No abstract

Background. Scars are an inevitable consequence and the final outcome of the restoration of the skin, after injuries, thermal effects on the skin, and are also formed as a result of the resolution of rash elements in various infectious skin diseases, with adverse wound healing after plastic surgery and cosmetic procedures. According to WHO data for 2020, scar complications affect about 10% of the world's population, which is approximately 600 million people. High-intensity laser therapy technologies are considered by experts to be the "gold" standard in the correction of pathological scars, but a significant number of them are updated by the personalized approach developed in the last decade, aimed at individualizing treatment, searching for predictors of the effectiveness of various methods, taking into account a number of basic mechanisms of pathogenesis. Aims: Scientific substantiation of the concept of personalized high-intensity laser therapy for patients with pathological skin scars. Materials and methods. We studied 306 patients with atrophic (n=115), hypertrophic (n=100) and keloid (n=91) scars, which were divided into subgroups with emerging (formation period up to 1.5 years) and mature scars. Genetic, phenotypic, clinical, instrumental, laboratory, and medical-sociological methods were used to study the patient's condition and scar tissue. Laser therapy combinations were used: fractional ablative photothermolysis, homogeneous photothermolysis, planar ablative photodestruction, selective angiophotothermolysis, and fractional selective photothermolysis. Results. It was found that various combinations of high-intensity laser therapy in patients with pathological skin scars cause a significant regression of clinical signs, restore the microrelief of tissues, improve the functional properties of scars (elasticity, elasticity, moisture, vascularization, etc.), which is accompanied by an improvement in the quality of life of patients. The complex of laser technologies forms a pronounced refibromodeling therapeutic effect in patients with pathological skin scars. Conclusion. The concept of personalized (variant) high-intensity laser therapy in patients with atrophic, hypertrophic and keloid scars, which determines the dependence of the effectiveness of various options for laser correction of pathological scars on the genetic, phenotypic, clinical, morphofunctional and medical-sociological characteristics of patients, is scientifically substantiated. The determinants of the effectiveness of laser technologies have been identified, taking into account which allows the productive use of high-intensity laser radiation in patients with atrophic, hypertrophic and keloid skin scars.

Due to the fact that the basis of hypertrophic scars is a coarse, richly vascularized fi brillar protein — collagen, laser ablation is promising for suppressing its growth, and selective laser angiophotothermolysis is promising for reducing the degree of vascularization. To improve the efficiency of scar remodeling, the development of methods of complex laser correction is relevant. The purpose of the study: to determine the therapeutic eff ects of various combinations of high-intensity laser therapy (HILT) in patients with hypertrophic scars at different times of their formation. Methods. 44 patients (26 women and 18 men) with developing and mature hypertrophic scars were examined. In patients with developing scars, a combination of selective angiophotothermolysis (λ = 0,578 μm) and subsequent fractional ablative photothermolysis (λ = 10,6 μm) was used, and in patients with mature scars, a combination of selective angiophotothermolysis (λ = 0,578 μm) followed by planar ablative photodestruction (λ = 10,6 μm) was applied. Dermatoscopic methods for assessing the functional properties of the skin, assessment of microcirculation, morphometric analysis of scars and assessment of the quality of life of patients were used. Results. A decrease in the thickness of the epidermis was found due to a reduction in the thickness of all its layers, especially the spiny layer, with an increase in the volume of keratinocytes of the granular layer. In patients with developing hypertrophic scars, a decrease in the predominantly variable component of blood fl ow was observed, while in patients with mature scars, changes in its constant component prevailed. An increase in the quality of life indicators according to the DIQL scale, more pronounced in patients with developing scars, was noticed. The effectiveness of HILT in patients with developing scars was 82 %, with mature — 74 %. Conclusion. Combined high-intensity laser therapy effectively remodels hypertrophic skin scars with different periods of their formation.

The multifactorial genesis of collagen synthesis disorders in atrophic scars suggests the need to develop combined methods of scar tissue remodeling. Objective: to determine the therapeutic effects of various combinations of high-intensity laser therapy (HILT) in patients with traumatic atrophic scars. Methods: 34 patients were studied in two groups with developing (N = 15) and mature (N = 19) skin scars. Homogeneous photothermolysis (λ = 1,064 microns) followed by fractional photothermolysis by laser radiation (λ = 10,6 microns) was used in patients with developing scars, and homogeneous photothermolysis (λ = 1,064 microns) and planar ablative laser photodestruction (λ = 10.6 microns) of scars were applied in patients with mature scars. Dermatoscopic methods were used to assess the functional properties of the skin, morphometric analysis of scars, assessment of the quality of life and integral effectiveness of HILT in patients. Results: An improvement in the functional properties of atrophic scars was found mainly due to smoothing the borders with the surrounding skin, restoring the thickness of the epidermis by reducing the thickness of all layers, especially the spiny layer with an increase in the volume of keratinocytes of the granular layer. As a result of the course of treatment, an improvement in the quality of life indicators on the DQLI scale was revealed. The effectiveness of HILT in patients with developing scars was 81 %, with mature — 75 %. Conclusion: A comparative analysis of the dynamics of the state of developing and mature scars under the influence of various protocols of high-intensity laser therapy will allow individualizing their use in the schemes of atrophic scars correction.