Treatment of hypertrophic scars and keloids using an intralesional 1470 nm bare-fibre diode laser: a novel efficient minimally-invasive technique

Abstract

Hypertrophic and keloid scars result from abnormal wound healing and can have a variable response to a number of available treatment modalities. The evolution of laser treatments in recent years has shown a wide range of clinical applications including their use in the treatment of scars. We investigated the effectiveness of a 1470 nm diode laser using an intralesional optical fibre delivery device in the treatment of hypertrophic and keloid scars. We evaluated its safety and efficacy as a novel and minimally invasive treatment alternative for scar modulation and volume reduction. A prospective cohort study was performed involving 21 patients with hypertrophic scars (HS) (n = 9) and keloids (n = 12) resulting from various aetiology. Patients were treated with one to three treatment sessions. Comprehensive evaluations were performed using the Vancouver Scar Scale, Doppler ultrasound, Cutometer, Mexameter and PeriCam PSI. Scar thickness was reduced by an average of 0.308 ± 0.138 cm (p < 0.001). In particular the two subgroups showed a significant 27.7% and 28.2% reduction in scar thickness of HS and Keloids, respectively. Scar firmness showed a significant improvement of 1.2% (p < 0.05) for HS, though for keloids this was 0.4% (p = 0.26). Keloids had a significant reduction in pigmentation at 21.3%. Blood perfusion had a significant reduction of 29.6% in HS and 22.7% in Keloids. Overall VSS total score improvement of 42% in the HS and at 37.9% in the Keloid subgroup. No adverse events such as hypo/hyperpigmentation, skin infection, or recurrence were reported. This study shows that the intralesional 1470 nm bare-fibre diode laser significantly improved hypertrophic and keloid scars based on both subjective and objective analyses and supports this type of laser therapy as a safe and effective minimally-invasive treatment option.

Figure 1

A 9-year-old boy [case 3] with a hypertrophic scar on his back prior laser treatment (A); 6 months post two laser therapy sessions (B); the scar blood perfusion showed 140.86 Units prior to treatment (C), a 32.64% reduction of the blood supply to the scar post laser treatment (D); the average thickness was 1.05 cm before the operation (E); a 63.81% decrease of scar thickness post laser treatment (F).

Figure 2

A 31-year-old man [case 20] had a hypertrophic scar on his left palm after sustaining a traumatic injury over 1.5-year ago (A); post one session of laser treatment (B).

Figure 3

An 18-years-old girl [case 7] sustained a keloid scar post traumatic injury on the dorsum of her left foot for the duration of 1 year (A); post two sessions using intralesional 1470 nm bare-fibre diode laser (B).

Figure 4

A 49-years-old woman [case 19] sustained a post-traumatic hypertrophic scar over 2-years prior to treatment (A); after 6 months follow-up and 2 laser sessions (B); the scar blood perfusion was significantly decreased: prior the operation was 104.29 Units (C), post operation there was a reduction of 28.46% (D); the scars thickness prior to the operation was 0.73 cm (E), post operation was decreased 43.84% (F).

Figure 5

A 66-years-old man [case 21] sustained a keloid on his chest caused by acne over 10 years period (A); after a 6 months follow-up and 2 treatments using intralesional 1470 nm bare-fibre diode laser (B); the scar blood perfusion showed 98.79 Units before the treatment (C), which decreased to 38.92% after two sessions of laser treatment (D); the average thickness of the scar was 0.79 cm (E), resulting in a decreased of 45.57% after the laser treatment (F).

Figure 6

A 46-years-old man [case 8] had a keloid burn scar over a 2-year period, which extended to his chest and arm (A); after a 6 months follow-up and 3 laser sessions the patient achieved significant cosmetic and functional outcomes (B).