Keloid Clinical Trial
Official title:
Within-subject Randomized Clinical Trial Comparing Dual-mode ER:YAG Laser in Patients With Long Keloid/Hypertrophic Scars
Skin injuries due to trauma are relatively common, and patients are very concerned about
scars caused by trauma and primary repair. Recently, the use of ablative and non-ablative
lasers based on the fractional approach has become a novel strategy for the treatment of
scars.
The objective of this study is to compare the efficacy of dual-mode Er:YAG laser delivering
pulses either with and without heat/coagulation in a cohort of patients with long
keloid/hypertrophic scars.
The main hypothesis is that ablative fractional laser without heat/coagulation is equivalent
to laser with heat/coagulation in terms of scars volume reduction, while the secondary
hypothesis is that ablative fractional laser without heat/coagulation is superior in terms
of post-operative erythema and hypopigmentation reduction.
Background
Skin injuries, such as lacerations or abrasions, due to trauma are relatively common, and
patients are very concerned about scars caused by trauma and primary repair. Multiple
modalities for improving the clinical appearance of scars have been attempted with varying
success, including corticosteroids, dermabrasion, surgical revision, chemical peeling,
silicone gel application, pressure therapy, and radiation. Lasers such as the carbon dioxide
(CO2), erbium: yttrium-aluminum-garnet (Er:YAG), and pulsed dye (PDL) lasers have all been
used with differing success in the treatment of scars. The goal of all these treatments is
to soften depressions and stimulate neocollagenesis in order to fill in the residual
defects.
Ablative lasers used for skin resurfacing, such as the CO2 and Er:YAG laser, can reduce
various scars, but significant adverse effects limit their use, and patient downtime can be
extensive. Owing to these potential risks, nonablative lasers have been developed as a safe
alternative to ablative laser resurfacing, and have been reported to be effective and safe
for scars. However outcomes have remained unsatisfactory and require several treatments to
achieve satisfactory efficacy.
Recently, the use of ablative and non-ablative lasers based on the fractional approach has
become a novel strategy for the treatment of scars, and some authors have suggested that
treatment with fractional lasers for various scars, such as postoperative, atrophic, and
acne scars, has been demonstrated to safely improve the appearance of the scars. However,
there is a lack of studies comparing coagulation modality of such lasers.
Objective
The objective of this study is to compare the efficacy of dual-mode Er:YAG laser delivering
pulses either with and without heat/coagulation in a cohort of patients with long
keloid/hypertrophic scars.
Methods
This is a single center, investigator initiated, double blind, within-subject split-lesion
design, equivalence randomized clinical study.
Consecutive patients, referring to Dermatology outpatient and fulfilling inclusion criteria,
are included. Participants are then randomly assigned to get treatment with Er:YAG laser on
half of scar section side by equally splitting the lesion area in two symmetric and uniform
parts. One side will be treated with coagulation while the other one will be without. In
case of multiple lesions per patient, only the largest and most uniform one is selected for
the study purpose.
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