Alexander Sajin, Girisha Banavasi S, Sripathi Handattu, Noronha Tonita M, Alva Akshata C
Department of Dermatology, K. S Hegde Medical Academy, NITTE (Deemed to be University), Mangalore, India.
J Cosmet Dermatol. 2019 Dec;18(6):1648-1656. doi: 10.1111/jocd.12887. Epub 2019 Feb 15.
Keloids and hypertrophic scars (HTS) are abnormal fibrous reactions that persist for prolonged periods, rarely regress without treatment and recur after excision. Many modalities of treatment have been advocated but the success rates of these have been variable. The present study is an attempt to evaluate and compare the efficacy of combination of fractional CO laser (FCL) and intralesional steroid (ILS) against ILS alone in the treatment of keloids and HTS.
Patients with keloids or HTS were divided into two groups of 25 each receiving four sessions of therapy. Group 1 (FCL + ILS) received combination of FCL and intralesional triamcinolone acetonide (TAC) 10 mg/mL. Group 2 (ILS only) received intralesional TAC 10 mg/mL alone. Pretreatment measurements and photographs were taken. Two unbiased qualified dermatologists made independent evaluation of the photographs using modified Manchester quartile score (MQS). The patient's satisfaction to treatment was graded on a scale of 1-4. Statistical analysis was done using a statistical software.
Statistically significant improvement was seen in height and length of the lesions. Overall appearance criteria of modified MQS showed an improvement of more than 50% in 43.3% of the lesions by the end of four sessions. Degree of hypertrophy showed more than 50% improvement in 40% of the lesions treated. Dyschromia showed more than 50% improvement in 33.4%. Texture showed the least improvement, with only 30% of lesions showing an improvement of more than 50%. The improvement of these parameters in ILS only group was significantly lower than the improvement seen in the FCL + ILS group.
Combination therapy with FCL and ILS was superior in efficacy when compared to ILS alone, in the treatment of keloids and HTS.
瘢痕疙瘩和增生性瘢痕（HTS）是异常的纤维反应，会持续很长时间，未经治疗很少会消退，切除后还会复发。人们提出了多种治疗方法，但这些方法的成功率各不相同。本研究旨在评估和比较分次二氧化碳激光（FCL）联合病灶内注射类固醇（ILS）与单纯病灶内注射类固醇治疗瘢痕疙瘩和增生性瘢痕的疗效。
瘢痕疙瘩或增生性瘢痕患者分为两组，每组25人，均接受四个疗程的治疗。第1组（FCL + ILS）接受FCL与10 mg/mL曲安奈德（TAC）病灶内注射联合治疗。第2组（仅ILS）仅接受10 mg/mL曲安奈德病灶内注射。治疗前进行测量并拍照。两名公正的合格皮肤科医生使用改良的曼彻斯特四分位数评分（MQS）对照片进行独立评估。患者对治疗的满意度按1 - 4级进行评分。使用统计软件进行统计分析。
病灶的高度和长度有统计学意义的改善。改良MQS的总体外观标准显示，在四个疗程结束时，43.3%的病灶改善超过50%。肥大程度在40%接受治疗的病灶中显示改善超过50%。色素沉着异常在33.4%的病灶中显示改善超过50%。质地改善最少，只有30%的病灶显示改善超过50%。仅ILS组这些参数的改善明显低于FCL + ILS组。
在治疗瘢痕疙瘩和增生性瘢痕方面，FCL与ILS联合治疗的疗效优于单纯ILS治疗。
