The Use of the 300 Microsecond 1064nm Nd:YAG Laser in the Treatment of Keloids

November 2013 | Volume 12 | Issue 11 | Original Article | 1256 | Copyright © 2013

Anthony Rossi MD,a,d Rebecca Lu MD,a Melissa K. Frey MD,d Takako Kubota MD,c
Lauren A. Smith MD,e and Maritza Perez MDa,b

aSt. Luke’s Roosevelt Hospital, Department of Dermatology, New York, NY
bAdvanced DermAesthetics, New Canaan, CT
cSt. Marianna University School of Medicine, Department of Dermatology, Kawasaki, Japan
dNew York Presbyterian Hospital- Weill Cornell Medical College, New York, NY
eNew York University School of Medicine, New York, NY

Abstract

BACKGROUND: Keloids can be quite resistant to conventional methods of treatment. A wide range of treatment modalities exists, often with suboptimal results, recurrences, and adverse events occurring. Laser therapy with the carbon dioxide, erbium:YAG, Q switched frequency doubled neodymium-doped yttrium aluminium garnet (Nd:YAG), and 585/595 nm pulsed dye lasers have all be purported as potential treatment modalities however with limited efficacy and data especially in the skin of color population is limited. We report the successful use of the 300 microsecond 1064 nm Nd:YAG laser in treating keloids in patients with skin types ranging from Fitzpatrick I through VI with special attention in treating skin of color patients.
OBJECTIVE: We examined the use of the 300 microsecond 1064 nanometer (nm) Nd:YAG laser for the treatment keloids in patients with skin types ranging from Fitzpatrick I through VI.
METHODS & MATERIALS: A retrospective analysis of treatment efficacy was conducted on 44 patients with keloids. Three separate treatment groups were compared. The groups consisted of: a “control group” in which the whole keloid was only treated with intralesional corticosteroid (triamcinolone 10mg/cc) (16 patients); a “laser only” group in which the patient’s keloid was only treated with the 1064nm Nd:YAG laser at a fluency of 13 to 18 Joules / centimeter2 (J/cm2), a fixed pulse duration of 300 microseconds, 5mm spot size, and a total of 2000 pulses (14 patients); and a “combination group” that received both the aforementioned laser therapy and adjuvant intralesional triamcinolone (14 patients).
RESULTS: Patients in the "combination group" treated with the 300 microsecond 1064nm Nd:YAG laser therapy plus intralesional corticosteroid and the "laser only" group both were observed to have durable clinical reduction in the thickness and erythema of the keloids. These results were shown to be superior to the "control group" whom were only treated with intralesional corticosteroids. Only mild and transient post treatment erythema was noted as an adverse effect.
STATISTICAL ANALYSIS: Data analysis was performed using IBM SPSS Statistics 19.0.0 (Armonk, NY). In order to assess the statistical significance of differences in keloid improvement among the three treatment groups, The Kruskal-Wallis test (non-parametric ANOVA test) was applied. The level of statistical significance was set at P<0.05. A statistically significant difference in keloid improvement was appreciated between treatment groups (P<0.0001).
LIMITATIONS: A small sample size and the retrospective nature of the analysis are limitations to the study.
CONCLUSION: The 300 microsecond 1064nm Nd:YAG laser proved effective in improving the clinical appearance of keloids. We recommended this laser protocol in conjunction with intralesional corticosteroids as a treatment option for patients with keloids, especially in the skin of color population. The 1064nm Nd:YAG laser did not show post inflammatory hyperpigmentation nor hypopigmenatation, which are concerns for skin types IV to VI, and therefore is a suitable option for such patients.

J Drugs Dermatol. 2013;12(11):1256-1262.

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BACKGROUND

Keloids are a prevalent problem, particularly in individuals of African, Hispanic, and Asian descent.1 Keloids can often be recalcitrant to treatment as well as disfiguring, thereby interfering with a patient’s quality of life.2 While keloids do occur in all skin types there is a higher incidence in the Black and Hispanic populations3 and therefore treatments minimizing adverse reactions or further cosmetic disfigurement are sought after and needed. The reported incidence of keloids in the literature varies; a high of 16% in Zairean adults has been reported as well as a low of 0.01% of English Caucasian adults. In comparing the incidence in the black population to the white population a ratio of 2:1 has been reported by Brenizer et al, while a ratio of 19:1 was reported by Fox et al. The incidence in the Asian and Latino populations is reported to fall in-between these groups.4

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