Multi-Modal Laser Combination Therapy of Pigmented Scars: A Case Series of 30 Patients.

Background and

Objectives

This study reports an adaptive experience of pigmented scar treatment management with different characteristics. It is complicated to define a single solution for all the patients. For this reason, we report a multi-modal approach combining CO2 laser, Q-switched lasers (QSL), and dye laser to adapt to every different patient clinical situation. Materials and

Methods

Thirty patients were enrolled to treat pigmented scars. Twenty patients presented scars with exogenous pigment (such as traumatic tattoos) and 10 with endogenous pigment (hyperpigmentation cases). A combination of CO2 laser, QSL, and dye laser was used. The number of treatment sessions performed for each laser, or their combination was as follow: For keloid scars from tattoo: 1-4 combined treatment sessions with QS and dye lasers; 3-4 combined treatment sessions with dye and CO2 laser;1-4 treatment sessions with QS followed by dye laser; for asphalt traumatic tattoo: 2-3 treatment sessions with QS; for surgical hypertrophic scars: 2-3 combined treatment sessions of QS and CO2 laser; for burn scars (due to asphalt contact) and hyperpigmentation: one treatment session with QS followed by CO2 laser. Six months after the final treatment, the patient's scar improvement was evaluated compared with baseline (T0) using a five-point Global Aesthetic Improvement Scale (GAIS).

Results

Regardless of the type of lesion and treatment, the whole population of the study showed satisfactory clinical results. The GAIS mean value was 3.3 ± 0.6. Specifically, 47% of the patients reported good results while 43% had excellent ones. No serious side effects were observed.

Conclusions

Our results suggest that a combination of CO2, dye, and Nd:YAG lasers is a feasible strategy for treating scars, reducing the pigmentary, fibrotic, and vascular components.