[Meta-analysis of the effects of PDL combined with fractional carbon dioxide laser in the treatment of hypertrophic scars in children].

Objective: To evaluate the effects of pulsed dye laser (PDL) combined with fractional carbon dioxide laser in the treatment of hypertrophic scars (HSs) in children. Methods: This study was a meta-analysis. Databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Service Platform were retrieved to obtain the publicly published retrospective and prospective studies on the effects of PDL combined with fractional carbon dioxide laser for pediatric HS from the establishment of each database to October 31, 2024. The outcome indexes included the total score of the patient and observer scar assessment scale (POSAS) and laser treatment-related adverse reactions. Stata version 16.0 software was used to conduct a meta-analysis. Results: A total of 7 studies were included, involving 348 children with HSs. Meta-analysis results showed that the total POSAS scores in HS children who received PDL combined with fractional carbon dioxide laser treatment were significantly lower than those before treatment (with a standardized mean difference of -7.76, a 95% CI of -10.91 to-4.61, P<0.05). Subgroup analysis results suggested that geographic distribution, scar duration (divided into ≤3 months group and >3 months group), intervention measures, and fractional carbon dioxide laser energy parameters might be sources of heterogeneity for the total POSAS score. The incidence of adverse reactions of PDL combined with fractional carbon dioxide laser for pediatric HS was 3.50% (with a 95% CI of 1.60% to 6.00%, P<0.05). There was no publication bias in the total POSAS score, its subgroup analyses (including geographic distribution, scar duration, intervention measures, fractional carbon dioxide laser energy parameters, and assessor), or adverse reactions related to laser treatment (P>0.05). Conclusions: PDL combined with fractional carbon dioxide laser is beneficial for the recovery of pediatric HS, with a low rate of adverse reactions and a favorable safety profile. For pediatric HS, the early intervention window within 3 months after scar formation should be prioritized, and a regimen combining low-energy fractional carbon dioxide laser flexibly with PDL should be adopted to achieve better therapeutic outcomes.