Fractional Carbon Dioxide (CO2) Laser Alone Versus Fractional CO2 Laser Combined With Triamcinolone Acetonide or Trichloroacetic Acid in Keloid Treatment: A Comparative Clinical and Radiological Study

Engy Abd El-Hamid El-Azhary; Fatma Mohamed Abd Al-Salam; Hala Shawky Abd El-Hafiz; Hala Maghraby Maghraby

doi:10.5826/dpc.1202a72

Fractional Carbon Dioxide (CO₂) Laser Alone Versus Fractional CO₂ Laser Combined With Triamcinolone Acetonide or Trichloroacetic Acid in Keloid Treatment: A Comparative Clinical and Radiological Study

Dermatol Pract Concept. 2022 Apr 1;12(2):e2022072. doi: 10.5826/dpc.1202a72. eCollection 2022 May.

Authors

Engy Abd El-Hamid El-Azhary¹, Fatma Mohamed Abd Al-Salam², Hala Shawky Abd El-Hafiz², Hala Maghraby Maghraby³

Affiliations

¹ Faculty of Medicine Kasr Al-Aini Faculty of Medicine, Cairo University, Cairo, Egypt.
² Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
³ Radiodiagnosis Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.

Abstract

Introduction: Keloids are benign fibro-proliferative scarring extending outside the initial wound. Different treatment modalities as intralesional corticosteroid injection, fractional CO₂ laser, and others can be used either as mono or combined therapies.

Objectives: To assess the efficacy of fractional CO₂ laser versus fractional CO₂ laser accompanied with either triamcinolone acetonide or trichloroacetic acid 20% in keloid treatment clinically and radiologically.

Methods: The current study was conducted on 45 Egyptian participants with keloid scars at different sites of the body. They were classified into 3 groups treated by fractional CO₂ laser only (group I), fractional CO₂ laser followed by triamcinolone acetonide (group II), or trichloroacetic acid application (group III), respectively. Evaluation of the keloid was done with Vancouver Scar Scale (VSS) and Color Doppler Ultrasound (CDU) before and after treatment. Four sessions 4 weeks apart were applied for the patients. They were followed-up for 8 weeks after the last session.

Results: After treatment, there was a high statistically significant reduction in VSS among the 3 groups (P ≤ 0.001); the reduction was more in group II than in I and III. Also, a high statistically significant reduction in keloid scar thickness assessed by CDU was recorded (P ≤0.001 in group II and P ≤0.01 in group I and III).

Conclusions: Combined therapy is favorable in the treatment of keloids. Trichloroacetic acid is a promising modality in treating keloid, hence it can be tried in different combinations. CDU is a promising method of keloids pre-and post-treatment assessment.

Keywords: TAC; TCA; doppler; fractional laser; keloid.