Cohen Joel L, Geronemus Roy
J Drugs Dermatol. 2016 Nov 1;15(11):1315-1319.
BACKGROUND & OBJECTIVE: Surgical scars are an unwanted sequela following surgical procedures. Several different treatment modalities and approaches are currently being employed to improve the cosmesis of surgical scars with each having varying degrees of success. The objective of this study was to assess the ef cacy and safety pulsed dye laser treatment, CO2 ablative fractional resurfacing, and a combined treatment with these two modalities for the cosmetic improvement of surgical scarring that occurred following the surgical removal of skin cancer from different anatomic areas.
Twenty-five patients with surgical scarring most frequently on the face following recent surgical excision of skin cancer with Mohs surgery were included in this multicenter, prospective clinical study. Patients were randomized into 4 treatment arms, namely, pulsed dye laser alone, CO2 laser alone, a combined treatment with these two modalities, and CO2 ablative fractional resurfacing on the same day of surgery to half of the scar, followed by a combined treatment with the two modalities to that half of the scar. Patients in each study arm received a total of 3-4 treatments, while those patients in Arm 4 underwent an additional treatment with CO2 laser immediately after surgery. Patients were followed up at 1 and 3 months after the final treatment session.
No adverse events were seen. Significant improvements in the appearance of scars were achieved in all study arms, as as- sessed by the Vancouver Scar Scale and Global Evaluation Response scales, with the best clinical outcomes seen in those scars that underwent a combination treatment. All patients reported very high satisfaction from treatment.
Both pulsed dye laser treatment and CO2 ablative fractional resurfacing, when used as a monotherapy, are safe and effective in the treatment and improvement of recent surgical scarring. When both of these modalities are used in combination, however, they appear to potentially have a synergistic effect and an accelerated outcome on the cosmesis of recent surgical scars. J Drugs Dermatol. 2016;15(11):1315-1319..
手术疤痕是外科手术后令人困扰的后遗症。目前采用了几种不同的治疗方式和方法来改善手术疤痕的美观度，每种方法的成功率各不相同。本研究的目的是评估脉冲染料激光治疗、二氧化碳剥脱性分次激光换肤以及这两种方式联合治疗对不同解剖部位皮肤癌手术切除后形成的手术疤痕进行美容改善的疗效和安全性。
本多中心前瞻性临床研究纳入了25例近期接受莫氏手术切除皮肤癌后面部出现手术疤痕的患者。患者被随机分为4个治疗组，即单独使用脉冲染料激光、单独使用二氧化碳激光、这两种方式联合治疗，以及在手术当天对一半疤痕进行二氧化碳剥脱性分次激光换肤，然后对另一半疤痕进行这两种方式联合治疗。每个研究组的患者总共接受3 - 4次治疗，而第4组的患者在手术后立即额外接受一次二氧化碳激光治疗。在最后一次治疗后1个月和3个月对患者进行随访。
未观察到不良事件。通过温哥华疤痕量表和整体评估反应量表评估，所有研究组的疤痕外观均有显著改善，联合治疗的疤痕临床效果最佳。所有患者对治疗的满意度都非常高。
脉冲染料激光治疗和二氧化碳剥脱性分次激光换肤单独作为单一疗法时，在治疗和改善近期手术疤痕方面是安全有效的。然而，当这两种方式联合使用时，它们似乎对近期手术疤痕的美观度可能具有协同作用和加速改善的效果。《皮肤药物学杂志》。2016年；15(11):1315 - 1319。
