Treating keloids with lasers

Lasers are rarely indicated as a monotherapy of keloids. However, they are recommended as a means to facilitate delivery of topical drugs, according to Dr Matteo Tretti Clementoni (Laserplast, Italy) [1].

“Lasers play a fundamental role in the treatment of hypertrophic scars,” said Dr Tretti Clementoni. Placing this in perspective, he explained that they give unsatisfactory results in most cases as monotherapy [1]. “I think that some distinctions should be made regarding specific anatomical sites, the dimension of the keloid, and the use of lasers in combination with other therapies,” Dr Tretti Clementoni continued. For example, CO2-ablation showed a recurrence rate of 100% in 18 weeks [2]. In a review, best results and lowest rates of recurrence were found in ablative laser treatment of small keloids of the earlobe [2]. Vascular lasers showed their best results when pulsed dye laser therapy was combined with triamcinolone acetonide (TAC). The evidence on Nd-YAG laser use is rather contradictory in terms of recurrence rates [1]. Several studies have investigated the impact of a same-session use of ablative fractional laser to assist increased drug delivery deeper into the skin. The rationale being the synergistic action in enabling the agents to penetrate the stratum corneum through laser-created microscopic treatment zones [2].

Combination of topical drug and laser causes less pain

The combination of topicals with laser not only has shown to be effective, but a study assessing the pain of the treatment found a mean pain score of 1.1 (laser+topical drug) vs 6.1 (steroid injection alone) [3-6]. For ear keloids, Dr Tretti Clementi achieved very good results by combining laser cutting of the keloid plus fractional deep treatment of the bed plus laser-assisted drug delivery with TAC, 5-fluorouracil, and botulinum toxin A [1]. Another practical tip from Dr Ozog (Henry Ford Hospital, USA) was the use of laser pre-treatment when addressing truncal or painful keloids by a multi-step regimen [7]. First, one should achieve complete anaesthesia with bacteriostatic saline followed by lidocaine. Then he advised to soften and treat the scar with a pulse dye laser (1.5 milliseconds in a 10 mm spot size at 7 joules). “This does two things,” explained Dr Ozog. “It has been shown to downregulate molecular pathways involving keloids, but it also immediately, within 20 to 30 seconds, creates an oedematous plane, which allows us to easily inject the keloid.” Another possibility would be to apply cryotherapy for 3-5 seconds that will cause the same oedema. He stressed that when employing this technique, dermatologists will have to get accustomed to inject more superficially than they are used to as they must visualise the steroid going into the keloid. “We have seen life-changing results in patients with sternal or painful keloids,” he reported.

1. 
   
   1. Tretti Clementoni M. 24th World Congress of Dermatology, 10-15 June 2019, Milan, Italy.
   2. Forbat E, et al. Lasers Med Sci. 2017;32: 2145-2154.
   3. Park JH, et al. Lasers Med Sci. 2017;32: 601-608.
   4. Wenande E, et al. Expert Opin Drug Deliv. 2017;14: 307-317.
   5. Haedersdal M, et al. Lasers Surg Med. 2010;42: 113-22.
   6. Waibel JS, et al. Lasers Surg Med. 2013;45: 135-40.
   7. Ozog DM. 24th World Congress of Dermatology, 10-15 June 2019, Milan, Italy.

 



Posted on 26 August, 201921 March, 2021