Hypertrophic Scar Outcomes in Fractional Laser Monotherapy Versus Fractional Laser-Assisted Topical Corticosteroid Delivery: A Randomized Clinical Trial

Authors

  • Woraphong Manuskiatti Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700 Bangkok, Thailand
  • Arisa Kaewkes
  • Chadakan Yan
  • Janice Natasha C. Ng
  • Joshua Zev Glahn
  • Rungsima Wanitphakdeedecha

DOI:

https://doi.org/10.2340/00015555-3781

Keywords:

hypertrophic scar, fractional laser, laser-assisted drug delivery, corticosteroid

Abstract

Topical corticosteroid delivery following fractional laser treatment is an effective means of treating hypertrophic scars. However, the relative efficacy of adjuvant corticosteroid treatment vs fractional laser mono­therapy alone is unclear. The aim of this study was to compare the efficacy and safety of fractional laser-assisted topical corticosteroid delivery with fractional laser monotherapy in the treatment of hyper­trophic scars. In this randomized, comparative, split-scar trial of 19 subjects, a borderline significant reduction in scar thickness was observed at 3-month follow-up in the laser+steroid group compared with laser+petrolatum (p = 0.049). However, no significant long-term difference in scar flattening was observed between the 2 groups. Patient and Observer Scar Assessment Scale scores showed significant improvement in scar appearance from baseline without significant differences between treatment groups. In conclusion, fractional laser monotherapy is an effective treatment for hypertrophic scars, and the application of topical corticosteroid provides no long-term synergistic effect to fractional laser monotherapy.

Downloads

Download data is not yet available.

References

Wolfram D, Tzankov A, Pulzl P, Piza-Katzer H. Hypertrophic scars and keloids - a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg 2009; 35: 171-181.

DOI: https://doi.org/10.1111/j.1524-4725.2008.34406.x

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: 113-125.

DOI: https://doi.org/10.2119/molmed.2009.00153

Ketchum LD, Cohen IK, Masters FW. Hypertrophic scars and keloids. A collective review. Plast Reconstr Surg 1974; 53: 140-154.

DOI: https://doi.org/10.1097/00006534-197402000-00004

Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A. The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 2008; 61: 1049-1058.

DOI: https://doi.org/10.1016/j.bjps.2008.03.020

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. Burns Trauma 2019; 7: 39.

DOI: https://doi.org/10.1186/s41038-019-0175-y

Bao Y, Xu S, Pan Z, Deng J, Li X, Pan F, et al. Comparative efficacy and safety of common therapies in keloids and hypertrophic scars: a systematic review and meta-analysis. Aesthetic Plast Surg 2020; 44: 207-218.

DOI: https://doi.org/10.1007/s00266-019-01518-y

Hochman B, Locali RF, Matsuoka PK, Ferreira LM. Intralesional triamcinolone acetonide for keloid treatment: a systematic review. Aesthetic Plast Surg 2008; 32: 705-709.

DOI: https://doi.org/10.1007/s00266-008-9152-8

Sherris DA, Larrabee WF, Jr., Murakami CS. Management of scar contractures, hypertrophic scars, and keloids. Otolaryngol Clin North Am 1995; 28: 1057-1068.

DOI: https://doi.org/10.1016/S0030-6665(20)30475-8

Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol 2002; 138: 1149-1155.

DOI: https://doi.org/10.1001/archderm.138.9.1149

Morelli Coppola M, Salzillo R, Segreto F, Persichetti P. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol 2018; 11: 387-396.

DOI: https://doi.org/10.2147/CCID.S133672

Wang X, Wu X, Liu K, Xia L, Lin X, Liu W, et al. Topical cryoanesthesia for the relief of pain caused by steroid injections used to treat hypertrophic scars and keloids. Medicine (Baltimore) 2017; 96: e8353.

DOI: https://doi.org/10.1097/MD.0000000000008353

Haedersdal M, Erlendsson AM, Paasch U, Anderson RR. Translational medicine in the field of ablative fractional laser (AFXL)-assisted drug delivery: a critical review from basics to current clinical status. J Am Acad Dermatol 2016; 74: 981-1004.

DOI: https://doi.org/10.1016/j.jaad.2015.12.008

van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP. Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale. Plast Reconstr Surg 2005; 116: 514-522.

DOI: https://doi.org/10.1097/01.prs.0000172982.43599.d6

Lin JY, Warger WC, Izikson L, Anderson RR, Tannous Z. A prospective, randomized controlled trial on the efficacy of fractional photothermolysis on scar remodeling. Lasers Surg Med 2011; 43: 265-272.

DOI: https://doi.org/10.1002/lsm.21061

Niwa AB, Mello AP, Torezan LA, Osorio N. Fractional photothermolysis for the treatment of hypertrophic scars: clinical experience of eight cases. Dermatol Surg 2009; 35: 773-777; discussion 777-778.

DOI: https://doi.org/10.1111/j.1524-4725.2009.01127.x

Azzam OA, Bassiouny DA, El-Hawary MS, El Maadawi ZM, Sobhi RM, El-Mesidy MS. Treatment of hypertrophic scars and keloids by fractional carbon dioxide laser: a clinical, histological, and immunohistochemical study. Lasers Med Sci 2016; 31: 9-18.

DOI: https://doi.org/10.1007/s10103-015-1824-4

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; 52: 959-965.

DOI: https://doi.org/10.1002/lsm.23249

Purschke M, Laubach HJ, Anderson RR, Manstein D. Thermal injury causes DNA damage and lethality in unheated surrounding cells: active thermal bystander effect. J Invest Dermatol 2010; 130: 86-92.

DOI: https://doi.org/10.1038/jid.2009.205

Ozog DM, Liu A, Chaffins ML, Ormsby AH, Fincher EF, Chipps LK, et al. Evaluation of clinical results, histological architecture, and collagen expression following treatment of mature burn scars with a fractional carbon dioxide laser. JAMA Dermatol 2013; 149: 50-57.

DOI: https://doi.org/10.1001/2013.jamadermatol.668

Berman B, Maderal A, Raphael B. Keloids and hypertrophic scars: pathophysiology, classification, and treatment. Dermatol Surg 2017; 43: S3-S18.

DOI: https://doi.org/10.1097/DSS.0000000000000819

Qu L, Liu A, Zhou L, He C, Grossman PH, Moy RL, et al. Clinical and molecular effects on mature burn scars after treatment with a fractional CO(2) laser. Lasers Surg Med 2012; 44: 517-524.

DOI: https://doi.org/10.1002/lsm.22055

Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med 2013; 45: 135-140.

DOI: https://doi.org/10.1002/lsm.22120

Cavalie M, Sillard L, Montaudie H, Bahadoran P, Lacour JP, Passeron T. Treatment of keloids with laser-assisted topical steroid delivery: a retrospective study of 23 cases. Dermatol Ther 2015; 28: 74-78.

DOI: https://doi.org/10.1111/dth.12187

Park JH, Chun JY, Lee JH. Laser-assisted topical corticosteroid delivery for the treatment of keloids. Lasers Med Sci 2017; 32: 601-608.

DOI: https://doi.org/10.1007/s10103-017-2154-5

Sabry HH, Abdel Rahman SH, Hussein MS, Sanad RR, Abd El Azez TA. The efficacy of combining fractional carbon dioxide laser with verapamil hydrochloride or 5-fluorouracil in the treatment of hypertrophic scars and keloids: a clinical and immunohistochemical study. Dermatol Surg 2019; 45: 536-546.

DOI: https://doi.org/10.1097/DSS.0000000000001726

Buelens S, Van Hove AS, Ongenae K, Lapeere H, Huvenne W, Vermeersch H, et al. Fractional carbon dioxide laser of recent surgical scars in the head and neck region: a split-scar, evaluator-blinded study. Dermatol Surg 2017; 43: S75-S84.

DOI: https://doi.org/10.1097/DSS.0000000000000963

Lee WR, Shen SC, Aljuffali IA, Li YC, Fang JY. Impact of different vehicles for laser-assisted drug permeation via skin: full-surface versus fractional ablation. Pharm Res 2014; 31: 382-393.

DOI: https://doi.org/10.1007/s11095-013-1167-4

Prausnitz MR, Mitragotri S, Langer R. Current status and future potential of transdermal drug delivery. Nat Rev Drug Discov 2004; 3: 115-124.

DOI: https://doi.org/10.1038/nrd1304

Waibel JS, Wulkan AJ, Rudnick A, Daoud A. Treatment of hypertrophic scars using laser-assisted corticosteroid versus laser-assisted 5-fluorouracil delivery. Dermatol Surg 2019; 45: 423-430.

DOI: https://doi.org/10.1097/DSS.0000000000001678

Banzhaf CA, Thaysen-Petersen D, Bay C, Philipsen PA, Mogensen M, Prow T, et al. Fractional laser-assisted drug uptake: Impact of time-related topical application to achieve enhanced delivery. Lasers Surg Med 2017; 49: 348-354.

DOI: https://doi.org/10.1002/lsm.22610

Forster B, Klein A, Szeimies RM, Maisch T. Penetration enhancement of two topical 5-aminolaevulinic acid formulations for photodynamic therapy by erbium:YAG laser ablation of the stratum corneum: continuous versus fractional ablation. Exp Dermatol 2010; 19: 806-812.

DOI: https://doi.org/10.1111/j.1600-0625.2010.01093.x

Haak CS, Farinelli WA, Tam J, Doukas AG, Anderson RR, Haedersdal M. Fractional laser-assisted delivery of methyl aminolevulinate: impact of laser channel depth and incubation time. Lasers Surg Med 2012; 44: 787-795.

DOI: https://doi.org/10.1002/lsm.22102

Manuskiatti W, Iamphonrat T, Wanitphakdeedecha R, Eimpunth S. Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians. Dermatol Surg 2013; 39: 111-120.

DOI: https://doi.org/10.1111/dsu.12030

Lademann J, Richter H, Teichmann A, Otberg N, Blume-Peytavi U, Luengo J, et al. Nanoparticles - an efficient carrier for drug delivery into the hair follicles. Eur J Pharm Biopharm 2007; 66: 159-164.

DOI: https://doi.org/10.1016/j.ejpb.2006.10.019

Mak WC, Patzelt A, Richter H, Renneberg R, Lai KK, Ruhl E, et al. Triggering of drug release of particles in hair follicles. J Control Release 2012; 160: 509-514.

DOI: https://doi.org/10.1016/j.jconrel.2012.04.007

Trelles MA, Leclere FM, Martinez-Carpio PA. Fractional carbon dioxide laser and acoustic-pressure ultrasound for transepidermal delivery of cosmeceuticals: a novel method of facial rejuvenation. Aesthetic Plast Surg 2013; 37: 965-972.

DOI: https://doi.org/10.1007/s00266-013-0176-3

Published

2021-03-17

How to Cite

Manuskiatti, W., Kaewkes, A., Yan, C., Ng, . J. N. C., Glahn, J. Z., & Wanitphakdeedecha, R. (2021). Hypertrophic Scar Outcomes in Fractional Laser Monotherapy Versus Fractional Laser-Assisted Topical Corticosteroid Delivery: A Randomized Clinical Trial. Acta Dermato-Venereologica, 101(3), adv00416. https://doi.org/10.2340/00015555-3781