With keloids, a fibroproliferative skin disorder characterized by gradually spreading skin involvement, patients not only have cosmetic disfigurement and functional impairment but also psychological burden. Available treatments include intralesional corticosteroid or 5-fluorouracil injection, surgical excision, laser therapy, radiotherapy, pressure therapy, and application of silicone gel. Despite the variety of available treatment methods, the recurrence rate remains high. 1 Laser is a fast-growing treatment that has been used in keloid treatment since 1984. 2 Traditionally, nonablative and ablative lasers are used primarily for prevention and treatment. Nonablative lasers, such as pulsed dye lasers (PDL), can improve symptoms and appearance but have little effect on reducing volume. 3 Ablative laser devices, including CO 2 lasers and Er:YAG lasers, produce microthermal injuries on the skin; then, the process of fibroblast proliferation and collagen remodeling Background: Keloids are a fibroproliferative skin disorder with a high recurrence rate. Combined therapies are often used in clinical treatment, but, in addition to the relatively high risk of relapse and complexity of the treatment process, side effects remain unknown for combination therapies. Methods: A total of 99 patients with keloids in 131 positions were included in this retrospective study. Fractional CO 2 laser therapy was first applied with energy ranging from 360 to 1008 mJ; then, 6-Mev, 900-cGy electron beam irradiation was applied twice. The first pass was initiated within 24 hours after the laser therapy, and the second pass was performed on the seventh day after laser therapy. The Patient and Observer Scar Scale evaluated the lesions before the treatment and at 6, 12, and 18 months after treatment. At each follow-up visit, the patients filled out a questionnaire on recurrence, side effects, and satisfaction. Results: The authors found a significant decrease in total Patient and Observer Scar Scale score [29 (23, 39) versus 61.2 ± 13.4; P < 0.001] at the 18-month follow-up compared with the baseline value (before the therapy). A total of 12.1% of the patients had recurrences during the 18-month follow-up period (11.1% partial recurrence and 1.0% complete recurrence). The total satisfaction rate was 97.0%. No severe adverse effects were observed during the followup period. Conclusions: Laser combined with radiotherapy is a new comprehensive therapy comprising ablative lasers and radiotherapy for keloids. It had excellent clinical efficacy, low recurrence rate, and no serious adverse effects. (Plast.

Background: Various laser therapies have been introduced in scar management. However, pain during treatment has limited the application of laser therapy in pediatrics.Objectives: To evaluate whether the use of the low-energy mode of a carbon dioxide (CO 2 ) laser improves hypertrophic scars in a pediatric population. Methods: This prospective, randomized, split-scar trial was designed to assess the safety and efficacy of low-energy CO 2 laser use. Patients aged <12 years with hypertrophic scars were enrolled. Each hypertrophic scar was equally divided into three parts: the two ends of each scar were randomly assigned to control and experimental groups, and the center portion was considered a transition zone and was not included in the analysis. A total of three laser treatments were performed at 1-month intervals. Scar scale scores 6 months after the final treatment was the primary outcome. Additionally, the Visual Analog Scale (VAS) was used to evaluate pain after each treatment. Results: Of the 23 patients enrolled, 20 completed the study. The total Patient and Observer Scar Assessment Scale (POSAS) score at the 6-month follow-up was significantly lower for the treated site (44.95 for the treated group vs. 64.85 for the control group, p < 0.0001). Both the patient and observer POSAS scores showed an obvious difference between the treated and control groups (19.95 vs. 29.95 for patient scores, respectively, p < 0.0001, and 26.00 vs. 34.90 for observer scores, respectively, p < 0.0001). All observer and patient scores describing pain, pruritus, color, stiffness, and thickness were statistically different and favored the treated site. No significant difference was found in patient score of irregularity. The average VAS therapeutic pain score was 3.5 ± 1.43 out of 10. Conclusions: Low-energy CO 2 fractional laser therapy improved hypertrophic scars in a pediatric population. Therefore, for children with hypertrophic scar, low-energy CO 2 laser with less procedure pain may be more appropriate.