Laser scar revision: Comparison of CO2 laser vaporization with and withoutsimultaneous pulsed dye laser treatment

BACKGROUND. Over the past decade, the 585-nm pulsed dye laser (PDL) has bee n used successfully to treat a variety of cutaneous vascular lesions as wel l as hypertrophic scars. Laser scar revision has been revolutionized by the recent development of high-energy, pulsed carbon dioxide (CO2) laser syste ms. These new CO2 lasers allow controlled vaporization of thin layers of sk in while minimizing damage to surrounding dermal structures. OBJECTIVE. To determine the effect of a high-energy, pulsed CO2 laser alone and in combination with a 585-nm PDL on non-erythematous hypertrophic scar s. METHODS. Twenty patients with nonerythematous hypertrophic scars were treat ed with a high-energy, pulsed CO2 laser. One-half of each scar was addition ally treated with the 585-nm PDL laser. Sequential clinical and photographi c analyses were performed independently by two blinded assessors. In additi on, erythema reflectance spectrometry measurements were obtained from the s cars before and at regular postoperative intervals. RESULTS. Global assessment scores and erythema spectrometry measurement wer e significantly improved after laser treatment. Combination CO2 and PDL las er treatment resulted in more significant improvement than CO2 laser irradi ation alone. CONCLUSION. Concomitant use of the high-energy, pulsed CO2 and PDL laser sy stems was superior to CO2 laser vaporization alone for revision of noneryth ematous hypertrophic scars. Once again, the vascular specificity of the 585 -nm PDL has been linked to improvement in hypertrophic scar tissue. (C) 199 8 by the American Society for Dermatologic Society, Inc.