Comparison of the effectiveness of pulsed dye laser vs pulsed dye laser combined with ultrapulse fractional CO₂ laser in the treatment of immature red hypertrophic scars

Abstract

Summary Introduction The objective was to investigate the clinical effect of an adjustable pulse width Pulsed Dye Laser (PDL) vs an adjustable pulse width PDL combined with fractional CO2 laser in treating immature red hypertrophic scars. Methods Fifty‐six patients (56 sites)were randomly divided into a treatment group and control group. The control group was treated with the 595 nm PDL at a fluence of 7‐15J/cm2 and pulse widths of 1.5‐3 ms, 7 mm spot size. The treatment group was treated with a fractional CO2 laser (UltraPulse CO2: Deep FX, Energy: 30~50 mJ, Frequency: 300 Hz, Density 5%, Scan Shape, and Spot Size were decided by shape and area of scar) after utilizing the 595 nm adjustable pulse width PDL (Fluence: 7‐15J/cm2, Pulse widths: 1.5‐3 ms, Spot size: 7 mm). MEBT/MEBO, previously described as a post‐treatment wound ointment, was used after laser treatment. The scars of the treatment group and the control group were evaluated for changes in pigment, height, vascularity, and pliability using the Vancouver Scar Scale (VSS) after two laser treatments. Results The total VSS score, as well as the score for melanin, height, vascularity, pliability in both groups, showed an obvious decrease following the treatments. There were statistically significant differences between before treatment and after treatment (P < .05); however, the total score of the VSS, and score of the melanin, height, vascularity, and pliability in the control group decreased more than that of treatment group, and there was a statistically significant difference (P < .05). Conclusions The 595 nm adjustable pulse width PDL combined with the fractional CO2 fractional laser appears to have a beneficial clinical effect on fresh red hypertrophic scars, with no severe adverse reactions seen.

Laser Therapy of Traumatic and Surgical Scars and an Algorithm for Their Treatment

“…The PDL reduces scar hypertrophy by suppressing fibroblast proliferation, reducing TGF‐β, and connective tissue growth factor (CTGF), promoting extracellular signal‐related kinases (ERK) and increasing p38‐mediated fibroblast apoptosis . For hypertrophic scars with a height greater than 3 mm, combination therapies with PDL and fractional technologies are often more effective . NAFR must be performed at low densities for immature/unstable scars, but more aggressive NAFR or AFR can be used in mature/stable scars with improved results.…”

Nonvascular uses of pulsed dye laser in clinical dermatology

“…The authors surmise the use of PDL lasers in keloid scars, demonstrating PDL and ablative lasers (such as the CO 2 laser) are the most widely trialed lasers for keloid scars . We reviewed 22 studies over the last 20 years for the use of PDL independently or in comparison or conjunction/comparison to Erbium‐glass laser, fractional CO 2 laser, Nd:YAG, botulinum toxin, KTP, low‐level laser, different parameters and wavelengths of PDL, triamcinolone/5‐FU, IPL in 477 scars including: hypertrophic, keloidal, burns, and traumatic.…”

“…All treatment modalities demonstrated improvement in scar outcome, however, when comparing PDL to the alternative modalities stated above the majority showed no significant improvement between treatment arms. Ouyang et al demonstrated that 595‐nm PDL alone to treat immature red hypertrophic scars had better outcome than combination of PDL with CO 2 (ablative) laser ( P < 0.05) in comparison with Park et al who found combination treatment with PDL and 1550‐nm erbium‐glass fractional laser showed a clinical improvement . Kim et al compared scar prevention between CO 2 laser and PDL using split‐scar analysis.…”

Minimally Invasive Technologies for Treatment of HTS and Keloids: Pulsed-Dye Laser

“…Ouyang et al (2018) reached significant improvement in height, vascularity, pliability, and Vancouver Scar Scale in 56 patients with fresh (immature), red hypertrophic scars [22], suggesting an early application and possible prevention strategy in conjunction with a recommendation of an international panel of experts [23].…”