On the first night of the American Academy of Dermatology Virtual Meeting Experience, Jill Waibel, MD, shared what dermatologists should know when it comes to treating scars with laser-based technologies.

Laser treatment is a major innovation that heals in ways never possible before, stated Dr Waibel. Utilizing lasers, such as the ablative fractional laser, can assist in vaporizing scar tissue and healing it as normal tissue.

When introducing laser-assisted drug delivery synergistic, it is noted that the zones may be used right after postoperation to deliver drugs and other substances to synergistically create an enhanced therapeutic response. Scar conditions with correlated treatments include:

• Postinflammatory hyperpigmentation: Triamcinolone acetonide
• Hypertrophic scar: Triamcinolone acetonide; 5-flourouracil
• Atrophic scar: Poly-L-lactic-acid (PLLA)
• Hypopigmented scar: Bimatoprost

Dr Waibel shared that it is important to space treatments 2 to 3 months (as scars heal slower), use multiple lasers in the same session, and practice meticulous postoperative care. It is important to tell the patient that they are going to look better but not perfect, explained Dr Waibel. Setting expectations is critical to maintaining a more positive patient experience and satisfaction.

Scar rehabilitation and treatment should include a review of the color of the scar so that the correct treatment can be selected. Red scars can be best treated by pulsed dye laser (PDL), intense pulsed light, and ablative fractional laser (AFL), including CO₂ or erbium. Brown scars can be treated with AFL or 1927 nm laser. White scars, or scars with hypopigmentation, are the toughest to treat. The best options likely are nonablative AFL (NAFL), AFL, AFL with bimatoprost, and epidermal harvesting.

Dermatologists should pay attention to whether there is a collagen problem within the scar to be treated. Atrophic scars are dermal depressions that occur due to collagen destruction after injury, but there also are atrophic scarring diseases of the skin. Deeper scars occur due to significant loss in dermal collagen, and these represent a reconstruction challenge. The solution is to utilize AFL and PLLA for both types of scars. Conversely, erbium AFL and PLLA are go-to options for acne scars, especially when you give them time to heal, which could take months.

Additionally, lasers can improve striae rubra, striae alba, and striae distensae. A recent study has shown that distensae marks go deeper than 800μm—these are not superficial lesions, which may mean it is time to rethink how deep lasers should go to treat this.

With catastrophic scars, lasers have been used for treating large surface areas, including burn and trauma scars alongside severe hypertrophic scars. However, most patients with catastrophic scarring may suffer from posttraumatic stress disorder, and the smells or hypesthetic could trigger them into an episode. On the other hand, laser treatment in catastrophic scars have brought new improvements such as hypertrophic scar contracture, where range of motion improves with AFL, and treating post burn itch, a constant, severe problem where PDL and CO₂ fractional lasers are effective.

Additionally, with early laser intervention it is possible to prevent scars. In the time occurring from injury to a wound becoming a scar, Dr Waibel suggested that applying a minimally invasive device early after injury may be key to preventing scarring, and that scars can be prevented by AFL lasers.

The pipeline for scar treatment includes microcoring procedure for acne scars and striae. This is a 20- to 25-minute procedure with tunable density and depth; there is minimal downtime, and the site of application heals without scarring. In addition, dermatologists can look forward to laser-assisted delivery of stem cells, a regenerative medicine. Emerging stem cell models are supported by recent evidence showing stem cells divide and release cytokines and other mediators locally. This will likely revolutionize health care. —Jessica Garlewicz

Reference
Waibel, J. Laser-assisted delivery for treatment of scars. Presented at: American Academy of Dermatology Virtual Meeting Experience 2021; April 23-25, 2021; virtual.