Lasers and device-based treatments are the gold standard for treating many scar types, and keeping up with scar treatment best practices is vital for dermatologists.
New York City-based dermatologist Arielle N.B. Kauvar, M.D., and colleagues talked about scar types, best treatment options and new devices and techniques during their presentation, “Laser and Device-Based Treatment of Scars,” at the 2017 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Fla.
Dr. Kauvar, who directed the AAD panel discussion, describes scar types and corresponding devices for treating them as:
- Erythematous and hypertrophic: vascular lasers, such as the pulsed dye laser or pulsed KTP laser.
- Burn scars: fractional ablative laser in combination with intralesional corticosteroid and 5-fluorouracil +/- vascular laser.
- Atrophic scars, including acne scars: fractional nonablative and ablative lasers or microneedling, with or without radiofrequency.
- Surgical/suture line scars: ablative carbon dioxide and erbium: YAG (full surface and fractional) or microneedling.
- Hyperpigmented scars: nanosecond and picosecond pigment lasers.
- Hypopigmented or depigmented scars: fractional ablative and nonablative lasers.
- Complex scars (usually from trauma; there may be multiple elements with atrophy, hypertrophy, erythema, traumatic tattooing and dyschromia): multiple modalities.
The dermatologist has these top tips for treating scars:
“Assess the scar type before treatment. New erythematous scars with active hypertrophy should be treated initially with vascular lasers alone or in combination with low density fractional lasers to avoid stimulating scar proliferation,” Dr. Kauvar says.
When traumatic tattooing, from gravel, asphalt or gun powder, is present in a complex scar, treatment starts with a nanosecond or picosecond laser for the tattoo pigment, prior to using a millisecond vascular laser to avoid potential treatment-related scarring, according to Dr. Kauvar, clinical professor of dermatology, New York University School of Medicine.
And scars that are 5 mm thick or thicker, including hypertrophic scars from burns or surgery, respond best to fractional ablative, including carbon dioxide and erbium: YAG, lasers. That should be in combination with intralesional or topically applied corticosteroids, with or without 5-fluorouracil, she says.
As for what’s new in scar treatment, Dr. Kauvar points to recent studies that show acne scars benefit from microneedling devices, with or without radiofrequency heat delivery. On the horizon: The use of platelet rich plasma (PRP) in combination with microneedling is being investigated for acne scar treatment, she says.
Dr. Kauvar is as an advisor, consultant or investigator for Allergan, Lumenis, Sebacia, Syneron and Valeant Pharmaceuticals North America.