Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids.
BACKGROUND
Hypertrophic scars affect 1.5% to 4.5% of the general population and remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with treatment. Pulsed dye laser (PDL) treatment and intralesional corticosteroids have individually been reported to be effective in reducing hypertrophic scar bulk and symptoms.


OBJECTIVE
To determine whether combination PDL and intralesional corticosteroid treatment produces better hypertrophic scar improvement than PDL treatment alone.


METHODS
Bilateral hypertrophic inframammary scars in 22 females were randomly assigned to receive treatment with 585-nm PDL alone or in combination with intralesional corticosteroid. Clinical evaluations and scar pliability scores were determined before each of the two treatment sessions and 6 weeks after the final treatment. Histologic evaluation of skin biopsies obtained before and after treatment was performed in four patients.


RESULTS
All scars showed clinical improvement with increased pliability and decreased symptoms (pruritus) after each of the two treatments. Clinical improvement scores were not significantly better with the concomitant use of corticosteroids. Side effects were limited to mild purpura and transient hyperpigmentation. Decreased sclerosis was seen in scars after PDL treatment (with or without concomitant corticosteroids).


CONCLUSIONS
Treatment of hypertrophic inframammary scars with 585-nm PDL irradiation alone effected substantial clinical and histologic improvement. The adjunctive use of intralesional corticosteroids did not significantly enhance clinical outcome except in those scars that were most symptomatic.
Alster
Tina
T
Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA. talster@skinlaser.com
D000328:Adult; D017439:Cicatrix, Hypertrophic / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods*; D016462:Mammaplasty / Q000009:adverse effects; D008875:Middle Aged; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use*
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide