Laser therapy for hypertrophic scars and keloids
- C Scott Hultman, MD, MBA, FACS
C Scott Hultman, MD, MBA, FACS
- Ethel and James Valone Distinguished Professor of Surgery; Division Chief and Program Director
- UNC Plastic Surgery
- Shunsuke Yoshida, MD, MS
Shunsuke Yoshida, MD, MS
- UNC Plastic & Reconstructive Surgery
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
Hypertrophic scars and keloids are cutaneous lesions resulting from an excessive tissue response to dermal injury (eg, surgical procedures, trauma, burns, inflammatory skin conditions) and characterized by local fibroblast proliferation and overproduction of abnormal collagen. The clinical features and classification of hypertrophic scars and keloids are summarized in the table (table 1).
Hypertrophic scars present as raised lesions with varying degree of erythema depending upon the maturation stage that typically do not exceed the margins of the original wound. They usually develop two to six months after the initial insult and show a tendency to regress at 18 to 24 months following injury . Associated symptoms include pain, pruritus, and functional limitations. Keloids can occur months or years after injury, extend beyond the limits of the initial injury, and show no tendency to regress.
Many treatments have been tried, with limited success, to reduce the symptoms associated with abnormal scarring, such as redness, pain, pruritus, or functional limitations, and to improve the clinical appearance. These treatments range from minimally invasive interventions (eg, massage, moisturizing agents, pressure garments, silicone sheeting) to topical or intralesional corticosteroids, surgical excision with various reconstructive techniques, or radiation therapy [2,3]. Unfortunately, recurrence rates are high, and multiple or combination therapies are often required to reduce the scar volume and achieve functional and/or cosmetic improvement.
Laser therapy is a relatively new treatment modality for keloids and hypertrophic scars. In particular, the utilization of specific laser platforms has emerged as a successful strategy in the treatment of symptomatic hypertrophic scars following burn injury.
This topic will discuss the available modes of laser therapy for the treatment of hypertrophic scars and keloids, with a focus on treatment of hypertrophic burn scars. Other treatment modalities for hypertrophic scars and keloids are discussed separately. The principles of laser therapy and the use of laser for the treatment of other skin conditions are also discussed separately.
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- LASER AND LIGHT-BASED PLATFORMS
- Pulsed dye laser
- - Efficacy
- Fractional laser resurfacing
- - Efficacy
- Intense pulsed light
- - Efficacy
- Other lasers
- GOALS OF TREATMENT
- INDICATIONS AND TIMING
- PREOPERATIVE MEASURES
- Patient preparation
- SAFETY MEASURES
- Pulsed dye laser
- Fractional CO2 laser
- Other lasers
- Our approach
- POSTOPERATIVE CARE
- ADJUVANT TREATMENTS