Successful Treatment of Keloid With Fractionated Carbon Dioxide (CO2) Laser and Laser-Assisted Drug Delivery of Triamcinolone Acetonide Ointment in an African-American Man
September 2017 | Volume 16 | Issue 9 | Case Reports | 925 | Copyright © September 2017
Ekaterina Kraeva MD,a,b Derek Ho MD,a,b and Jared Jagdeo MD MSa,b,c
aDermatology Service, Sacramento VA Medical Center, Mather, CA bDepartment of Dermatology, University of California Davis, Sacramento, CA cDepartment of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY
to non-fractionated CO2 laser, including: minimal downtime; decreased risk of infection, bleeding, and dyschromia; and reduced patient discomfort.6 This case report and review highlights that fractionated CO2 laser therapy may be efficacious for treatment of keloids, however, several sessions may be necessary to achieve clinical improvement.8-10 Due to a paucity of published evidence, we recommend additional research on fractionated CO2 laser treatment of keloids.Combination therapy with fractionated CO2 laser and LADD of topical TAC ointment may yield excellent cosmetic results without recurrence or significant side effects in patients with keloids.11,12 To the best of our knowledge, this is the first report of successful treatment of keloid using combination therapy of fractionated CO2 laser and LADD with topical TAC ointment in an African-American man (Fitzpatrick VI) with excellent cosmetic results sustained at 22 months post-treatment. We believe that this combination treatment modality may be safe and efficacious for keloids in skin of color (Fitzpatrick IV-VI) and other patients. Application of topical TAC ointment immediately following fractionated CO2 laser treatment may be an efficacious, non-invasive alternative to intralesional steroids. Fractionated CO2 laser allows for penetration of topical drugs into the dermis, after generation of MTZs, and enhances drug delivery to target tissue, while forgoing the need for painful and invasive injections compared to the commonly performed intralesional corticosteroids. We propose that LADD with topical steroids has the following benefits: (1) decreases the risk of dyschromia following treatment; (2) attenuates local inflammatory response; and (3) decreases fibrosis associated with keloids.This case highlights the ability of laser surgeons to safely use fractionated CO2 lasers in patients of all skin colors. Additional randomized controlled trials and split-scar studies are needed to optimize fractionated CO2 laser settings and treatment regimen for strong recommendation of keloid treatment using fractionated CO2 laser and LADD with topical TAC ointment in skin of color patients.
No conflicts of interest or author disclosures to report and no industry funding provided.This material is the result of work supported with resources and the use of facilities at the VA Northern California Health Care System.The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.
- Alster TS, Tanzi EL. Hypertrophic scars and keloids: Etiology and management. Am J Clinical Dermatol. 2003;4(4):235-243.
- Bock O, Schmid-Ott G, Malewski P, Mrowietz U. Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res. 2006;297(10):433-438.
- Mamalis AD, Lev-Tov H, Nguyen DH, Jagdeo JR. Laser and light-based treatment of Keloids - A review. J Eur Acad Dermatol Venereol. 2014;28(6):689-699.
- Bayat A, McGrouther DA, Ferguson MWJ. Skin scarring. British Medical Journal. 2003;326(7380):88-92.
- Sobanko JF, Alster TS. Laser Treatment for Improvement and Minimization of Facial Scars. Facial Plastic Surgery Clinics of North America. 2011;19(3):527-542.
- Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: A new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426-438.
- Tierney EP, Kouba DJ, Hanke CW. Review of fractional photothermolysis: Treatment indications and efficacy. Dermatol Surg. 2009;35(10):1445-1461.
- El-Zawahry BM, Sobhi RM, Bassiouny DA, Tabak SA. Ablative CO2 fractional resurfacing in treatment of thermal burn scars: an open-label controlled clinical and histopathological study. J Cosmet Dermatol. 2015;14(4):324-331.
- Scrimali L, Lomeo G, Nolfo C, et al. Treatment of hypertrophic scars and keloids with a fractional CO2 laser: A personal experience. J Cosmet Laser Ther. 2010;12(5):218-221.
- Scrimali L, Lomeo G, Tamburino S, Catalani A, Perrotta R. Laser CO2 versus radiotherapy in treatment of keloid scars. J Cosmet Laser Ther. 2012;14(2):94-97.
- Waibel J, Wulkan A. Treatment of hypertrophic scars using laser assisted corticosteroids vs laser assisted 5-fluoruracil delivery. Lasers Surg Med. 2013;45:14.
- Martin MS, Collawn SS. Combination treatment of CO2 fractional laser, pulsed dye laser, and triamcinolone acetonide injection for refractory keloid scars on the upper back. J Cosmet Laser Ther. Jun 2013;15(3):166-170.
- Apfelberg DB, Maser MR, Lash H. Preliminary results of argon and carbon dioxide laser treatment of keloid scars. Lasers Surg Med. 1984;4(3):283-290.
- Kantor GR, Wheeland RG, Bailin PL. Treatment of earlobe keloids with carbon dioxide laser excision: A report of 16 cases. J Dermatol Surg Oncol. 1985;11(11):1063-1067.
- Apfelberg DB, Maser MR, White DN, Lash H. Failure of carbon dioxide laser excision of keloids. Lasers Surg Med. 1989;9(4):382-388.
- Stern JC, Lucente FE. Carbon dioxide laser excision of earlobe keloids. A prospective study and critical analysis of existing data. Arch Otolaryngol Head Neck Surg. 1989;115(9):1107-1111.
- Norris JEC. The Effect of Carbon-Dioxide Laser-Surgery on the Recurrence of Keloids. Plastic Reconstruct Surg. 1991;87(1):44-49.
Jared Jagdeo MD MS email@example.com