Application of high-intensity laser radiation for correction of hypertrophic scars

Abstract

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.