Table 4.
Laser therapy
| First author, year | Study design | Treatment | Duration | N | Outcome (s) | Follow-up time | Adverse events | Comments |
|---|---|---|---|---|---|---|---|---|
| Abd El-Deyem, 2020 [76] | P, split side controlled | IL TAC (10 mg/ ml) versus 2940 nm Er:YAG laser with betamethasone and film covering immediately after | Q4 weeks for 4 treatments | 30 | VSS from 6.90 to 2.63 versus 2.07 (p > 0.05) | 12 weeks after last session | Telangiectasia, atrophy, leukoderma, hyperpigmentation versus just hyperpigmentation | |
| Annabathula, 2017 [77] | P | Sequential fractional CO2, PDL, then Nd:YAG | Q4 weeks for 5 sessions | 15 | Improvement: 9% excellent, 9% good, 37% moderate, 27% with no change | 6 months | none | 4 patients lost to follow-up, 1 patient with increased size of keloid |
| Behera, 2016 [78] | RCT | CO2 then IL TAC (40 mg/ml) versus contact cryotherapy then IL TAC (40 mg/ml) | Q4 weeks for 3 months | 60 (101 keloids) | 38.89% versus 40.47% complete flattening (p = 1.00); 16.66% recurrence in CO2 treated | 12 months | Infection, erythema, hypopigmentation (more with cryotherapy), erosion, pain, atrophy, telangiectasia, comedone; early side effects more common with CO2 | |
| Chen, 2017 [79] | P |
IL CS (diprospan) versus IL 5 FU and CS versus IL 5-FU and CS then 1,064-nm Nd:YAG |
Q4 weeks for 3 sessions | 62 (69 keloids) |
Patient: excellent response 20% vs 58% vs 78% Blinded observer: excellent response 12% vs 48% vs 68% |
3 months |
Pain for all groups 36% atrophy and telangiectasia vs none vs initial purpura |
|
| Garg, 2011 [80] | P | CO2 laser then IL TAC of 40 ng/ml | IL TAC Q3–4 weeks for 6 months | 28 (35 keloids) |
Regular follow-up: 11.7% recurrence Irregular follow-up: 75% recurrence |
1 year, 6 months after final IL TAC | Erythema, infection, telangiectasia, atrophy, dyschromia, | 5 patients lost to follow-up |
| Kassab, 2012 [81] | P | 980-nm diode then IL TAC (40 mg/ml) | Q3 weeks for 2 to 5 sessions | 12 (16 keloids) | 12 out of 16 had > 75% reduction in size | 12 months | Infection, hyperpigmentation | Earlobe keloids |
| Park, 2017 [82] | P, split side controlled | Er:YAG laser then IL TAC (10 mg/cm3) vs topical desoximetasone 0.25% ointment with 3 h occlusion using transparent film dressing | Q6 weeks for four sessions | 10 | Improvement in VSS, but no difference between sides | 12 weeks after last treatment | Higher pain for IL TAC, telangiectasia | |
| Srivastava, 2019 [71] | RCT | IL TAC (40 mg/ml) vs IL verapamil (2.5 mg/ml) vs fractional CO2 | Q3 weeks for 24 weeks or flattening | 60 | All groups improved VSS; IL TAC had fastest improvement | 6 months | Pain, telangiectasia, atrophy vs none vs pain and charring | |
| Wang, 2020 [83] | P | Fractional CO2 laser then applied triamcinolone acetonide (40 mg/ml) with 4 h occlusion with transparent film dressing | Q4 weeks for 8 sessions | 41 |
POSAS observer score 37.73 to 25.29 after treatment; patient 39.59 to 22.34 10.5% recurrence |
24 months | Telangiectasia, hyperpigmentation | 3 subjects lost to follow-up |
P prospective trial, RCT randomized controlled trial, IL intralesional, TAC triamcinolone acetonide, qn weeks every n weeks, PDL pulsed-dye laser, CS corticosteroid