Clinical effects of pulsed dye laser dynamically combined with triamcinolone acetonide in the treatment of keloids

Liu Zhennan; Zhou Yuemin; Liu Ruoxuan; Li Yaling; Li Qing; Zhang Ting; Zhang Shuman

doi:10.3760/cma.j.cn501225-20220620-00249

Volume 38 Issue 9

Sep. 2022

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2022 > 38(9): 822-829

Liu ZN,Zhou YM,Liu RX,et al.Clinical effects of pulsed dye laser dynamically combined with triamcinolone acetonide in the treatment of keloids[J].Chin J Burns Wounds,2022,38(9):822-829.DOI: 10.3760/cma.j.cn501225-20220620-00249.

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Clinical effects of pulsed dye laser dynamically combined with triamcinolone acetonide in the treatment of keloids

doi: 10.3760/cma.j.cn501225-20220620-00249

Department of Plastic and Reconstructive Surgery, Huaihe Hospital of Henan University, Kaifeng 475000, China

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Science and Technology Development Plan of Henan Province of China 172102410005

Medical Science and Technology Plan for Tackling Key Problems of Henan Province of China 201401014

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Corresponding author: Zhou Yuemin, Email: yueminzhou2@hotmail.com
Received Date: 2022-06-20

Abstract

Abstract

Objective To explore the clinical effects of pulsed dye laser (PDL) dynamically combined with triamcinolone acetonide (TAC) in the treatment of keloids. Methods A retrospectively observational study was conducted. From April 2015 to October 2020, 34 keloid patients (46 keloids) who met the inclusion criteria were admitted to Huaihe Hospital of Henan University. The patients were divided into TAC group and dynamic treatment group according to their treatment methods. There were 18 patients (26 keloids) in TAC group, including 8 males and 10 females, aged (30±12) years, who were treated with TAC injection alone. There were 16 patients (20 keloids) in dynamic treatment group, including 6 males and 10 females, aged (26±11) years, who were treated with TAC injection, PDL, or PDL combined with TAC injection according to the Vancouver scar scale (VSS) score before each treatment. Before the first treatment (hereinafter referred to as before treatment) and 12 months after the first treatment (hereinafter referred to as after treatment), the keloids were assessed by VSS, patient and observer scar assessment scale (POSAS), and the effect of keloids on the quality of life of patients was evaluated with dermatology life quality index (DLQI) scale. Twelve months after treatment, the curative effect of keloid was evaluated according to the VSS score and the effective rate was calculated. The first effective time and the cumulative times of TAC injection at the first effective time, the number of follow-up and the occurrence of adverse reactions of keloids within 12 months after treatment were recorded, and the incidence of adverse reactions was calculated. Data were statistically analyzed with paired sample t test, independent sample t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. Results The total VSS scores of patients' keloids in TAC group and dynamic treatment group 12 months after treatment were significantly lower than those before treatment (with t values of 7.53 and 8.09, respectively, P<0.01), and the total scores of pigmentation and vascularity in VSS and POSAS, the total POSAS score, and the DLQI scale score were significantly lower than those before treatment (with Z values of -3.71, -4.04, -4.21, -4.11, -3.76, -3.73, -3.92, and -3.93, respectively, P<0.01). The total scores of pigmentation and vascularity in VSS and POSAS of patients' keloids in dynamic treatment group 12 months after treatment were significantly lower than those in TAC group (with Z values of -2.03 and -2.12, respectively, P<0.05). Twelve months after treatment, the effective rate of patients' keloids in dynamic treatment group was significantly higher than that in TAC group (χ²=3.88, P<0.05). The first effective time of patients' keloids in dynamic treatment group was 5.5 (2.0, 6.0) months, which was significantly shorter than 6.0 (2.3, 10.3) months in TAC group (χ²=4.02, P<0.05). The cumulative times of TAC injection at the first effective time of patients' keloids in dynamic treatment group was 3.2±1.7, which was significantly less than 4.2±1.8 in TAC group (t=2.09, P<0.05). The number of follow-up of patients' keloids within 12 months after treatment in dynamic treatment group was significantly more than that in TAC group (t=-2.94, P<0.01), and the total incidence of adverse reactions was lower than that in TAC group but without statistically significant difference (P>0.05). Conclusions Compared with TAC injection alone, PDL dynamically combined with TAC in the treatment of keloid can shorten the effective time, reduce the number of TAC injection, and improve the patient's compliance and clinical efficacy.
- Keloid,
- Triamcinolone acetonide,
- Combined modality therapy,
- Pulsed dye laser

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References

[1]	LimandjajaGC,NiessenFB,ScheperRJ,et al.The keloid disorder: heterogeneity, histopathology, mechanisms and models[J].Front Cell Dev Biol,2020,8:360.DOI: 10.3389/fcell.2020.00360.
[2]	MotokiTHC,IsoldiFC,BritoMJA,et al.Keloid negatively affects body image[J].Burns,2019,45(3):610-614.DOI: 10.1016/j.burns.2018.10.009.
[3]	Morelli CoppolaM,SalzilloR,SegretoF,et al.Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives[J].Clin Cosmet Investig Dermatol,2018,11:387-396.DOI: 10.2147/CCID.S133672.
[4]	GrabowskiG,PacanaMJ,ChenE.Keloid and hypertrophic scar formation, prevention, and management: standard review of abnormal scarring in orthopaedic surgery[J].J Am Acad Orthop Surg,2020,28(10):e408-e414.DOI: 10.5435/JAAOS-D-19-00690.
[5]	中国整形美容协会瘢痕医学分会常务委员会专家组.中国瘢痕疙瘩临床治疗推荐指南[J].中国美容整形外科杂志,2018,29(5):前插3-前插14.DOI: 10.3969/j.issn.1673-7040.2018.05.001.
[6]	ElsaieML.Update on management of keloid and hypertrophic scars: a systemic review[J].J Cosmet Dermatol,2021,20(9):2729-2738.DOI: 10.1111/jocd.14310.
[7]	WangJ,WuJ,XuM,et al.Combination therapy of refractory keloid with ultrapulse fractional carbon dioxide (CO2) laser and topical triamcinolone in Asians-long-term prevention of keloid recurrence[J].Dermatol Ther,2020,33(6):e14359.DOI: 10.1111/dth.14359.
[8]	宋黎,熊琳.激光及强脉冲光治疗病理性瘢痕的研究进展[J].中国美容医学,2015,24(16):76-79.
[9]	刘若璇动态量化评估体系在瘢痕疙瘩治疗中的应用郑州河南大学2020 刘若璇.动态量化评估体系在瘢痕疙瘩治疗中的应用[D].郑州:河南大学,2020.
[10]	LvK,XiaZ,Chinese consensus panel on the prevention and treatment of scars. Chinese expert consensus on clinical prevention and treatment of scar[J/OL]. Burns Trauma,2018;6:27[2022-08-22].https://pubmed.ncbi.nlm.nih.gov/30263894/.DOI: 10.1186/s41038-018-0129-9.
[11]	OuyangHW,LiGF,LeiY,et al.Comparison of the effectiveness of pulsed dye laser vs pulsed dye laser combined with ultrapulse fractional CO2 laser in the treatment of immature red hypertrophic scars[J].J Cosmet Dermatol,2018,17(1):54-60.DOI: 10.1111/jocd.12487.
[12]	谭欢,张远理,唐原,等.瘢痕疙瘩患者128例生活质量评估及影响因素分析[J].中国皮肤性病学杂志,2021,35(2):200-204.DOI: 10.13735/j.cjdv.1001-7089.202008003.
[13]	吴丽珍,后晨蓉,谢振谋,等.曲安奈德联合玻璃酸酶注射辅助浅层X线放射治疗多发性瘢痕疙瘩的有效性研究[J].中华整形外科杂志,2021,37(1):79-83.DOI: 10.3760/cma.j.cn114453-20200624-00384.
[14]	于磊,杨雅婷,刘伟.瘢痕疙瘩患者瘢痕疙瘩与其周围正常皮肤水屏障功能的差异及其相关机制[J].中华烧伤与创面修复杂志,2022,38(1):63-68.DOI: 10.3760/cma.j.cn501120-20210427-00156.
[15]	LuWS,WangJF,YangS,et al.Association of HLA-DQA1 and DQB1 alleles with keloids in Chinese Hans[J].J Dermatol Sci,2008,52(2):108-117.DOI: 10.1016/j.jdermsci.2008.04.010.
[16]	PiresJA,BragatoEF,MomolliM,et al.Effect of the combination of photobiomodulation therapy and the intralesional administration of corticoid in the preoperative and postoperative periods of keloid surgery: a randomized, controlled, double-blind trial protocol study[J].PLoS One,2022,17(2):e0263453.DOI: 10.1371/journal.pone.0263453.
[17]	YooMG,KimIH.Keloids and hypertrophic scars: characteristic vascular structures visualized by using dermoscopy[J].Ann Dermatol,2014,26(5):603-609.DOI: 10.5021/ad.2014.26.5.603.
[18]	XiaY,WangY,ShanM,et al.Advances in the pathogenesis and clinical application prospects of tumor biomolecules in keloid[J/OL].Burns Trauma,2022,10:tkac025[2022-08-26].https://pubmed.ncbi.nlm.nih.gov/35769828/.DOI: 10.1093/burnst/tkac025.
[19]	OgawaR,AkaishiS.Endothelial dysfunction may play a key role in keloid and hypertrophic scar pathogenesis - keloids and hypertrophic scars may be vascular disorders[J].Med Hypotheses,2016,96:51-60.DOI: 10.1016/j.mehy.2016.09.024.
[20]	RoquesC,TéotL.The use of corticosteroids to treat keloids: a review[J].Int J Low Extrem Wounds,2008,7(3):137-145.DOI: 10.1177/1534734608320786.
[21]	Blanco de TordM,Plana PlaA,JakaA.Big ear keloid response to PDL laser[J].Med Clin (Barc),2021,157(4):217.DOI: 10.1016/j.medcli.2020.07.045.
[22]	KhattabFM,NasrM,KhashabaSA,et al.Combination of pulsed dye laser and verapamil in comparison with verapamil alone in the treatment of keloid[J].J Dermatolog Treat,2020,31(2):186-190.DOI: 10.1080/09546634.2019.1610550.
[23]	GoldMH,BermanB,ClementoniMT,et al.Updated international clinical recommendations on scar management: part 1--evaluating the evidence[J].Dermatol Surg,2014,40(8):817-824.DOI: 10.1111/dsu.0000000000000049.
[24]	刘振楠,周粤闽.脉冲染料激光在创伤后瘢痕早期治疗中的应用研究进展[J].中华烧伤杂志,2021,37(7):688-691.DOI: 10.3760/cma.j.cn501120-20200315-00164.
[25]	陈立新,王莹,林杨杨,等.脉冲染料激光对体外瘢痕成纤维细胞中TGF-β1和TGF-β3表达的影响[J].中国中西医结合皮肤性病学杂志,2019,18(1):11-14.DOI: 10.3969/j.issn.1672-0709.2019.01.003.
[26]	NastA,GauglitzG,LorenzK,et al.S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids) - update 2020[J].J Dtsch Dermatol Ges,2021,19(2):312-327.DOI: 10.1111/ddg.14279.
[27]	KuoYR,WuWS,WangFS.Flashlamp pulsed-dye laser suppressed TGF-beta1 expression and proliferation in cultured keloid fibroblasts is mediated by MAPK pathway[J].Lasers Surg Med,2007,39(4):358-364.DOI: 10.1002/lsm.20489.
[28]	赵烨德,高萍,陈云祥,等.脉冲染料激光和曲安奈德局部注射治疗病理性瘢痕的临床体会[J].海军医学杂志,2007,28(2):102-103.DOI: 10.3969/j.issn.1009-0754.2007.02.003.
[29]	梁文,陈瑞,蒋雨薇,等.595nm脉冲染料激光联合醋酸曲安奈德治疗瘢痕疙瘩的疗效[J].中国激光医学杂志,2021,30(1):35.
[30]	MuneuchiG,SuzukiS,OnoderaM,et al.Long-term outcome of intralesional injection of triamcinolone acetonide for the treatment of keloid scars in Asian patients[J].Scand J Plast Reconstr Surg Hand Surg,2006,40(2):111-116.DOI: 10.1080/02844310500430003.

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Clinical effects of pulsed dye laser dynamically combined with triamcinolone acetonide in the treatment of keloids

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Clinical effects of pulsed dye laser dynamically combined with triamcinolone acetonide in the treatment of keloids

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