Personalized high-intensity laser therapy for patients with abnormal skin scars

Abstract

Background. Scars are an inevitable consequence and the final outcome of the restoration of the skin, after injuries, thermal effects on the skin, and are also formed as a result of the resolution of rash elements in various infectious skin diseases, with adverse wound healing after plastic surgery and cosmetic procedures. According to WHO data for 2020, scar complications affect about 10% of the world's population, which is approximately 600 million people. High-intensity laser therapy technologies are considered by experts to be the "gold" standard in the correction of pathological scars, but a significant number of them are updated by the personalized approach developed in the last decade, aimed at individualizing treatment, searching for predictors of the effectiveness of various methods, taking into account a number of basic mechanisms of pathogenesis.
 Aims: Scientific substantiation of the concept of personalized high-intensity laser therapy for patients with pathological skin scars.
 Materials and methods. We studied 306 patients with atrophic (n=115), hypertrophic (n=100) and keloid (n=91) scars, which were divided into subgroups with emerging (formation period up to 1.5 years) and mature scars. Genetic, phenotypic, clinical, instrumental, laboratory, and medical-sociological methods were used to study the patient's condition and scar tissue. Laser therapy combinations were used: fractional ablative photothermolysis, homogeneous photothermolysis, planar ablative photodestruction, selective angiophotothermolysis, and fractional selective photothermolysis.
 Results. It was found that various combinations of high-intensity laser therapy in patients with pathological skin scars cause a significant regression of clinical signs, restore the microrelief of tissues, improve the functional properties of scars (elasticity, elasticity, moisture, vascularization, etc.), which is accompanied by an improvement in the quality of life of patients. The complex of laser technologies forms a pronounced refibromodeling therapeutic effect in patients with pathological skin scars.
 Conclusion. The concept of personalized (variant) high-intensity laser therapy in patients with atrophic, hypertrophic and keloid scars, which determines the dependence of the effectiveness of various options for laser correction of pathological scars on the genetic, phenotypic, clinical, morphofunctional and medical-sociological characteristics of patients, is scientifically substantiated. The determinants of the effectiveness of laser technologies have been identified, taking into account which allows the productive use of high-intensity laser radiation in patients with atrophic, hypertrophic and keloid skin scars.