Molecular Features of Hypertrophic Scars after Thermal Injury: Is there a biologic basis for laser therapy?

Due to the fact that the basis of hypertrophic scars is a coarse, richly vascularized fi brillar protein — collagen, laser ablation is promising for suppressing its growth, and selective laser angiophotothermolysis is promising for reducing the degree of vascularization. To improve the efficiency of scar remodeling, the development of methods of complex laser correction is relevant. The purpose of the study: to determine the therapeutic eff ects of various combinations of high-intensity laser therapy (HILT) in patients with hypertrophic scars at different times of their formation. Methods. 44 patients (26 women and 18 men) with developing and mature hypertrophic scars were examined. In patients with developing scars, a combination of selective angiophotothermolysis (λ = 0,578 μm) and subsequent fractional ablative photothermolysis (λ = 10,6 μm) was used, and in patients with mature scars, a combination of selective angiophotothermolysis (λ = 0,578 μm) followed by planar ablative photodestruction (λ = 10,6 μm) was applied. Dermatoscopic methods for assessing the functional properties of the skin, assessment of microcirculation, morphometric analysis of scars and assessment of the quality of life of patients were used. Results. A decrease in the thickness of the epidermis was found due to a reduction in the thickness of all its layers, especially the spiny layer, with an increase in the volume of keratinocytes of the granular layer. In patients with developing hypertrophic scars, a decrease in the predominantly variable component of blood fl ow was observed, while in patients with mature scars, changes in its constant component prevailed. An increase in the quality of life indicators according to the DIQL scale, more pronounced in patients with developing scars, was noticed. The effectiveness of HILT in patients with developing scars was 82 %, with mature — 74 %. Conclusion. Combined high-intensity laser therapy effectively remodels hypertrophic skin scars with different periods of their formation.

Download Full-text

The influence of morphofunctional parameters on the effectiveness of high-intensity laser therapy for patients with hypertrophic skin scars

Fizioterapevt (Physiotherapist) ◽

10.33920/med-14-2106-01 ◽

2021 ◽

pp. 8-13

Author(s):

Inga Gennadievna Kurganskaya ◽

Denis Viktorovich Kovlen

Keyword(s):

Quality Of Life ◽

Laser Therapy ◽

High Intensity ◽

Clinical Signs ◽

Scar Tissue ◽

Therapeutic Effects ◽

Hypertrophic Scars ◽

High Intensity Laser ◽

Intensity Laser

Different combinations of high-intensity laser therapy (HILT) methods cause multidirectional therapeutic effects, the causes of dissociation of which may be due to the parameters of the morphofunctional status of scar tissue — the determinants of the effectiveness. Objective: to identify the determinants of the effectiveness of high-intensity laser therapy in patients with developing and mature hypertrophic skin scars. Methods: 100 patients with developing (n=49) and mature (n=51) hypertrophic scars were studied. In patients with developing scars, acombination of selective angiophotothermolysis (λ=0,578 µm) and subsequent fractional ablative photothermolysis (λ=10,6 µm) was used, and in patients with mature scars, acombination of selective angiophotothermolysis (λ=0,578 µm) followed by planar ablative photodisruption (λ=10,6 µm) was applied. Dermatoscopic methods for assessing the morphofunctional properties of the skin, instrumental methods for assessing the elasticity, microcirculation and metabolism of scar tissue, and assessment of the quality of life of patients were used. Results. Combinations of selective angiophotothermolysis, fractional ablative photothermolysis and planar ablative photodisruption cause pronounced therapeutic effects in patients with developing and mature hypertrophic skin scars, which are manifested by regression of clinical signs of scar tissue, remodeling of scar tissue, improvement of elasticity, microcirculation and metabolism of scars, which leads to an improvement in the quality of life of patients. Conclusion. The determinants of the effectiveness of HILT in patients with developing hypertrophic scars are the indicators of the patient’s clinical status, the morphofunctional properties of the scar tissue, the parameters of microcirculation and metabolism.

Download Full-text

Anomalous expression of HLA class II molecules on keratinocytes and fibroblasts in hypertrophic scars consequent to thermal injury

Clinical & Experimental Immunology ◽

10.1111/j.1365-2249.1990.tb05451.x ◽

2008 ◽

Vol 82 (2) ◽

pp. 350-354 ◽

Cited By ~ 42

Author(s):

C. CASTAGNOLI ◽

M. STELLA ◽

G. MAGLIACANI ◽

S. TEICH ALASIA ◽

P. RICHIARDI

Keyword(s):

Thermal Injury ◽

Class Ii ◽

Hla Class Ii ◽

Hypertrophic Scars ◽

Hla Class Ii Molecules

Download Full-text

Biologic Basis for the Treatment of Keloids and Hypertrophic Scars

Southern Medical Journal ◽

10.1097/00007611-197007000-00002 ◽

1970 ◽

Vol 63 (7) ◽

pp. 755-760 ◽

Cited By ~ 175

Author(s):

ERLE E. PEACOCK ◽

JOHN W. MADDEN ◽

WILLIAM C. TRIER

Keyword(s):

Hypertrophic Scars ◽

Biologic Basis

Download Full-text

Healing of self-inflicted thermal injury of palatal mucosa by low-level laser therapy

Special Care in Dentistry ◽

10.1111/scd.12256 ◽

2017 ◽

Vol 37 (6) ◽

pp. 314-317 ◽

Cited By ~ 5

Author(s):

Abdul Ahad ◽

Shazra Tasneem ◽

Arundeep Kaur Lamba ◽

Saif Khan

Keyword(s):

Laser Therapy ◽

Thermal Injury ◽

Low Level Laser Therapy ◽

Low Level ◽

Low Level Laser ◽

Level Laser ◽

Palatal Mucosa

Download Full-text

Pulse dye laser therapy and superficial cryotherapy as a novel combination treatment for hypertrophic scars and keloids

Our Dermatology Online ◽

10.7241/ourd.20221.5 ◽

2022 ◽

Vol 13 (1) ◽

pp. 28-31

Author(s):

Iqbal A. Bukhari

Keyword(s):

Laser Therapy ◽

Combination Treatment ◽

Treatment Options ◽

Fibrous Tissue ◽

Surgical Excision ◽

Skin Lesions ◽

Dye Laser ◽

Hypertrophic Scars ◽

Pressure Therapy ◽

One Year

Background: Hypertrophic scars are benign and fibrotic skin lesions caused by defects in the regulation of cellularity during the wound-healingprocess, in which there is higher collagen production and less degradation. Genetic predisposing factors and different skin injuries may play a role in developing these types of lesions. On the other hand, keloids are overgrowths of fibrous tissue outside the original boundaries of trauma, yet these may also occur spontaneously. There are numerous treatment options for both conditions, including silicone gel sheeting, pressure therapy, intralesional triamcinolone acetonide, radiation, laser therapy, cryosurgery, interferon, 5-fluorouracil, and surgical excision as well as a multitude of extracts and topical agents. Objective: The objective was to evaluate the effectiveness of pulse dye laser (PDL) therapy and superficial cryotherapy as a combination treatment for hypertrophic scars and keloids. Method: Four Arabic female patients were seen at the outpatient clinic of the Department of Dermatology at the King Fahd Hospital of the University in Khobar, Saudi Arabia. The patients had keloids and hypertrophic scars. Treatment with cryotherapy every week for three weeks followed by one session of pulsed dye laser was administered rotationally for three to six months until the lesions displayed remarkable physical improvement or complete resolution. Results: All patients experienced significant improvement, showing a reduction in the size, erythema, pliability, and pruritus. None of the hypertrophic scars or keloids deteriorated during the one year of treatment. No complications were noted during the treatment period. Conclusion: Sequential PDL therapy combined with superficial cryotherapy may be an option for treating hypertrophic scars and keloids.

Download Full-text

Long-Pulsed 1064 nm Nd:YAG Laser Treatment for Keloids and Hypertrophic Scars

Textbook on Scar Management ◽

10.1007/978-3-030-44766-3_32 ◽

2020 ◽

pp. 271-278

Author(s):

Rei Ogawa

Keyword(s):

Energy Density ◽

Laser Beam ◽

Laser Therapy ◽

Nd:Yag Laser ◽

Laser Power ◽

Vascular Diseases ◽

Skin Surface ◽

Spot Size ◽

Hypertrophic Scars ◽

Spot Diameter

AbstractThere are many therapeutic options for keloids and hypertrophic scars, including surgery, radiation, corticosteroids, 5-fluorouracil, cryotherapy, laser therapy, anti-allergy agents, anti-inflammatory agents, bleaching creams, and make-up therapies. In terms of laser therapy, we have used long-pulsed 1064 nm Nd:YAG laser to treat keloids and hypertrophic scars. This laser was developed for the treatment of vascular diseases, including inflammatory scars that exhibit neovascularization. The depth that is reached is determined by the spot size, the laser power, and the fluence: the larger the spot size, power, or fluence, the deeper the laser beam penetrates. The laser should generally be applied to the skin surface with the following standard treatment settings: a spot diameter of 5 mm, an energy density of 75 J/cm2, an exposure time per pulse of 25 ms, and a repetition rate of 2 Hz.

Download Full-text

Laser therapy in the treatment of post-burn scars in children

Pediatria i Medycyna Rodzinna ◽

10.15557/pimr.2020.0067 ◽

2020 ◽

Vol 16 (4) ◽

pp. 373-376

Author(s):

Artur Weremijewicz ◽

◽

Ewa Matuszczak ◽

Wojciech Dębek ◽

◽

...

Keyword(s):

Laser Therapy ◽

Carbon Dioxide Laser ◽

Combined Therapy ◽

Paediatric Population ◽

Scar Tissue ◽

Normal Function ◽

Hypertrophic Scars ◽

Psychological Burden ◽

Multi Stage ◽

Selective Photothermolysis

Burns are one of the most common injuries in the paediatric population. Despite improved medical care, many burn patients develop permanent scars, which are a serious cosmetic, functional and psychological burden. We present the possible use of a pulsed dye laser (PDL) and an ablative fractional CO2 laser (AFCL) in the treatment of post-burn scars, with particular emphasis on the paediatric population. PDL is intended to reduce scar redness through selective photothermolysis of blood vessels to reduce local hypervascularity. This type of laser can be also used to reduce pruritus, most likely by modifying local cytochemical reactions. Ablative fractional carbon dioxide laser therapy (AFCL) may be optionally used to improve scar texture and reduce its thickness. AFCL can also restore normal function of the scarred area. It causes vaporisation of scar tissue fragments, thereby stimulating collagen reconstruction. The fact that PDL and AFCL can be safely combined during the same procedure is an important advantage of using laser therapy in the treatment of hypertrophic scars. Combined therapy allows to reduce the overall number of sessions. The use of two lasers during one session also allows to reduce the amount of anaesthesia. The combined use of PDL and AFCL is safe. No serious complications were reported during combined therapy. Doctors treating patients with burn scars should consider the use of laser therapy as a modern standard for the treatment of hypertrophic scars. Scars that cause contractures and significantly impair motor functions may require multi-stage surgical treatment, supported by laser therapy, rehabilitation and conservative treatment.

Download Full-text