Hypertrophic scar treated with a pulse dye laser
Laser Scar Revision
There are several forms of scars. Their color and shape help determine laser treatment. Hypertrophic scars are raised red scars. Keloids are raised, thick, reddish, purple scars. Atrophic scars are depressed scars that occur with inflammatory diseases such as acne or chicken pox. Where as ice pick or boxcar depressions are treated with fillers or excision, other flatter atrophic scars respond better to laser therapy.
Hypertrophic scars and keloids can be treated with lasers. PDL lasers have been used with improvement in scar redness, bulk and discomfort, sometimes combined with intralesional steroids for thick keloids. While being radiated, patients may feel a snapping sensation like that of a rubber band. Afterwards there is a sunburn feeling for 15-30 minutes.
Moderate atrophic scars treated with a CO2 laser can be improved 50-80%. Further improvement may occur for 12-18 months later, so repeat treatments should be delayed at least a year. Other devices like the 1320 nm Nd:YAG laser given as three monthly treatments can improve scars 40-50% over 6 months.
Side effects after laser therapy includes bruising for several days, swelling for 48 hours, redness, oozing of fluid, infection, acne, or abnormal pigmentation. Transient hyperpigmentation (skin darkening) occurs more with darker skin types but can happen to anyone. It appears with in 1-2 months and resolves on its own but improvement can be accelerated by bleaching agents like hydroquinone or acids like glycolic, retinoic, azelaic, or ascorbic.
Hypopigmentation (abnormal skin lightening) can be seen 6 months or later, is permanent but rare. The most severe complications are hypertrophic scarring and abnormal eyelid position (ectropion). Hypertrophic scars can be treated with a PDL, but ectropion requires surgery.
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