How effective is pulsed-dye laser (PDL) (595 nm) for treatment of keloids and hypertrophic scars?

Updated: Jun 12, 2018
  • Author: Brian Berman, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Answer

In a prospective randomized clinical trial, Conologue et al treated 16 patients with postoperative scars immediately after suture removal with a 595-nm cryogen-cooled PDL at 8 J/cm2 and showed significant improvement (60%) versus the untreated control (-3%) in the average sum of all clinical parameters measured. [92] Improvement was noted in vascularity (69%) versus the control (0%) (P = .53) and in pliability (67%) compared with the control (-8%) (P = .337).

In order to compare the 0.45-millisecond (short) pulse width with the 40-millisecond (long) pulse width, Manuskiatti et al treated 19 patients with keloidal and hypertrophic sternotomy scars in a prospective randomized clinical trial, with a 595-nm PDL at 7 J/cm2 and a cryogen spray cooling device. [93] The short pulse width demonstrated greater overall improvement (P = .046) and scar pliability. Both pulse widths significantly reduced scar height compared with baseline; however, no differences were found between the groups. No effects were noted on scar erythema with either treatment. Both treatments were safe and effective in dark-skinned individuals.

Bellew et al randomly treated 15 hypertrophic scars with a 595-nm long-pulsed PDL at 7 J/cm2 with a concomitant skin-surface cooling device or with an IPL system with a 570-nm cut-off filter and a fluence of 40-45 J/cm2 and a triple pulse, reporting a mean improvement in the long-pulsed PDL group of 80% compared with 65% in the IPL group. [94] However, no statistical difference was noted between the 2 groups. Both systems are equally effective in improving the appearance of hypertrophic surgical scars. IPL minimizes the risk of purpura.

In contrast, however, Alam et al found no beneficial effect on clinical scar appearance at 6 weeks post treatment versus untreated control, after treating 20 patients with postoperative scars in a prospective, randomized, controlled trial using a 595-nm PDL at 7 J/cm2 and a 30-millisecond dynamic cooling spray. [95]


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