The Use of Laser in Keloid and Hypertrophic Scar

Authors

  • Odelia Jovita Jusuf Fantoni Dermatology and Venereology Department, Sriwijaya University, Dr. Moh. General Hospital, Palembang, Indonesia
  • Yuli Kurniawati Department of Dermatology and Venereology, Faculty of Medicine, Sriwijaya University; Dr. Mohammad Hoesin General Hospital, Palembang, South Sumatera, Indonesia
  • Sarah Diba Department of Dermatology and Venereology, Faculty of Medicine, Sriwijaya University; Dr. Mohammad Hoesin General Hospital, Palembang, South Sumatera, Indonesia
  • Nopriyati Department of Dermatology and Venereology, Faculty of Medicine, Sriwijaya University; Dr. Mohammad Hoesin General Hospital, Palembang, South Sumatera, Indonesia
  • M. Izazi Hari Purwoko Department of Dermatology and Venereology, Faculty of Medicine, Sriwijaya University; Dr. Mohammad Hoesin General Hospital, Palembang, South Sumatera, Indonesia

Keywords:

keloid, hpertrophic scar, laser, photothermolysis

Abstract

Keloid and hypertrophic scar are hyperproliferation of dense connective tissue characterized by the growth of fibrotic tissue. The pathogenesis of keloid and hypertrophic scar is still expanding, hence there is no optimal therapy. Laser is one of the modalities of keloid and hypertrophic scar therapy. Laser’s modality which can be used for keloid and hypertrophic scar are pulsed dye laser (PDL), carbon dioxide (CO2) lasers, neodymium-doped yttrium aluminum garnet (Nd: YAG) lasers, fractional laser as well as laser assisted drug delivery (LADD) techniques. The target of laser is the selective photothermolysis with chromophores of hemoglobin and water. The mechanism of laser causing coagulation necrosis is by generating heat, resulting in neocolagenesis, while LADD is a technique of laser to assist application of drugs, such as triamcinolone acetonide. Benefit of laser is less painful thus can be an option for extensive scar. Purpose of this study is to determine the role of lasers as a treatment modality for keloid and hypertrophic scar to improve clinical skills of clinician. Keywords: keloid, hypertrophic scar, laser, photothermolysis

References

Lovell CR. Abnormal fibrotic responses to skin injury: keloids and hypertrophic scars. In: Griffiths CE, Barker J, Blelker B, Chalmers R, Creamer D, editors. Rook’s Textbook of Dermatology. 9th ed. Oxford: Wiley Blackwell; 2016. p. 96.45-9.

Ogawa R, Akita S, Akaishi S, Aramaki-Hattori N, Dohi T, Hayashi T, et al. Diagnosis and Treatment of Keloids and Hypertrophic Scars—Japan Scar Workshop Consensus Document 2018. Burn Trauma. 2019;7:1–40.

Lee HJ, Jang YJ. Recent understandings of biology, prophylaxis and treatment strategies for hypertrophic scars and keloids. Int J Mol Sci. 2018;19(3).

Berman B, Maderal A, Raphael B. Keloids and hypertrophic scars: Pathophysiology, classification, and treatment. Dermatologic Surg. 2017;43:S3–18.

Annabathula A, Sekar CS SC. Fractional carbon dioxide, long pulse Nd:YAG and pulsed dye laser in the management of keloids. J cutan Aesthet Surg. 2017;10:76–80.

Ogawa R. Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci. 2017;18(3).

Chan Y-C. Vascular lasers in the Asian skin. In: Tay Y-K, Chan Y-C, editors. Textbook of Laser and Light Dermatology in tTe Asian Skin. Singapore: World Scientific; 2011. p. 27–36.

Machan S, Molina-Ruiz AM RL. Dermal hypertrophies. In: Bolognia JL, Schaffer J V, Cerroni L, editors. Dermatology. 4th ed. United States: Elsevier; 2018. p. 1712–22.

Alavi A KR. Wound Healing. In: Kang S, Amagai M, Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 2700–17.

Betarbet U, Blalock TW. Keloids: A review of etiology, prevention, and treatment. J Clin Aesthet Dermatol. 2020;13(2):33–43.

Mokos ZB, Jović A, Grgurević L, Dumić-Čule I, Kostović K, Čeović R, et al. Current therapeutic approach to hypertrophic scars. Front Med. 2017;4(JUN):1–11.

Bouzari N, Davis SC, Nouri K. Laser treatment of keloids and hypertrophic scars. Int J Dermatol. 2007;46(1):80–8.

Kuehlmann B, Stern-Buchbinder Z, Wan DC, Friedstat JS, Gurtner GC. Beneath the Surface: A Review of Laser Remodeling of Hypertrophic Scars and Burns. Adv Wound Care. 2019;8(4):168–76.

Gauglitz GG. Management of keloids and hypertrophic scars: Current and emerging options. Clin Cosmet Investig Dermatol. 2013;6:103–14.

Small R. Introduction and foundation concepts. In: Small R, Hoang D, editors. A Practical Guide to Laser Procedures. Philadelphia: Wolters Kluwer; 2016. p. 5–50.

Ibrahim O, Dover JS. Fundamentals of Laser and Light-Based Treatments. In: Kang S, Amagai M, Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw-Hill Education; 2019. p. 3820–33.

Klifto KM, Asif M, Hultman CS. Laser management of hypertrophic burn scars: a comprehensive review. Burn Trauma. 2020;8(00):1–8.

Sardana K, Garg VK, Bansal S, Sandhu J, Daulaguphu T. Basic of laser-tissue interactions. In: Sardana K, Garg VK, editors. Laser in Dermatological Practice. Kathmandu: Jaypee Brothers Medical Publishers (P) LTD; 2014. p. 1–24.

Kim YH, Kim B. Scar Treatment Using 585-nam Pulsed Dye Laser. Med Lasers. 2016;5(1):17–21.

Sardana K. Lasers for scars, keloids, and stretch marks. In: Sardana K, Garg VK, editors. Laser in Dermatological Practice. Kathmandu: Jaypee Brothers Medical Publishers (P) LTD; 2014. p. 361–73.

Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: Pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1–2):113–25.

Tawfic SO, El-Tawdy A, Shalaby S, Foad A, Shaker O, Sayed SS, et al. Evaluation of Fractional CO2 Versus Long Pulsed Nd:YAG Lasers in Treatment of Hypertrophic Scars and Keloids: A Randomized Clinical Trial. Lasers Surg Med. 2020;(April):1–7.

Vejjabhinanta V, Patel SS NK. Laser for scars. In: Nouri K, editor. Lasers in Dermatology and Medicine. 2nd ed. Switzerland: Springer; 2018. p. 63–71.

De Las Alas JMG, Siripunvarapon AH, Dofitas BL. Pulsed dye laser for the treatment of keloid and hypertrophic scars: A systematic review. Expert Rev Med Devices. 2012;9(6):641–50.

Al-Mohamady AESAEH, Ibrahim SMA, Muhammad MM. Pulsed dye laser versus long-pulsed Nd:YAG laser in the treatment of hypertrophic scars and keloid: A comparative randomized split-scar trial. J Cosmet Laser Ther. 2016;18(4):208–12.

Sardana K, Narayan V, Ranjan R. Ablative lasers. In: Sardana K, Garg VK, editors. Laser in Dermatological Practice. Kathmandu: Jaypee Brothers Medical Publishers (P) LTD; 2014. p. 25–51.

Kwok C. Carbon Dioxide Laser Surgery in the Asian Skin. In: Tay Y-K, Chan Y-C, editors. Textbook of Laser and Light Dermatology in The Asian skin. Singapore: World Scientific; 2011. p. 17–25.

Hamilton MM. The science behind lasers: how the physical properties of lasers affect the skin. In: Truswell WH, editor. Lasers and Light, Peels and Abrasions. New York: Thieme; 2016. p. 14–9.

Sklar LR, Burnett CT, Waibel JS, Moy RL, Ozog DM. Laser assisted drug delivery: A review of an evolving technology. Lasers Surg Med. 2014;46(4):249–62.

Waibel JS, Gianatasio C, Rudnick A. Randomized, Controlled Early Intervention of Dynamic Mode Fractional Ablative CO2 Laser on Acute Burn Injuries for Prevention of Pathological Scarring. Lasers Surg Med. 2020;52(2):117–24.

El-Zawahry BM, Sobhi RM, Bassiouny DA, Tabak SA. Ablative CO2 fractional resurfacing in treatment of thermal burn scars: An open-label controlled clinical and histopathological study. J Cosmet Dermatol. 2015;14(4):324–31.

Koike S, Akaishi S, Nagashima Y, Dohi T, Hyakusoku H, Ogawa R. Nd:YAG laser treatment for keloids and hypertrophic scars: An analysis of 102 cases. Plast Reconstr Surg - Glob Open. 2014;2(12):1–9.

Zaleski-Larsen LA, Fabi SG. Laser-assisted drug delivery. Dermatol Surg. 2016;42(8):919–31.

Hsiao CY, Yang SC, Alalaiwe A, Fang JY. Laser ablation and topical drug delivery: a review of recent advances. Expert Opin Drug Deliv. 2019;16(9):937–52.

Choi JE, Oh GN, Kim JY, Seo SH, Ahn HH, Kye YC. Ablative fractional laser treatment for hypertrophic scars: Comparison between Er:YAG and CO2 fractional lasers. J Dermatolog Treat. 2014;25(4):299–303.

Downloads

Published

2023-10-12

How to Cite

1.
Fantoni OJJ, Kurniawati Y, Diba S, Nopriyati, Purwoko MIH. The Use of Laser in Keloid and Hypertrophic Scar. J Pak Assoc Dermatol [Internet]. 2023Oct.12 [cited 2024Dec.2];33(4):1633-44. Available from: https://www.jpad.com.pk/index.php/jpad/article/view/2330

Issue

Section

Review Articles

Most read articles by the same author(s)