Beneath the Surface: A Review of Laser Remodeling of Hypertrophic Scars and Burns

Abstract

Significance: Hypertrophic scars, keloids, and burn injuries of the skin have a significant impact on patients' lives and impact the health care system tremendously. Treating skin wounds and lesions can be challenging, with a variety of choices available for treatment. Scar and burn managements range from invasive, surgical options such as scar excision to less invasive, nonsurgical alternatives such as laser therapy or topical drug application. Recent Advances: Laser treatment has become increasingly popular, with a growing body of research supporting its use for scars and burns. Numerous methods are available for the treatment of these skin diseases, including different nonsurgical laser therapies. Critical Issues: To date, the optimal treatment method for scars, keloids, and burn injuries of the skin has not yet been established, although it is an area of increasing clinical concern. Future Directions: This review provides an updated summary of the treatment of scars and burn wounds of the skin using different laser treatments, including the most recent technologies. It addresses their indications, mechanisms of action, differences, efficacies, and complications.

Fractional CO2 laser combined with 595-nm PDL inhibiting hypertrophic scars via measuring BMP-7 and Fas expression in rabbit models

“…Untreated HSs can also bring about some physiological and psychological disturbance from cosmetic dis gurement and even economic burden for the victims [2]. Clinically, lasers of diverse parameters are recognized as effective and safe treatment options for HSs, especially fractional CO2 laser and 595-nm PDL [5][6][7][8][9][10][11][12][13][14]. The primary mechanisms of the two laser systems may be involved in some inter-cell factors and pathways in skin resurfacing, such as BMP-7 and Fas expression [29-33, 45, 46].…”

“…Hypertrophic scar (HS) represents a frequent complication in abnormal wound healing, and remains intractable in its treatment [1][2][3], because abnormal and excessive broblast growth and collagen deposition play critical roles in the process of HS formation [3][4][5][6]. HSs are characterized by signs of hard and red nodules, and symptoms of pain and itch, and treatment of them primarily rely on corticosteroid injection, laser therapy and surgery [4][5][6][7][8]. Fractional CO2 laser(FCO2L) and 595-nm pulsed dye laser (PDL) are selective phototherapeutics, and have been validated to be effective in therapy of HS [9][10][11][12][13][14], yet their underlying mechanisms remain unclear, and need validation through measurement of bone morphogenetic protein-7(BMP-7) and Fas gene, the two important proteins that affect the prognosis of this condition on molecular study basis.…”

Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods: An Update

“…Pulsed dye laser (PDL) and fractional ablative CO 2 laser are also becoming increasingly popular, with a growing body of research supporting their use for the management of HTSs and keloids. However, the level of evidence of their efficacy remains low [11]. Ablative fractional laser therapies have been shown also to improve the uptake of topical agents into all skin layers in animal experimental models.…”

“…Ablative fractional laser therapies have been shown also to improve the uptake of topical agents into all skin layers in animal experimental models. However, laser-assisted drug delivery (LAD) efficacy still needs to be demonstrated in long-term studies on humans [11].…”

“…Despite increasing clinical concern and tremendous progress in our understanding of wound healing biology and kinetics and despite the many proposed intervention pathways, effective and optimal treatment method for scars and keloids to date is still illusive [11]. With the current state of knowledge, the recommendation remains that treatment of pathologic scars must be individualized and that the combination approach of surgery and adjuvant therapy, such as steroid injections and silicone materials, remains the best option, considering as well promising results of readily available, simple, and cost-effective laser therapy, microneedling and microfat grafting.…”