Impact of fractional CO₂ laser treatment on hypertrophic scars and keloids: a systematic review

▪ ABSTRACT

Introduction:

Hypertrophic scars and keloids cause aesthetic and functional damages, and are difficult to treat. This review aimed to identify prospective studies on fractional CO₂ laser to present the clinical and histological changes and the methodology used for the evaluation of scars before and after intervention.

Methods:

We conducted an electronic review (LILACS, Medline, and SciELO) of studies published between January 2004 and December 2017, using the search terms “keloid/queloide,” “hypertrophic scar/cicatriz hipertrófica,” and “CO laser, ” according to the PRISMA Statement. Studies that compared scars before and after isolated treatment with fractional CO₂ laser were selected. Two independent reviewers analyzed the data.

Results:

One hundred two articles were analyzed, of which 7 met the inclusion criteria. Of the 7 articles, all analyzed hypertrophic scars, 2 analyzed keloids in addition to hypertrophic scars, and 3 analyzed histological changes. Most studies showed a statistically significant difference in clinical scores between before and after treatment of hypertrophic scars, with improvement in symptoms, flexibility, and scar height. Between the 2 studies that analyzed keloids, 1 reported a clinical difference after treatment. The histological changes showed significant differences in the orientation and density of the collagen fibers, and in the thickness of the epidermis.

Conclusion:

The use of fractional CO₂ laser should be considered as a promising treatment option for pathological scars, as it improves clinical signs and symptoms such as color, thickness, and pruritus.

Keywords:
Gas laser; Hypertrophic scar; Keloid; Carbon dioxide; Pathology.