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Hong N, Sheng B, Yu P. Early postoperative interventions in the prevention and management of thyroidectomy scars. Front Physiol 2024; 15:1341287. [PMID: 38523809 PMCID: PMC10958159 DOI: 10.3389/fphys.2024.1341287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Thyroidectomy scars, located on the exposed site, can cause distress in patients. Owing to the cosmetic importance of thyroidectomy scars, many studies have been conducted on its prevention and treatment. Scar formation factors mainly include inflammatory cell infiltration, angiogenesis, fibroblast proliferation, secretion of cytokines such as transforming growth factor (TGF)-β1, and mechanical tension on the wound edges. Anti-scar methods including topical anti-scar agents, skin tension-bearing devices, and local injections of botulinum toxin, as well as lasers and phototherapies, that target these scar formation factors have been developed. However, current studies remain fragmented, and there is a lack of a comprehensive evaluation of the impacts of these anti-scar methods on treating thyroidectomy scars. Early intervention is a crucial but often neglected key to control hyperplastic thyroidectomy scars. Therefore, we review the currently adopted early postoperative strategies for thyroidectomy scar reduction, aiming to illustrate the mechanism of these anti-scar methods and provide flexible and comprehensive treatment selections for clinical physicians to deal with thyroidectomy scars.
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Affiliation(s)
- Nan Hong
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Department of Dermatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bin Sheng
- Department of Medical Cosmetology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Pan Yu
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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2
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Mohammed GF, Al‐Dhubaibi MS. Triple steps acne scar revision technique a new combination therapeutic modality for atrophic acne scars. J Cosmet Dermatol 2022; 21:4659-4668. [DOI: 10.1111/jocd.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ghada F. Mohammed
- Department of Dermatology and Venereology Faculty of Medicine Suez Canal University Ismailia Egypt
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3
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Jiayi F, Ling Z, Lvping H. Quantitative analysis of collagen after Intense Pulsed Light and Erbium-Doped Yttrium Aluminum Garnet Laser Treatment on Rabbit Skin. J Cosmet Dermatol 2022; 21:4378-4382. [PMID: 35150199 DOI: 10.1111/jocd.14841] [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: 09/21/2021] [Revised: 01/16/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of intense pulsed light (IPL) and ablative 2.940 nm erbium-doped yttrium aluminum garnet (Er: YAG) laser on dynamic changes in collagen by quantitative analysis of type I collagen (Col I) and type III collagen (Col III), transforming growth factor (TGF) and matrix metalloproteinases (MMPs) in the dermis of rabbits. METHODS Backs of ten rabbits were divided into four treatment areas: IPL normal energy group, IPL high energy group, erbium laser normal energy group and erbium laser high energy group. HE staining was performed immediately after the first treatment and two weeks after the first treatment. Col I, Col III, TGF-β1 and MMP-1 were collected by real-time PCR at baseline, 2 weeks after each session and three months after the entire treatment monthly. RESULTS HE staining showed that collagen fibers in the superficial layer of the dermis in the four treatment groups were increased and thickened to different degrees. Real-time PCR showed that statistically differences were noted in each checkpoint before and after treatments in the four groups, whereas no significant difference in the change in the four biomarkers was found among the four treatment groups. CONCLUSION Both the IPL and Er:YAG laser can effectively upregulate collagens, but in this experiment, there was no significant difference in the therapeutic effect among the four irradiation groups. Moreover, the high energy level group tended to bring more serious epidermal injury.
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Affiliation(s)
- Feng Jiayi
- Laser Aesthetic Center, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100144, China
| | - Zhang Ling
- Laser Aesthetic Center, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100144, China
| | - Huang Lvping
- Laser Aesthetic Center, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100144, China
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4
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Kim JW, Huh CH, Na JI, Hong JS, Yoon Park J, Shin JW. Evaluating outcomes of pulsed dye laser therapy combined with intralesional triamcinolone injection after surgical removal of hypertrophic cesarean section scars. J Cosmet Dermatol 2021; 21:1471-1476. [PMID: 34008912 DOI: 10.1111/jocd.14238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/21/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recently, pulsed dye laser (PDL) combined with triamcinolone intralesional injection (TAILI) has been introduced for surgical scar prevention. However, little is known about this procedure's effectiveness in preventing hypertrophic scar following surgical scar removal. OBJECTIVES This study aimed to evaluate the outcome of early intervention using PDL combined with TAILI after surgical removal of hypertrophic cesarean section (CS) scars. METHODS The medical records of 35 patients who underwent early intervention using PDL and TAILI after removal of hypertrophic CS scars were retrospectively reviewed. The scars' average Vancouver Scar Scale (VSS) scores before scar removal and 3 months after the final treatment were compared. RESULTS The patients received 4.23 treatments on average and were followed up for a mean period of 7.74 months. The mean final VSS was 3.11 ± 1.52 and was significantly lower than that of the previous VSS (9.29 ± 1.74, p = 0.000). VSS of the previous CS scar, and the presence or absence of keloid formation in other areas, was associated with treatment outcome (p = 0.003 and 0.008, respectively). CONCLUSIONS Early intervention using PDL combined with TAILI could prevent the recurrence or progression of hypertrophic CS scarring after surgical scar removal.
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Affiliation(s)
- Jee-Woo Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hun Huh
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Im Na
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Daerim Saint Mary's Hospital, Seoul, Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
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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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Alster TS, Li MK. Dermatologic Laser Side Effects and Complications: Prevention and Management. Am J Clin Dermatol 2020; 21:711-723. [PMID: 32529468 DOI: 10.1007/s40257-020-00530-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The evolution of modern laser and light-based systems has mirrored the demand for clinically effective treatments and the need for safer technologies with reduced postoperative recovery, side effects, and complications. With each new generation of lasers, more selective tissue destruction can be achieved with reduced unwanted sequelae. Patient selection and preparation, operator technique, and expeditious recognition and management of post-treatment side effects are paramount in avoiding complications and patient dissatisfaction. An overview of important variables to consider for dermatologic laser treatments are presented in order to provide a framework to reduce the severity and duration of possible post-treatment side effects and complications.
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Affiliation(s)
- Tina S Alster
- Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA.
| | - Monica K Li
- City Medical Aesthetics Center, Vancouver, BC, Canada
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Mitigation of Postsurgical Scars Using Lasers: A Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2746. [PMID: 32440416 PMCID: PMC7209879 DOI: 10.1097/gox.0000000000002746] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/05/2020] [Indexed: 11/25/2022]
Abstract
Background: Most postsurgical scars are considered esthetically and functionally acceptable. Currently, there is no definite consensus treatment for postsurgical scarring. The purpose of this review is to shed some light on the value of scar mitigation and the efficacy of different lasers employed on postsurgical wounds. Methods: A systematic literature review and computational analysis were conducted to identify relevant clinical articles that pertained to the use of lasers for mitigating postsurgical scars. Articles included the National Institutes of Health–National Center for Biotechnology Information–PubMed search and sources cited from relevant studies after 1995. Trials that attributed pre- and posttreatment scores of scar severity based on a verified scar evaluation scale (eg, Patient and Observer Scar Assessment Scale, Vancouver Scar Scale, Global Assessment Scale) were chosen. Clinical assessments varied for each study. To adequately assess the efficacy of the modalities, the final scaled scar appearance scores were realigned and normalized to a standard scale for unbiased comparison. Results: After filtering through a total of 124 studies, 14 relevant studies were isolated and thus included in the review. Studied lasers were as follows: Pulsed dye laser (PDL), carbon dioxide, diode, potassium titanyl phosphate (KTP), and erbium glass (Er-Glass) lasers. Conclusion: Treatment with lasers in the postsurgical wound healing phase is safe, effective, and advised in mitigation of pathologic scar formation.
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You H, Choi Y, Hwang N, Kim D, Oh KH, Kwon SY. The Outcome of Early Ablative Fractional Laser Treatment for Thyroidectomy Scars. Lasers Surg Med 2020; 52:721-729. [DOI: 10.1002/lsm.23217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Hi‐Jin You
- Department of Plastic Surgery Korea University College of Medicine Seoul 15355 Korea
| | - Young‐Soo Choi
- Department of Plastic Surgery Korea University College of Medicine Seoul 15355 Korea
| | - Na‐Hyun Hwang
- Department of Plastic Surgery Korea University College of Medicine Seoul 15355 Korea
| | - Deok‐Woo Kim
- Department of Plastic Surgery Korea University College of Medicine Seoul 15355 Korea
| | - Kyoung Ho Oh
- Department of Otolaryngology‐Head and Neck Surgery Korea University College of Medicine Seoul 15355 Korea
| | - Soon Young Kwon
- Department of Otolaryngology‐Head and Neck Surgery Korea University College of Medicine Seoul 15355 Korea
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Cialdai F, Colciago A, Pantalone D, Rizzo AM, Zava S, Morbidelli L, Celotti F, Bani D, Monici M. Effect of Unloading Condition on the Healing Process and Effectiveness of Platelet Rich Plasma as a Countermeasure: Study on In Vivo and In Vitro Wound Healing Models. Int J Mol Sci 2020; 21:ijms21020407. [PMID: 31936443 PMCID: PMC7013931 DOI: 10.3390/ijms21020407] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 12/24/2022] Open
Abstract
Wound healing is a very complex process that allows organisms to survive injuries. It is strictly regulated by a number of biochemical and physical factors, mechanical forces included. Studying wound healing in space is interesting for two main reasons: (i) defining tools, procedures, and protocols to manage serious wounds and burns eventually occurring in future long-lasting space exploration missions, without the possibility of timely medical evacuation to Earth; (ii) understanding the role of gravity and mechanical factors in the healing process and scarring, thus contributing to unravelling the mechanisms underlying the switching between perfect regeneration and imperfect repair with scarring. In the study presented here, a new in vivo sutured wound healing model in the leech (Hirudo medicinalis) has been used to evaluate the effect of unloading conditions on the healing process and the effectiveness of platelet rich plasma (PRP) as a countermeasure. The results reveal that microgravity caused a healing delay and structural alterations in the repair tissue, which were prevented by PRP treatment. Moreover, investigating the effects of microgravity and PRP on an in vitro wound healing model, it was found that PRP is able to counteract the microgravity-induced impairment in fibroblast migration to the wound site. This could be one of the mechanisms underlying the effectiveness of PRP in preventing healing impairment in unloading conditions.
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Affiliation(s)
- Francesca Cialdai
- ASA campus Joint Laboratory, ASA Res. Div., Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
| | - Alessandra Colciago
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (A.C.); (A.M.R.); (S.Z.); (F.C.)
| | - Desiré Pantalone
- Unit of Surgery and Trauma Care, Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy;
| | - Angela Maria Rizzo
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (A.C.); (A.M.R.); (S.Z.); (F.C.)
| | - Stefania Zava
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (A.C.); (A.M.R.); (S.Z.); (F.C.)
| | - Lucia Morbidelli
- Department of Life Sciences, University of Siena, 53100 Siena, Italy;
| | - Fabio Celotti
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (A.C.); (A.M.R.); (S.Z.); (F.C.)
| | - Daniele Bani
- Research Unit of Histology & Embryology, Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy;
| | - Monica Monici
- ASA campus Joint Laboratory, ASA Res. Div., Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
- Correspondence: ; Tel.: +39-055-275-8366
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Kosche C, Mansh M, Luskus M, Nguyen A, Martinez-Diaz G, Inwards-Breland D, Yeung H, Boos MD. Dermatologic care of sexual and gender minority/LGBTQIA youth, Part 2: Recognition and management of the unique dermatologic needs of SGM adolescents. Pediatr Dermatol 2019; 36:587-593. [PMID: 31259441 PMCID: PMC6750974 DOI: 10.1111/pde.13898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sexual and gender minority (SGM) individuals, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) persons, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Part 2 of this two-part review will address unique concerns regarding acne, tanning behavior, sexually transmitted infections, and other health disparities among SGM adolescents. A more comprehensive understanding of the dermatologic needs of SGM youth will better allow pediatric dermatologists to actively and compassionately care for this health disparity population.
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Affiliation(s)
- Cory Kosche
- Rush Medical College, Rush University School of Medicine, Chicago, Illinois
| | - Matthew Mansh
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Mark Luskus
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Andy Nguyen
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts
| | | | - David Inwards-Breland
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
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Urdiales-Gálvez F, Martín-Sánchez S, Maíz-Jiménez M, Castellano-Miralla A, Lionetti-Leone L. Concomitant Use of Hyaluronic Acid and Laser in Facial Rejuvenation. Aesthetic Plast Surg 2019; 43:1061-1070. [PMID: 31073742 PMCID: PMC6742610 DOI: 10.1007/s00266-019-01393-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Facial aging is a process that involves many different changes. Therefore, in many patients, it may be necessary to perform a combined treatment. Botulinum toxin A and dermal fillers are the two most popular nonsurgical cosmetic procedures performed globally to treat age-associated changes. However, there are not many studies reporting the concomitant use of dermal fillers and laser technology for facial rejuvenation. This review aims to assess the concomitant use of dermal hyaluronic acid (HA) fillers and laser technology for facial rejuvenation. METHODS The present updated consensus recommendations are based on the experience and opinions of the authors and on a literature search. RESULTS If a combined procedure (HA and light treatments) is to be performed, on the same day, the panel recommends starting always with the light treatments, avoiding skin manipulations after having injected HA. To customize the therapeutic management, it is crucial to establish a precise diagnosis of the photodamage and loss of volumes suffered by the patients. CONCLUSIONS The currently available scientific evidence about the combined use of HA fillers and laser-radiofrequency-intense pulsed light (laser/RF/IPL) is limited and encompasses mainly small and nonrandomized studies. Nevertheless, most of these studies found that, on average, the concomitant use (same day) of laser and HA fillers for facial rejuvenation represents an effective and safe strategy which improves clinical results and patient's satisfaction. Future well-designed clinical studies are needed regarding the effectiveness and safety of combination filler/laser treatments. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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12
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Abou Eitta RS, Ismail AA, Abdelmaksoud RA, Ghezlan NA, Mehanna RA. Evaluation of autologous adipose-derived stem cells vs. fractional carbon dioxide laser in the treatment of post acne scars: a split-face study. Int J Dermatol 2019; 58:1212-1222. [PMID: 31297798 DOI: 10.1111/ijd.14567] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/22/2019] [Accepted: 06/07/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Scarring is a distressing outcome of acne, as it causes cosmetic and psychological problems to the patients. Unfortunately no single treatment is satisfactory; instead, employing multiple modalities may have better outcome. Autologous adipose tissue-derived adult stem cells (AT-ASCs) and their secretory factors can stimulate collagen synthesis; angiogenesis and migration of fibroblasts thus regenerate damaged tissues. Also, conventional treatments for acne scarring, such as lasers and topical regimens, induce new collagen synthesis via activation of dermal fibroblasts or growth factors. The aim of the study was to verify the effectiveness of AT-ASCs for the treatment of acne scarring vs. the fractional carbon dioxide laser (FxCR). SUBJECTS AND METHODS Split face comparative study included 10 adult patients with post-acne scars on both sides of the face. One side received AT-ASCs single injection while the other received three sessions of FxCR. Scars were then assessed using the global scoring system Goodman and Baron, scar area percent using NIH ImageJ software and functional assessment by measuring the transepidermal water loss (TEWL) and skin hydration. Both sides were followed for three months. RESULTS A significant improvement in the degree of scar severity, scar area percent, skin hydration, and TEWL after 3 months of treatment on both sides of the face with insignificant differences between both treatment modalities, provided that AT-ASCs treatment was employed once vs. three sessions of FxCR. CONCLUSION One injection of AT-ASCs is as effective as three sessions of FxCR in the treatment of atrophic acne scars.
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Affiliation(s)
- Rania S Abou Eitta
- Dermatololgy, Venereology and Andrology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Aisha A Ismail
- Dermatololgy, Venereology and Andrology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rania A Abdelmaksoud
- Dermatololgy, Venereology and Andrology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Naser A Ghezlan
- Plastic surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Radwa A Mehanna
- Medical Physiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Center of Excellence for Research in Regenerative Medicine and Applications (CERRMA), Faculty of Medicine, Alexandria University, Alexandria, Egypt
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13
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Ibrahim SM, Saudi WM, Abozeid MF, Elsaie ML. Early fractional carbon dioxide laser intervention for postsurgical scars in skin of color. Clin Cosmet Investig Dermatol 2019; 12:29-34. [PMID: 30655685 PMCID: PMC6324605 DOI: 10.2147/ccid.s177622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Fractional CO2 laser is one of the most effective treatment options used to resurface scars. Objective To evaluate the efficacy and safety of early treatment of postsurgical scar by fractional ablative CO2 laser. Methods A total of 27 Egyptian patients with recent postoperative scars were enrolled in this study. Three sessions of fractional CO2 laser with a 1-month interval were started 4 weeks after surgery. Vancouver Scar Scale (VSS) was used as an assessment tool at 1 and 3 months after the final treatment. Patients reported their satisfaction using a subjective 4-point scale. Results Results demonstrated a statistically significant overall average improvement of the VSS (5.33±1.33) before compared with (2.55±1.06) 3 months after the last laser treatment (P≤0.001). Among the individual parameters in the VSS, the most significant improvements were found in pigmentation, height, and pliability. Patient's subjective satisfaction scores showed a significant greater degree of satisfaction after laser treatment. Conclusion Fractional ablative CO2 laser is an effective and safe treatment modality for surgical scars in the early postsurgical period.
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Affiliation(s)
- Shady M Ibrahim
- Department of Dermatology, Al Azhar University, Cairo, Egypt
| | - Wael M Saudi
- Department of Dermatology, Misr University for Science & Technology, 6th of October City, Egypt
| | | | - Mohamed L Elsaie
- Department of Dermatology, National Research Centre, Cairo, Egypt,
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14
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McGoldrick RB, Theodorakopoulou E, Azzopardi EA, Murison M. Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars. Scars Burn Heal 2017; 3:2059513116689805. [PMID: 29799579 PMCID: PMC5965340 DOI: 10.1177/2059513116689805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies.
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Affiliation(s)
- Rory Boyd McGoldrick
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | - Evgenia Theodorakopoulou
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | | | - Maxwell Murison
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
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15
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Comparison of the Effectiveness of Ablative and Non-Ablative Fractional Laser Treatments for Early Stage Thyroidectomy Scars. Arch Plast Surg 2016; 43:575-581. [PMID: 27896191 PMCID: PMC5122549 DOI: 10.5999/aps.2016.43.6.575] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/08/2016] [Accepted: 10/12/2016] [Indexed: 11/26/2022] Open
Abstract
Background Open thyroidectomy is conventionally performed at the anterior side of neck, which is a body part with a comparatively great degree of open exposure; due to this, postoperative scarring may cause distress in patients. We aimed to compare the effects of ablative and nonablative fractional laser treatments on thyroidectomy scars. We examined medical records in a retrospective manner and analyzed scars based on their digital images by using the modified Manchester Scar Scale (mMSS). Methods Between February 2012 and May 2013, 55 patients with thyroidectomy scars were treated with ablative (34 patients) or nonablative (21 patients) fractional laser. Each patient underwent 4 laser treatment sessions in 3–4 week intervals, 1–2 months postoperatively. Scar improvement was assessed using patient images and the mMSS scale. Results The mean decrease in scar score was 3.91 and 3.47 in the ablative and nonablative groups, respectively; the reduction between 2 groups did not exhibit any significant difference (P=0.16). We used the scale once again to individually evaluate scar attributes. The nonablative group accounted for a considerably higher color score value (P=0.03); the ablative group accounted for a considerably higher contour score value (P<0.01). Patient satisfaction was high and no complications occurred. Conclusions Both types of fractional laser treatments can be used successfully for thyroidectomy scar treatment with minimal complications; however, results indicate that higher effectiveness may be obtained from the use of ablative and nonablative lasers for hypertrophic scars and early erythematous scars, respectively. Therefore, the appropriate laser for scar treatment should be selected according to its specific characteristics.
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Husain Z, Alster TS. The role of lasers and intense pulsed light technology in dermatology. Clin Cosmet Investig Dermatol 2016; 9:29-40. [PMID: 26893574 PMCID: PMC4745852 DOI: 10.2147/ccid.s69106] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The role of light-based technologies in dermatology has expanded dramatically in recent years. Lasers and intense pulsed light have been used to safely and effectively treat a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair, while also providing extensive therapeutic options for cosmetic rejuvenation and other dermatologic conditions. Dermatologic laser procedures are becoming increasingly popular worldwide, and demand for them has fueled new innovations and clinical applications. These systems continue to evolve and provide enhanced therapeutic outcomes with improved safety profiles. This review highlights the important roles and varied clinical applications that lasers and intense pulsed light play in the dermatologic practice.
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Affiliation(s)
- Zain Husain
- Department of Dermatology, Georgetown University Hospital, Washington, DC, USA
| | - Tina S Alster
- Department of Dermatology, Georgetown University Hospital, Washington, DC, USA; Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
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Block L, Gosain A, King TW. Emerging Therapies for Scar Prevention. Adv Wound Care (New Rochelle) 2015; 4:607-614. [PMID: 26487979 PMCID: PMC4593896 DOI: 10.1089/wound.2015.0646] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/04/2015] [Indexed: 11/13/2022] Open
Abstract
Significance: There are ∼12 million traumatic lacerations treated in the United States emergency rooms each year, 250 million surgical incisions created worldwide every year, and 11 million burns severe enough to warrant medical treatment worldwide. In the United States, over $20 billion dollars per year are spent on the treatment and management of scars. Recent Advances: Investigations into the management of scar therapies over the last decade have advanced our understanding related to the care of cutaneous scars. Scar treatment methods are presented including topical, intralesional, and mechanical therapies in addition to cryotherapy, radiotherapy, and laser therapy. Critical Issues: Current treatment options for scars have significant limitations. This review presents the current and emerging therapies available for scar management and the scientific evidence for scar management is discussed. Future Directions: Based upon our new understanding of scar formation, innovative scar therapies are being developed. Additional research on the basic science of scar formation will lead to additional advances and novel therapies for the treatment of cutaneous scars.
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Affiliation(s)
- Lisa Block
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Pediatric Trauma Program, American Family Children's Hospital, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Timothy W. King
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Siadat AH, Rezaei R, Asilian A, Abtahi-Naeini B, Rakhshanpour M, Raei M, Hosseini SM. Repigmentation of Hypopigmented Scars Using Combination of Fractionated Carbon Dioxide Laser with Topical Latanoprost Vs. Fractionated Carbon Dioxide Laser Alone. Indian J Dermatol 2015; 60:364-8. [PMID: 26288404 PMCID: PMC4533534 DOI: 10.4103/0019-5154.160481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Fractionated carbon dioxide (CO2) can treat hypopigmented scars. Latanoprost is a prostaglandin analog used to treat glaucoma. It can cause adverse effects, such as periocular hyperpigmentation. The aim of this study was to assess the efficacy and safety of latanoprost plus CO2 laser on the repigmentation of hypopigmented scars. Patients and Methods: 28 patients with hypopigmented scars were divided randomly into two groups. The patients in group A were treated in six sessions (1-month intervals) with 10600-nm fractional CO2 laser plus latanoprost 0.005% and those of group B fractionated CO2 laser plus placebo (distilled water). Digital photographs were taken at baseline and 3 months after the last treatment session. The blinded dermatologist compared the photographs and evaluated the efficacy of treatment in the hypopigmented scars using a 4-scale point (grade 1-4). Patient satisfaction was scored from 0 to 10 on a visual analog scale. Results: Follow-up results 12 weeks after the last treatment session demonstrated that 11 of the 14 patients in group A had more than 50% improvement in hypopigmentation The difference in improvement of the two groups was statistically significant (P = 0.027). The mean of the VAS scores of patients in group A was 6.50 ± 1.45 and in group B 4.57 ± 1.6. The difference in mean satisfaction of the two groups was statistically significant (P = 0.003). Side effects were mild and resolved within 1 to 5 days. Conclusion: The fractional CO2 laser resurfacing plus topical latanoprost can be used as a safe and efficacious method to treat hypopigmented scars.
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Affiliation(s)
- Amir Hossein Siadat
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Rezaei
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asilian
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahareh Abtahi-Naeini
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ; Department of Dermatology, Medicine Students' Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Rakhshanpour
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Raei
- Department of Epidemiology and Biostatistics, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Mohsen Hosseini
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
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Park GH, Chang SE, Bang S, Won KH, Won CH, Lee MW, Choi JH, Moon KC. Usefulness of Skin Explants for Histologic Analysis after Fractional Photothermolysis. Ann Dermatol 2015; 27:283-90. [PMID: 26082585 PMCID: PMC4466281 DOI: 10.5021/ad.2015.27.3.283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 05/29/2014] [Accepted: 10/12/2014] [Indexed: 11/22/2022] Open
Abstract
Background Fractional laser resurfacing treatment has been extensively investigated and is widely used. However, the mechanism underlying its effects is poorly understood because of the ethical and cosmetic problems of obtaining skin biopsies required to study the changes after laser treatment. Objective To evaluate the usefulness of human skin explants for the investigation of fractional photothermolysis. Methods Full-thickness discarded skin was treated in 4 ways: no treatment (control), fractional carbon dioxide laser, fractional Er:YAG laser, and fractional 1,550-nm erbium-doped fiber laser. Both treated and non-treated skin samples were cultured ex vivo at the air-medium interface for 7 days. Frozen tissue was sectioned and stained with hematoxylin & eosin for histologic examination and nitro blue tetrazolium chloride for viability testing. Results Skin explants cultured for up to 3 days exhibited histologic changes similar to those observed in in vivo studies, including microscopic treatment zones surrounded by a thermal coagulation zone, re-epithelialization, and formation of microscopic epidermal necrotic debris. However, the explant structure lost its original form within 7 days of culture. The viability of skin explants was maintained for 3 days of culture but was also lost within 7 days. Conclusion The skin explant model may be a useful tool for investigating the immediate or early changes following fractional photothermolysis, but further improvements are required to evaluate the long-term and dermal changes.
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Affiliation(s)
- Gyeong-Hun Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Kwang Hee Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Chan Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Oh IY, Kim BJ, Kim MN. Depressed Facial Scars Successfully Treated with Autologous Platelet-Rich Plasma and Light-Emitting Diode Phototherapy at 830 nm. Ann Dermatol 2014; 26:417-8. [PMID: 24966653 PMCID: PMC4069664 DOI: 10.5021/ad.2014.26.3.417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/28/2013] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- In Young Oh
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myeung Nam Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Ko AC, Erickson BP, Ko MJ, Sayed MS, Lee WW. Ablative laser assisted topical delivery of antifibrotics in the management of cicatricial ectropion. World J Ophthalmol 2014; 4:7-13. [DOI: 10.5318/wjo.v4.i2.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/11/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
A variety of surgical techniques have traditionally been used to manage cicatricial ectropion. These techniques primarily aim at vertical lengthening of the anterior lamella and include a variety of skin flaps and grafts. Alternative techniques such as dermal filler injection to support the eyelid margin may also be used in the management of select patients with cicatricial ectropion. The application of different types of laser for scar revision throughout the body has rapidly evolved; similar mechanisms, principles and treatment rationale can be applied to the use of lasers in the management of cicatricial ectropion. Additionally, ablative lasers, such as Carbon Dioxide and Erbium:yttrium-aluminum-garnet lasers, may be used in the transdermal delivery of antifibrotic agents, such as interferon gamma, interferon alpha, vitamin D, triamcinolone and 5-fluorouracil, resulting in efficient target tissue penetration, limitation of systemic drug toxicity and decreased degradation. Although the combination of ablative fractional resurfacing and topical antifibrotic agents is a new treatment modality, there is a great potential for its efficient utility in the management of periocular scarring and cicatricial ectropion. The introduction of these innovative therapeutic modalities offers ophthalmologists a greater range of possible effective treatments to address periocular scar tissue and the resultant cicatricial ectropion.
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Son IP, Park KY, Kim B, Kim MN. Pilot Study of the Efficacy of 578 nm Copper Bromide Laser Combined with Intralesional Corticosteroid Injection for Treatment of Keloids and Hypertrophic Scars. Ann Dermatol 2014; 26:156-61. [PMID: 24882968 PMCID: PMC4037666 DOI: 10.5021/ad.2014.26.2.156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 11/30/2022] Open
Abstract
Background Treatments including intralesional corticosteroid injection, pressure therapy, cryotherapy, and various laser therapies have had limited success for keloids and hypertrophic scars. Objective This trial evaluated the efficacy of a combination of 578 nm copper bromide laser and the more traditional intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with respect to scar color. Methods Keloids or hypertrophic scars of 12 Korean patients were treated five times by the combined treatment at 4-week intervals. Clinical improvement was assessed by the physicians' global assessment (PGA) comparing pre- and post-treatment photographs, as well as 4 weeks after the last treatment. Erythema intensity was quantified using a mexameter. Results Most scars showed significant clinical improvement in PGA and decreased erythema intensity after 5 treatments. All patients showed improvements in symptoms like pruritus. Conclusion The combined treatment is effective for keloids and hypertrophic scars, especially when the telangiectatic portion of the scars is prominent. The adjunctive use of 578 nm copper bromide laser decreased the telangiectatic side effects of an intralesional corticosteroid injection by reducing the vascular components of scars.
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Affiliation(s)
- In Pyeong Son
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Beomjoon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myeung Nam Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Cho S, Jung JY, Shin JU, Lee JH. Non-Ablative 1550 nm Erbium-Glass and Ablative 10,600 nm Carbon Dioxide Fractional Lasers for Various Types of Scars in Asian People: Evaluation of 100 Patients. Photomed Laser Surg 2014; 32:42-6. [DOI: 10.1089/pho.2013.3608] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Suhyun Cho
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Jung
- Yeouido Oracle Cosmetic Dermatosurgery Clinic, Seoul, Korea
| | - Jung U. Shin
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hee Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Sobanko JF, Alster TS. Management of acne scarring, part I: a comparative review of laser surgical approaches. Am J Clin Dermatol 2012; 13:319-30. [PMID: 22612738 DOI: 10.2165/11598910-000000000-00000] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Acne scarring is the result of a deviation in the orderly pattern of healing and can have profound psychosocial implications for patients. While the most effective means of addressing acne scarring is to prevent its formation through good acne control, there are a number of therapeutic interventions that improve the appearance of acne scars. Many of these procedural modalities have flaws and are limited by operator skill and experience. Laser scar revision, on the other hand, is a precise, well tolerated procedure with clinically demonstrable efficacy and minimal adverse effects that may be used alone or in combination with other scar treatments. The last 20 years has seen a dramatic evolution in laser treatment of acne scars, spanning ablative and nonablative technologies, to the current popularity of fractional laser scar revision. Determining which laser system to use depends upon the type and severity of acne scarring, the amount of recovery a patient can tolerate, and the ultimate goals and expectations of each patient. The importance of proper acne scar classification, laser scar revision techniques, and the evidence that addresses each laser system is reviewed in this article.
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Affiliation(s)
- Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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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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Hedelund L, Haak CS, Togsverd-Bo K, Bogh MK, Bjerring P, Haedersdal M. Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation. Lasers Surg Med 2012; 44:447-52. [PMID: 22766970 DOI: 10.1002/lsm.22048] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND The treatment of acne scars with fractional CO(2) lasers is gaining increasing impact, but has so far not been compared side-by-side to untreated control skin. OBJECTIVE In a randomized controlled study to examine efficacy and adverse effects of fractional CO(2) laser resurfacing for atrophic acne scars compared to no treatment. METHODS Patients (n = 13) with atrophic acne scars in two intra-individual areas of similar sizes and appearances were randomized to (i) three monthly fractional CO(2) laser treatments (MedArt 610; 12-14 W, 48-56 mJ/pulse, 13% density) and (ii) no treatment. Blinded on-site evaluations were performed by three physicians on 10-point scales. Endpoints were change in scar texture and atrophy, adverse effects, and patient satisfaction. RESULTS Preoperatively, acne scars appeared with moderate to severe uneven texture (6.15 ± 1.23) and atrophy (5.72 ± 1.45) in both interventional and non-interventional control sites, P = 1. Postoperatively, lower scores of scar texture and atrophy were obtained at 1 month (scar texture 4.31 ± 1.33, P < 0.0001; atrophy 4.08 ± 1.38, P < 0.0001), at 3 months (scar texture 4.26 ± 1.97, P < 0.0001; atrophy 3.97 ± 2.08, P < 0.0001), and at 6 months (scar texture 3.89 ± 1.7, P < 0.0001; atrophy 3.56 ± 1.76, P < 0.0001). Patients were satisfied with treatments and evaluated scar texture to be mild or moderately improved. Adverse effects were minor. CONCLUSIONS In this single-blinded randomized controlled trial we demonstrated that moderate to severe atrophic acne scars can be safely improved by ablative fractional CO(2) laser resurfacing. The use of higher energy levels might have improved the results and possibly also induced significant adverse effects.
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Affiliation(s)
- Lene Hedelund
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
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Pulsed dye laser treatment with different onset times for new surgical scars: a single-blind randomized controlled trial. Lasers Med Sci 2012; 27:1095-8. [DOI: 10.1007/s10103-011-1044-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 12/12/2011] [Indexed: 11/27/2022]
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Ibrahim AE, Dibo SA, Hayek SN, Atiyeh BS. Reverse tissue expansion by liposuction deflation for revision of post-surgical thigh scars. Int Wound J 2011; 8:622-31. [PMID: 21895976 DOI: 10.1111/j.1742-481x.2011.00842.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Scars hypertrophy and widen when stretching mechanical forces are applied to resilient newly formed collagen before it reaches final maturity marring the final result of many surgical procedures and resulting in a clinical problem for many patients. Scar revision by surgical excision remains the traditional treatment for hypertrophic or widespread scars. It relies upon recruitment of local tissues for closure of the ensuing defect. Providing tension-free skin closure is the best option to avoid recurrence. Although tissue expansion procedure is a valuable and reliable technique for scar revision, it has its own disadvantages and potential complications. We describe an alternative method for scar revision that may be applicable in certain situations. Instead of expanding the soft tissues to make available additional skin, deflation by liposuction may be affected to relax the skin envelope thus indirectly providing additional skin for scar revision. We call this method 'reverse tissue expansion'.
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Affiliation(s)
- Amir E Ibrahim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Laser Treatment for Improvement and Minimization of Facial Scars. Facial Plast Surg Clin North Am 2011; 19:527-42. [DOI: 10.1016/j.fsc.2011.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Treatment of keloids and hypertrophic scars with the triple-mode Er:YAG laser: A pilot study. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.mla.2010.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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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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Hirsch R, Stier M. Complications and Their Management in Cosmetic Dermatology. Dermatol Clin 2009; 27:507-20, vii. [DOI: 10.1016/j.det.2009.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Recontouring, Resurfacing, and Scar Revision in Skin Cancer Reconstruction. Facial Plast Surg Clin North Am 2009; 17:469-487.e3. [DOI: 10.1016/j.fsc.2009.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, Shalita AR, Lozada VT, Berson D, Finlay A, Goh CL, Herane MI, Kaminsky A, Kubba R, Layton A, Miyachi Y, Perez M, Martin JP, Ramos-E-Silva M, See JA, Shear N, Wolf J. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol 2009; 60:S1-50. [PMID: 19376456 DOI: 10.1016/j.jaad.2009.01.019] [Citation(s) in RCA: 438] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 01/06/2009] [Accepted: 01/10/2009] [Indexed: 12/13/2022]
Abstract
The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.
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Affiliation(s)
- Diane Thiboutot
- Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, USA.
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Lee DH, Choi YS, Min SU, Yoon MY, Suh DH. Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. J Am Acad Dermatol 2009; 60:801-7. [DOI: 10.1016/j.jaad.2008.11.883] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 11/03/2008] [Accepted: 11/19/2008] [Indexed: 12/22/2022]
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Abstract
Lasers frequently are used by dermatologists for their multiple aesthetic applications, but they also can be used to treat a variety of medical dermatology conditions. Conditions such as acne vulgaris, psoriasis, and vitiligo can all be successfully treated with laser, thereby providing the patient with additional therapeutic options. Lasers have also been used for years to improve the appearance of scars. The newer fractionated lasers have been especially effective in enhancing the clinical outcomes of scar revision.
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