El-Tayeb Nada M, Fattah Nermeen S A Abdel, El-Badawy Nafissa, El-Samahy May H
Department of Dermatology, Ain Shams University, Cairo, Egypt.
Department of Pathology, Ain Shams University, Cairo, Egypt.
Arch Dermatol Res. 2025 Mar 17;317(1):568. doi: 10.1007/s00403-025-04058-5.
Keloids represent a therapeutic challenge due to lack of satisfactory treatment and high rate of recurrence. Various treatment modalities exist, including intralesional steroids, photodynamic therapy (PDT), lasers and different combinations have been used to reach better results. This study assessed the efficacy and safety of fractional carbon dioxide-assisted delivery of Methylene blue in treatment of keloids to provide an additional treatment option for keloids. A total of 20 previously-untreated keloids have been treated with 3 monthly sessions of fractional carbon dioxide (CO) laser and methylene blue PDT using intense pulsed light (IPL). In the first session debulking of the keloid's height by at least 50% with ablative CO2 was performed. Patients were photographed and assessed before treatment and 2 months after the last session, clinically using patient and observer scar assessment scale (POSAS), histopathologically by H&E and Masson trichrome. The follow up showed significant reduction in total POSAS scores. Histopathologically, collagen improved from 3.45 ± 1.05to 2.65 ± 0.875. Side effects were tolerable & included pain, burning sensation, erythema, desquamation, slight edema, slight exudation, and hyperpigmentation. Clinical and histopathological improvements were seen after methylene blue-PDT, and it could be a potential treatment option for keloids. However, further controlled studies are needed to compare its effectiveness with other established modalities along with determination of ideal parameters of IPL & fractional CO2.
瘢痕疙瘩由于缺乏令人满意的治疗方法和高复发率而成为一个治疗难题。现有的治疗方式多种多样，包括病灶内注射类固醇、光动力疗法（PDT）、激光，并且已经使用了不同的联合治疗方法以取得更好的效果。本研究评估了二氧化碳点阵激光辅助亚甲蓝给药治疗瘢痕疙瘩的疗效和安全性，为瘢痕疙瘩提供一种额外的治疗选择。共有20个未经治疗的瘢痕疙瘩接受了3次每月一次的二氧化碳（CO）点阵激光治疗以及使用强脉冲光（IPL）的亚甲蓝光动力疗法。在第一次治疗中，使用剥脱性二氧化碳激光将瘢痕疙瘩的高度至少降低50%。在治疗前以及最后一次治疗后2个月对患者进行拍照和评估，临床使用患者和观察者瘢痕评估量表（POSAS），组织病理学检查采用苏木精-伊红染色（H&E）和马松三色染色。随访结果显示POSAS总分显著降低。组织病理学方面，胶原蛋白从3.45±1.05改善至2.65±0.875。副作用可以耐受，包括疼痛、烧灼感、红斑、脱屑、轻微水肿、轻微渗出和色素沉着。亚甲蓝光动力疗法后可见临床和组织病理学改善，它可能是瘢痕疙瘩的一种潜在治疗选择。然而，需要进一步的对照研究来将其有效性与其他已确立的治疗方式进行比较，并确定强脉冲光和二氧化碳点阵激光的理想参数。
