Journal of Cosmetic Dermatology | 2021
Laser‐assisted topical steroid application vs steroid injection for treating keloids: A split side study
Abstract
Dear Editor, We have read the recent article by Mohamed et al1 on comparing the therapeutic effect of combining two modalities of scar treatment with great interest, including fractional ablative laser treatment with occluded topical application of corticosteroid and intralesional steroid injection. In this study, the authors concluded that the use of ablative fractional laserassisted delivery of topical corticosteroid application could offer a safer and a better aesthetic treatment option. The conclusions above were encouraging and of great significance. Here, we provide some opinions on this study. Keloid is a kind of disease with a high recurrence rate after treatment, which often brings great trouble to patients, posing a formidable challenge to clinical treatment.2 In this study, after four identical treatment sessions, keloid patients achieved significant improvement after fractional ablative 2940 nm Er: YAG laser treatment with occluded topical application of corticosteroid based on the Vancouver Score Scale. However, three patients (10% of the whole patients) experienced itching and tingling sensations, 12 weeks after treatment, suggesting a great possibility of recurring. Additionally, the authors did not mention the specific parts of the two identical parts, which showed signs of recurring. We would be very grateful if the author could provide more detailed information in this regard, which would give us a further understanding of the effectiveness of this treatment. As a kind of ablative fractional laser treatment, other adverse events for keloid treatment with Er: YAG laser therapy should also be fully aware of, including infection, inflammationrelated hyperpigmentation, and delayed depigmentation. In this study, it has been mentioned that there was no significant correlation between the keloid duration and the final changes assessed by VSS. However, based on clinical studies conducted by our center, we suggested that keloids with short duration had a better response to laser treatment and laser therapy might exert therapeutic effects via damaging blood vessels. Keloids with short duration tended to appear more tender and ruddier, which indicated that blood flow perfusion was higher and richer than that of keloids with long duration.3,4 Additionally, combined with the data measured by laser Doppler flowmetry (LDF) and laser speckle contrast imaging (LSCI), we found that the blood perfusion in the boundary area of keloids and adjacent region of normal skin was significantly higher than that in the distant region of normal skin (P < .05, Figure 1). Further studies on detailed mechanism are being carried out. ACKNOWLEDG MENT The authors declare that they have no conflict of interest.