Skin damage can cause scar formation on the skin, which is a very common cosmetic skin problem that patients request treatment for. Keloid scars can be caused by surgery, burns, trauma or inflammation and are very common. Keloid scars are usually long lasting, while hypertrophic keloids may subside over time. However, it is impossible to predict whether hypertrophic keloids will eventually fade and, in addition to their cosmetic impact, these abnormal keloids may cause symptoms such as itching and dullness of sensation, prompting patients to seek medical attention.
There are also many treatments for scarring, which used to include surgery, grinding, freezing, compression therapy, local injections of corticosteroids or 5-fluorouracil, and medications (interferon, imiquimod). The development of laser and photon technology has led them to gradually become a means of treating scarring in clinical practice.
For example, various pulsed lasers (e.g. dye laser, Nd:YAG laser), pulsed vaporization type lasers (e.g. CO2 laser, erbium laser), and fractional lasers. Hypertrophic scars usually have a high recurrence rate and side effects after treatment, but overall, hypertrophic scars are treated much more successfully than keloids.
Dye lasers were originally designed based on the principle of selective photothermal action for the treatment of vascular diseases of the skin, such as the treatment of nevus of the vivid red spots. However, this year it has been found that this type of laser is effective for hyperplastic scarring, or acne atrophic scarring, as well as for fine wrinkles in the skin. The energy used for treatment is lower, and the treatment is done in such a way that it does not cause significant burns to the skin, in other words, the energy density of the treatment is lower than when treating vascular diseases.
With clinical development, it was soon found that almost all lasers used in the past for the treatment of vascular diseases, such as the long pulse 532nm laser, the long pulse width 585nm laser, the long pulse width 595nm laser and the long pulse width infrared laser (1064nm, 1320nm, 1450nm), were effective, except for the dye laser.
The dye laser is effective for hyperplastic keloids and keloid scars. Treatment with the 585nm laser with a pulse width of 0.45ms can be performed once a month, several times in a row, and the energy setting can be in the range of 3-7J/cm2, and this energy range is effective. There seems to be no correlation between the efficacy and the energy density, but a lower energy density may have better efficacy. If better results are needed, multiple treatments are recommended. Generally, 2 treatments will provide significant therapeutic results, including improvement in scar height, erythema and scar tenderness.
The 585nm dye laser has been clinically shown to be effective in treating surgical scars in all areas of the body. Starting treatment at the early stages of surgical scarring, when stitches are removed, can significantly improve the appearance of the healing scar.
The 595nm laser is also effective in the treatment of keloid scars. Although controlled studies have shown that both 585nm and 595nm (pulse width 1.5ms) dye lasers are effective in the treatment of post-surgical scars, with no difference in efficacy, the 585nm laser appears to be slightly more effective than the 595nm laser in terms of clinical outcomes.
I. Proliferative scars and keloids
1. Medication: There are various medications or ambrosia products used to treat scarring mainly for this type of scar. You can choose cumene products, which can be used externally and internally. In addition, topical application of onion extract (e.g., Conrad) can also be effective. Various topical potent corticosteroids are also effective, especially when the lesions are itchy or painful.
2. Intra-dermal injection: For early hyperplastic scars, the treatment method of intra-dermal injection of corticosteroids is more effective, which can make the scar quiescent and eliminate the pain or itchiness very quickly. The most commonly used drug is a local injection of de-inflammatory pine suspension, which can be injected with 2% lidocaine once a week, or every 10 days, for fast results.
At present, some people apply slow-release preparations for treatment, once a month, whether it is reasonable has yet to be confirmed, because the main purpose of slow-release preparations is to slowly release drugs into the blood circulation for the treatment of systemic diseases, and the requirements of local injection is to try not to enter the blood circulation and the therapeutic effect occurs locally.
3, radiation therapy: local superficial X-ray treatment is still a very effective treatment method, and the treatment itself is not painful. However, it is not certain whether the treatment is absolutely safe, at least for those patients with hemangioma who receive X-ray treatment, the risk of malignant tumor in the skin increases significantly in the future.
4. Surgical excision: Surgical excision alone tends to make the result counterproductive and the scar tissue may be more pronounced, especially in keloids, and surgical excision alone may significantly aggravate the condition. Surgical excision along with combined radiotherapy can improve the appearance as soon as possible. Of course, combined surgical treatment along with intra-dermal injection treatment is also effective and can be tried.
Atrophic scar
1. Drug treatment: Various drugs have almost no substantial therapeutic effect on atrophic scars.
2.Filler: Intra-dermal injection of appropriate amount of filler has certain therapeutic value for atrophic scars with obvious depressions, and filler has three types: long-acting, medium-acting and short-acting, which can be selected according to clinical needs. At present, there are more fillers available for clinical use, such as hyaluronic acid, various collagen products, etc.
3.Pulsed Intense Light: For lighter atrophic scars, such as acne scars, the application of IPL can obtain exact efficacy, especially for early acne scars, and it is satisfactory for improving the appearance of large red acne scars with fast efficacy, and it also has a certain improvement effect on minor depressed scars.
Infrared laser: Infrared laser with wavelength of 1064nm-1450nm, when the wavelength is microsecond or millisecond, is effective for depressed atrophic scars. This laser can obviously stimulate the dermal fibroblasts to produce new collagen tissue to fill the atrophic scars. There are also more commercial devices, such as 1064nm laser, 1320nm laser, 1450nm laser, etc. are successfully used in clinical practice.
5. Vascular treatment lasers: Most of the skin lasers for vascular treatment have some therapeutic effect on depressed scar when low energy density setting is used. For example, lasers with wavelengths of 532nm, 585nm and 595nm are effective. The treatment mechanism may also be through the absorption of laser energy by hemoglobin to stimulate the endothelium or dermis of blood vessels to achieve the purpose.
6. Fractional laser: Fractional laser is a new treatment technology developed in recent years and successfully applied to the treatment of atrophic scarring, especially post-acne atrophic scarring. There are also more types of fractional lasers, but the light sources are all infrared lasers, such as the wavelength of 10600nm CO2 laser, 2940nm Erbium laser, 1440nm YAG laser, 1550nm semiconductor laser, etc. This is a treatment method with similar efficacy to skin grinding but with fewer side effects, and is now starting to be promoted in China. From the few existing clinical applications in China, the efficacy is encouraging.
6.Dermabrasion: Traditional dermabrasion treatment can be used. Traditional skin grinding treatment has clear efficacy on atrophic scarring of acne scarring, but the treatment bleeds a lot, the field of view is not clear, and the depth of grinding is sometimes not easy to control, and some physicians even use point grinding technology to carry out the treatment.
7.Laser resurfacing treatment is different from the traditional skin grinding treatment, laser resurfacing technology uses pulsed laser as a treatment tool to treat the skin and vaporize the tissue on the surface of the scar. During the treatment, an “additional” but very important therapeutic effect is produced due to the thermal stimulation of the laser on the dermis, so that the laser surface reconstruction treatment does not only apply the laser to grind the skin, but also to properly stimulate the dermis.
This method is actually simpler than dermabrasion, the depth of treatment is easier to control, and the treatment is very uniform, making it ideal for the treatment of more severe atrophic scarring. The former treatment is suitable for treating obvious scars, while the latter is suitable for treating minor scars, and the combined use may be more effective.
8. Surgical excision: For deep depressed keloid scars or lesions with large depressed keloid scars, simple excision can be used, or dermatological ring drill treatment: the scar tissue is removed by applying a ring drill, while the normal skin tissue of the donor area is drilled by applying the same type of ring drill and finally filled to the original scar.