Safety and Efficacy Evaluation of Pulsed Dye Laser Treatment, CO2 Ablative Fractional Resurfacing, and Combined Treatment for Surgical Scar Clearance
November 2016 | Volume 15 | Issue 11 | Original Article | 1315 | Copyright © 2016
Joel L. Cohen MDa and Roy Geronemus MDb
aAboutSkin Dermatology & DermSurgery, Greenwood Village, CO bLaser & Skin Surgery Center of New York, NY
BACKGROUND & OBJECTIVE: Surgical scars are an unwanted sequela following surgical procedures. Several different treatment modalities and approaches are currently being employed to improve the cosmesis of surgical scars with each having varying degrees of success. The objective of this study was to assess the ef cacy and safety pulsed dye laser treatment, CO2 ablative fractional resurfacing, and a combined treatment with these two modalities for the cosmetic improvement of surgical scarring that occurred following the surgical removal of skin cancer from different anatomic areas. MATERIALS AND METHODS: Twenty-five patients with surgical scarring most frequently on the face following recent surgical excision of skin cancer with Mohs surgery were included in this multicenter, prospective clinical study. Patients were randomized into 4 treatment arms, namely, pulsed dye laser alone, CO2 laser alone, a combined treatment with these two modalities, and CO2 ablative fractional resurfacing on the same day of surgery to half of the scar, followed by a combined treatment with the two modalities to that half of the scar. Patients in each study arm received a total of 3-4 treatments, while those patients in Arm 4 underwent an additional treatment with CO2 laser immediately after surgery. Patients were followed up at 1 and 3 months after the final treatment session. RESULTS: No adverse events were seen. Significant improvements in the appearance of scars were achieved in all study arms, as as- sessed by the Vancouver Scar Scale and Global Evaluation Response scales, with the best clinical outcomes seen in those scars that underwent a combination treatment. All patients reported very high satisfaction from treatment. CONCLUSION: Both pulsed dye laser treatment and CO2 ablative fractional resurfacing, when used as a monotherapy, are safe and effective in the treatment and improvement of recent surgical scarring. When both of these modalities are used in combination, however, they appear to potentially have a synergistic effect and an accelerated outcome on the cosmesis of recent surgical scars. J Drugs Dermatol. 2016;15(11):1315-1319.
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Scars resulting from surgical procedures are of significant concern to patients and surgeons due to potential physical complications, and can be the cause of anxiety and psychological distress in affected patients. Reducing the severity of a potential scar or preventing the development of a scar is one peri-surgical goal that may be achieved with different treatment modalities— with each having varying degrees of success. Treatment options for the aesthetic improvement of a scar and/or its prevention include injections of botulinum toxin, soft-tissue augmentation agents, as well as lasers— all of which have shown efficacy in minimizing the appearance of the scar. Preventing scar formation or improving the cosmesis of a scar can be in part achieved with proper wound care practices by the patient, but continued research has shed light on the complex mechanisms of action of wound healing and has led to the development of new and effective treatment modalities for scar prevention and treatment.1One such modality is the pulsed dye laser (PDL), which has been shown to safely and effectively improve the cosmesis of various types of scarring. In a randomized, blinded, split-scar study, patients with scars post Mohs surgery received four treatments with a 1,550 nm nonablative fractional laser (NAFL) on half of the scar, and the 595 nm PDL to the other half of the scar. Results showed that although both the NAFL and PDL were effective and safe in improving the appearance of surgical scars, the NAFL treated scars achieved a greater improvement in scar cosmesis.2 In one case study, the 1,550 nm nonablative fractional laser was used as a monotherapy for the treatment of a postsurgical Mohs surgery scar with results showing a greater than 75% clinical improvement at 2 weeks after a single treatment with the device.3Weiss et al4 reported treatment success in a cohort of patients with atrophic postoperative and traumatic scarring using a 30W ablative CO2 fractional laser device. Each scar underwent three ablative fractional resurfacing treatments spaced one to four months apart, leading to a 26-50% improvement in scar atrophy, pigmentation and texture, as assessed by the study