Patients with a tendency to develop keloids are often warned away from laser treatment such as ablative skin resurfacing. However, other types of lasers can actually be used to treat an existing keloid scar to normalize pigmentation, surface texture, and flexibility.
What is a Keloid?
A keloid scar develops when skin is injured and the healing process triggers the overdevelopment of collagen and fibrous connective tissue called fibroblasts. These keep growing even after they have fulfilled their purpose of closing the wound. They often grow far beyond the boundaries of the initial injury. Because of this abnormal growth pattern, they are classified as a type of benign (non-cancerous) tumor. The raised, bulbous appearance of the scar and the fact that it may red, purple, or dark brown make it an unsightly blemish. Some keloid scars may also cause discomfort such as hypersensitivity, itching, or a sharp pinching sensation.
Problems with Treatment
The most challenging aspect of keloid scar revision is that the tissue tends to grow back in a high percentage of patients. Surgical excision may stimulate the formation of even more scar tissue than there was before. This means surgeons are exploring other options to reduce the appearance of this type of scarring. For example, they may use surgical lasers such as the CO2 rather than a scalpel to minimize tissue damage during excision.
Pulsed Dye Laser 585 nm
PDL (pulsed dye laser) is the most commonly used laser therapy for keloid scar reduction. It has been used since the 1980s to treat hypertrophic scarring. The device generates a beam of laser light in a wavelength that targets the vascular system in the keloid tissue with heat. This causes coagulation and clotting in the blood vessels that feed the scar tissue. The results (over multiple sessions) can include a lessening of redness, an increase in pliability of the tissue, and smoother texture. This approach may be used in combination with other treatments such as steroid injections to improve results.
However, even in the best of circumstances, this therapy is unlikely to return the skin to fully normal appearance. Some patients see only minimal improvement in the cosmetic appearance of their scar with PDL revision. Dermatologists must use special care in treating patients with dark skin to limit hyperpigmentation (making the scar darker). The upside of this treatment is that it is not as expensive or invasive as some other options and is not likely to make the scar start growing again.