Clinical and histologic effects from CO2 laser treatment of keloids

Abstract

Keloids and hypertrophic scars are abnormal responses to wound healing. In general, keloids exhibit a proliferative growth beyond the margins of the scar and remain persistent; while hypertrophic scars are contained to the original wound and may regress over time. In particular, keloid formation is one of the most challenging clinical problems, with increasing frequency in surgical practice. Many treatments are available such as intralesional corticosteroids, topical applications, cryotherapy, surgical excision, radiation therapy, silicone gel sheeting, pressure therapy, and laser therapy. There are no set guidelines for the treatment of keloids and the most common treatments are individualized and depended on the distribution, size, thickness, and consistency of lesions. The authors have evaluated carbon dioxide laser successfully in the treatment of keloids and the aim of this study was to determine the immediate and long-term histologic and clinical effects of keloids after carbon dioxide laser. Fifty consecutive patients (40 females, 10 males, ages 18-60 years, mean age 40 years) with moderate to severe keloids were evaluated. All the patients received regional treatments (deltoid, elbow, chin, and ear) in an outpatient setting with a high-energy pulsed CO2 laser. Significant immediate and prolonged clinical improvement in skin tone, texture, and appearance of carbon dioxide laser was examined in all patients. Dermal remodeling was observed also on histologic examination of biopsied tissue after treatment. Carbon dioxide laser appears to be effective and well tolerated for the treatment of keloids, avoiding the adverse effects and lengthy recovery time.

Efficacy of fractional CO2 laser with intralesional steroid compared with intralesional steroid alone in the treatment of keloids and hypertrophic scars

“…Intralesional steroid (ILS) has been one of the most commonly used treatment modalities in keloid therapy . When intralesional steroid was combined with other modalities like 5 fluorouracil and ablative fractional CO 2 laser (FCL), it produced a better result compared to intralesional steroid alone …”

“…2 When intralesional steroid was combined with other modalities like 5 fluorouracil and ablative fractional CO 2 laser (FCL), it produced a better result compared to intralesional steroid alone. 4,6,7 Recent advances in laser technology have provided newer options for improvement in function, symptoms, and cosmetic appearance of keloids and HTS. FCL therapy leads to the formation of zones of ablation at variable depths of the skin with the subsequent response involving wound healing and collagen remodeling.…”

Strategic management of keloid disease in ethnic skin: a structured approach supported by the emerging literature

“…Historically, a number of treatment modalities such as cryotherapy, 23 interferon 24 and veramapril 25 have been utilized for treating KD, with inconsistent levels of success. However, more recent treatments such as lasers, 26 intralesional steroid injections, 27 silicone gel, 28 5-fluorouracil (FU), 29 radiotherapy, 30 bleomycin, 31 imiquimod, 32 photodynamic therapy (PDT), 33 electrical stimulation (ES) 34 and surgery 35 have also been used in the management of KD, but not all have shown efficacy in ethnic pigmented skin. These commonly available and newly emerging treatment modalities (Table 3) will be discussed in detail below.…”

Algorithm of chest wall keloid treatment

“…[5–8] A chest wall keloid has a higher recurrence rate due to multiple reasons. [9–13] The proper treatment should be free of tension with a smooth healing process.…”