Regeneration, National Cheng Kung University, Tainan 701,
Taiwan
| | | | - Wan-Rung Chen
- Department of Dermatology, National Cheng Kung University College of Medicine and Hospital, Tainan 701,
Taiwan
| | - Michael Hughes
- International Research Center of Wound Repair and Regeneration, National Cheng Kung University, Tainan 701,
Taiwan
| | - Yu-Wen Chen
- Department of Photonics, National Cheng-Kung University, Tainan 701,
Taiwan
- Advanced Optoelectronic Technology Center, National Cheng-Kung University, Tainan 701,
Taiwan
| | - Yu-Kai Liao
- Department of Photonics, National Cheng-Kung University, Tainan 701,
Taiwan
- Advanced Optoelectronic Technology Center, National Cheng-Kung University, Tainan 701,
Taiwan
| | - Sheng-Hao Tseng
- Department of Photonics, National Cheng-Kung University, Tainan 701,
Taiwan
- Advanced Optoelectronic Technology Center, National Cheng-Kung University, Tainan 701,
Taiwan
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Nd:YAG Laser Treatment for Keloids and Hypertrophic Scars: An Analysis of 102 Cases. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 2:e272. [PMID: 25587506 PMCID: PMC4292254 DOI: 10.1097/gox.0000000000000231] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/08/2013] [Indexed: 12/02/2022]
Abstract
Background: The present retrospective cohort study was performed to determine the efficacy of contact-mode 1064 nm neodymium-yttrium-aluminum-garnet (Nd:YAG) laser laser for keloids and hypertrophic scars. The indication and limitations of this modality are discussed. Methods: The cohort consisted of 102 consecutive Japanese patients (23 males and 79 females) with keloids and hypertrophic scars for more than 1 year. They were treated every 3–4 weeks for 1 year with a long-pulsed 1064 nm Nd:YAG laser (Cutera, Brisbane, Calif.) in contact mode. Thirty-eight patients had hypertrophic scars and 64 had keloids. The scars were evaluated before the treatment commenced and 1 month after the last session by using the Japan Scar Workshop Scar Scale 2011. Recurrence was assessed at 6 months after the termination of treatment. Results: The average total Japan Scar Workshop score of the keloid and hypertrophic scar region groups dropped significantly after 1 year of treatment compared with before treatment (all P < 0.05). None of the hypertrophic scars or keloids deteriorated. However, 3 of the 34 anterior chest keloids (8.8%) did not respond. The following recurrence rates were observed 6 months after stopping laser treatment: 1 of the abdomen hypertrophic scars (4%), 18 of the anterior chest keloids (52.9%), 5 of the upper arm keloids (35.7%), and 4 of the scapula keloids (25%). Conclusions: Hypertrophic scars responded significantly better to 1064 nm Nd:YAG laser treatment than keloids. However, keloid recurrence occurred when there was remaining redness and induration, even if only a small part of the scar was affected.
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Shin JU, Gantsetseg D, Jung JY, Jung I, Shin S, Lee JH. Comparison of non-ablative and ablative fractional laser treatments in a postoperative scar study. Lasers Surg Med 2014; 46:741-9. [DOI: 10.1002/lsm.22297] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jung U Shin
- Department of Dermatology and Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Dorjsuren Gantsetseg
- Department of Dermatology and Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Jin Young Jung
- Yeouido Oracle Cosmetic & Dermatologic Surgery Clinic; Seoul South Korea
| | - Inhee Jung
- Department of Dermatology and Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Sungsik Shin
- Department of Dermatology and Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Ju Hee Lee
- Department of Dermatology and Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul South Korea
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Abstract
Most surgical patients end up with a scar and most of these would want at least some improvement in the appearance of the scar. Using sound techniques for wound closure surgeons can, to a certain extent, prevent suboptimal scars. This article reviews the principles of prevention and treatment of suboptimal scars. Surgical techniques of scar revision, i.e., Z plasty, W plasty, and geometrical broken line closure are described. Post-operative care and other adjuvant therapies of scars are described. A short description of dermabrasion and lasers for management of scars is given. It is hoped that this review helps the surgeon to formulate a comprehensive plan for management of scars of these patients.
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Affiliation(s)
- Mohit Sharma
- Department of Plastic Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Abhijeet Wakure
- Department of Plastic Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Ohshiro T, Ohshiro T, Sasaki K. Laser scar management technique. Laser Ther 2013; 22:255-60. [PMID: 24511202 DOI: 10.5978/islsm.13-or-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/06/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIMS Scars are common and cause functional problems and psychological morbidity. Recent advances in optical technologies have produced various laser systems capable of revising the appearance of scars from various etiologies to optimize their appearance. METHODS Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Several optical technologies are currently available and combined laser/light treatments are required for treatment of scars. Since 2006, we have set up a scar management department in our clinic and more than 2000 patients have been treated by our combined laser irradiation techniques. Herein, we review several available light technologies for treatment of surgical, traumatic, and inflammatory scars, and discuss our combined laser treatment of scars, based upon our clinical experience. RESULTS AND CONCLUSIONS Because scars have a variety of potential aetiologies and take a number of forms, no single approach can consistenty provide good scar treatment and management. The combination of laser and devices is essential, the choice of wavelength and approach being dictated by each patient as an individual.
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Affiliation(s)
- Takafumi Ohshiro
- Department of Plastic and Reconstructive Surgery, Ohshiro Clinic, Tokyo
| | - Toshio Ohshiro
- Department of Plastic and Reconstructive Surgery, Ohshiro Clinic, Tokyo
| | - Katsumi Sasaki
- Department of Plastic and Reconstructive Surgery, Ohshiro Clinic, Tokyo
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Gladsjo JA, Jiang SIB. Treatment of surgical scars using a 595-nm pulsed dye laser using purpuric and nonpurpuric parameters: a comparative study. Dermatol Surg 2013; 40:118-26. [PMID: 24373006 DOI: 10.1111/dsu.12406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies have examined laser treatment of scars, but cosmetic results have been variable. Although no studies have examined the effect of purpura on scar improvement using the pulsed dye laser (PDL), many clinicians believe inducing purpura results in better and quicker improvement. OBJECTIVE To determine whether PDL treatment of fresh surgical scars with purpura-inducing settings improves clinical appearance more than non-purpura-inducing settings or no treatment. METHODS Twenty-six subjects with surgical scars enrolled in this prospective study. Scars were divided into three equal segments; treatment was randomized: 595-nm PDL with purpuric (1.5 ms) or nonpurpuric (10 ms) settings or no treatment. Fluences were adjusted to Fitzpatrick skin type. Scars were treated three times, 1 month apart, beginning at suture removal. Outcome measures included Vancouver Scar Scale (VSS) and blind clinical ratings. RESULTS The nonpurpuric condition showed significant improvement on the VSS total score, vascularity, and pliability ratings. The purpuric condition demonstrated a trend for improvement on the VSS total. According to blind observer ratings, all conditions improved, without differences between groups. CONCLUSION Nonpurpuric settings on the PDL resulted in significant improvements in the appearance of fresh surgical scars for vascularity, pliability, and VSS total scores, although all scar segments improved over time.
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Affiliation(s)
- Julie Akiko Gladsjo
- Division of Dermatology, Department of Medicine, University of California at San Diego, San Diego, California
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Sheu M, Sridharan S, Paul B, Mallur P, Gandonu S, Bing R, Zhou H, Branski RC, Amin MR. The utility of the potassium titanyl phosphate laser in modulating vocal fold scar in a rat model. Laryngoscope 2013; 123:2189-94. [PMID: 23821526 DOI: 10.1002/lary.23745] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 08/20/2012] [Accepted: 08/23/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS We hypothesize that the KTP laser has the potential to augment wound healing in a rat model, and this modality may serve as a therapeutic tool for the management of vocal fold fibrosis. STUDY DESIGN Prospective, laboratory animal study. METHODS Rats were subjected to either vocal fold injury ± KTP laser treatment at low energy to simulate clinically relevant endpoints. In addition, cohorts were subjected to therapeutic KTP laser alone. Endpoints included the analyses of gene expression data related to the acute inflammatory response and extracellular matrix deposition and organization. RESULTS Therapeutic KTP treatment was associated with an additive effect on inflammatory gene expression in the context of the injured rat vocal fold mucosa. A similar additive effect was observed for matrix metalloproteinase gene expression, similar to data previously reported in the dermatology literature. However, histologically, the KTP had little effect on established vocal fold fibrosis. CONCLUSIONS These data are the first to attempt to provide mechanistic insight into the clinical utility of angiolytic lasers for vocal fold scar. Similar to previous data obtained in the skin, it appears that these effects are mediated by MMPs.
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Affiliation(s)
- Mike Sheu
- New York University Voice Center, Department of Otolaryngology, New York University School of Medicine, New York, New York
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Eke U, Diaz C, Abdullah A. Keloid scars in type VI skin successfully treated with combined surgery and pulsed dye laser therapy. Br J Dermatol 2012; 168:1360-2. [PMID: 23252810 DOI: 10.1111/bjd.12159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nast A, Eming S, Fluhr J, Fritz K, Gauglitz G, Hohenleutner S, Panizzon RG, Sebastian G, Sporbeck B, Koller J. German S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids). J Dtsch Dermatol Ges 2012; 10:747-62. [PMID: 22937806 DOI: 10.1111/j.1610-0387.2012.08012.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Charité-Universitätsmedizin Berlin, Germany
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Qu L, Liu A, Zhou L, He C, Grossman PH, Moy RL, Mi QS, Ozog D. Clinical and molecular effects on mature burn scars after treatment with a fractional CO2 laser. Lasers Surg Med 2012; 44:517-24. [DOI: 10.1002/lsm.22055] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2012] [Indexed: 12/16/2022]
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Yang Q, Ma Y, Zhu R, Huang G, Guan M, Avram MM, Lu Z. The effect of flashlamp pulsed dye laser on the expression of connective tissue growth factor in keloids. Lasers Surg Med 2012; 44:377-83. [PMID: 22539077 DOI: 10.1002/lsm.22031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate connective tissue growth factor (CTGF) expression before and after pulsed dye laser (PDL, 595 nm) treatment, and to better understand the mechanism of PDL treatment of keloids. METHOD Twenty-six patients with keloids were recruited for this study. For each patient, two keloids of similar anatomic location, duration, texture, and appearance were chosen for study; one of these keloids was treated and the other served as a control. Three sessions of PDL treatment, with pulse duration of 1.5 milliseconds, spot size 7 mm, DCD duration 20 milliseconds/delay 10 milliseconds and fluence of 10 J/cm(2), were performed on the keloids at 3- to 4-week intervals. Punch biopsies were performed both on the treated and untreated keloids prior to the first treatment and after the final treatment. The specimens underwent realtime polymerase chain reaction (PCR) and immunohistochemistry (IHC) to investigate the CTGF mRNA and protein expression after PDL treatment. RESULTS According to realtime PCR, the CTGF mRNA was significantly down-regulated after PDL treatment in 80.77% of patients as compared to the control group. IHC investigation showed that after treatment the CTGF positive cells also significantly decreased in number as compared to the control group in 80.77% of patients. Using the Vancouver scar scale (VSS), there was an average decrease of 20.85 ± 12.33% after PDL treatment. CONCLUSIONS Pulsed dye laser treatment of keloids significantly down-regulates the expression of CTGF in most cases. This may partially explain the mechanism of action of PDL treatment of keloids.
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Affiliation(s)
- Qiaorong Yang
- Dermatology Department, Huashan Hospital, Fudan University, Shanghai 200040, China
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To WS, Midwood KS. Plasma and cellular fibronectin: distinct and independent functions during tissue repair. FIBROGENESIS & TISSUE REPAIR 2011; 4:21. [PMID: 21923916 PMCID: PMC3182887 DOI: 10.1186/1755-1536-4-21] [Citation(s) in RCA: 385] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 09/16/2011] [Indexed: 01/01/2023]
Abstract
Fibronectin (FN) is a ubiquitous extracellular matrix (ECM) glycoprotein that plays vital roles during tissue repair. The plasma form of FN circulates in the blood, and upon tissue injury, is incorporated into fibrin clots to exert effects on platelet function and to mediate hemostasis. Cellular FN is then synthesized and assembled by cells as they migrate into the clot to reconstitute damaged tissue. The assembly of FN into a complex three-dimensional matrix during physiological repair plays a key role not only as a structural scaffold, but also as a regulator of cell function during this stage of tissue repair. FN fibrillogenesis is a complex, stepwise process that is strictly regulated by a multitude of factors. During fibrosis, there is excessive deposition of ECM, of which FN is one of the major components. Aberrant FN-matrix assembly is a major contributing factor to the switch from normal tissue repair to misregulated fibrosis. Understanding the mechanisms involved in FN assembly and how these interplay with cellular, fibrotic and immune responses may reveal targets for the future development of therapies to regulate aberrant tissue-repair processes.
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Affiliation(s)
- Wing S To
- Department of Matrix Biology, Kennedy Institute of Rheumatology Division, Nuffield Department of Orthopedic Rheumatology and Musculoskeletal Sciences, Oxford University, 65 Aspenlea Road, London, W6 8LH, UK.
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Dang Y, Liu B, Liu L, Ye X, Bi X, Zhang Y, Gu J. The 800-nm diode laser irradiation induces skin collagen synthesis by stimulating TGF-β/Smad signaling pathway. Lasers Med Sci 2011; 26:837-43. [PMID: 21892789 DOI: 10.1007/s10103-011-0985-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 08/16/2011] [Indexed: 12/14/2022]
Abstract
The 800-nm diode laser is used clinically for hair removal and leg vein clearance. However, the effects of the laser on skin collagen synthesis have not been established. This study aims to research whether the 800-nm laser can be used for non-ablative rejuvenation and its possible mechanism by using an animal model. Eight 2-month-old rats were irradiated with the 800-nm diode laser at 20, 40, and 60 J/cm(2), respectively. Skin samples were taken for histological study and dermal thickness measurement at day 30 after laser irradiation. The expression of procollagen type I, III, IV, transforming growth factor-β (TGF-β), Smad2, 3, 4, and phosphorylated-Smad2, 3 in the rat skin was analyzed 24 h after completing all laser treatments by using RT-PCR and Western blot. Immunohistochemistry was performed to evaluate the content of type I collagen in the skin at day 30 after laser irradiation. The 800-nm diode laser treatments markedly improved the histological structure and increased dermal thickness compared to the non-irradiated controls. Laser irradiation at 40 J/cm(2) significantly up-regulated the expression of procollagen type I and IV, TGF-β and Smad2, 3, 4. The p-Smad2 and p-Smad3 levels were also enhanced in the laser-irradiated skin. The 800-nm laser is effective in improving skin structure and inducing skin new collagen expression. New collagen synthesis induced by the 800-nm laser was mediated by TGF-β/Smad signaling pathway. Thus, it seemed that the 800-nm laser could be used for non-ablative rejuvenation in the future.
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Affiliation(s)
- Yongyan Dang
- School of Life Science, East China Normal University, Shanghai, 200062, China.
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Lin JY, Warger WC, Izikson L, Anderson RR, Tannous Z. A prospective, randomized controlled trial on the efficacy of fractional photothermolysis on scar remodeling. Lasers Surg Med 2011; 43:265-72. [DOI: 10.1002/lsm.21061] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Wang JJ, Li J, Shi L, Lv XW, Cheng WM, Chen YY. Preventive effects of a fractioned polysaccharide from a traditional Chinese herbal medical formula (Yu Ping Feng San) on carbon tetrachloride-induced hepatic fibrosis. J Pharm Pharmacol 2011; 62:935-42. [PMID: 20636883 DOI: 10.1211/jpp.62.07.0016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The study was to investigate the prevention effects and possible mechanism of Yu Ping Feng San fractioned polysaccharide (YPF-P) on CCl(4)-induced liver fibrosis in rats. METHODS YPF-P was prepared from root of Astragalus membranaceus, rhizome of Atractylodes macrocephaia and root of Raidix saposhnikoviae, and compared with polysaccharide from root of Astragalus membranaceus (AP). Hepatic fibrosis was induced by subcutaneous injection with carbon tetrachloride twice weekly for 12 weeks in Sprague-Dawley rats. YPF-P, AP and colchicine were administered intragastrically daily to carbon tetrachloride-treated rats. Histopathological changes of the liver and hepatic stellate cells were evaluated by Masson staining and transmission electron microscopy, respectively. Markers of fibrosis were determined by radioimmunoassay, biochemistry assay and ELISA. The mRNA expressions of tissue inhibitor of metalloproteinase-1 (TIMP-1), matrix metalloproteinase-13 (MMP-13), procollagen I and collagen III were detected by RT-PCR. KEY FINDINGS YPF-P dose-dependently alleviated the degree of liver fibrosis and inhibited hepatic stellate cell transformation into myofibroblast-like cells, markedly reduced the elevated levels of hyaluronic acid, laminin, type IV collagen, type III procollagen, hydroxyproline and transforming growth factor beta-1, suppressed procollagen I, collagen III and TIMP-1 expression, and improved the TIMP-1/MMP-13 ratio. MMP-13 expression was only promoted moderately by YPF-P. Compared with AP, YPF-P showed more potency on most markers except laminin, type IV collagen and MMP-13 mRNA. CONCLUSIONS YPF-P prevented the progress of rat liver fibrosis induced by carbon tetrachloride and had a more potent preventative effect. The preventative effect may be associated with the ability of YPF-P to inhibit the synthesis of matrix collagen and balance the TIMP/MMP system.
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Khaheshi I, Keshavarz S, Imani Fooladi AA, Ebrahimi M, Yazdani S, Panahi Y, Shohrati M, Nourani MR. Loss of expression of TGF-βs and their receptors in chronic skin lesions induced by sulfur mustard as compared with chronic contact dermatitis patients. BMC DERMATOLOGY 2011; 11:2. [PMID: 21235789 PMCID: PMC3031210 DOI: 10.1186/1471-5945-11-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 01/14/2011] [Indexed: 01/17/2023]
Abstract
BACKGROUND Sulfur mustard (SM) is a blister-forming agent that has been used as a chemical weapon. Sulfur mustard can cause damage in various organs, especially the skin, respiratory system, and eyes. Generally, the multiple complications of mustard gas result from its alkalizing potency; it reacts with cellular components like DNA, RNA, proteins, and lipid membranes.TGF-β is a multi-functional cytokine with multiple biological effects ranging from cell differentiation and growth inhibition to extracellular matrix stimulation, immunosuppression, and immunomodulation. TGF-β has 3 isoforms (TGF-β 1, 2, 3) and its signaling is mediated by its receptors: R1, R2 and intracellular Smads molecules.TGF-β has been shown to have anti-inflammatory effects. TGF-βs and their receptors also have an important role in modulation of skin inflammation, proliferation of epidermal cells, and wound healing, and they have been implicated in different types of skin inflammatory disorders. METHODS Seventeen exposed SM individuals (48.47 ± 9.3 years), 17 chronic dermatitis patients (46.52 ± 14.6 years), and 5 normal controls (44.00 ± 14.6 years) were enrolled in this study.Evaluation of TGF-βs and their receptors expressions was performed by semiquantitative RT-PCR. Only TGF1 was analyzed immunohistochemically. RESULTS Our results showed significant decreases in the expression percentages of TGF-β 1, 2 and R1, R2 in chemical victims in comparison with chronic dermatitis and normal subjects and significant decreases in the intensity of R1 and R2 expressions in chemical victims in comparison with chronic dermatitis and normal controls. (P value < 0.05) CONCLUSIONS TGF-βs and their receptors appear to have a noticeable role in chronic inflammatory skin lesions caused by sulfur mustard.
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MESH Headings
- Adult
- Aged
- Burns, Chemical/complications
- Burns, Chemical/etiology
- Burns, Chemical/genetics
- Burns, Chemical/metabolism
- Chemical Warfare
- Chemical Warfare Agents/adverse effects
- Chemical Warfare Agents/pharmacology
- Chronic Disease
- Dermatitis, Allergic Contact/complications
- Dermatitis, Allergic Contact/genetics
- Dermatitis, Allergic Contact/metabolism
- Epidermis/drug effects
- Epidermis/metabolism
- Gene Expression/drug effects
- Humans
- Inflammation/genetics
- Iran
- Irritants/adverse effects
- Irritants/pharmacology
- Male
- Middle Aged
- Military Personnel
- Mustard Gas/adverse effects
- Mustard Gas/pharmacology
- Protein Serine-Threonine Kinases/deficiency
- Protein Serine-Threonine Kinases/genetics
- Pruritus/etiology
- Pruritus/genetics
- Pruritus/metabolism
- Receptor, Transforming Growth Factor-beta Type I
- Receptor, Transforming Growth Factor-beta Type II
- Receptors, Transforming Growth Factor beta/deficiency
- Receptors, Transforming Growth Factor beta/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Transforming Growth Factor beta1/genetics
- Transforming Growth Factor beta2/deficiency
- Transforming Growth Factor beta2/genetics
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Affiliation(s)
- Isa Khaheshi
- Genomics Division, Chemical Injury Research Center (CIRC) Baqiyatallah University of Medical Sciences, Tehran-Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran-Iran
| | - Saeed Keshavarz
- Genomics Division, Chemical Injury Research Center (CIRC) Baqiyatallah University of Medical Sciences, Tehran-Iran
| | - Abbas Ali Imani Fooladi
- Research Center of Molecular Biology, Baqiyatallah University of Medical Sciences, Tehran-Iran
| | - Majid Ebrahimi
- Genomics Division, Chemical Injury Research Center (CIRC) Baqiyatallah University of Medical Sciences, Tehran-Iran
| | - Samaneh Yazdani
- Genomics Division, Chemical Injury Research Center (CIRC) Baqiyatallah University of Medical Sciences, Tehran-Iran
| | - Yunes Panahi
- Genomics Division, Chemical Injury Research Center (CIRC) Baqiyatallah University of Medical Sciences, Tehran-Iran
| | - Majid Shohrati
- Genomics Division, Chemical Injury Research Center (CIRC) Baqiyatallah University of Medical Sciences, Tehran-Iran
| | - Mohammad Reza Nourani
- Genomics Division, Chemical Injury Research Center (CIRC) Baqiyatallah University of Medical Sciences, Tehran-Iran
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Fabbrocini G, Annunziata MC, D'Arco V, De Vita V, Lodi G, Mauriello MC, Pastore F, Monfrecola G. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract 2010; 2010:893080. [PMID: 20981308 PMCID: PMC2958495 DOI: 10.1155/2010/893080] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 09/07/2010] [Accepted: 09/28/2010] [Indexed: 11/30/2022] Open
Abstract
Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%-14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options.
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Affiliation(s)
- Gabriella Fabbrocini
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - M. C. Annunziata
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - V. D'Arco
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - V. De Vita
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - G. Lodi
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - M. C. Mauriello
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - F. Pastore
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - G. Monfrecola
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
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Leclère FM, Mordon SR. Twenty-five years of active laser prevention of scars: What have we learned? J COSMET LASER THER 2010; 12:227-34. [DOI: 10.3109/14764172.2010.514923] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pulsed dye laser in burn scars: Current concepts and future directions. Burns 2010; 36:443-9. [DOI: 10.1016/j.burns.2009.08.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 08/14/2009] [Indexed: 01/22/2023]
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Dang Y, Ye X, Weng Y, Tong Z, Ren Q. Effects of the 532-nm and 1,064-nm Q-switched Nd:YAG lasers on collagen turnover of cultured human skin fibroblasts: a comparative study. Lasers Med Sci 2010; 25:719-26. [PMID: 20490593 DOI: 10.1007/s10103-009-0657-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Indexed: 10/19/2022]
Abstract
Cultured human skin fibroblasts were irradiated twice successively with the 1.5 J/cm(2) of 532-nm and 1,064-nm lasers, respectively. The mRNA of procollagen, matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), heat-shock protein 70 (Hsp70), interleukin-6 (IL-6) and transforming growth factor beta (TGF-beta) were analyzed at 24 and 48 h post-irradiation by using RT-PCR. Both lasers significantly increased the expression of type I and III procollagen, TIMP1, and TIMP2, but decreased MMP1 and MMP2 expression. The 1,064-nm laser initiated TGF-beta expression while the 532-nm laser elicited the increase of Hsp70 and IL-6. The increase/decrease rates of procollagen, TIMPs and MMPs for the 1,064-nm laser were higher than that of the 532-nm laser. Thus, both lasers effectively accelerated collagen synthesis and inhibited collagen degradation. Collagen synthesis induced by the 1,064-nm laser might be partly due to the upregulation of TGF-beta expression, while the increase of Hsp70 and IL-6 might be partly responsible for collagen synthesis stimulated by the 532-nm laser. With the parameters used in this study, the 1,064-nm infrared laser is more effective in promoting the beneficial molecular activities than the 532-nm visible laser.
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Affiliation(s)
- Yongyan Dang
- School of Life Science, East China Normal University, Shanghai, China
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Mordon S, Capon A, Fournier N, Iarmarcovai G. Lasers thermiques et cicatrisation cutanée. Med Sci (Paris) 2010; 26:89-94. [DOI: 10.1051/medsci/201026189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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