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Ud-Din S, Bayat A. Controlling Inflammation Pre-Emptively or at the Time of Cutaneous Injury Optimises Outcome of Skin Scarring. Front Immunol 2022; 13:883239. [PMID: 35711461 PMCID: PMC9197255 DOI: 10.3389/fimmu.2022.883239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Inflammation plays an active role during the wound healing process. There is a direct association between the extent of injury as well as inflammation and the amount of subsequent cutaneous scarring. Evidence to date demonstrates that high levels of inflammation are associated with excessive dermal scarring and formation of abnormal pathological scars such as keloids and hypertrophic scars. In view of the multiple important cell types being involved in the inflammatory process and their influence on the extent of scar formation, many scar therapies should aim to target these cells in order to control inflammation and by association help improve scar outcome. However, most current treatment strategies for the management of a newly formed skin scar often adopt a watch-and-wait approach prior to commencing targeted anti-inflammatory therapy. Moreover, most of these therapies have been evaluated in the remodelling phase of wound healing and the evaluation of anti-inflammatory treatments at earlier stages of healing have not been fully explored and remain limited. Taken together, in order to minimise the risk of developing a poor scar outcome, it is clear that adopting an early intervention prior to skin injury would be optimal, however, the concept of pre-emptively priming the skin prior to injury has not yet been thoroughly evaluated. Therefore, the aim of this review was to evaluate the available literature regarding scar therapies that aim to target inflammation which are commenced prior to when a scar is formed or immediately after injury, with a particular focus on the role of pre-emptive priming of skin prior to injury in order to control inflammation for the prevention of poor scarring outcome.
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Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom.,Medical Research Council - South Africa (MRC-SA) Wound Healing Unit, Division of Dermatology, University of Cape Town, Cape Town, South Africa
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Schaffrick L, Ding J, Kwan P, Tredget EE. Molecular Features of Hypertrophic Scars After Thermal Injury: Is There a Biologic Basis for Laser Therapy? Adv Wound Care (New Rochelle) 2022; 11:163-178. [PMID: 34663086 DOI: 10.1089/wound.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Hypertrophic scars (HTS) and keloids are common after thermal injuries and other trauma to deep regions of dermis of the skin. These abnormal scars can cause contractures and the thick masses of scar tissue that result in functional and cosmetic impairment. Management of these dermal fibrotic conditions includes a wide range of medical and surgical treatments, which can be time consuming, only partially effective, and often uncomfortable for patients. Recent Advances: The molecular pathophysiology of HTS has become more understood over the past two decades, where thermal injury to the reticular dermis results in an inflammatory response, fibrogenic growth factor release, and the formation of a dermal scar with increased collagen and proteoglycan composition in an abnormal morphology. Lasers are becoming a widely used form of treatment for these types of scars; however, the evidence for the beneficial effects of laser treatments and the understanding of their mechanism of action are still evolving. Critical Issues: Paradoxically, laser delivery of thermal energy to the skin is suggested to improve scar remodeling and wound healing, yet HTS is a well-recognized complication of excessive thermal energy delivered by laser treatments. This review aims to examine the current evidence for the use of lasers for HTS, and to investigate the molecular mechanisms where re-injury of a burn scar from laser treatment could result in overall improvements in scar quality. Future Directions: Improved design of clinical trials for the treatment of scarring in the future will evolve from new methodology and models of HTS in animals and humans.
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Affiliation(s)
- Lindy Schaffrick
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Edward E. Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
- Department of Surgery, Division of Critical Care, University of Alberta, Edmonton, Canada
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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.
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Akerman L, Solomon-Cohen E, Rozenblat M, Hodak E, Lapidoth M, Levi A. 1064-nm Q-switched fractional Nd:YAG laser is safe and effective for the treatment of post-surgical facial scars. Lasers Med Sci 2020; 36:871-874. [PMID: 32845427 DOI: 10.1007/s10103-020-03134-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
Post-surgical facial scars are often associated with unaesthetic outcome. Treatment of these scars using various lasers could be beneficial; however, the use of the Q-switched fractional (QSF) 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has yet to be evaluated for this indication. Our objective was to determine the safety and efficacy of a QSF-Nd:YAG laser for the treatment of post-surgical facial scars. Eleven (5 male, 6 female) patients who underwent facial surgery with significant scarring were treated using the QSF-Nd:YAG laser. Scars were exposed to 600-1200 mJ/stacked pulses (12-24 mJ per pixel), emitted at a rate of 10 Hz for up to 2 passes per treatment session, receiving overall 3-6 treatments. Patient follow-up was 3 months. Scars' photographs were blindly assessed by two dermatologists, who graded them on a scale of scar severity from 1 to 5 (1 = least severe, 5 = most severe) before and after treatment. A blinded before/after recognition of these photographs was also performed. Patient satisfaction was assessed 3 months post-treatment and graded on a scale of 1-5 (1 = not satisfied, 5 = very satisfied). Pain perception and adverse effects were also evaluated. Patients demonstrated a decrease in scar severity score by a mean of 1.57 points (p = 0.0005). A blinded before/after recognition was correct in 86.5% of the cases. Pain and adverse effects were mild and transient. Patient satisfaction was high (4.2). QSF-Nd:YAG laser is a safe and effective modality for the treatment of post-surgical facial scars.
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Affiliation(s)
- Lehavit Akerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Solomon-Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel.
| | - Mati Rozenblat
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Emmilia Hodak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel
| | - Moshe Lapidoth
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel
| | - Assi Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel
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Liu XJ, Ouyang HW, Lei Y, Yu YL, Gold MH, Tan J. Moist exposed burn therapy in recovery of patients with immature, red hypertrophic scars successfully treated with a pulsed dye laser in combination with a fractional CO 2 laser. J Cosmet Dermatol 2020; 19:1353-1358. [PMID: 32441467 DOI: 10.1111/jocd.13426] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/01/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The efficacy of pulsed dye laser combined (PDL) and UltraPulse fractional CO2 in treatment of hypertrophic scars is well documented. The present study investigates the efficacy of moist exposed burn ointment (MEBO)/moist exposed burn therapy (MEBT) in postlaser wound management. METHODS Sixty-one patients with immature, red hypertrophic scars were enrolled in this clinical trial. Patients were randomly divided into two groups: (a) the MEBO treatment group (n = 30) and (b) the control group (n = 31) treated with chlortetracycline hydrochloride ointment. Demographic data such as age, gender, and cause of scars were recorded. A visual analogue score (VAS) was collected to measure pain at 1, 6, 24, 72 hours, and 7 days post-treatment. The Vancouver Scar Scale (VSS) was used to determine the response of the scars before and 3 months after the treatment. The wound healing time and pigmentation scores were also recorded. RESULTS No significant differences were found in age, gender, and etiology of the scars in the two groups. The VAS scores in MEBO group were significantly lower than the control group within the first 3 days after treatment. The wound healing time of the MEBO group was significantly shorter than the control group. For both groups, VSS scores were significantly decreased and the scar markedly improved. However, the VSS scores were significantly lower in the MEBO group compared with the control group 3 months after treatment and pigmentation formation was dramatically lower in MEBO group compared with the control. CONCLUSION MEBT/MEBO treatment reduced the post-treatment pain, shortened the wound healing duration, promoted the overall scar condition, and reduced the incidence of pigmentation.
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Affiliation(s)
- Xiao-Jia Liu
- Department of Plastic & Laser Cosmetic, Hunan Provincial People's Hospital, Changsha City, China
| | - Hua-Wei Ouyang
- Department of Plastic & Laser Cosmetic, Hunan Provincial People's Hospital, Changsha City, China
| | - Ying- Lei
- Department of Plastic & Laser Cosmetic, Hunan Provincial People's Hospital, Changsha City, China
| | - Yi-Ling Yu
- Department of Plastic & Laser Cosmetic, Hunan Provincial People's Hospital, Changsha City, China
| | | | - Jun Tan
- Department of Plastic & Laser Cosmetic, Hunan Provincial People's Hospital, Changsha City, China
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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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Rosenthal A, Kolli H, Israilevich R, Moy R. Lasers for the prevention and treatment of hypertrophic scars: a review of the literature. J COSMET LASER THER 2020; 22:115-125. [PMID: 32576064 DOI: 10.1080/14764172.2020.1783451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite the increasing knowledge about wound healing mechanisms and the advancements made in laser technology, hypertrophic scars remain difficult to manage. This review intends to discuss the laser devices studied in the prevention and treatment of HS, arising from trauma, surgery, and burns, detail their mechanisms of action, and emphasize those devices with the most promising effects. Most of the suggested mechanisms and explanations for the use of lasers in treating hypertrophic scars are based on selective photothermolysis, in which the light energy emitted from a laser is absorbed by its intended target, thereby disrupting existing collagen and altering the cycle of neocollagenesis. Through our literature review, we have determined that combination therapies, utilizing more than one laser target demonstrate enhanced clinical efficacy. Further, early use of laser devices has been shown to enhance the cosmetic result of sutured wounds and may play a role in preventing the development of hypertrophic scars.
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Affiliation(s)
- Amanda Rosenthal
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine , Miami, FL, USA.,Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
| | - Hiren Kolli
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
| | - Rachel Israilevich
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
| | - Ronald Moy
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
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Guida S, Bencini P, Pellacani G. Picosecond laser for atrophic surgical scars treatment:
in vivo
monitoring of results by means of reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2018; 33:e114-e116. [DOI: 10.1111/jdv.15289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. Guida
- Dermatology Unit Department of Surgical Medical, Dental and Morphological Science with Interest transplant Oncological and Regenerative Medicine University of Modena and Reggio Emilia via del Pozzo 71 41125 Modena Italy
- ICLID Istituto di Chirurgia e Laser‐Chirurgia in Dermatologia via della Moscova 42 20121 Milano Italy
| | - P.L. Bencini
- ICLID Istituto di Chirurgia e Laser‐Chirurgia in Dermatologia via della Moscova 42 20121 Milano Italy
| | - G. Pellacani
- Dermatology Unit Department of Surgical Medical, Dental and Morphological Science with Interest transplant Oncological and Regenerative Medicine University of Modena and Reggio Emilia via del Pozzo 71 41125 Modena Italy
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Lin L, Guo P, Wang X, Huo R, Li Q, Yin S, Cao Y. Effective treatment for hypertrophic scar with dual-wave-length PDL and Nd:YAG in Chinese patients. J COSMET LASER THER 2018; 21:228-233. [PMID: 30260709 DOI: 10.1080/14764172.2018.1516889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Li Lin
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Peng Guo
- Tuina Department, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Xining Wang
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Ran Huo
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Qiang Li
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Siyuan Yin
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
| | - Yongqian Cao
- Burns and Plastic Surgery, Provincial hospital affiliated to Shandong University, Jinan, China
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Optimizing Postsurgical Scars: A Systematic Review on Best Practices in Preventative Scar Management. Plast Reconstr Surg 2017; 140:782e-793e. [PMID: 28806293 DOI: 10.1097/prs.0000000000003894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scar management is critical for every plastic surgeon's practice and, ultimately, the patient's satisfaction with his or her aesthetic result. Despite the critical nature of this component of routine postoperative care, there has yet to be a comprehensive analysis of the available literature over the past decade to assess the best algorithmic approach to scar care. To this end, a systematic review of best practices in preventative scar management was conducted to elucidate the highest level of evidence available on this subject to date. METHODS A computerized MEDLINE search was performed for clinical studies addressing scar management. The resulting publications were screened randomized clinical trials that met the authors' specified inclusion/exclusion criteria. RESULTS This systematic review was performed in May of 2016. The initial search for the Medical Subject Headings term "cicatrix" and modifiers "therapy, radiotherapy, surgery, drug therapy, prevention, and control" yielded 13,101 initial articles. Applying the authors' inclusion/exclusion criteria resulted in 12 relevant articles. All included articles are randomized, controlled, clinical trials. CONCLUSIONS Optimal scar care requires taking into account factors such as incisional tension, anatomical location, and Fitzpatrick skin type. The authors present a streamlined algorithm for scar prophylaxis based on contemporary level I and II evidence to guide clinical practice.
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Salah el din MM, Samy NA, Salem AE. Comparison of pulsed dye laser versus combined pulsed dye laser and Nd:YAG laser in the treatment of inflammatory acne vulgaris. J COSMET LASER THER 2017; 19:149-159. [DOI: 10.1080/14764172.2016.1262962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Nevien Ahmed Samy
- National Institute of Laser Enhanced Sciences, Cairo University, Cairo, Egypt
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Zhao H, Li S, Nabi O, Hu L, Gao X, Luo F. Treatment of axillary bromhidrosis through a mini-incision with subdermal vascular preservation: a retrospective study in 396 patients. Int J Dermatol 2016; 55:919-25. [PMID: 27207185 DOI: 10.1111/ijd.13313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/31/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Hengguang Zhao
- Department of Dermatology; the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Shuang Li
- Department of Dermatology; Chongqing Third People's Hospital; Chongqing China
| | - Owais Nabi
- Department of Dermatology; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Li Hu
- Department of Dermatology; the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Xi Gao
- Department of Dermatology; University-Town Hospital of Chongqing Medical University; Chongqing China
| | - Fuling Luo
- Department of Pharmacy; the First Affiliated Hospital of Chongqing Medical University; Chongqing China
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