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Early laser intervention for improved appearance of surgical scars

Scars following surgical procedures occur every day in thousands of patients worldwide. Postoperative scar tissue may lead to pain and itching, as well as functional and cosmetic consequences that may adversely affect patients’ quality of life. Methods that may improve appearance and symptoms from scars are therefore warranted. While laser treatment on mature scars has shown some remodelling of scar tissue, early laser intervention for immature scars and even during wound healing has been proposed as a preventative approach to improve scar appearance. Laser intervention during the early wound-healing phases stimulates heat shock proteins and cytokine responses that appear to modulate the formation and distribution of collagen fibres towards what is observed in normal skin. The preventative effect of scar formation during phases of wound-healing formation has been assessed predominantly with fractional lasers, which create microscopic channels of ablated or coagulated tissue, respectively, leaving the surrounding skin intact. A recent systematic review found some improvement of scar appearance in 40– 75% of studies that initiated laser treatment within 3 months after wounding. However, the authors concluded that the limited methodological quality of the studies undermines the assumption of the true clinical efficacy of early laser treatment for scar appearance. In the December issue of the BJD, Karmisholt et al. report a randomized, controlled, split-wound study describing a beneficial effect of nonablative fractional laser (NAFL) treatments during early wound-healing phases compared with an untreated control. Applying NAFL treatment immediately before excision, at suture removal and 6 weeks after excision, the authors found a subtle yet consistent effect. At 3-month follow-up, NAFL treatment resulted in improvement of both overall opinion and vascularity, surface relief, pliability and reduced surface area. These findings were obtained by thorough blinded evaluation using two standardized scales, the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS), as well as photo evaluation and patient-reported outcomes. Of interest, the best response to NAFL was observed on the thorax region compared with the head/neck and extremities, which may be due to more severe scarring in this region. The split-wound design and high methodological quality lends substantial weight to the findings of this study showing a positive and consistent effect of NAFL in early wound healing for improvement of surgical scar appearance. Although 1-year follow-up data would be of interest, this manuscript provides sound data that early NAFL treatment may reduce the functional and cosmetic burden that scars impose on patients. Consequently, NAFL treatment may be considered for selected patients with planned surgery and at risk of potentially disfiguring scars on the trunk.