Minimally Invasive Technologies for Treatment of HTS and Keloids: Pulsed-Dye Laser

We present another minimally invasive technology for the treatment of hypertrophic scars and keloids: the pulsed-dye laser. Being first introduced by two groups around Schaefer (Germany) and Sorokin & Lankard (USA) in 1966, the pulsed dye laser is a rather new technology. The first clinical use of pulsed-dye lasers was reported in 1983 for the treatment of naevus flammeus, and was the first laser used for the treatment of keloids in the mid-1990s.Its efficacy is based on the principle of selective photothermolysis, enabling a selective destruction of defined structures absorbing the respective wavelength used, as compared to other lasers working based on thermal coagulation or ablative tissue interaction. The preferred wavelengths being used are 585 or 595 nm, which makes small cutaneous vessels the main targets. Their destruction leads to a diminished blood supply of the irradiated area, thus reducing symptoms of hypertrophic scars like itching, vascularity, and redness, and secondary – probably by the induced hypoxemia – a reduction in scar height and pliability. This therapeutic approach also implies the use of pulsed-dye laser in the prevention of pathologic scars. While significant side effects are usually rare, slight signs of use like edema or scab formation can pertain for several days. Since the sensory impact of laser pulses are comparable to needle pricks, some form of analgesia during the application is highly recommended. The elusive data and still existing scarcity of high-quality studies on the use of pulsed-dye laser, however, make it hard to develop clear recommendations.