Combined fractional carbon dioxide laser with long pulsed Nd:YAG laser for treatment of immature hypertrophic scar

Abstract

Background Immature hypertrophic scar complicated with contracture, disability, disfigurement, social embarrassment, pain, itching, residual scar, and prolonged maturation period. Various treatments for immature hypertrophic scar are used with limitations for each treatment. Objective To evaluate the efficacy and safety of combined fractional carbon dioxide (CO2) and Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) lasers for the treatment of immature hypertrophic scar both clinically and histopathologically. Patients and methods Total of 30 patients with single or multiple immature hypertrophic scars. The single scar was not less than 14 cm in length. In the same patient, single or multiple scars were divided randomly into treated areas and control areas. The treated areas were submitted to 5 sessions of fractional CO2 laser combined with long pulsed Nd:YAG laser, one month in between sessions, the control areas did not receive any treatment. Vancouver Scar Scale (VSS) and patient and observer scar assessment scale (POSAS) were used for clinical evaluation before, 3, and 6 months after treatment. Collagen area percent, elastin area percent, and epidermal thickness were assessed histopathologically before and 3 months after treatment. Results The scar areas treated with combined fractional CO2 laser and long pulsed Nd:YAG laser showed superior significant clinical improvement with VSS and POSAS than areas did not receive any treatment (except for the pigmentation parameter of both VSS and POSAS), especially 6 months after last treatment without significant side effects for laser therapy. Opinions of the patients showed superior significant improvement in laser treated areas than areas did not receive any treatment. Epidermal thickness, collagen area percent and elastin area percent showed superior significant improvement in laser treated areas than areas did not receive any treatments three months after last laser session. Conclusion Combined treatment of immature hypertrophic scar with fractional CO2 and Nd:YAG lasers is effective, tolerable, and safe.