High-intensity laser therapy of patients with atrophic scars: results of a comparative prospective interventional cohort study

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Abstract

BACKGROUND: Scars of various sizes and localization are formed in more than 100 million patients annually. Atrophic scarring defects of the skin are verified in more than 80% of patients with acne and in 30% of patients with other injuries. Different skin remodeling technologies have different effectiveness, which actualizes the search for optimal methods of scar correction. The most promising of them are combinations of high-intensity laser radiation.

AIMS: Determination of therapeutic effects of high-intensity laser therapy in patients with atrophic skin scars.

MATERIALS AND METHODS: A prospective interventional cohort comparative study of the therapeutic effects of high-intensity laser therapy in patients with atrophic skin scars was conducted. In patients with emerging scars, a combination of homogeneous photothermolysis by long-pulse Nd:YAG laser radiation (l=1.064 microns) followed by fractional ablative photothermolysis of CO2 laser (l=10.6 microns) was used, and in patients with mature scars, a combination of homogeneous photothermolysis of long-pulse Nd:YAG laser (l=1.064 microns) and planar laser photodestruction of CO2 laser (l=10.6 microns).

115 patients with the diagnosis of "atrophic scars" (ICD-X, Class XII "Diseases of the skin and subcutaneous tissue", L90.5) were examined, among which groups with emerging (49 patients) and mature (66 patients) scars were identified. Empirical research methods ― clinical, instrumental, and medico-sociological ― have been applied. The analysis of the obtained data was carried out using the methods of descriptive, parametric and multifactorial statistics with the determination of the specific weight of the studied features.

RESULTS: The improvement of the clinical status, pronounced remodeling of the skin in the area of atrophic scars, under the influence of various combinations of high-intensity laser therapy was revealed. An increase in the quality of life indicators according to the Skindex-29 and Dermatology Life Quality Index (DLQI) scales was determined, more pronounced in the groups of patients with atrophic scars in comparison with the group of patients with mature scar deformities. Combinations of high-intensity laser therapy have a favorable safety profile, are characterized by a high degree of compliance and satisfaction with the results of treatment. The effectiveness of variant high-intensity laser therapy in patients with atrophic scars is 86–90%.

CONCLUSIONS: Combinations of high-intensity laser therapy in patients with developing atrophic scars cause dermoplastic and fibromodeling therapeutic effects, in patients with mature ones ― reepithelizing, fibrocorrecting therapeutic effects.

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About the authors

Inga G. Kurganskaya

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: manga-85@mail.ru
ORCID iD: 0000-0001-6550-6940
SPIN-code: 7930-2463

MD, Dr. Sci. (Med.), Associate Professor

Russian Federation, 47, Piskarevsky prospect, Saint-Petersburg, 195067

Svetlana V. Kluchareva

North-Western State Medical University named after I.I. Mechnikov

Email: genasveta@rambler.ru
ORCID iD: 0000-0003-0801-6181
SPIN-code: 9701-1400

MD, Dr. Sci. (Med.), Professor

Russian Federation, 47, Piskarevsky prospect, Saint-Petersburg, 195067

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Supplementary files

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2. Fig. 1. Dynamics of clinical signs of developing atrophic scars under the influence of high-intensity laser therapy.

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3. Fig. 2. Dynamics of clinical signs of mature atrophic scars under the influence of high-intensity laser therapy.

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4. Fig. 3. The proportion of the structure of initial signs: elasticity and sensitivity (factor 1), phototype (factor 2), scar life (factor 3), that significantly determine the dispersion of changes in the microrelief in patients with emerging atrophic scars during the course of high-intensity laser therapy.

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5. Fig. 4. The share of the structure of initial signs: indicators of elasticity and vascularization (factor 1), phototype and history of acne (factor 2), scar life (factor 3), that significantly determine the dispersion of changes in elasticity in patients with developing atrophic scars during the course of high-intensity laser therapy.

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6. Fig. 5. The share of the structure of initial signs: depth and hydration of the scar (factor 1), etiological factor and pigmentation (factor 2), vascularization and sensitivity of the scar (factor 3), that significantly determine the dispersion of changes in the microrelief in patients with mature atrophic scars during the course of high-intensity laser therapy.

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7. Fig. 6. Results of factorial analysis of the structure of initial signs: depth and elasticity (factor 1), vascularization and sensitivity (factor 2), acne and pigmentation (factor 3), that significantly affect the dispersion of changes in elasticity in patients with mature atrophic scars during the course of high-intensity laser therapy.

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