Pulse dye laser therapy and superficial cryotherapy as a novel combination treatment for hypertrophic scars and keloids

Iqbal A. Bukhari

doi:10.7241/ourd.20221.5

Abstract

Background: Hypertrophic scars are benign and fibrotic skin lesions caused by defects in the regulation of cellularity during the wound-healingprocess, in which there is higher collagen production and less degradation. Genetic predisposing factors and different skin injuries may play a role in developing these types of lesions. On the other hand, keloids are overgrowths of fibrous tissue outside the original boundaries of trauma, yet these may also occur spontaneously. There are numerous treatment options for both conditions, including silicone gel sheeting, pressure therapy, intralesional triamcinolone acetonide, radiation, laser therapy, cryosurgery, interferon, 5-fluorouracil, and surgical excision as well as a multitude of extracts and topical agents. Objective: The objective was to evaluate the effectiveness of pulse dye laser (PDL) therapy and superficial cryotherapy as a combination treatment for hypertrophic scars and keloids. Method: Four Arabic female patients were seen at the outpatient clinic of the Department of Dermatology at the King Fahd Hospital of the University in Khobar, Saudi Arabia. The patients had keloids and hypertrophic scars. Treatment with cryotherapy every week for three weeks followed by one session of pulsed dye laser was administered rotationally for three to six months until the lesions displayed remarkable physical improvement or complete resolution. Results: All patients experienced significant improvement, showing a reduction in the size, erythema, pliability, and pruritus. None of the hypertrophic scars or keloids deteriorated during the one year of treatment. No complications were noted during the treatment period. Conclusion: Sequential PDL therapy combined with superficial cryotherapy may be an option for treating hypertrophic scars and keloids.

Highlights

Hypertrophic scars are benign fibrotic skin lesions caused by defects in regulating fibrous tissue cellularity during wound-healing limited to the area of trauma
The first patient had multiple keloid scars on the back, the second patient had a single keloid on the right shoulder area, the third patient had a single keloid on the upper chest (Fig. 1a), and the fourth had a hypertrophic scar on the lower abdomen following cesarian section (Fig. 2a), who used topical clobetasol for several months before presentation, discontinued clobetasol because of its ineffectiveness
None of the hypertrophic scars or keloids deteriorated during the one year of treatment

Summary

Introduction

Hypertrophic scars are benign fibrotic skin lesions caused by defects in regulating fibrous tissue cellularity during wound-healing limited to the area of trauma. While keloids are overgrowths of fibrous tissue outside the original boundaries of trauma and occur secondary to defective wound healing, they may occur spontaneously without previous trauma. Both are abnormal responses to trauma followed by excessive wound tension, inducing fibroblast proliferation and overproduction of dense collagen and glycosaminoglycans [1]. Objective: The objective was to evaluate the effectiveness of pulse dye laser (PDL) therapy and superficial cryotherapy as a combination treatment for hypertrophic scars and keloids. Conclusion: Sequential PDL therapy combined with superficial cryotherapy may be an option for treating hypertrophic scars and keloids

Objectives

Methods

Discussion

Conclusion