Efficacy of Combined Intense Pulsed Light (IPL) With Fractional CO2 -Laser Ablation in the Treatment of Large Hypertrophic Scars: A Prospective, Randomized Control Trial.

Abstract

Scar rehabilitation is a complex process that incorporates medical, surgical, and physical therapeutic measures to best restore function and visual normalcy. Lasers have emerged as essential tools in the management of scars, with devices available to address scar size, dyschromia, and contour irregularities. As different lasers treat these different features, multi-laser, same session therapeutic approaches may offer a more comprehensive approach to scar revision. In this study, we aim to demonstrate the effect of a combinatorial, same session treatment with intense pulsed light (IPL) and fractional ablative CO2 as compared to single laser treatment with fractional ablative CO2 laser alone or control in the treatment of mature hypertrophic scars. This institutional review board-approved, randomized controlled trial, enrolled 23 healthy adults with large (>100 cm2 ) hypertrophic scars who were randomized to one of three treatment arms: (i) IPL and CO2 ablative fractional laser (AFL), (ii) CO2 AFL alone, and (iii) control (no laser treatment). Subjects underwent a total of four treatment sessions at 6-8-week intervals with follow-up visits at 1, 3, and 6 months following the last treatment session. Primary endpoints included blinded scoring of before and after photographs via the Manchester Scar Scale (MSS). Secondary endpoints included the Patient-Observer Scar Assessment Scale (POSAS). As compared to control and CO2 AFL laser alone, the combination of CO2 AFL and IPL demonstrated statistically significant improvement across a greater number of scar domains, as assessed by the MSS. 100% of subjects in both treatment groups showed a statistically significant decrease in the POSAS scale after the series of four treatment sessions. No adverse events were reported. Treatment with combined IPL and CO2 AFL demonstrated higher average improvements across the majority of assessed scar domains, as compared to both control and CO2 laser alone. The difference was not statistically significant in overall MSS score as expected due to the role of CO2 as the main source of improvement. However, only the combination group had statistically significant improvement in both color and texture. These findings support the assertion that a multi-photo-thermolytic approach with combined IPL and CO2 AFL can have a positive impact on the treatment of hypertrophic scars by using multiple wavelengths to maximize laser-skin interactions in targeting the different chromophores expressed in scar tissue. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.