595-nm long pulsed dye laser and 1450-nm diode laser in combination with intralesional triamcinolone/5-fluorouracil for hypertrophic scarring following a phenol peel

Progress in the clinical treatment of keloids

Keloid is a pathological scar that is higher than the skin surface following skin damage. Its lesion range often extends beyond the original damage boundary and does not naturally subside over time. Its pathogenesis is very complex, currently the main causes include fibroblast excessive proliferation, collagen and extracellular matrix (Extracellular matrix, ECM) excessive deposition, excessive angiogenesis, and so on. The traditional treatment method primarily involves surgical intervention, but it is associated with a high recurrence rate post-surgery. Consequently, many treatment methods are derived according to the different clinical characteristics of keloid. This paper will review the therapeutic progress in recent years from surgical treatment, physiotherapy, drug therapy, and biological therapy, with the goal of offering valuable insights for the clinical treatment of keloids.

Posttraumatic Laser Treatment of Soft Tissue Injury

Laser treatment for posttraumatic injury offers the clinician the unique opportunity for early intervention in mediating early scar formation, or for reducing the appearance of scars after maturation. In this review, the authors focus on the mechanisms by which lasers exert their therapeutic effects, highlighting several popular lasers and dosimetry used, and underscoring the power of combined surgical scar revision in managing posttraumatic facial scars.

A multimodal approach to the treatment of extensive burn scars: a modified subcision technique for intralesional delivery of corticosteroid and 5-fluorouracil in combination with several procedural laser therapies; a case report

Introduction:

Hypertrophic scars and keloids are challenging to manage due to recurrence and often sub-optimal response to treatment. There is a lack of both definitive treatment standards and randomised controlled trials comparing therapeutic options. While a wide array of procedures has been utilised to improve traumatic burn scars, such interventions have been used with varying degrees of success. Some reported methods include intralesional injections of anti-inflammatory and anti-mitotic medications, laser-based therapy, topical therapies, cryotherapy, silicone gel sheeting, pressure therapy, radiotherapy and reconstructive surgery.

Case:

We report a case of extensive traumatic burn scarring on the head and neck successfully treated with a multimodal approach comprised of an infrequently used modified subcision technique to deliver alternating intralesional injections of anti-inflammatory (high-dose steroid) and anti-metabolite (5-flurouracil) concurrently with a series of laser (epilatory, vascular and fractional) treatments.

Methods:

Our treatment modality utilised a subcisional technique to deliver intralesional steroid and anti-metabolite medications directly into scar tissue to downregulate inflammation and inhibit collagen synthesis. Alexandrite, fractional and pulsed dye laser therapy was employed to improve skin texture, reduce dyschromia and reduce tissue burden of hypertrophic scar and keloid tissue, resulting in improved mobility and skin elasticity.

Conclusion:

Our case supports a combined medical and procedural, subcisional, approach to successfully treat a patient with extensive hypertrophic scarring and keloid formation with associated hair entrapment after a head and neck burn.

Head and neck scarring can result in significant psychological and physical impairments that may interfere with a patient’s daily life activities and self-esteem. Burn injuries can result in hypertrophic scars and keloids that are large in size, out of proportion to the initial area of injury, thought to be due to inflammation that increases collagen production in the skin. In our case report, we utilise a combined, non-surgical method of steroid and anti-metabolite injections as well as laser technology to successfully reduce the symptoms and appearance of large head and neck scars. Treatments consisted of a non-invasive combination of injections into the scar tissue delivering medication to reduce inflammation, pulsed dye laser to aid in decreasing scar thickness and Alexandrite laser to reduce inflammation associated with trapped hair follicles. One session of erbium fractional laser therapy was performed with local anaesthesia, creating microscopic wounds to stimulate collagen remodelling in the skin and facilitate resurfacing and healing of the scar. These treatment sessions were performed outpatient and occurred at eight-week intervals for 10 months. Results included decreased associated itching, increased mobility of the head and neck, and improved skin texture and colour. Our patient also reported an overall improvement in his mental wellbeing.

5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Comprehensive Review of the Literature

Hypertrophic (HTSs) and keloid scars are common dermatological complaints produced by disruption of the normal wound-healing process. Despite a wide array of therapeutic options available to treat these lesions, HTSs and keloids continue to pose a significant challenge to clinicians in everyday practice. The chemotherapeutic drug 5-fluorouracil (5-FU) is a well-known treatment option reserved for recalcitrant HTSs and keloid lesions. We present clinicians with a comprehensive review of the published data concerning the use of 5-FU in the treatment of HTSs and keloids. The current evidence suggests that 5-FU is a safe and practical alternative for the treatment of HTSs and keloids as it may substantially improve the appearance of proliferative scars and reduce the chance of recurrence. This therapeutic option is most effective in conjunction with adjuvant therapy such as corticosteroids. Additional randomized controlled clinical trials with large sample sizes should be conducted to corroborate the existing efficacy and safety data in patients with HTSs and keloids.

Pulsed dye laser in treatment of steroid-induced atrophy

BACKGROUND

One of the important and distressing cutaneous side effects of steroid therapy is skin atrophy, which has no definite and effective treatment. To the best of our knowledge, laser therapy for steroid-induced atrophic scars has not been investigated to date.

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of pulsed dye laser in the treatment of steroid-induced atrophic scars.

METHODS

In this pilot study, 15 patients with at least one atrophic patch were treated with the 585-nm pulsed dye laser at 4-week interval sessions until achieving complete improvement or until patient were lost to follow-up. Clinical outcome was assessed via standard photographic method before each treatment session and after the final visit. An independent dermatologist evaluated the photographs.

RESULT

All of the patients (13 females and two males) with 25-59 years of age experienced some degree of improvement, except one patient who withdrew from the treatment after three sessions. The treatment was well tolerated.

CONCLUSION

The results of our study indicated that pulsed dye laser therapy could be employed as a new method in the treatment of steroid-induced atrophic scars. Pulsed dye laser might affect the lesions through inducing collagen deposition and production of more superficial dermal elastin as well as less unidirectional collagen in clusters.

Optical clearing in photoacoustic flow cytometry

Clinical applications of photoacoustic (PA) flow cytometry (PAFC) for detection of circulating tumor cells in deep blood vessels are hindered by laser beam scattering, that result in loss of PAFC sensitivity and resolution. We demonstrate biocompatible and rapid optical clearing (OC) of skin to minimize light scattering and thus, increase optical resolution and sensitivity of PAFC. OC effect was achieved in 20 min by sequent skin cleaning, microdermabrasion, and glycerol application enhanced by massage and sonophoresis. Using 0.8 mm mouse skin layer over a blood vessel in vitro phantom we demonstrated 1.6-fold decrease in laser spot blurring accompanied by 1.6-fold increase in PA signal amplitude from blood background. As a result, peak rate for B16F10 melanoma cells in blood flow increased 1.7-fold. By using OC we also demonstrated the feasibility of PA contrast improvement for human hand veins.

Effects of low-level laser therapy on ROS homeostasis and expression of IGF-1 and TGF-β1 in skeletal muscle during the repair process

The aim of the present study was to determine the effects of low-level laser therapy (LLLT) on the homeostasis of reactive oxygen species (ROS) and expression of IGF-1 and TGF-β1 in the gastrocnemius muscles of rats following contusion. Muscle regeneration involves cell proliferation, migration, and differentiation and is regulated by growth factors. A growing body of evidence suggests that LLLT promotes skeletal muscle regeneration and accelerates tissue repair. Adult male Sprague-Dawley rats (n=96) were randomly divided into three groups: control group (no lesion, untreated, n=6), contusion group (n=48), and contusion-plus-LLLT group (n=42). Gallium aluminum arsenide (GaAlAs) laser irradiation (635 nm; beam spot, 0.4 cm(2); output power, 7 mW; power density, 17.5 mW/cm(2); 20 min) was administered to the gastrocnemius contusion for 20 min daily for 10 days. Muscle remodeling was evaluated at 0 h and 1, 2, 3, 7, 14, 21, and 28 days after injury. Hematoxylin and eosin and Van Gieson staining were used to evaluate regeneration and fibrosis; muscle superoxide dismutase (SOD) and malondialdehyde (MDA) were detected via biochemical methods; expression of transforming growth factor beta-1 (TGF-β1) and insulin-like growth factor-1 (IGF-1) were investigated via immunohistochemistry. The results showed that LLLT markedly promoted the regeneration of muscle and reduced scar formation. LLLT also significantly enhanced muscle SOD activity and significantly decreased muscle MDA levels 1, 2, and 3 days after injury. LLLT increased the expression of IGF-1 2, 3, and 7 days after injury and decreased the expression of IGF-1 21 and 28 days after injury. LLLT decreased the expression of TGF-β1 3 and 28 days after injury but increased expression at 7 and 14 days after injury. Our study showed that LLLT could modulate the homeostasis of ROS and of the growth factors IGF-1 and TGF-β1, which are known to play important roles in the repair process. This may constitute a new preventive approach to muscular fibrosis.

Single-session combination treatment with intense pulsed light and nonablative fractional photothermolysis: a split-face study

BACKGROUND

Intense pulsed light (IPL) and fractional photothermolysis (FP) are effective nonablative treatments for photoaging.

OBJECTIVE

To investigate the safety and efficacy of administering these two treatments in the same session with the aim of maximizing results while maintaining safety and minimizing downtime. We sought to compare the efficacy of the combination treatment with that of individual treatments of IPL and FP by conducting a split-face study.

MATERIALS AND METHODS

Twenty-nine subjects received a full-face standard-strength treatment with IPL immediately followed by treatment with 1550-nm FP. A further 14 patients underwent a split-face study comparing combined IPL and FP on one side of the face with these two treatments performed in isolation, 4 weeks apart, on the other side.

RESULTS

The combination treatment achieved results statistically superior to treatment with IPL alone, FP alone, and treatment with IPL and FP performed 4 weeks apart. Downtime and adverse events were similar to those expected with individual treatments of IPL or FP alone.

CONCLUSION

Intense pulsed light and PF appear to be synergistic when performed together in a single session, and the combination treatment is associated with a good safety profile and minimal downtime.

Wound healing in adult skin: aiming for perfect regeneration

Wound healing in adult skin, a complex process involving many cell types and processes such as epidermal, fibroblastic, and endothelial cell proliferation, cell migration, matrix synthesis, and wound contraction, almost invariably results in scar tissue formation and wound induration. Unlike in adult skin, wound healing in embryos involves repair processes that result in the essentially perfect regeneration of damaged tissue. This paper discusses key mechanisms that lead to scar tissue formation in adult human skin and treatment modalities, including curcumin gel, that may result in essentially perfect skin regeneration following surgical procedures.