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Pulsed Dye Laser Treatment of Hypertrophic and Keloidal Scars

Effective treatment of hypertrophic and keloidal scars remains a difficult therapeutic challenge. Based on a recent uncontrolled trial showing that the 585-nm pulsed dye laser improved hypertrophic scars, these investigators performed a controlled trial to evaluate the effects of this laser on the appearance and symptoms of hypertrophic and keloidal scars.

Hypertrophic or keloidal median sternotomy scars resulting from heart surgery were treated in 16 patients. Half of the scar was treated with the pulsed dye laser at fluences of 6.5 to 7.25 J/cm² on two successive occasions six to eight weeks apart, while the other half was not treated. Symptoms, clinical appearance, and pliability were evaluated before and six months after treatment by two observers not involved in the treatment. Scars were also evaluated histologically and by digital image analysis of molds made of the surface texture.

All patients had improvement in the clinical appearance of the treated portions of the scars. Eleven of 12 patients noted cessation of pruritus. Although erythema was still present in all treated scars, there was a statistically significant decrease after one and two treatments. Mean scar height, scar pliability, and skin surface texture also improved significantly after one and two treatments. Histologically, laser-treated scars had a reduction in the number of fibroblasts; a change in the consistency of the dermis, with looser, less coarse collagen fibers; and an increase in the number of mast cells.

Comment: This study suggests that the 585-nm pulsed dye laser is effective in the treatment of at least some scars. Not only was pruritus eliminated in most patients, but erythema and scar height decreased and pliability increased significantly. It is not clear from the study whether the treated scars were hypertrophic scars or true keloids. Also unclear is the mechanism by which the pulsed dye laser alters scars. This laser is known to selectively damage cutaneous blood vessels, which is why it is effective for treating port-wine stains and other benign cutaneous vascular lesions. Whether thermal damage as a result of vascular injury plays a role in the treatment of scars is not known, but it seems possible, given that erythema decreased concomitantly with flattening of the scars in this study.

— JS Dover

Published in Journal Watch Dermatology July 1, 1995

Citation(s):

Alster TS; Williams CM. Treatment of keloids sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet 1995 345 1198-1200.

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