1
|
Bronte J, Zhou C, Vempati A, Tam C, Khong J, Hazany S, Hazany S. A Comprehensive Review of Non-Surgical Treatments for Hypertrophic and Keloid Scars in Skin of Color. Clin Cosmet Investig Dermatol 2024; 17:1459-1469. [PMID: 38911337 PMCID: PMC11193462 DOI: 10.2147/ccid.s470997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/02/2024] [Indexed: 06/25/2024]
Abstract
Hypertrophic and keloid scars are fibroproliferative growths resulting from aberrant wound healing. Individuals with Fitzpatrick skin types (FSTs) IV-VI are particularly predisposed to hypertrophic and keloid scarring, yet specific guidelines for these populations are still lacking within the literature. Therefore, this comprehensive review provides a list of various treatments and considerations for hypertrophic and keloid scarring in patients with skin of color. We constructed a comprehensive PubMed search term and performed quadruple-blinded screening on all resulting studies to achieve this objective. Our findings demonstrate 1) the lack of efficacious treatments for raised scars within this population and 2) the need to empirically investigate individualized and multimodal therapeutic options for those with skin of color.
Collapse
Affiliation(s)
- Joshua Bronte
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Crystal Zhou
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Abhinav Vempati
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Curtis Tam
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Khong
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sanam Hazany
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Salar Hazany
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| |
Collapse
|
2
|
Wang B, Zhang S, Cheng A, Yan J, Gao Y. Soluble Polymer Microneedles Loaded with Interferon Alpha 1b for Treatment of Hyperplastic Scar. Polymers (Basel) 2023; 15:2621. [PMID: 37376266 DOI: 10.3390/polym15122621] [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: 05/04/2023] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
To achieve the painless administration of interferon alpha 1b (rhIFNα-1b), a double-layered soluble polymer microneedle (MN) patch loaded with rhIFNα-1b was used to deliver rhIFNα-1b transdermally. The solution containing rhIFNα-1b was concentrated in the MN tips under negative pressure. The MNs punctured the skin and delivered rhIFNα-1b to the epidermis and dermis. The MN tips implanted in the skin dissolved within 30 min and gradually released rhIFNα-1b. The rhIFNα-1b had a significant inhibitory effect on the abnormal proliferation of fibroblasts and excessive deposition of collagen fibers in the scar tissue. The color and thickness of the scar tissue treated using the MN patches loaded with rhIFNα-1b were effectively reduced. The relative expressions of type I collagen (Collagen I), type III collagen (Collagen III), transforming growth factor beta 1 (TGF-β1), and α-smooth muscle actin (α-SMA) were significantly downregulated in scar tissues. In summary, the MN patch loaded with rhIFNα-1b provided an effective method for the transdermal delivery of rhIFNα-1b.
Collapse
Affiliation(s)
- Baorui Wang
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Suohui Zhang
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing 100190, China
- Beijing CAS Microneedle Technology Ltd., Beijing 102609, China
| | - Aguo Cheng
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing 100190, China
- Beijing CAS Microneedle Technology Ltd., Beijing 102609, China
| | - Juan Yan
- Beijing CAS Microneedle Technology Ltd., Beijing 102609, China
- College of Life Sciences, Changchun Normal University, Changchun 130032, China
| | - Yunhua Gao
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
- Beijing CAS Microneedle Technology Ltd., Beijing 102609, China
| |
Collapse
|
3
|
Yang Q, Xue P, Fan X, Yin Y, Dang H, Li W, Song B. Lasers treatment for traumatic facial tattoo. Lasers Med Sci 2022; 38:28. [PMID: 36580127 PMCID: PMC9800346 DOI: 10.1007/s10103-022-03658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/28/2022] [Indexed: 12/30/2022]
Abstract
Effective treatment for traumatic tattoo is lacking. We aimed to compare the effectiveness and safety between Q-1064 nm laser as monotherapy and alternating Q-1064 nm laser with CO2 AFL in treating traumatic facial tattoo (black or blue color) and accompanied scars. Clinical data of 98 patients were grouped and analyzed based on the different treatment lasers. Tattoo clearance was evaluated with a 4-point scale, and scar improvement was analyzed with modified VOSAS scores. Patient satisfaction of the tattoo clearance and scar improvement, and treatment-related complications were analyzed. Significant increased clinical effects with patient satisfaction and decreased worsened scar were confirmed with the two alternated lasers, relative to those with Q-1064 nm laser alone (P < 0.05). Consequently, alternating Q-1064 nm laser and CO2 AFL treatment could be used for traumatic facial tattoo with black or blue color removal safely and effectively.
Collapse
Affiliation(s)
- Qing Yang
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Ping Xue
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Xing Fan
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Yue Yin
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Hui Dang
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Wei Li
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China.
| |
Collapse
|
4
|
Kim JC, Choi JW, Kim YC. A prospective study to evaluate the treatment effect of pulsed dye laser on thyroidectomy hypertrophic scars using 3D imaging analysis. Lasers Surg Med 2022; 54:1082-1088. [PMID: 35842822 DOI: 10.1002/lsm.23584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/18/2022] [Accepted: 06/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The pulsed dye laser (PDL) is an effective modality for preventing and improving hypertrophic scars (HSs). However, the heterogeneity of the parameter settings of the laser and subjective scar assessment methods used in most studies resulting in uncertainty with treatment plans. Therefore, we investigated the treatment effect of the PDL (V-beam; Candela Laser Corporation) on HSs in post-thyroidectomy patients using three-dimensional imaging analysis and intended to provide a systemic and optimal treatment protocol. METHODS Nineteen patients with HS after thyroidectomy underwent eight treatment sessions with the 595 nm PDL (with the dose gradually increased by 0.5 J/cm2 ) at 4- to 6-week intervals. Patients with an elevated lesion also received intralesional corticosteroid (ICS) treatment. After every two treatment sessions, we assessed the patients' HS using the Vancouver Scar Scale (VSS), a patient satisfaction questionnaire, and with a three-dimensional (3D) skin imaging device (Antera 3D™; Miravex Limited). RESULTS In repeated-measures analysis of variance, the mean VSS and patient satisfaction significantly improved (p < 0.001), with significant differences in these values observed until the sixth and eighth treatment sessions, respectively. In the quantitative analysis using Antera 3D™, the mean height, pigmentation, and vascularity scores were observed to be significantly improved (p < 0.001). Significant differences in these values were observed until the fourth, second, and eighth treatment sessions, respectively. Subgroup analysis according to ICS treatment showed no significant differences in scar characteristics between those with and without ICS treatment. CONCLUSIONS In this study, we found that the PDL was effective in reducing scar height, vascularity, and pigmentation in patients with thyroidectomy HS using 3D imaging analysis. Furthermore, we have suggested a cost-effective treatment plan with the 595 nm PDL.
Collapse
Affiliation(s)
- Jin Cheol Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Jee Woong Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Zhang J, Luo W, Han M, Wu L, Peng Z, Xia Z, Yang R. Verifying the outcomes of artesunate plus 595-nm PDL in hypertrophic scars via determining BMP-7 and Fas level in model rabbits. Lasers Surg Med 2022; 54:716-724. [PMID: 35234299 DOI: 10.1002/lsm.23518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Single-use of artesunate (ART) or 595-nm pulsed-dye laser (PDL) has proven clinical efficacy in the treatment of hypertrophic scars (HSs), yet little research has been done on the combined use of ART and PDL. Bone morphogenetic protein-7 (BMP-7) and Fas are recognized to be two important proteins in reducing scar formation. This study was designed to observe the effect of ART combined with 595-nm PDL in the treatment of HS in rabbit models, and investigate the effect of such protocol on the expression of BMP-7 and Fas in rabbit models. STUDY DESIGN/MATERIALS AND METHODS Twenty-four New Zealand white rabbits were randomly divided into the control group, ART group, PDL group, and combined treatment (ART + PDL) group. ART was respectively applied to the ART group and combined treatment group. Treatment was once every 2-week for a total of three sessions for both groups. Animals in the PDL group were simply treated with 595-nm PDL. Then, hematoxylin & eosin and Van Gieson straining, immunohistochemical study, enzyme-linked immunosorbent assay (ELISA), Cell counting kit-8 test, western blot assay, and real-time polymerase chain reaction (RT-PCR) were carried out to observe the development of HS samples and expression of BMP-7 and Fas proteins in the sample tissues. RESULTS After treatment, the scar samples grew lower and flatter, which was particularly evident in the combined treatment group, with notably inhibited fibroblast and collagen compared to other groups (p < 0.001). Western blot assay and RT-PCR demonstrated that the expression of BMP-7 was most increased in scar samples treated by ART + PDL. BMP-7 level was correspondingly and notably upregulated in treatment groups, especially in the ART + PDL group. In addition, relevant expression of Fas was also higher after treatment, especially in the ART + PDL group compared to either ART or 595-nm PDL group. The difference was significant among groups (p < 0.001). CONCLUSIONS Combined use of ART and 595-nm PDL can inhibit HSs in rabbit models via inhibiting extra fibroblast and collagens. The potential mechanism may be involved in enhanced BMP-7 and Fas expression. Our observations may create an alternative therapeutic strategy for HSs in the clinic.
Collapse
Affiliation(s)
- Jinxia Zhang
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Wanting Luo
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Minna Han
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Lili Wu
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Zhuoying Peng
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Zhikuan Xia
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Rongya Yang
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| |
Collapse
|
7
|
Bennardo L, Fasano G, Tamburi F, Zappia E, Rizzuto F, Nisticò SP, Cannarozzo G. Sequential Use of CO 2 Laser Prior to Nd:YAG and Dye Laser in the Management of Non-Facial Warts: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:115. [PMID: 35056422 PMCID: PMC8780825 DOI: 10.3390/medicina58010115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022]
Abstract
Background and Objectives: Warts are benign lesions of viral etiology characterized by a hyperkeratotic appearance tending to spread across the skin surface. Various treatments have been proposed to manage this condition, such as acids, imiquimod, photodynamic therapy, cryotherapy, and various lasers. Materials and Methods: In this paper, we describe a combination protocol using CO2 laser prior to Nd:YAG laser for lesions interesting the palmoplantar areas or dye laser for lesions on other skin surfaces in the management of non-facial warts resistant to traditional therapies. In total, 34 patients with 103 warts suffering from wart infection resistant to traditional therapies treated from 1 January 2019 to 1 June 2020 were retrospectively enrolled at the Dermatological Unit of Magna Graecia University (Catanzaro, Italy). Two dermatologists measured clinical results, classifying lesions with complete resolution, partial resolution, or non-responding. Patients at four months follow-up were asked to evaluate their degree of satisfaction with a visual analog scale (VAS). Results: Almost all patients reported the complete resolution of lesions, with no patient reporting scarring. Five patients reported hypopigmentation in the treated areas. The mean satisfaction level was high. Only three patients experienced a relapse of the condition. Conclusions: Using a vascular laser following a CO2 superficial ablation of warts may help reduce the risk of scarring and decrease the incidence of relapses for lesions resistant to traditional therapies. Therefore, more extensive studies will be necessary to confirm the obtained results.
Collapse
Affiliation(s)
- Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Gaia Fasano
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Federica Tamburi
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Elena Zappia
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Francesco Rizzuto
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Steven Paul Nisticò
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | | |
Collapse
|
8
|
Cenk H, Sarac G. Efficacy of 2940 nm Multifractional Er: YAG Lasers in Self-inflicted Razor Blade Incision Scars. J Cosmet Dermatol 2021; 21:1013-1017. [PMID: 34918442 DOI: 10.1111/jocd.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Deliberate self-harm (DSH) can be defined as self-inflicted injury without an intention to suicide, and it may result in scar formation with a particular shape. AIMS There is no treatment algorithm for DSH scars, nor is there a gold standard for the treatment of hypertrophic scars. Therefore, we aimed to share our experience with Er: YAG laser treatment of self-inflicted razor blade incision scars. PATIENTS/METHODS The study involved 18 patients with DSH scars treated with fractional ablative Er: YAG laser (MCL 31 Asclepion laser Technologies) between 2017 and 2020, with the parameters of 40 J/cm2 , 300 µs, and 4 Hz. The sessions were repeated by increasing 10 joules in every session with 4-week intervals until reaching a maximum of 80 joules. The patients were evaluated retrospectively by two different dermatologists in terms of scar improvement over digital photographs taken before and 4 weeks after the treatment. Evaluations have been made based on a 4-point score (0:no change, 1:1%-25% mild, 2:26%-50% moderate, 3:51%-75% well, and 4:76%-100% excellent improvement). RESULTS After the third session, 90.9% of the patients showed a moderate improvement. After the fourth session, only 27.2% of the patients had a good, and 63.2% of the patients had a moderate improvement rate. CONCLUSIONS Er: YAG laser is a safe and effective treatment method for the hypertrophic scars induced by razor blades. Also, we believe that combined treatments with other treatment modalities will provide better results in DSH scars.
Collapse
Affiliation(s)
- Hulya Cenk
- Department of Dermatology, Pamukkale University, Denizli, Turkey
| | - Gulbahar Sarac
- Department of Dermatology, Inonu University, Malatya, Turkey
| |
Collapse
|
9
|
Zhang J, Zhou S, Xia Z, Peng Z, Cheng X, Yang X, Luo W, Yang R. 595-nm pulsed dye laser combined with fractional CO 2 laser reduces hypertrophic scar through down-regulating TGFβ1 and PCNA. Lasers Med Sci 2021; 36:1625-1632. [PMID: 34117539 DOI: 10.1007/s10103-020-03240-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022]
Abstract
595-nm pulsed dye laser and fractional CO2 laser have been demonstrated effective to treat hypertrophic scar. The underlying mechanism may involve transforming growth factor-beta1 (TGFβ1) and proliferating cell nuclear antigen (PCNA), but remains to be clarified. Our study was performed to investigate how 595-nm pulsed dye laser combined with fractional CO2 laser treats hypertrophic scars in a rabbit model through regulating the expression of TGFβ1 and PCNA. Twenty-four New Zealand white rabbits were randomly divided into control group, pulsed dye laser group, fractional CO2 laser group, and pulsed dye laser + fractional CO2 laser (combination) group. Surgical wounds were made and allowed to grow into hypertrophic scars at day 28. Next, 595-nm pulsed dye laser (fluence: 15 J/cm2; square: 7 mm; pulse duration: 10 ms) was used in pulsed dye laser and combination group, while fractional CO2 laser (combo mode, deep energy: 12.5 mJ; super energy: 90 mJ) in fractional CO2 laser and combination groups, once every 4 weeks for 3 times. The appearance and thickness of hypertrophic scar samples were measured with hematoxylin-eosin and Van Gieson's straining. The expressions of TGFβ1 and PCNA were evaluated by immunohistochemical and western blot analysis. A significant improvement was noted in the thickness, size, hardness, and histopathology of hypertrophic scar samples after laser treatment, especially in combination group. Scar Elevation Index (SEI), fiber density (NA), and collagen fiber content (AA) decreased most significantly in combination group (2.10 ± 0.14; 2506 ± 383.00; 22.98 ± 2.80%) compared to 595-nm pulsed dye laser group (3.35 ± 0.28; 4857 ± 209.40; 42.83 ± 1.71%) and fractional CO2 laser group (2.60 ± 0.25; 3995 ± 224.20; 38.33 ± 3.01%) (P < 0.001). Furthermore, TGFβ1 and PCNA expressions were more suppressed in combination group (8.78 ± 1.03; 7.81 ± 1.51) than in 595-nm pulsed dye laser (14.91 ± 1.68; 15.73 ± 2.53) and fractional CO2 laser alone group (15.96 ± 1.56; 16.13 ± 1.72) (P < 0.001). The combination of 595-nm pulsed dye laser with fractional CO2 laser can improve the morphology and histology of hypertrophic scars in a rabbit model through inhibiting the expression of TGFβ1 and PCNA protein. Our findings can pave the way for new clinical treatment strategies for hypertrophic scars.
Collapse
Affiliation(s)
- Jinxia Zhang
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Shuanglin Zhou
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Zhikuan Xia
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Zhuoying Peng
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Xiaoxian Cheng
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Xin Yang
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Wanting Luo
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Rongya Yang
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China.
| |
Collapse
|
10
|
Laser Speckle Contrast Imaging for the Objective Assessment of Blood Perfusion in Keloids Treated With Dual-Wavelength Laser Therapy. Dermatol Surg 2021; 47:e117-e121. [PMID: 33795568 DOI: 10.1097/dss.0000000000002836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Most of the widely used methods for the assessment of keloid treatment are subjective grading scales based on the opinion of an individual clinician or patient. There is a growing need for objective methods to evaluate keloid treatment. OBJECTIVE This study aimed to evaluate the value of laser speckle contrast imaging (LSCI) as an objective method for the assessment of dual-wavelength laser therapy for keloids. METHODS This prospective study included 21 patients with 54 keloids. All patients were treated with a combined 585-nm pulsed dye laser and 1,064 nm neodymium-doped yttrium aluminum garnet dual-wavelength laser at 4 weeks to 6 weeks intervals. Keloids were assessed using the Vancouver Scar Scale (VSS) and LSCI. RESULTS The total VSS score significantly decreased after 4 sessions of treatment (p < .05). Blood perfusion in keloids as measured by LSCI was significantly reduced after treatment (p < .05). The improvement of chest keloids in terms of the total VSS score and blood perfusion was significantly greater than that of scapular keloids (p < .05). There was a positive correlation between decreased perfusion and reduced total VSS score (R2 = 0.84). CONCLUSION Blood perfusion in keloids significantly decreased after dual-wavelength laser therapy. Laser speckle contrast imaging is a promising objective method for assessing the improvement of keloids treated with laser therapy.
Collapse
|
11
|
Li N, Yang L, Cheng J, Han J, Yang X, Zheng Z, Guan H, Hu D. A retrospective study to identify the optimal parameters for pulsed dye laser in the treatment of hypertrophic burn scars in Chinese children with Fitzpatrick skin types III and IV. Lasers Med Sci 2021; 36:1671-1679. [PMID: 33486651 DOI: 10.1007/s10103-021-03252-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
For over several decades, 595-nm pulsed dye laser (PDL) has been used effectively, reducing erythema and improving the pliability and texture of burn scars. Children usually tolerate PDL treatment as it is non-invasive and causes only mild pain compared to other laser treatments. However, currently, there are limited data on scar management in children who underwent PDL treatment, especially for Fitzpatrick skin types III and IV. The objective of the study was to identify the optimal parameters for the PDL treatment that induce inhibitory effects on scar tissue in children with Fitzpatrick skin types III and IV. Besides, the study assessed the usefulness of high-frequency ultrasound (20 MHz) and laser Doppler flowmetry in assessing these lesions. A total of 165 (79 males and 86 females) children with hypertrophic scars treated by PDL were assessed by the Vancouver scar scale (VSS), high-frequency ultrasound (20 MHz), and laser Doppler flowmetry. The parameters used for the 595-nm PDL treatment were pulse duration of 0.45 ms, fluence between 5 and 9 J/cm2, a spot size of 7 mm, and treatment intervals from 3 to 8 weeks. There were no significant differences between pretreatment and post-treatment in terms of the distribution of sex, type of skin color, and low and high fluences. While the mean scores of all scar parameters based on VSS, except thickness and pliability between pre and post-treatment, showed significant differences in ≤3-year-old children vs. to >3-year-old children, except for the subscore, a significant improvement was observed when PDL was initiated within 4 to 6 months of the scar age. In Chinese children with Fitzpatrick skin types III and IV, early intervention, appropriate treatment intervals, and low fluence of PDL were optimal parameters in treating hypertrophic burn scars. The combined high-frequency ultrasound and laser Doppler flowmetry assessment of scars helped assess these lesions and compare the efficacy of different treatment modalities.
Collapse
Affiliation(s)
- Na Li
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Li Yang
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Jing Cheng
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Juntao Han
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China.
| | - Xuekang Yang
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Zhao Zheng
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Hao Guan
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Dahai Hu
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|