Laser combined with radiotherapy for keloid treatment: a novel and efficient comprehensive therapy with a lower recurrence rate

Abstract

With keloids, a fibroproliferative skin disorder characterized by gradually spreading skin involvement, patients not only have cosmetic disfigurement and functional impairment but also psychological burden. Available treatments include intralesional corticosteroid or 5-fluorouracil injection, surgical excision, laser therapy, radiotherapy, pressure therapy, and application of silicone gel. Despite the variety of available treatment methods, the recurrence rate remains high. 1 Laser is a fast-growing treatment that has been used in keloid treatment since 1984. 2 Traditionally, nonablative and ablative lasers are used primarily for prevention and treatment. Nonablative lasers, such as pulsed dye lasers (PDL), can improve symptoms and appearance but have little effect on reducing volume. 3 Ablative laser devices, including CO 2 lasers and Er:YAG lasers, produce microthermal injuries on the skin; then, the process of fibroblast proliferation and collagen remodeling Background: Keloids are a fibroproliferative skin disorder with a high recurrence rate. Combined therapies are often used in clinical treatment, but, in addition to the relatively high risk of relapse and complexity of the treatment process, side effects remain unknown for combination therapies. Methods: A total of 99 patients with keloids in 131 positions were included in this retrospective study. Fractional CO 2 laser therapy was first applied with energy ranging from 360 to 1008 mJ; then, 6-Mev, 900-cGy electron beam irradiation was applied twice. The first pass was initiated within 24 hours after the laser therapy, and the second pass was performed on the seventh day after laser therapy. The Patient and Observer Scar Scale evaluated the lesions before the treatment and at 6, 12, and 18 months after treatment. At each follow-up visit, the patients filled out a questionnaire on recurrence, side effects, and satisfaction. Results: The authors found a significant decrease in total Patient and Observer Scar Scale score [29 (23, 39) versus 61.2 ± 13.4; P < 0.001] at the 18-month follow-up compared with the baseline value (before the therapy). A total of 12.1% of the patients had recurrences during the 18-month follow-up period (11.1% partial recurrence and 1.0% complete recurrence). The total satisfaction rate was 97.0%. No severe adverse effects were observed during the followup period. Conclusions: Laser combined with radiotherapy is a new comprehensive therapy comprising ablative lasers and radiotherapy for keloids. It had excellent clinical efficacy, low recurrence rate, and no serious adverse effects. (Plast.

Application of fractional carbon dioxide laser monotherapy in keloids: A meta‐analysis

“…22,23 In recent years, with the advancement of optoelectronic technology and a public focus on aesthetics, laser therapy has been widely used in clinical practice because of its advantages such as less trauma, faster recovery, and significant improvement in scar appearance. [24][25][26] Because of its low efficiency and high recurrence 95% CI: −1.17 to −0.63) were significantly improved after fractional CO 2 laser treatment for keloids, although vascularity did not significantly change. However, there was significant heterogeneity (I 2 = 98.0%, p = 0.000) in the analysis of vascularity, challenging the confidence in this aspect of our results.…”

“…However, laser‐assisted 5‐FU delivery tended to show a higher extent of improvement in scar characteristics than laser‐assisted verapamil hydrochloride delivery, without significance 25 . The latest study also found that fractional CO 2 laser combined with radiotherapy is a new comprehensive therapy composed of ablative lasers and radiotherapy for keloids with excellent clinical efficacy, low recurrence rate and no serious adverse effects 26 . Therefore, future studies will focus on exploring the efficacy and safety of fractional CO 2 laser combined with keloids.…”

“…new comprehensive therapy composed of ablative lasers and radiotherapy for keloids with excellent clinical efficacy, low recurrence rate and no serious adverse effects. 26 Therefore, future studies will focus on exploring the efficacy and safety of fractional CO 2 laser combined with keloids. If conditions permit, meta-analysis can be carried out to compare the efficacy of fractional CO 2 laser combined with different drugs.…”

“…In recent years, with the advancement of optoelectronic technology and a public focus on aesthetics, laser therapy has been widely used in clinical practice because of its advantages such as less trauma, faster recovery, and significant improvement in scar appearance 24–26 . Because of its low efficiency and high recurrence rates, the conventional CO 2 laser has been supplanted by the fractional CO 2 laser.…”

A Novel Method for Patients With Ear Keloid

“…These methods include surgical excision, compression therapy, radiotherapy, topical silicone bands, silicone gels, intralesional injections (steroids, verapamil, bleomycin, 5-fluorouracil, botolinum toxin type A, platelet rich plasma), cryotherapy, and laser treatments. [4][5][6][7][8] When only surgical excision is performed, the recurrence rate varies between 45% and 100%. For this reason, keloid treatment is a very difficult process, and due to these high recurrence rates, it is recommended to use surgical treatment in combination with other methods as recurrence rates decrease when combined treatments are used.…”