Excimer Laser Corrects Hypopigmentation of Scars and Striae Alba

Yael Waknine

August 17, 2004

Aug. 17, 2004 — Therapy with the 308-nm excimer laser is a safe and effective method of correcting hypopigmentation in scars and striae alba, according to the results of a randomized controlled trial published in the August issue of the Archives of Dermatology.

"Hypopigmented scars and striae alba have long been a therapeutic challenge for which a highly effective, low-risk treatment modality has been lacking," write Macrene R. Alexiades-Armenakas, MD, PhD, and colleagues, from the Laser & Skin Surgery Center of New York in New York City. "The 308-nm excimer laser has been used in the repigmentation of vitiligo and postresurfacing leukoderma."

To assess effects of 308-nm excimer laser therapy, lesions in 31 adult subjects with hypopigmented scars (22 patients) and striae alba (nine patients) were site-matched with normal control areas and randomized to receive treatment or no treatment. Pigment correction was the primary end point of treatment and assessed both visually and by colorimetric measurements.

Laser treatment of affected areas was initiated using a patient's individual erythema dose minus 50 mJ/cm2. Biweekly treatments were administered until 50% to 75% pigment correction was achieved and then reduced to a bimonthly schedule to a maximum of 10 treatments, 75% increase in colorimetric measurements, or 100% visual pigment correction.

Results showed that the percentage of pigment correction, as assessed by both methods, increased in direct proportion to the number of treatments. No incidences of blistering or dyspigmentation were reported.

After nine treatments, scars achieved significant pigment correction compared with control areas, as assessed visually (mean, 61%; 95% confidence interval [CI], 55% - 67%) and by colorimetric measurement (mean, 101%; 95% CI, 99% - 103%).

Significant pigment correction was likewise achieved after nine treatments in striae alba compared with control areas, as assessed visually (mean, 68%; 95% CI, 62% - 74%) and by colorimetric measurement (mean, 102%; 95% CI, 99% - 104%).

Values gradually declined toward baseline during a six-month follow-up, suggesting the need for maintenance treatments.

"A major limitation of this new therapeutic intervention for pigment correction of scars and striae alba is the need for maintenance treatments," the authors write, noting that patients with lighter skin types would likely require maintenance treatment more frequently (every one to two months) than patients with darker skin types.

Increased risk of carcinogenesis may also be associated with cutaneous use of the UV-B–based laser therapy. "Inconsistent results regarding squamous cell carcinoma and other non-melanoma skin cancer rates in UV-B–treated patients have been reported; nevertheless, the calculated increased risk appears to be low," the authors write.

"Treatment with the 308-nm excimer laser is safe and effective in pigment correction of scars and striae alba," the authors conclude. "The practitioner should inform patients of the need for maintenance treatments for durable results."

One of the authors received funding from Photomedex, the maker of the Xtrac xenon chloride excimer laser used in this study.

Arch Dermatol. 2004;140:955-960

Reviewed by Gary D. Vogin, MD

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