Early laser intervention to reduce scar formation: a systematic review

Abstract

The ability of laser treatment to affect wound healing and subsequently minimize scar formation has been investigated in recent years. However, no systematic review links these clinical trials. The aim of this study is to systematically review and evaluate clinical evidence for early laser intervention to reduce scar formation in studies where laser treatment were introduced less than 3 months after wounding. We searched PubMed using relevant key words in June 2017. Titles, abstracts and articles were sorted according to inclusion and exclusion criteria. Methodological quality was evaluated according to Cochrane Collaborations risk-of-bias assessment guideline by two independent authors. Twenty-five articles met the inclusion criteria. In total 22 of 25 studies were controlled studies and 17 of 25 studies compared laser treatment versus untreated control scars. The following laser devices have been investigated; pulsed-dye laser (PDL) laser, potassium-titanyl-phosphat (KTP) laser, fractional Erbium:Glass 1540 nm/1550 nm, fractional/full-ablation erbium-doped-yttrium-aluminium-garnet (Er:YAG) laser, or fractional CO₂-laser. Eighteen studies applied laser treatments 2-4 times with 2-8 weeks intervals, while 7 studies applied only one laser treatment. Follow-up time ranged from 1-12 months with 18 studies using a follow-up time ≤3 months. In general, laser treated wounds and scars showed benefit from laser intervention, though not always reaching significance. Significant scar improvement were found in: 3 of 4 studies using laser treatment in inflammation phase, in 6 of 16 studies with laser initiated in the proliferation phase and in 2 of 5 studies in the remodeling phase. High risk-of- bias were found in randomization and allocation concealment, and low risk-of-bias with regard to blinding of outcome assessment and lost to follow-up. In conclusion, laser intervention when introduced in inflammation, proliferation or remodeling phase has the potential to reduce cutaneous scar formation. Further high quality studies are needed before standard protocols can be implemented in clinical practice.

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