Comparison Between Er: Yag and Co2 Ablative Fractional Lasers in The Treatment of Keloid and Hypertrophic Scars: Histopathological, Immuno-Histochemical and Ultrastructural Study

Abstract

Background: Scarring is a frequent occurrence, since it results from skin damage in individuals of all ages. This work aimed compare clinical results and effect on histopathological architecture and expression of CTGF of the ablative fractional 10,600-nm CO 2 and 2,940 nm Er:YAG lasers in keloid and hypertrophic scars treatment. Methods: that randomized, prospective, double-blinded comparative study included 60 individuals (Fitzpatrick skin type II to V), that are diagnosed clinically and histopathologically with hypertrophic scars. Those were split into 2 groups; 30 patients in group I (Fractional Er:YAG laser), and 30 patients in group II (fractional CO 2 laser). Results: A substantial decrease in post treatment VSS with fractional ablative Er:YAG and Co2 lasers mostly as a result of improved vascularity, pliability and to a lesser extent in height with Er:YAG ,while after CO 2 improvement was significant in height and pliability only. Histopathological examination of skin biopsies in current study, showed that there were increased thickness of epidermis and irregular collagen bands replacement with parallel new collagen fibril organisation after fractional ablative Er:Yag. Immunohistochemical staining of CTGF showed significant reduction 6 months follwoing fractional Erbium YAG and CO2 laser treatment with prominent decrease after Fr Er: YAG. Conclusions: Fractional ablative lasers including both CO2 and Er:YAG have combined impressive ablative laser results with greater protection profile of nonablative lasers. Fractional ablative Er:YAG laser mainly improve vascularity and pliability of hypertrophic scars while Co2 improvement was significant in height and pliability.

A Comprehensive Review of Non-Surgical Treatments for Hypertrophic and Keloid Scars in Skin of Color

“…68 Notably, in all patients, improvements in pigmentation were noted and no dyschromia was observed. 68 Consensus among clinicians generally supports the usage of fractional CO 2 laser over erbium-based treatment within the general population; however, this preference reverses specifically for patients with skin of color. 62 For FSTs IV-VI, the lower risk of PIH favors Er:YAG energy-based devices.…”

“…68 Patients treated specifically with Er:YAG revealed replacement of disorganized collagen fibers with parallel organization on histological examination. 68 Notably, in all patients, improvements in pigmentation were noted and no dyschromia was observed. 68 Consensus among clinicians generally supports the usage of fractional CO 2 laser over erbium-based treatment within the general population; however, this preference reverses specifically for patients with skin of color.…”

“…In a 2023 study, Elsaid et al demonstrated the ability of an Er:YAG laser to reduce vascularity and improve pliability in patients with skin types II–V, whereas CO 2 laser improved pliability and significantly reduced height. 68 Patients treated specifically with Er:YAG revealed replacement of disorganized collagen fibers with parallel organization on histological examination. 68 Notably, in all patients, improvements in pigmentation were noted and no dyschromia was observed.…”

Enhancement of drug permeation across skin through stratum corneum ablation

“…However, RF, in the depth range of ±80–90 μm, had an average fluorescence intensity of 15.27 AU, and it was not effective like AFLs and microneedles. 86 Furthermore, Elsaid et al 87 conducted a comparison of 60 patients suffering from hypertrophic scars. 30 patients received treatment with the AFL–Er:YAG, while another 30 received treatment with AFL–CO 2 .…”

“…AFLs and microneedles. 86 Furthermore, Elsaid et al 87 conducted a comparison of 60 patients suffering from hypertrophic scars. 30 patients received treatment with the AFL-Er: YAG, while another 30 received treatment with AFL-CO 2 .…”