烧伤疤痕治疗中加压疗法、药物及剂量、激光的作用及剂量研究

目的探究瘢痕表皮细胞在低能量CO 2 点阵激光改善烧伤后瘢痕中的作用及可能的分子机制。 方法建立大鼠背部大面积烧伤后瘢痕模型。对3只烧伤后瘢痕模型大鼠给予30 mJ低能量CO 2 点阵激光干预，观察瘢痕表皮细胞活化情况，分离表皮组织行转录组测序筛选激活通路。将18只烧伤后瘢痕模型大鼠随机分为3组（ n ＝6）：对照组不予激光干预，激光组予30 mJ CO 2 点阵激光干预，激光+抑制剂组予30 mJ CO 2 点阵激光干预+IWR-1（Wnt/β-联蛋白通路抑制剂）瘢痕内注射，以验证筛选到的通路激活情况及其效应。通过H-E染色、马松染色和蛋白质印迹法检测表皮细胞和成纤维细胞活化、Wnt/β-联蛋白通路激活及瘢痕改善情况。 结果低能量激光干预后，烧伤后瘢痕模型大鼠瘢痕表皮组织Ki67、增殖细胞核抗原（PCNA）、细胞角蛋白19（CK19）、p63阳性细胞数量增多，活化明显；转录组测序结果结合文献分析筛选出Wnt/β-联蛋白通路作为候选通路。在验证性实验中，与对照组相比，激光干预后第5天烧伤后瘢痕模型大鼠瘢痕表皮细胞Wnt/β-联蛋白通路被激活，激光干预后第30天大鼠瘢痕组织真皮胶原排列更为疏松、真皮厚度变薄、α-平滑肌肌动蛋白阳性成纤维细胞数减少、Ⅰ型和Ⅲ型胶原蛋白的含量及Ⅰ型/Ⅲ型胶原蛋白的比例下降；给予Wnt/β-联蛋白通路抑制剂后，上述低能量激光干预诱导的Wnt/β-联蛋白通路激活、瘢痕表皮细胞活化和瘢痕改善现象均被逆转。 结论低能量CO 2 点阵激光可通过激活瘢痕表皮细胞Wnt/β-联蛋白通路活化瘢痕表皮细胞、改善烧伤后瘢痕。

Objective Explored the clinical efficacy and mechanism of improved CO 2 fractional laser on treatment for refractory wounds. Methods A total of 122 patients with refractory wounds who were admitted to the hospital from May 2022 to May 2024 were selected and randomly divided into a conventional group （conventional dressing change treatment + photodynamic therapy + conventional CO 2 fractional laser treatment） and an improved group （conventional dressing change treatment + photodynamic therapy + improved CO 2 fractional laser treatment） by lottery， with 61 cases in each group. The serum C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR） levels， the number of wound bacteria before treatment and after 1， 2， and 3 weeks of treatment were compared between the two groups. The wound healing rates after 1， 2， and 3 weeks of treatment were compared between the two groups. The clinical efficacy of the two groups was compared. The levels of wound exudate basic fibroblast growth factor （bFGF） and angiopoietin-1 （Ang-1） before treatment and after 1， 2， and 3 weeks of treatment were compared. The adverse reactions of the two groups were compared. Results Repeated measures analysis of variance showed that there were an interaction effect between groups and over time in the serum CRP and ESR levels， the number of wound bacteria in both groups （P < 0.05）. There were no significant differences in the serum CRP and ESR levels and the number of wound bacteria between the two groups before treatment （P > 0.05）. The serum CRP and ESR levels and the number of wound bacteria in the improved group were lower than those in the conventional group after 1， 2， and 3 weeks of treatment （P < 0.05）. Repeated measures analysis of variance showed that there was an interaction effect between groups and over time in the wound healing rates of both groups （P < 0.05）. The wound healing rates in the improved group were higher than those in the conventional group after 1， 2， and 3 weeks of treatment （P < 0.05）. The total clinical effective rate of the improved group was higher than that of the conventional group （P < 0.05）. Repeated measures analysis of variance showed that there was an interaction effect between groups and over time in the levels of bFGF and Ang-1 in wound exudates of both groups （P < 0.05）. There was no significant difference in the levels of bFGF and Ang-1 in wound exudates between the two groups before treatment （P > 0.05）. The levels of bFGF and Ang-1 in wound exudates in the improved group were higher than those in the conventional group after 1， 2， and 3 weeks of treatment （P < 0.05）. There were no significant differences in the incidence of pain， pruritus and rash between the two groups （P > 0.05）. Conclusions In the treatment of refractory wounds， the combination of improved CO 2 fractional laser and photodynamic therapy could promote the secretion of wound exudate growth factors， inhibit wound bacterial growth and inflammatory response， accelerate wound healing， and improve clinical efficacy， with high safety. The mechanism of action is related to the promotion of wound exudate growth factor secretion.

Abstract Conservative management for hypertrophic scars (HSc) and scar contractures is of utmost importance to optimally reintegrate burn survivors into society. Many conservative treatment interventions have been described in the literature for the management of HSc. Recent advancements in the literature pertaining to postburn scarring and HSc formation have advanced our understanding of the mechanisms that support or refute the use of common rehabilitation treatment modalities after burn injury. This is particularly relevant for recent advancements in the fields of mechanotransduction and neurogenic inflammation, resulting in the need for rehabilitation clinicians to reflect upon commonly employed treatment interventions. The aim of this review article is to summarize and clinically apply the evidence that supports or refutes the use of common conservative treatment interventions for scar management employed after burn injury. The following treatments are discussed, and mechanotransduction and neurogenic inflammation concepts are highlighted: (1) edema management (compression, positioning/elevation, pumping exercises, retrograde massage, and manual edema mobilization); (2) pressure therapy (including custom fabricated pressure garments, inserts, face masks, and other low-load long-duration orthotic devices); (3) gels or gel sheets; (4) combined pressure therapy and gels; (5) serial casting; (6) scar massage; and (7) passive stretching. This review supports the following statements: (1) Compression for edema reduction should be initiated 48–72 hours postinjury and continued for wounds that require longer than 21 days to heal until scar maturation; (2) Elevation, pumping exercises, and retrograde massage/MEM should be used in combination with other edema management techniques; (3) Custom-fabricated pressure garments should be applied once the edema is stabilized and adequate healing has occurred. Garments should be monitored on a regular basis to ensure that optional pressure, >15 mm Hg, is maintained, adding inserts when necessary. The wearing time should be >16 hours/day; (4) Gels for postburn scar management should extend beyond the scar; (5) Serial casting should be applied when contractures interfere with function; (6) Forceful scar massage should be avoided early in the wound healing process or when the scar is inflamed or breaks down; and (7) Other treatment modalities should be prioritized over passive stretching for scar management.

Pressure therapy is a widely adopted approach to suppressing hypertrophic scar formation after burns. However, current clinical practice primarily relies on the manual experience of medical staff and lacks accurate pressure feedback. Available commercial pressure sensors target high-pressure uses, mismatching low-pressure needs for burn rehabilitation, and suffer accuracy interference from nonpressure factors. To address these challenges, we developed a wearable multifunctional flexible sensor that integrates a patterned Cr/Au metallized polyimide (PI) substrate with a conductive PDMS film featuring bionic spinosum textures. The epidermis-inspired pressure sensing unit allows real-time monitoring of pressure variations in pressure therapy, achieving a sensitivity of 35%/kPa within the pressure range required for burn rehabilitation (1.3-3.3 kPa). Additionally, the metal electrodes featuring a localized cracking and serpentine design exhibit high linearity in temperature response and exceptional sensitivity to strain, respectively. Furthermore, both finite-element analysis (FEA) simulations and experimental results confirm that pressure and strain effects are spatially localized on our sensor, while temperature exhibits a global effect, enabling effective cross-parameter interference elimination. The applications, including real-time pressure monitoring in bandages, pressure distribution tracking in elastic gloves, and distinguishing joint movement patterns, highlight how our sensor can serve as an excellent clinical tool for optimizing pressure therapy protocols, quantifying rehabilitation intensity, and improving therapeutic outcomes in burn rehabilitation.

Background: Scar impairments impose a significant economic burden and negatively impact an individual’s well-being and quality of life. However, there is a lack of standardization in physical therapy interventions for scar management. Objective: This study aimed to provide a comprehensive overview of studies addressing non-invasive physical therapy interventions for scar management. Methods: This scoping review was conducted following the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. Six databases were searched, and additional studies were retrieved through gray literature and the reference lists of included articles. All studies considering non-invasive physical therapy interventions for scar management were included. No restrictions were applied regarding time, context or publication type. Results were illustrated using descriptive statistics and summarized in an infographic. Results: Out of 13,419 initial records, 92 studies met the inclusion criteria. Most articles were narrative reviews (n = 41) followed by randomized controlled trials (RCT) (n = 18). The most reported interventions were pressure therapy (n = 41), physical therapy modalities (n = 37), silicone-based products (n = 29) and massage (n = 20). Conclusions: Scar management involves a wide range of physical interventions. However, research has predominantly focused on adults, particularly those with burns, with limited attention given to pediatric or non-adult populations. Furthermore, there is significant variability in the application parameters, scar localization and size. Examining the included study designs, most of the research presented reduced sample sizes and lacked control groups. Notably, almost half of the studies were based on expert opinions. Future high-quality research is needed to identify evidence-based interventions for the clinical management of scars.

Burn cases pose a significant burden on the healthcare system worldwide. The acute loss of the barrier function of the skin can lead to severe shock and sepsis. Burn wounds can evolve into hypertrophic scars and keloids that impair function and aesthetic appearance. Early intervention with both non-surgical and surgical management strategies is crucial to curtail severe consequences. This review aims to provide a comprehensive assessment of treatment modalities ranging from topical and intralesional therapies to surgical procedures, while also highlighting the role of adjunct and emerging strategies. Topical emollients, corticosteroid creams and injections, and silicone gel help restore barrier function and reduce inflammation in patients with superficial or partial-thickness burn injuries. Autologous and allogenic grafts and flaps have proven effective in restoring function and increasing patient satisfaction in treating deep partial-thickness and full-thickness burns. However, the appropriate timing for employing these conventional therapies to gain maximum benefit remains debatable and can result in undesirable complications. Adjunct therapies, including microneedling, platelet-rich plasma (PRP), laser, and physical therapy, have shown mixed results in improving outcomes. Newly emerging techniques, such as stem cells, nanomedicine, and 3D bioprinting, have demonstrated promising potential in enhancing patient outcomes. Nonetheless, large clinical trials with human participants are needed before these modalities can be widely implemented in clinical practice without reservations. It is imperative to establish definitive treatment guidelines and explore advanced avenues to further augment the quality of life among burn victims.

The most common aftereffect of severe burns in patients is hypertrophic scarring. Hypertrophic scars typically form following severe burns; it refers to excessive collagen production in the dermal layer during the healing process, resulting in an abnormal raised scar. Currently, practical treatments for suppressing hypertrophic scars include laser therapy, pressure therapy, and the application of silicone sheets for moisture retention. The most extensively used treatment involves compression therapy using specially designed garments for the affected areas. However, this method has limitations when applied to curved surfaces like the face. To address this issue, three-dimensional (3D) scanning and 3D printing techniques have been actively developed for face masks and have shown promising clinical results. Unfortunately, current facial masks under development lack a sensor system to measure pressure, making it difficult to ensure consistent and appropriate pressures during clinical trials. In this study, we have developed a burn pressure mask capable of real-time pressure monitoring. The facial mask developed in this study utilizes an FSR-type sensor to measure the pressure applied to the skin. We have also embedded electrical wires within the mask to enhance its comfort and wearability. For this study, two patients wore the facial mask with real-time pressure measurement capabilities for 4 weeks in 12 h per day on average. We evaluated whether the mask maintained the appropriate pressure range (15–25 mmHg) throughout the clinical trial and whether it effectively inhibited scar formation. Through the analysis of recorded pressure signal data, we confirmed that the patients consistently maintained the appropriate pressure while wearing the mask during the clinical trial. Additionally, we observed significant differences in skin moisture levels, transepidermal water loss, and scar thickness before and after the experiment. These findings suggest that the facial mask, featuring real-time monitoring capabilities, effectively prevents the formation of hypertrophic scars.

It was to investigate the histological and molecular mechanism of pressure therapy on hypertrophic scar (HS). HS animal model was established. A total of 63 male Sprague–Dawley rats were randomly rolled into blank group (BG, no modeling), control group (CG, modeling), and test group (TG, modeling and pressure therapy), with 21 rats in each group. Hypertrophic scar animal model was induced by heat burn, and hematoxylin and eosin (H&E) and Masson staining were performed on the skin tissues of rat. mRNA levels and protein expression levels of vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), IGF 1 receptor (IGF1R), and MEK2 signaling pathway were detected by quantitative PCR (qPCR) and Western blotting. After the pressure therapy, the collagen fibers in the skin tissues of the rat in TG returned to regular arrangement, and the fibroblasts were arranged orderly. On the 28th day, the mRNA levels of IGF-1 and VEGF in TG greatly surpassed CG (P < 0.05), mRNA expression levels of IGF-1R, PI3K, MEK2, and ERK2 were lower than CG (P < 0.05), and PI3K protein expression levels were higher than CG (P < 0.05). The AKT2 protein expression levels in TG on the 28th and 35th days differed slightly versus CG (P > 0.05). On the 28th day, MEK2 protein expression levels in TG were lower than CG (P < 0.01), and MEK2 protein expression levels were higher on the 35th day (P < 0.05). The ERK2 protein expression levels in TG were lower than CG on 28th day and 35th day (P < 0.05), while VEGF protein expression levels were higher than CG (P < 0.05). Stress therapy effectively inhibited the formation of hypertrophic scars (HS) by significantly downregulating the expression of the MEK/ERK signaling pathway while concurrently upregulating VEGF expression. Furthermore, stress therapy alleviated the pathological process of HS by downregulating the expression of the IGF-1/IGF-1R signaling pathway and its downstream PI3K/AKT signaling cascade. These results suggest that stress therapy plays a crucial role in regulating the molecular mechanisms underlying HS formation.

… Early and consistent interventions, such as pressure garment therapy (PGT), are … role of PGT in pediatric burn care, aiming to assist nurses in reducing hypertrophic scarring, preventing …

Chronic scars and pain following burns not only impair patients’ quality of life but also resist current empirical treatments, highlighting an urgent need for mechanism-based therapies. Early studies have characterized key mediators of scar fibrosis and nociception, yet integration of molecular and neural pathways remains limited. Here, we comprehensively review 1 molecular and cellular drivers of burn scar formation—particularly transforming growth factor-β (TGF-β)–induced fibroblast activation and extracellular matrix remodeling; 2 bidirectional interactions between scar tissue and nerve regeneration via neuropeptides (Nerve growth factor, Substance P, calcitonin gene-related peptide); 3 mechanisms underpinning long-term scar pain, including peripheral/central sensitization through TRPV1/Nav channels and neuroinflammation; and 4 emerging treatments—such as laser, extracorporeal shock wave therapy (ESWT), regenerative injections, and transient receptor potential (TRP) antagonists—that target these pathways. We conclude that a detailed understanding of scar–nerve crosstalk at the molecular level is pivotal for developing targeted interventions and improving long-term outcomes.

Deep burns damage the reticular dermis and may lead to the formation of hypertrophic scars. Compression therapy reduces local vascularity and realigns collagen fibers, resulting in esthetic and functional improvements. This study evaluated the effect of Kinesio tape compression with maximum mechanical tension on vascularity, pliability and the height of hypertrophic scars following deep burns. A single blind, randomized pilot clinical trial was carried out. The elastic compression of Kinesio tape was applied at maximum stretch in the intervention group (n=11) and no stretch in the sham group (n=11). Vascularity, pliability and height (the primary outcomes) were evaluated at 0, 45 and 90 days using the Vancouver Scar Scale (VSS). The association between the VSS scores, the intervention and the evaluation moment were analyzed using linear mixed-effects regression models, while comparisons of means between the groups were performed using the t Student test was. Significance was set at 5%. The mean VSS scores were similar between the groups. Significant improvement occurred in both groups when post-treatment and baseline scores were compared. No further improvement was found in the vascularity, pliability or height of hypertrophic scars resulting from deep burns when an elastic compression of Kinesio tape was used at maximum tension compared to lesser mechanical tension.

… type of scars, the assessment indexes, treatment modalities, … laser in the treatment of hypertrophic scars, and both showed significant improvement. The average number of treatment …

… satisfaction of various laser therapies for treating atrophic, hypertrophic, and keloid scars. A … Studies were included if they compared two or more laser types for the treatment of scars. …

Hypertrophic scar could be associated with several complications that interfere with patient daily activities, physical and psychological health and impact patient quality of life. Several therapeutics and maneuvers are used for treatment of hypertrophic scar with variable success and side effects. We aim to evaluate safety and efficacy of fractional carbon dioxide laser on treatment of hypertrophic scar both clinically and histopathologically. Hypertrophic scars in each patient of total thirty patients were subjected to random division with sealed envelope into two parts, part A treated with fractional carbon dioxide laser every month for 5 sessions, and part B lift without treatment for control. Hypertrophic scars in each patient were single or multiple, Single scar was more than 15 cm length. Clinical evaluation was done by two blinded dermatologists, using Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) for each part before, 3 months and 6 months after treatment. Histopathological evaluation was done for each part before and 3 months after treatment by measuring epidermal thickness, collagen area percent, and elastin area percent. The upper significant clinical and histopathological improvement was shown in carbon dioxide laser treated parts than control parts without significant side effects for fractional carbon dioxide laser treatment. Treatment of hypertrophic scar with fractional carbon dioxide laser is beneficial and generally considered safe, with minimal risk of harm when performed with appropriate laser parameters for male and female patients with skin type III and IV, at different ages and different body regions.

… laser treatment in the context of hypertrophic scars. This research aims to assess the synergistic effects of SVF and CO2 laser … optimization of treatment strategies for hypertrophic scars, …

Abstract Fractional ablative laser (FAL) is a minimally invasive method of hypertrophic scar management first introduced in 2004. Laser technologies and techniques have continued to evolve since that time and have included the addition of laser-assisted drug delivery (LADD) to augment the effects of the laser on scars. Laser-assisted drug delivery is increasingly reported in the literature and standard treatment protocols, underscoring the popularity of this technique among clinicians. Given this popularity, it is important to scrutinize evidence relating to the clinical outcomes LADD may achieve for patients. This scoping review examined literature relating to LADD for the treatment of hypertrophic scars in humans, aiming to clarify what clinical outcomes are achieved with its use and examining how these outcomes were studied and measured. PubMed, EMBASE, Cochrane, the WHO International Clinical Trials Registry and ClinicalTrials.gov were systematically searched, and data about study methodology, outcome measurement tools and results were extracted. Fifty-five publications that discussed LADD for the treatment of hypertrophic scars in humans were identified. Sixteen different substances, most frequently corticosteroids, were used for LADD treatment of hypertrophic scars, most often in conjunction with a carbon dioxide FAL. Study designs, outcome measurement strategies and follow-up time-frames were highly variable, as were the patient outcomes achieved. The clinical outcomes achieved with LADD are unclear, largely due to the variability of study methodology and outcome measurement. The efficacy of this technique requires further investigation with robustly designed, large trials which have comparison groups and use validated scar outcome measurement tools.

This review aims to investigate the mechanisms underlying the application of ablative fractional CO2 laser in scar treatment and analyze its effects on inflammatory responses, cell proliferation and collagen remodeling during wound healing. It focuses on how the fractional CO2 laser promotes skin repair by modulating molecular mechanisms, thereby effectively improving scar appearance. This review summarizes numerous clinical and experimental studies on ablative fractional CO2 laser treatment, focusing particularly on its regulatory effects on immune cells, fibroblasts, matrix metalloproteinases (MMPs), transforming growth factor-β (TGF-β), heat shock proteins (HSPs), microRNAs (miRNAs), and basic fibroblast growth factor (bFGF) at various stages of repair. The findings demonstrate that ablative fractional CO2 laser significantly improves scars through precise thermal damage and modulation of the tissue repair. Specifically, by precisely regulating key factors such as MMPs, TGF-β, HSPs, miRNAs, and bFGF during the tissue repair phases, it promotes re-epithelialization, neovascularization, and the synthesis and orderly deposition of collagen, thereby balancing antifibrotic and pro-repair effects to improve scar texture and function. The fractional CO2 laser is an effective modality for scar treatment that promotes scar resolution and wound healing through dynamic regulation. It demonstrates significant clinical efficacy for both atrophic and hypertrophic scars, offering new perspectives and approaches for future scar management.

… identified significant heterogeneity in laser protocols. Mapping laser operative practices can help … A questionnaire to characterize laser treatment techniques for hypertrophic scars was …

… Laser treatment, involving both ablative CO2 fractional laser and non-ablative 1570 nm Erbium glass fractional laser … We observed that hypertrophic scars required higher fluences and …

… HS and keloids compared to other laser treatments. A … CO2 laser therapy to other laser treatments for hypertrophic scars and … Vancouver Scar Scale scores, percent improvement in scar …

BACKGROUND Hypertrophic burn scarring (HBS) is described as "the greatest unmet challenge after burn injury". This ELABS trial hypothesised that early pulsed dye laser (PDL) treatment of HBS improves both scar quality and quality of life (QoL). METHODS A parallel arm randomised controlled trial to assess the effectiveness and cost-effectiveness of PDL was undertaken at seven centres in the UK. Patients were eligible if their burn injury was within three months of wound healing, and ineligible either with history of keloid scarring or aged < 16 years. A total of 153 (77 male, 76 female) participants were recruited between Nov 17, 2021, and Jun 30, 2023, and were randomised using software in a 1:1 ratio stratified by study centre; 138 (69 each arm) were included in the final complete-case analysis. Both study arms received standard care, and the intervention arm received three PDL treatments. The primary outcome was patient-rated scar quality (POSAS) at six months. The trial was registered with International Standard Randomised Controlled Trial Number registry (ISRCTN14392301). FINDINGS Early PDL showed a statistically significant improvement in patient-rated scar quality (p = 0·041) and the secondary outcome, participant's perception of change in scar quality (p = 0·01), at six months. There were no statistically significant differences for Quality-of-Life, observer-rated POSAS scar quality, or colour measurement. Early PDL was not cost-effective at 6 months follow-up for the willingness-to-pay threshold of £20,000 per Quality-Adjusted-Life-Year (QALY). There were no unexpected adverse events related to the intervention. INTERPRETATION Early PDL treatment of HBS is safe and shows improvement for patient-rated scar quality but not QoL at six months. As scar maturation is prolonged and dynamic, longer-term follow-up of upwards of two years is required both to understand the eventual clinical effect on scar outcome and to make any definitive conclusion concerning cost-effectiveness.

… This study evaluated fractional ablative laser treatment for … itch would decrease post-treatment, and that demographic or … pre-treatment and six post-laser sessions using the Patient Scar …

Purpose A considerable percentage of patients develop hypertrophic scarring due to the healing process after heart surgery. The purpose of this study was to determine whether PDL applied on the day of suture removal, is even more successful in minimizing symptoms that impair the patient’s quality of life and the cosmetic appearance of scars from median sternotomy cardiac surgery procedure. Materials/methods: A total of 12 patients with hypertrophic sternotomy scars resulting from cardiac surgeries underwent 4–5 treatment sessions with Dye laser as soon as the wound’s sutures were taken out. After 40 days, the patient was re-assessed using an in-vivo multispectral skin imaging optical evaluation of the skin structures. Images were captured before and after each treatment, as well as 6 and 12 months after the last treatment. Twelve months after the last session each patient’s level of improvement was assessed using the Vancouver Scar Scale (VSS). Twelve months following the conclusion of treatments, the patients were given photographs and filled out a satisfaction questionnaire. Results Analysis of the VSS subscales after 1 year from the last laser treatment showed significant improvement in all parameters examined. Nine patients (75%) were very satisfied, 3 patients (25%) were satisfied, and no patients expressed dissatisfaction or insufficient satisfaction. Relevant side effects were absent. Before and after all treatments, multispectral and hemoglobin analyses showed overall patient’s improvement. Conclusions PDL therapy has been proven to physically improve hypertrophic sternotomy scars with few side effects, reducing or even completely avoiding the need for reconstructive surgery.

Skin scars represent a complex therapeutic challenge, with significant functional, aesthetic and psychological implications. Despite advances in laser therapy, monotherapy has significant limitations, particularly in complex scars with atrophic, hypertrophic, vascular and pigmentary components. The combined use of multiple laser sources, in sequential or simultaneous mode, allows selective targeting of different tissue targets and improves clinical efficacy while maintaining a good safety profile. This narrative review critically analyses the available evidence on combination therapies for atrophic, hypertrophic, keloid, post-surgical and burn scars. Protocols combining ablative lasers (CO₂, Er:YAG), non-ablative lasers (1540–1550 nm), vascular lasers (PDL, Nd:YAG) and intense pulsed light (IPL) are reported. Possible integrations with adjuvant techniques, such as radiofrequency, PRP and laser-assisted drug delivery, are also mentioned as areas for future development. Available data suggest a promising role for multimodal strategies, but the literature remains limited by small cohorts, heterogeneous protocols and short follow-up periods. Further prospective and multicentre studies are needed to define standardised protocols and consolidate the role of combination therapies in the management of scars.

Background Keloids and hypertrophic scars are fibroproliferative disorders with high recurrence rates, lacking a definitive treatment standard. This review systematically evaluates current therapies and their effectiveness in treating keloid and hypertrophic scars. Method The inclusion criteria were based on the population, intervention, comparator, outcomes, and study design (PICOS) framework. Electronic searches through April 2025 across databases such as PubMed, EMBASE, Cochrane Library, and Web of Science used keywords such as ‘keloid’, ‘occlusive dressings’, and ‘imiquimod’, among others. Meanwhile, we used the keywords ‘Antigens, CD’ and ‘MicroRNAs’ to search for molecular mechanisms associated with keloid and hypertrophic scars. The Risk of Bias 2 (RoB2) and Methodological Index for Non-Randomized Studies (MINORS) checklists were used to assess the quality of the included studies and potential bias. Results This study synthesizes findings from 162 studies, exploring a range of treatments including monotherapies and combination therapies, such as local corticosteroid injections, optical therapy, radiation therapy, 5-fluorouracil (5-FU) therapy, bleomycin therapy, verapamil therapy, excision surgery, cryotherapy, and topical treatments, as well as various multi-drug regimens. It also examines innovative therapies such as stem cells and RNA microneedles. Technological developments continue to expand the range of available interventions. Treatment strategies increasingly emphasized combination therapies that integrate intralesional corticosteroids, surgical excision, laser modalities, and radiotherapy, demonstrating superior outcomes compared with single-modality approaches, particularly in reducing recurrence, prolonging therapeutic benefit, and improving patient prognosis. Conclusion Sole treatments and inadequate therapy are major risk factors for recurrence. Anti-fibroblast growth strategies are crucial, aside from physical interventions. Despite the lack of an established gold standard, corticosteroid and excision therapies remain critical benchmarks for evaluating new treatments.

Background: Once scars form and begin to proliferate, treatment becomes challenging. Traditional methods of scar treatment often provide suboptimal results. Therefore, early intervention has become widely accepted, with a focus on prevention during the wound-healing phase rather than later treatment. Here, the authors evaluate the effectiveness of early treatment with intense pulsed light (IPL) combined with fractional erbium laser in preventing the formation of post-traumatic hypertrophic scars. Methods: A total of 120 patients who underwent emergency cosmetic suture surgery for facial trauma between January 2019 and December 2021 were selected for the study. The control group received conventional antiscar therapy (pressure therapy or antiscar medication), while the observation group received IPL combined with fractional erbium laser in addition to the conventional treatment. The specific treatment doses were adjusted based on the patient’s age, scar color, texture, and thickness. A treatment course consisted of 3 to 5 sessions, with 4-week intervals between treatments. Follow-up was conducted within 1 year after treatment to assess the improvement in scar appearance before and after therapy. Results: After IPL combined with fractional erbium laser treatment, patients in the observation group showed significantly lower scores in color, thickness, vascular distribution, softness, and total scores on the Vancouver Scar Scale (VSS) compared with the control group. During the follow-up, 3 complications were observed: 2 cases of skin blisters and 1 case of pigmentation. No immediate skin lesions, depigmentation, infections, ulcers, or other adverse reactions were reported. Conclusions: For patients with early-stage superficial scars following trauma surgery, early treatment with IPL combined with fractional erbium laser not only leads to significant improvements in appearance and effectively prevents hypertrophic scar formation but also promotes rapid recovery with few complications. This approach has clinical value.

Fractional CO2 laser therapy has become a cornerstone in the management of hypertrophic scars due to its ability to promote dermal remodeling through controlled thermal injury. However, there is ongoing debate regarding the ideal laser energy parameters that balance efficacy with safety. This review synthesizes clinical data from studies published between 2005 and 2025 that utilized ablative fractional CO2 laser (ablative fractional resurfacing [AFR]) for hypertrophic scars, comparing outcomes between high-energy protocols (≥30 mJ/microthermal zone [MTZ]) and low-energy protocols (≤20 mJ/MTZ). High-energy settings demonstrated superior short-term clinical efficacy, with significant reductions in scar thickness, erythema, and stiffness often observed within fewer treatment sessions. These outcomes were corroborated by histopathological findings, showing deeper collagen remodeling and increased neocollagenesis. However, these benefits were offset by increased risk of side effects such as prolonged post-treatment erythema, edema, pain, and post-inflammatory hyperpigmentation, especially in patients with Fitzpatrick skin types IVVI. Low-energy settings, while requiring more sessions to achieve comparable improvements, were associated with fewer adverse effects and greater patient comfort, with histologic evidence of gradual, superficial dermal remodeling. Patient satisfaction was generally higher when treatment was personalized based on scar characteristics, anatomical site, skin phototype, and individual tolerance. Notably, high-energy protocols were more suitable for mature, thick scars located on less pigment-sensitive areas, whereas low-energy settings were preferable for recent or facial scars, or those in darker skin tones. The review underscores the importance of individualized treatment planning and suggests that energy modulation should be guided by a comprehensive assessment of scar morphology and patient-specific factors. Overall, both high- and low-energy AFR protocols are effective, but strategic personalization is critical to optimizing therapeutic outcomes while minimizing treatment-related risks.

Background and Objectives: Pediatric patients can acquire scars from both accidental injury and surgical procedures. While scars cannot be avoided if a full-thickness injury occurs, scar visibility may be minimized through a variety of approaches. In this narrative review, we evaluate the current evidence and propose an algorithm for scar management in pediatric patients. Materials and Methods: A review of the literature was performed for scar management techniques for pediatric patients. Management modalities based on the type of scar and dosing, treatment regimen, and safety profiles are described in this article and used to create a scar management algorithm. Results: The initial step to scar management in the pediatric population involves ensuring minimal wound tension, which can be achieved through making the incision along relaxed skin tension lines, and early, minimal tension wound closure. Subsequent treatments to optimize scar care should begin 2–3 weeks following wound closure and involve the application of silicone gel or sheets and scar massaging. When topical products are insufficient, laser therapy can be utilized for the management of immature erythematous or thick scars. When mature, pathological scars form such as atrophic scars, hyperpigmentation, hypertrophic scars, or keloids, a combination of modalities is recommended. These modalities vary by scar type and include retinoids and dermabrasion for atrophic scars; retinoids, hydroquinone, and laser therapy for hyperpigmentation; and pressure therapy, corticosteroids, and laser therapy for hypertrophic scars and keloids. When mature, pathological scars persist following 12 months of non-invasive therapies, surgical excision should be considered. Conclusions: Several treatment options are available to manage scars in the pediatric population depending on scar type.

Background: Assessing hypertrophic scar (HTS) interventions is challenging because scars continue to undergo dynamic changes. A split-scar design can distinguish treatment effects from natural HTS evolution. Despite promising reports of ablative fractional CO2 lasers (AFCO2Ls) for HTS, split-scar evidence, particularly in pediatric scars, remains limited. Objective: To explore the feasibility of a split-scar design in assessing AFCO2L’s impact on pediatric HTS and to identify potential trends in treatment outcomes. Methods: Initially designed as a prospective single-center split-scar randomized controlled trial, our study transitioned to a feasibility trial due to recruitment challenges. Pediatric patients aged 1–17 years with HTS suitable for split-scar evaluation received three AFCO2L treatments at 6–8-week intervals, with outcomes assessed using the Vancouver Scar Scale (VSS), SCAR-Q, and Cutometer. Results: Recruitment was limited by COVID-19 restrictions, concerns about general anesthesia for split-scar treatment, and low interest in divided-scar interventions, resulting in only 6 participants with 9 scars enrolled, far below the target sample size of 44. This small heterogeneous sample precluded meaningful clinical outcome analysis. Conclusions: Our feasibility trial highlights challenges in conducting rigorous pediatric HTS studies and the need for careful interpretation of evidence due to potential publication bias. Future trials should focus on tailored recruitment and comprehensive reporting to improve feasibility and reliability.

… Low-energy fractional laser has been reported conducive to wound healing. This study … 10,600 nm ablative fractional CO 2 laser (AFL) and 1565 nm non-ablative fractional laser (NAFL) …

Surgical scars with textural changes can be disfiguring and uncomfortable for patients. Various laser therapies have shown promise in softening and flattening these scars. Therefore, the authors conducted a systematic review and meta‐analysis on the efficacy of fractional CO2 laser in treating surgical scars.

Background Fractional carbon dioxide (CO2) lasers are commonly used in dermatological resurfacing, offering precise ablation and controlled dermal remodeling. Although clinical outcomes vary with the energy and pulse settings, comparative morphometric and histometric data on power-dependent tissue interactions are limited. Objective To evaluate and compare fractional CO2 laser-induced microscopic thermal zones (MTZs) ablation characteristics at peak powers of 30 W and 40 W using an ex vivo porcine skin model. Methods Ex vivo porcine skin was treated with a fractional CO2 laser at energy levels ranging from 40 to 240 mJ under 30 W and 40 W settings. Frozen tissue was used for dermoscopic assessment of ablation diameters, while unfrozen tissue at physiological temperature (30–32°C) was analyzed histologically for ablation depth. Morphometric and histometric measurements were performed and statistically analyzed. Results The 30 W and 40 W settings demonstrated energy-dependent increases in ablation depth and diameter. The 40 W laser consistently generated deeper ablation columns (average 11.8% deeper) with narrower surface diameters (average 7.3% narrower) and reduced peripheral carbonization. Linear regression showed strong correlations between energy and ablation depth (r > 0.91) and diameter (r > 0.91), with higher slope coefficients in the 40 W group, indicating greater ablation efficiency. Conclusion The 40 W fractional CO2 laser system offers enhanced precision, deeper dermal penetration, and reduced thermal diffusion compared with the 30 W, despite delivering equivalent total energy. These findings suggest that higher peak power settings may improve fractional resurfacing procedures’ safety and clinical outcomes, particularly in populations with darker skin phototypes.

Scars from skin cancer surgery impact patients' quality of life. In recent years, fractional CO2 (fCO2) laser has been used for scar improvement. A single-center retrospective study (n = 22) was conducted to evaluate the safety and efficacy of the fCO2 laser in improving the aesthetic outcome of post-surgical skin cancer scars, using the validated Vancouver Scar Scale (VSS). We obtained a mean VSS reduction of 44.5% and an absolute decrease of 2.77 points (p < .001). Statistically significant improvements were observed in all VSS parameters except for pigmentation. No significant correlation was found between time since surgery and reduction in VSS. Fractional CO2 laser is a safe and effective approach for improving surgical scars following skin cancer treatment. Its efficacy is not limited to early scars.

Background: Pathological scars, particularly hypertrophic and keloid types, often pose significant cosmetic and functional challenges. Although fractional CO₂ lasers and pulsed dye lasers have individually shown promise in scar treatment, their combined efficacy remains underexplored. Methods: Following preferred reporting items for systematic reviews and meta-analyses guidelines and registered in PROSPERO (CRD42024619973), a comprehensive search across 6 databases identified studies involving patients treated with combined fractional CO₂ laser and pulsed dye laser for scars of various etiologies. Inclusion criteria focused on clinical outcomes such as scar thickness, vascularity, pliability, and pigmentation, assessed via validated tools such as the Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, and Observer Scar Assessment Scale. Nine studies, involving a total of 247 patients, were included. Meta-analyses were performed using a random-effects model. Results: The combination therapy significantly improved scar appearance across multiple scales. The pooled mean differences were −18.09 for the Patient and Observer Scar Assessment Scale, −19.44 for the Observer Scar Assessment Scale, and −3.80 for the Vancouver Scar Scale, all of which were statistically significant (P < 0.0001). Improvements were consistent across pigmentation, vascularity, texture, and patient satisfaction, with minimal adverse effects reported. Heterogeneity was high, but it did not impact the direction of the findings. Conclusions: Combining fractional CO₂ and pulsed dye lasers offers superior outcomes in scar remodeling compared with monotherapy, improving both functional and aesthetic aspects with a favorable safety profile. Future studies should focus on standardizing treatment protocols and exploring long-term outcomes to optimize clinical use.

Ablative fractional CO2 laser is an established tool for dermatologic and aesthetic indications. Non-ablative wavelengths, such as 1540 and 1570 nm, are increasingly being combined with CO2 laser to optimise the results while reducing the recovery time. A narrative review of the literature was conducted, including ex vivo, in vivo, and in vitro studies, as well as human clinical trials that evaluated the efficacy, safety, and histological impact of dual-laser systems. Preclinical studies have shown that sequential application of fractional CO2 followed by 1540/1570 nm expands the thermal coagulation zone without increasing the ablation depth. At the histological level, the dual protocol promotes collagen remodelling with greater thermal precision. On a clinical level, a combined treatment has shown efficacy in improving scars, striae distensae, skin laxity, and wrinkles, with reduced recovery times compared to CO2 monotherapy. Preliminary data also suggest potential benefits in inflammatory conditions such as hidradenitis suppurativa. The sequential CO2 + 1540/1570 nm combination represents an effective and well-tolerated approach in regenerative dermatology. Current evidence supports its use as a versatile, safe, and reproducible technique for skin rejuvenation and scar modulation; however, further comparative studies are needed to standardise protocols.

Background Intralesional corticosteroid injection (ILCSI) has been proven to successfully treat hypertrophic scars (HTSs) and keloids and attain remission in 50% of keloids. Pain is a significant problem with ILCSI, which can affect treatment compliance and effectiveness. To date, many techniques involving ILCSI have been described and used to achieve scar treatment while reducing side effects. The injection technique remains the most widely available method in many healthcare centres. Objective This scoping review explores strategies for alleviating pain while administering ILCSIs for hypertrophic scarring and keloid management. ILCSI is a second-line treatment for HTSs and a first-line treatment for keloids. Eligibility criteria This scoping review included studies where HTSs and keloids were treated with ILCSI and considered diverse demographics and injection methods. This review excludes other methods of corticosteroid drug delivery where injection is not involved and where the pain assessed is unrelated to injection or infiltration of the scar. Sources of evidence This review systematically searched critical databases from inception to December 2023, including ScienceDirect, PubMed and Web of Science, and handpicked articles traced from available review papers. Only English-language publications focused on pain management during ILCSIs for HTSs and keloids were included. All levels of scientific evidence were considered. An in-depth evaluation of the injection technique, type of analgesia or anaesthesia administered, effectiveness of pain management and overall treatment outcomes was conducted. Charting methods Citations were compiled in an Excel spreadsheet, with three authors screening the titles and abstracts based on inclusion criteria. Decisions were finalised collaboratively, exclusions were documented and results were presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Results 16 prospective studies, 2 retrospective studies, 1 case study and 15 journal articles were included. These studies examined ILCSI for hypertrophic scarring and keloid treatment. No differences in pain intensity between HTSs and keloids were reported. 11 studies systematically explored pain reduction methods such as topical analgesia, cryoanaesthesia, mixing triamcinolone acetonide with local analgesics, slow infiltration techniques, vibration analgesia and needle-free injectors. Conclusion Pain can significantly impact patient compliance and treatment outcomes. This review offers a foundational reference for healthcare providers and researchers in the field of scar management, providing insights into current practices and highlighting areas for future research and development.

Hypertrophic scar (HS) tends to raised above skin level with high inflammatory microenvironment and excessive proliferation of myofibroblasts. The HS therapy remains challenging due to dense scar tissue which makes it hard to penetrate, and the side effects resulting from intralesional corticosteroid injection which is the mainstay treatment in clinic. Herein, bilayer microneedle patches combined with dexamethasone and colchicine (DC-MNs) with differential dual-release pattern is designed. Two drugs loaded in commercially available materials HA and PLGA, respectively. Specifically, after administration, outer layer rapidly releases the anti-inflammatory drug dexamethasone, which inhibits macrophage polarization to pro-inflammatory phenotype in scar tissue. Subsequently, inner layer degrades sustainedly, releasing antimicrotubular agent colchicine, which suppresses the overproliferation of myofibroblasts with extremely narrow therapeutic window, and inhibits the overexpression of collagen, as well as promotes the regular arrangement of collagen. Only applied once, DC-MNs directly delivered drugs to the scar tissue. Compared to traditional treatment regimen, DC-MNs significantly suppressed HS at lower dosage and frequency by differential dual-release design. Therefore, this study put forward the idea of integrated DC-MNs accompany the development of HS, providing a non-invasive, self-applicable, more efficient and secure strategy for treatment of HS.

Hypertrophic scars and keloids are fibroproliferative disorders arising from aberrant wound healing, often leading to aesthetic disfigurement, functional impairment, and psychosocial burden. Intralesional therapies remain a mainstay of treatment, yet the comparative efficacy and recurrence profiles of different agents have not been definitively established. We conducted a systematic search of PubMed (National Institutes of Health, Bethesda, MD), Cochrane Library (Wiley, Hoboken, NJ), US National Institutes of Health Ongoing Trials Register, EMBASE (Elsevier, Amsterdam, the Netherlands), and Google Scholar (Alphabet, Inc., Mountain View, CA) from inception through May 2025, restricted to English-language publications, to identify randomized controlled trials comparing two or more intralesional treatments for hypertrophic scars or keloids. Twenty-four eligible trials were included in a frequentist random-effects network meta-analysis integrating direct and indirect comparisons. Pooled estimates demonstrated that triamcinolone acetonide combined with 5-fluorouracil (TAC+5-FU) achieved the most consistent improvements in treatment efficacy and recurrence control. Botulinum toxin A (BTA) ranked highest in treatment response but did not significantly reduce recurrence risk. Verapamil (VER) was associated with significantly lower efficacy compared with TAC, whereas bleomycin (BLM) and 5-FU monotherapies provided intermediate outcomes without statistical superiority. Overall, TAC+5-FU offered the most favorable balance between efficacy and recurrence reduction, while BTA showed strong response efficacy. These findings provide a comprehensive synthesis of intralesional therapies for hypertrophic scars and keloids, support the consideration of combination regimens in scar management, and underscore the need for further well-designed head-to-head trials with standardized endpoints to refine individualized treatment strategies.

Hypertrophic scars and keloids are fibroproliferative scars that can cause disfigurement, pruritus, pain, contracture, and reduced quality of life. Outcomes remain inconsistent because phenotypes vary by anatomic site, thickness, skin type, and time since injury, and no single modality is uniformly curative. We performed a narrative review informed by a structured search of MEDLINE/PubMed, Embase, Cochrane Library, Web of Science, and Scopus (2000 to November 2025), including clinical trials, observational studies, systematic reviews, and consensus guidance with clinically actionable treatment parameters. Evidence most consistently supports early, low-risk modulation with silicone gel or sheets for the prevention and early treatment of hypertrophic scars. For established hypertrophic scars and keloids, intralesional triamcinolone acetonide combined with 5-fluorouracil provides a practical pharmacological backbone, offering more reliable flattening and symptom control than steroid monotherapy. Adjuncts should be selected according to dominant clinical features, including cryotherapy for relatively thin lesions, fractional carbon dioxide laser for thickness and texture, and botulinum toxin A when tension, pruritus, or contracture is prominent. For selected thin keloids, radiotherapy options include external beam techniques and brachytherapy; superficial beta-brachytherapy with strontium-90 may serve as consolidation after response to intralesional therapy or as targeted postoperative adjuvant at high-risk sites. Because pigmentary adverse effects are clinically important in darker skin types, procedural choices should incorporate explicit counseling and conservative parameters. A pragmatic algorithm, reassessment triggers, and a modality summary table are provided to support routine clinical decision-making.

Scar formation is a normal wound-healing process, but prolonged inflammation can lead to abnormal scarring such as hypertrophic scars and keloids, which are unique to humans. While intralesional steroids (ILSs) are the standard treatment, intralesional verapamil remains underexplored despite some promising results. The purpose of this study was to compare the safety and efficacy of intralesional corticosteroids versus intralesional verapamil in keloid and hypertrophic scars. A randomized, parallel-group comparative study was conducted in the outpatient department of dermatology in a tertiary hospital. Fifty patients, aged over 18 years with keloid or hypertrophic scars, were randomly assigned to two groups: Group A (n = 25) received corticosteroids, and Group B (n = 25) received verapamil. Scar outcomes were assessed using the Vancouver Scar Scale (VSS), across five visits. Safety was monitored through adverse event documentation. Data were compiled in Excel and analyzed with SPSS 24.0. Quantitative data were expressed as means, standard deviations, and categorical data as percentages with visual aids. The VSS scores consistently decreased in both the verapamil and ILS groups at all visits. Significant improvements in scar height, vascularity, and pliability were observed starting from the second (P < 0.05). However, pigmentation showed no change in the first two visits for both the groups. The incidence of adverse effects was lower with verapamil. Both corticosteroids and verapamil demonstrated a reduction in scar height, pliability, and vascularity over time. However, the rate of improvement was more pronounced with triamcinolone. Verapamil presents a viable alternative with more favorable safety profile.

… Additionally, the occurrence and severity of steroid side effects are often dose-dependent, posing … of low-dose steroids in children, especially for extensive hypertrophic scars, is limited. …

ABSTRACT Background Hypertrophic scars (HTS) are common complications of wound healing characterized by excessive fibroblast proliferation and collagen deposition. HTS causes local elevation, pruritus, and pain, significantly impacting aesthetics and quality of life. While triamcinolone acetonide (TA) and compound betamethasone (CB) are standard treatments, direct comparative studies regarding their efficacy and recurrence rates remain limited. Objective To evaluate the clinical efficacy, safety, and recurrence rate over 6 months of local injection of TA and CB monotherapy in the treatment of HTS. Methods We retrospectively analyzed 126 patients with HTS who received intralesional injection therapy at our hospital between December 2021 and December 2024. Patients were divided into the TA group (n = 63) and the CB group (n = 63) based on the injected drug. All patients were observed during treatment and followed for at least 6 months to monitor adverse reactions and recurrence. Scar assessment was performed using the Vancouver Scar Scale (VSS), combined with high‐frequency ultrasonography to measure scar thickness changes. Clinical efficacy was evaluated based on the percentage reduction in VSS scores. Results Baseline characteristics were not significantly different between the two groups. Both CB and TA significantly reduced VSS scores and ultrasonographically measured scar thickness in patients with HTS; however, the CB group exhibited greater reductions in both VSS scores and scar thickness compared with the TA group. Evaluation of clinical efficacy revealed a total effective rate of 93.65% in the CB group versus 80.95% in the TA group. The incidence of adverse reactions was similar between the two groups, primarily consisting of local skin atrophy, pigmentation changes, and telangiectasia. The 6‐month recurrence rate was significantly lower for CB (3.17%) than for TA (15.87%, p = 0.015). Conclusion Both CB and TA intralesional injections are effective in improving VSS scores, reducing scar thickness, and achieving high clinical efficacy rates in patients with HTS. However, CB demonstrates superior therapeutic outcomes and a significantly lower recurrence rate compared with TA, supporting its wider clinical application.

Abstract Background Keloids are pathological scars causing pain, pruritus, and emotional distress. While common treatments exist, emerging options such as insulin and botulinum toxin A (BTX-A) are underrepresented in comparative analyses. This network meta-analysis (NMA) aimed to evaluate the efficacy and safety profiles of various intralesional therapies for keloid scars. Methods A PRISMA-guided search across seven databases was conducted on July 2025 and preregistered on PROSPERO (CRD420251088758). Included studies were randomized, non-randomized, and crossover trials of intralesional therapies. Pairwise and NMA were conducted for efficacy (keloid size/volume reduction), recurrence, and safety (adverse effects). Treatment rankings were based on surface under the cumulative ranking curve (SUCRA) scores. Statistical significance was set at (p < 0.05). Results From 51 studies (3234 participants, 23 interventions), 5-fluorouracil (5-FU) + corticoids significantly improved keloid reduction compared to corticoids alone (RR = 1.59; 95% CI: 1.31–1.92; p < 0.01), with 5-FU + corticoids + YAG:Laser (RR = 2.73; 95% CI: 1.36–5.48; p < 0.01) showing an even greater effect. SUCRA values indicated that 5-FU + corticoids + YAG:Laser (0.95), vitamin D + platelet rich plasma (0.83), and 5-FU + corticoids (0.78) had the highest probability of effectiveness. For recurrence, no significant differences were found across interventions, suggesting insufficient evidence. Regarding adverse effects, a significant risk reduction was found for BTX-A (RR = 0.29; 95% CI: 0.09–0.95; p = 0.04) and Verapamil (RR = 0.35; 95% CI: 0.14–0.84; p = 0.01) compared to corticoids; others showed no significant effects. Conclusion This NMA provides a comparative overview, indicating that combination therapies, most notably 5-FU + corticoids + YAG:Laser, offer the greatest benefit. While data for novel agents (insulin and BTX-A) suggest potential, further research with standardized methodologies and longer-term follow-up is crucial to define optimal treatment algorithms.

Background Pediatric hypertrophic and keloid scars have traditionally been treated via intralesional steroid injections. The advent of modalities such as 5-fluorouracil (5-FU) and tangential excision present opportunities for improved therapy; however, 5-fluorouracil (5-FU) safety and efficacy in the pediatric population are not well established. The aim of this study is to compare the risk and efficacy of 5-FU in pediatric scar management. Methods A multi-institution retrospective study from 2012 to 2023 was designed with identification of 108 patients aged ≤17, undergoing CO2 laser-assisted 5-FU delivery, or tangential excision with immediate or delayed 5-FU/triamcinolone injections. Modified Scar Rating Scale assessed individual scar outcomes comparing the following groups: 5-FU alone versus triamcinolone use; tangential excision with immediate versus delayed injections; and number of injections above/below the median of 4 episodes of injections. Mann-Whitney U test determined significance. Fisher exact test compared complication and recurrence rates. Results Total scar quality scores improved (P < 0.05) with tangential excision plus <4 injections (n = 44; Δ = −0.581) and tangential excision with 5-FU only (n = 39; Δ = −0.775). Tangential excision with 5-FU alone decreased height (P < 0.05; Δ = −0.5878) compared to tangential excision with triamcinolone use (n = 46). Color match improved (P < 0.05) with tangential excision plus <4 injections (Δ = −0.449) and tangential excision with delayed injections (n = 29; Δ = −0.380). Tangential excision with any 5-FU use (n = 62) had higher complication rates (4.84%) than tangential excision with triamcinolone only (n = 30; 0%) or tangential excision with 5-FU only (n = 37; 5.41%), but complication rates did not significantly differ. CO2 laser-assisted 5-FU (n = 16) complication rates (6.25%) did not significantly differ from tangential excision with 5-FU or triamcinolone. No systemic complications were identified. Recurrence rates between all groups did not differ significantly. Conclusions Tangential excision with 5-FU monotherapy demonstrated lower scar height and improved overall scar quality, further solidifying the benefits of 5-FU. CO2 laser-assisted 5-FU delivery had similar complication rates as the other studied modalities. This pediatric study had no systemic complications and overall similar complication rates compared to adult studies. This study demonstrates the utility of 5-FU in pediatric scar therapy and provides data regarding novel approaches to difficult pediatric scar management.

ABSTRACT Objective Intralesional steroid injection is the first‐line therapy for scars. Emerging evidence indicates that combining intralesional steroid injection with cryotherapy yields promising therapeutic outcomes for scar management. However, a consensus on the efficacy and safety of this combined regimen has not yet been reached. Consequently, the present meta‐analysis aimed to assess the efficacy and safety of this combination compared with control groups. Methods A full‐scale literature retrieval was performed across a range of databases to identify eligible randomized controlled trials (RCTs) and prospective non‐randomized studies that evaluated the efficacy and safety of cryotherapy plus intralesional steroid injection against control treatments for keloids or hypertrophic scars. Key outcome data, including the mean percentage change in scar improvement, the excellent clinical response rate (defined as ≥ 75% reduction in scar volume), and the incidence of adverse events, were extracted. Meta‐analyses were performed using a fixed‐ or random‐effects model based on the heterogeneity assessment results. Results Thirteen studies involving 1012 cases were included in this meta‐analysis. The pooled results exhibited that cryotherapy combined with intralesional steroid injection yielded a significantly higher efficacy rate than various control interventions (including intralesional steroid monotherapy, cryotherapy alone, bleomycin/verapamil treatment, laser plus steroid, and surgical excision plus radiotherapy) (risk ratio [RR] = 1.19, 95% confidence interval (CI): 1.03–1.36; p = 0.01). However, no statistically significant differences were detected between the experimental and control groups in either the mean percentage change in scar improvement (standard mean difference (SMD) = 0.14, 95% CI: −0.39 to 0.68; p = 0.60) or the overall incidence of adverse events (RR = 1.35, 95% CI: 0.99–1.83; p = 0.06). Conclusions Cryotherapy combined with intralesional steroid injection is a viable alternative to other first‐line treatments for keloids and hypertrophic scars. Clinical recommendations should be made cautiously based on specific patient and scar conditions. Further well‐designed, large‐scale RCTs are required to validate the long‐term efficacy and safety of this combined regimen.

… scars, intralesional corticosteroids such as triamcinolone acetonide (TAC) are widely used to soften scar … pain and dystrophy when injected in small doses. For psoriasis vulgaris, BoNT A…

… Intralesional corticosteroids remain a first-line approach for … Evidence directly supporting intralesional insulin for keloid … scar evidence suggests low-dose insulin can improve scar …