Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
Br J Dermatol. 2011 Nov;165(5):934-42. doi: 10.1111/j.1365-2133.2011.10492.x.
Hypertrophic scars are difficult to improve and remain a therapeutic challenge. Several lasers and light sources have been evaluated in the past decades and have been shown to improve hypertrophic scars. However, a systematic review is not available. To assess current evidence of efficacy of all laser and intense pulsed light therapies used in the treatment of hypertrophic scars, we performed a systematic review searching electronic databases MEDLINE, EMBASE and CENTRAL. The quality of the controlled clinical trials was evaluated according to the Cochrane Collaboration's tool for assessing risk of bias. Thirteen articles involving seven different lasers met the inclusion criteria. Most evidence was found for the pulsed dye laser (PDL) 585 nm (eight studies), followed by the PDL 595 nm (two studies), whereas limited evidence (one trial per laser) was available for the fractional nonablative laser 1540 nm, CO₂ laser 10,600 nm, low-level laser therapy, Nd:YAG laser 532 nm and Erbium:YAG laser 2940 nm. Treatment recommendations should be formulated with caution as current evidence is insufficient for comparing the efficacy of different laser therapies. The PDL 585 nm showed a low efficacy for the treatment of hypertrophic scars. With moderate efficacy, the PDL 595 nm is promising, although more research is necessary. Little evidence was found for the efficacy of other lasers. Future research, with a low risk of bias, well-defined scar characteristics, validated outcome measures, standardized measurement methods, follow-up periods of at least 6 months and well-defined laser settings, is needed.
增生性瘢痕难以改善，仍然是治疗的挑战。过去几十年已经评估了几种激光和光源，它们被证明可以改善增生性瘢痕。然而，目前还没有系统的评价。为了评估所有用于治疗增生性瘢痕的激光和强脉冲光治疗的疗效的现有证据，我们对 MEDLINE、EMBASE 和 CENTRAL 电子数据库进行了系统检索。根据 Cochrane 协作组评估偏倚风险的工具，对对照临床试验的质量进行了评估。符合纳入标准的有 13 篇文章涉及 7 种不同的激光。最有证据的是脉冲染料激光（PDL）585nm（8 项研究），其次是 PDL 595nm（2 项研究），而分数非消融性激光 1540nm、CO₂激光 10600nm、低水平激光治疗、Nd：YAG 激光 532nm 和 Erbium：YAG 激光 2940nm 则仅有一项试验。由于目前的证据不足以比较不同激光治疗的疗效，因此应谨慎制定治疗建议。PDL 585nm 治疗增生性瘢痕的疗效较低。PDL 595nm 的疗效中等，很有前途，但需要更多的研究。其他激光的疗效证据很少。需要进行未来的研究，这些研究应具有低偏倚风险、明确的瘢痕特征、经过验证的结局测量、标准化的测量方法、至少 6 个月的随访期以及明确的激光设置。
