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Elisabetta Perosino
Elisabetta Perosino 1
Eleonora Tati 2
1 Medico Chirurgo Dermatologo
Roma, Italy
2 Medico Chirurgo, Roma, Italy
Case report: treatment of keloid
with Intense Pulsed Light
Summary
I ntroduction
Hypertrophic scars and keloids are
common problems especially in young women
and dark skin types (Fitzpatrick VI) like in individuals
of African, Hispanic, and Asian descent 1 .
Hypertrophic scars and keloids occur as a result
of excessive healing reactions to damage to the
deep skin tissues after traumatic or surgical
wounds that have a prolonged phase of inflammation
and fibroplasias.
This healing reaction leads to excessive fibroblast
proliferation and collagen synthesis that result in
benign fibrous outgrowths for both keloids and
hypertrophic scars. Both have a similar clinical
appearance; however, the growth reaction
remains within the margins of the scar in hypertrophic
scars, while in keloids the reaction has
the ability to extend the boundaries of the initial
scar and is likely to recur after treatment 2 .
The exact pathogenesis of keloids and hypertrophic
scar formation still remains unknown
which makes treatment even more complicated
3 ; however, an imbalance of matrix degradation
and collagen biosynthesis, resulting in
excess accumulation of collagen in the wound,
has been postulated to be the primary biochemical
feature of these skin lesions 4-6 .
Case report: treatment of keloid
with Intense Pulsed Light
Keloids are scars, unique to humans that grow beyond the boundaries of a cutaneous
injury, inflammation, burn or surgical incision. However spontaneous keloids sometimes
develop without a preceding trauma, most commonly over the sternum. A wide
range of therapies is available for keloids but the reported efficacy has been variable.
These options include intralesional steroid injections, pressure dressing, silicone gel
sheeting, topical retinoids, excisional surgery, radiotherapy and cryosurgery. Lasers
are now being used to improve keloids. In this article we present a case of a young
woman with keloid of the sternum region treated with Intense Pulsed Laser.
KEY WORDS: Keloid, Intense Pulsed Laser
Many persons seek medical attention for the
treatment of scars, not only for aesthetic reasons
(an unsightly scar can be very distressing, especially
to young females) but also for functional
reasons; scar contracture over a joint can
severely restrict movement of the affected area.
Pain and pruritus are typical symptoms associated
with a proliferative scar.
A wide range of therapies is also available for
keloids, but the reported efficacy has been variable.
These options include intralesional steroid
injections, pressure dressing, silicone gel sheeting,
topical retinoids, excisional surgery, radiotherapy,
and cryosurgery 7-10 . Lasers are now
being used to improve hypertrophic scars and
keloids 11 .
Since their introduction for hypertrophic scars
and keloids by Apfelberg et al. 12 and Castro et
al. 13 in the mid-1980s, more and more lasers
with different wavelengths have been studied.
Q-switched lasers (e.g. Nd: YAG, alexandrite,
ruby) can be used to treat hyperpigmented
scars and to remove artificial pigment from a
scar (e.g. tarmac or gun powder particles
embedded in a scar after traffic or explosives
accident, respectively).
Journal of Plastic Dermatology 2010; 6, 2 149