In Which Cases Are Lasers Used in the Treatment of Cicatricial and Keloids?

In Which Cases Are Lasers Used in the Treatment of Cicatricial and Keloids?

Scars and keloid formations that can develop after traumas, surgical interventions, infections, burns and some dermatological diseases can lead to significant problems both cosmetically and functionally. While hypertrophic scars are usually limited in area, pink, hard and spontaneously regressive, keloids are thick structures that grow beyond the trauma area, are red-purple in color and cause symptoms such as itching and pain.

In addition to classical methods in the treatment of these lesions, laser treatments that have developed rapidly in recent years offer successful results. However, there is still no standard treatment protocol in this area.

Which Lasers Are Used in Hypertrophic Cicatricial and Keloids?
Lasers were first applied with continuous wave lasers such as CO₂, argon and Nd:YAG in the treatment of hypertrophic scars and keloids. However, due to the extensive side effects and high recurrence rates of these lasers, they have been replaced by pulsed lasers.

One of the most notable lasers, PDL (Pulse Dye Laser, 585-595 nm), provides significant improvement in symptoms such as erythema, consistency, itching and pain. While it can be used alone in small scars, it is often combined with fractional lasers. The effect of PDL has been associated with collagen destruction, suppression of fibroblast proliferation and selective photothermolysis of vascular structures.

What are the Effects of Nd:YAG and KTP Lasers on Scars and Keloids?
Nd:YAG laser (532 nm and 1064 nm) is a more effective option than PDL, especially in thick keloids. It provides more effective photothermolysis thanks to its ability to penetrate deep tissues. In addition, KTP laser is a preferred laser type in scars with intense vascularization.

In pigmented scars, 532 nm Nd:YAG laser is also advantageous over PDL in terms of melanin absorption. Studies have shown that Nd:YAG laser provides a 38% success rate and PDL a 36.1% success rate.

In Which Types of Scars Are Fractional Lasers Effective?
Fractional lasers restart the wound healing process by causing microthermal damage to the tissue. Ablative fractional CO2 lasers are more successful than non-ablative lasers in hypertrophic scars because they create deeper thermal damage.

While the effects of CO2 laser such as consistency softening and thickness reduction are more pronounced, non-ablative fractional lasers are more effective in regulating pigmentation and erythema. Combination treatments can provide better results by reducing side effects.

How is Laser Treatment Planned in Atrophic Scars?
The purpose of lasers in atrophic scar treatment is to smooth the surface and stimulate collagen production. CO₂ and Er:YAG lasers are especially the most effective methods for contour correction. The reepithelialization period lasts 4–7 days for Er:YAG laser and 7–10 days for CO2 laser.

Fractional ablative lasers are more effective than non-ablative lasers; however, they also have a higher risk of side effects. Therefore, combined use with low energy may be preferred.

How Effective Are Non-Ablative Lasers in Atrophic Scars?
Non-ablative lasers work with fewer side effects, but their effectiveness is moderate. Erbium:Glass (1540-1550 nm), Nd:YAG (1064-1320 nm) and Diode (1450 nm) lasers support collagen production by creating thermal damage in the dermis. The success rate is especially high in “rolling” and “boxcar” type scars.

When comparing CO2 laser and Erbium laser, CO2 laser is superior in terms of clinical effect; Erbium laser is safer in terms of side effects. Clinical studies show that combination treatments provide higher patient satisfaction.

What Kind of Developments Are There in Scar and Keloid Treatment with New Laser Systems?

In the literature, Copper Bromide (578 nm) laser gives successful results when used with intralesional corticosteroids. In addition, LLLT (Low Level Laser Therapy) is used to suppress inflammatory symptoms, especially by performing a photobiomodulation effect with low energy.

Picosecond pulse lasers developed in recent years also show promise in scar treatment. It has been reported that these systems provide similar effectiveness to ablative lasers but have fewer side effects.

How Should Laser Selection Be Made in Scar and Keloid Treatment?
The selection in laser treatment should be made according to the type of scar (hypertrophic, keloid, atrophic), color, age, depth and localization. In general:

For hypertrophic scar: PDL (585-595 nm) and ablative CO2 lasers.

For keloid: Nd:YAG (532 nm, 1064 nm) and KTP lasers.

For atrophic scarring: Fractional ablative CO2, Er:YAG and non-ablative Erbium:Glass lasers.

However, laser application alone may not be sufficient most of the time. While combined treatment approaches provide better results, individual planning should be made for each patient.

In Conclusion, Are Lasers Effective in Scarring and Keloids?
Yes, laser treatments are effective in scarring and keloid treatment when applied with the right patient selection and appropriate protocols.