Joint CO2 Fractional Laser and Intense Pulsed Light Improves Hypertrophic Scars

The appearance and profile of hypertrophic scars significantly improves with combined CO2 fractional laser and narrowband intense pulsed light (IPL) treatment compared with single IPL treatment, according to study findings published in Journal of Dermatological Treatment.

Researchers conducted a randomized, controlled, observer-blinded, prospective study that of patients with hypertrophic scars recruited from August 2017 to January 2021. The participants aged 16 to 55 years with Fitzpatrick skin types II, III, or IV with hypertrophic scars present for at least 9 weeks (mean duration, 6.4 months; range, 2-15 months) and at least 2 cm in length were randomly assigned to either the CO2 plus IPL group (n=52) or the IPL alone group (n=49). Those who were pregnant, lactating, diagnosed with serious skin disorders, keloids, or systemic diseases, or had undergone dermabrasion, intralesional treatment, or laser treatment for hypertrophic scars in the past 3 months were excluded.

The participants received 3 sessions of treatment at 10- to 14-week intervals; the follow-up period was 3 months after the third treatment session. Treatments were assessed using the Patient and Observer Scar Assessment Scales (POSAS) by 2 independent plastic surgeons. The Patient Satisfaction Scale (PSS) was used to assess overall satisfaction. There were no significant differences in sex, scar location, scar duration, or source (ie, burn, surgery, trauma) between groups.

The researchers found participants in the CO2 plus IPL group vs those in the IPL group showed significant improvement in follow-up in thickness, stiffness, color, itching, and irregularity in PSAS scores (P <.01). Improvement in pain was not statistically significant (P =.4205).

Evaluated by the OSAS, the researchers noted significant differences in relief, thickness, pigmentation, vascularization, and scar pliability (P <.01).

At the final follow-up, 100% of participants in the CO2 plus IPL group reported satisfaction (54% very satisfied; 46% satisfied) vs patients in the IPL alone group (84% satisfied; 16% dissatisfied). No serious adverse effects were reported in the combination therapy and treatment sessions were shorter in combined therapy vs IPL alone.

Study limitations include the single-center design and lack of objective testing."The combination of CO2 fractional laser and narrowband IPL efficiently improved the appearance and profile of hypertrophic scars, offering a comprehensive and reliable approach for scar therapy," the researchers conclude. "Independent observers found the combined treatment to be more effective in terms of vascularization, pigmentation, thickness, relief, and pliability, while patients reported reduced pruritus, lighter color, thinner scars, and more regular shape."

Zhang Y, Ye R, Bai Y, He Y, Ni W, Yao M. Efficacy and safety of ablative CO2 fractional laser and narrowband intense pulsed light for the treatment of hypertrophic scars: a prospective, randomized controlled trial. J Dermatolog Treat. Published online April 18, 2023. doi:10.1080/09546634.2023.2202287