title: Energy density and numbers of treatment affect response of keloidal and hypertrophic sternotomy scars to the 585-nm flashlamp-pumped pulsed-dye laser.
abstract: BACKGROUND
  The 585-nm flashlamp-pumped pulsed-dye laser (PDL) has proven to be the treatment of choice for certain keloids and hypertrophic scars, but the precise fluence, numbers of treatment, and treatment interval remain anecdotal.
  
  
  OBJECTIVE
  This study was performed to determine whether the therapeutic outcome of the PDL varies with the energy density (fluence) of the laser pulses and numbers of treatment.
  
  
  METHODS
  Ten previously untreated, erythematous, keloidal or hypertrophic median sternotomy scars of 10 patients were divided into 4 segments and were randomly treated with a 585-nm PDL at a fluence of 3, 5, and 7 J/cm(2) to 3 of 4 segments every 4 weeks for a total of 6 treatment sessions. One segment of each patient's scars was untreated and served as a control. Clinical improvement including scar height, erythema, and pliability was evaluated before treatment and every 8 weeks for a total period of 32 weeks. Self-assessment was also determined by patients on a 25% increment of improvement scale comparing week 0 and week 32.
  
  
  RESULTS
  A significant improvement in scar height, erythema, and pliability was noted in all laser-treated scar areas. There was no significant difference in treatment outcome versus the fluence of the laser (3, 5, and 7 J/cm(2)), although there was a trend for lower fluences to show more improvement. Objective clinical improvement was seen as early as week 16, after more than two treatments were given. Multiple treatments (>2) appeared to provide a greater percentage of scar resolution.
  
  
  CONCLUSIONS
  The clinical improvement of scars after PDL treatment demonstrates no statistically significant fluence dependence in this study, but a trend toward better response with lower fluences is seen. In addition, multiple treatment sessions are suggested for achieving greater response.
authors.affiliation: Dermatology Associates and Cosmetic Laser Associates of San Diego County, Inc, La Jolla, CA 92037, USA.
authors.forename: W
authors.initials: W
authors.lastname: Manuskiatti
authors.forename: R E
authors.initials: RE
authors.lastname: Fitzpatrick
authors.forename: M P
authors.initials: MP
authors.lastname: Goldman
mesh_terms: D000328:Adult; D000368:Aged; D017439:Cicatrix, Hypertrophic / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007627:Keloid / Q000473:pathology / Q000628:therapy*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D013249:Sternum / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing