Abstract
To summarise research studies on scar laser therapy since the 21st century using bibliometric methods, and to speculate on the possible development in the future. The literature about scar laser therapy in Web of Science database was searched. CiteSpace and VOSviewer were used to analyse main countries, institutions, journals，subject hotspots and trends, etc. A total of 884 papers have been published since the 21st century. These publications were written by 653 authors from 515 institutions in 58 countries. The United States published 287 papers in this field and ranks first. Laser in Surgery and Medicine is the most widely published journal, with Shumaker as the core author. The main keyword clustering includes terms such as combination therapy, wound healing, fractional photothermolysis, experience, scar formation, etc. CiteSpace and VOSviewer were used to sort out and summarise the countries, institutions, authors, journals, research hotspots and frontier topics of related literature about scar laser therapy since the 21st century. The current situation of its application and basic scientific research in clinical treatments were summarised briefly. This provides a new idea for the development and research of scar laser therapy in the future.
Keywords: bibliometric, data visualisation, laser, laser therapy, scar
1. BACKGROUND
Scars are the result of the wound repair process and are caused by abnormal healing of skin tissue after injury. Each year, tens of thousands patients endure both physical and mental distress due to scars. 1 Scars can be broadly categorised into superficial scars, atrophic scars, hypertrophic scars and keloids. 2 Itching and pain are the primary symptoms accompanying scars. Up to 87% of burn patients have been reported to experience itching and pain that severely affect sleep quality and daily activities, especially in the case of hypertrophic scars. 3 Facial deformities and restricted joint mobility resulting from scar contractures are often the most severe complications and require multiple surgical interventions. Patients with scar‐related issues frequently bear a substantial financial burden and face societal discrimination, rendering them more susceptible to anxiety, depression and even serious risk of suicide. 4
Surgical intervention stands as one of the primary approaches for addressing traumatic scars. This method is employed to rectify defects and deformities, particularly in cases where scar contracture results in functional impairment. 5 Nevertheless, surgery, as an invasive technique, carries the risk of triggering new scar formation and scar recurrence. The recurrence rate for simple surgical resection of pathological scars can be as high as 45%–100%. 6 Non‐surgical scar treatment techniques encompass intralesional injections of steroids or other medications, compression therapy, radiation therapy, silicone applications, lasers and light therapy. 7 Compression therapy is ineffective and unstable when applied to existing scar tissue. 7 The effectiveness of silicone gel products remains inconclusive. 8 The most significant challenge to the broader application of injected drugs such as glucocorticoids and chemotherapy agents is their potential side effects. 9 Radiotherapy necessitates a meticulous evaluation of its safety to mitigate the risk of secondary carcinogenesis. 7 Laser treatment can substantially ameliorate scar thickness, erythema, texture, pigmentation and even alleviate pain, itching and other discomforting symptoms, markedly enhancing the function of scarred areas and thereby reducing the necessity for surgical removal. 10 In comparison with intralesional steroid injections, radiotherapy and surgery, laser treatment exhibits considerably improved safety when applied to scars.
Scar laser therapy entails multifaceted and diverse clinical applications. Their intricacies manifest through a range of laser options, scar variations, patient‐specific changes, treatment timing and cycles, and modification of laser instrument parameters. Consequently, this bibliometric examination of scar laser therapy serves to systematically analyse and visualise the entire research framework. It furnishes a valuable reference for devising and optimising treatment strategies and guidelines for laser application. Furthermore, it aids scientific researchers in identifying crucial and valuable entry points while helping to establish a comprehensive clinical, scientific and regulatory framework within the realm of scar laser therapy.
Bibliometrics is an independent discipline within statistical methodology and is widely employed to quantitatively investigate, examine and analyse scientific research outcomes within specific fields. 11 The objective of this article is to provide a comprehensive and visual bibliometric study within the domain of scar laser therapy. Specifically, our analysis focuses on elucidating the collaborative dimensions of pertinent research endeavours in the field of scar laser therapy, including countries, institutions, authors and summarising keyword cluster, trends and frontiers. The principal aims of this study are as follows: (1) to encapsulate and assess the research results of scar laser therapy in the context of globalisation since the 21st century; (2) to delve into prevalent research topics and their distinctive attributes within this domain; (3) to scrutinise potentially valuable research trajectories based on our analysis of emerging trends; (4) to identify authoritative countries, institutions, author teams and journals in this field, thereby furnishing readers with a roadmap to rapidly comprehend this topic.
2. METHODS
2.1. Search strategy
All data used in this study were downloaded from the Science Citation Index‐Expanded database of the Web of Science Core Collection (WoSCC) on 10 June 2023. The search formula was (TI = ((‘scar * ‘ OR ’ scarring * ‘ OR ’ cicatrix * ‘ OR ’ keloid * ‘ OR ’ cicatric * ’) AND (‘laser ‘ OR ’ laser ’)) OR AB = ((‘scar * ‘ OR ’ scarring * ‘ OR ’ cicatrix * ‘ OR ’ keloid * ‘ OR ’ cicatric * ’) AND (‘laser ‘ OR ’ laser ’)) AND TS = (‘dermatolog * ‘ OR ’ cutaneous * ‘ OR ’ skin * ‘ OR ’ derma * ‘ OR ’ epidermis * ’). The period spanned from 1 January 2000, to 10 June 2023, and a total of 1809 publications were retrieved. A total of 1744 English articles were screened, and a total of 1438 articles were selected with the condition setting as article. After the correlation search by two independent researchers, the remaining 884 articles were retrieved. A scientometrical analysis of 844 articles was carried out in this article. The data retrieval and filtering process is shown in Figure 1.
FIGURE 1.
The search strategy used for the present bibliometric analysis.
2.2. Data analysis
CiteSpace is a Java application that combines computing and visualisation techniques. 12 It is rooted in the data standardisation methodology of calculus set theory, enabling a lucid delineation of the evolution of knowledge in the time dimension. Notably, its distinctive burst word detection function can identify abrupt surges in specialised terminology in the literature published during specific years, thereby aiding in the capture of cutting‐edge trends within the discipline. 13 VOSviewer is a software for constructing and visualising bibliometric network. 14 It utilises a data standardisation methodology rooted in set theory and provides three distinct visualisation modes: network view, overlay view and density view. The tool boasts advantages in generating aesthetically pleasing images that are easy to interpret. 15 In this study, we will synergistically employ these two tools to systematically and comprehensively illustrate the progression of scar laser therapy.
3. RESULTS
3.1. Country analysis
In order to find out which countries have made outstanding contributions in the field of scar laser therapy, and to analyse the academic exchanges and cooperation within countries, ‘Country’ was selected as the analysis object in CiteSpace in this study. Time Slicing was set to 2000–2023 and Years Per Slice was set to 1. Finally, a national analysis map with 58 network nodes and 193 connections was obtained, with a density of 0.1168. Researchers from 58 countries published a total of 884 papers with 193 partners, with only the top 20 countries shown in Figure 2A. Table 1 lists the top 20 countries in this field. The frequency represents the number of country's publication, and the centrality represents the importance of the country's position in this field. It can be seen from Figure 2A that the more connected a country is, the higher the centrality of the country, the richer the research and the greater the authority in the research field. It can be seen from Table 1 that the number of articles published by United States has reached 287, and the intermediary centrality ranks first, indicating that the United States is in a leading position in this field of research, laying the foundation for this field, and has been a stable and continuous academic producer. China ranks second in the number of publications, but the intermediary centrality is only 0.08, indicating that China's international exchange and cooperation in this field is still lacking. South Korea ranks third in the number of publications, but has a low degree of intermediary centrality and almost no international cooperation. Germany has been studying this area since 2001. Although Germany ranks fourth in the number of publications, it ranks second in terms of intermediary centrality and has good exchanges and cooperation with other international institutions. The distribution of papers is relatively uniform among countries, as shown in Figure 2B.
FIGURE 2.
(A) Cooperation network of countries. (B) Analysis of geographical distribution of countries.
TABLE 1.
The centrality and count of literature in countries.
| Rank | Country/region | Publications | Centrality | Starting year |
|---|---|---|---|---|
| 1 | United States | 287 | 0.52 | 2000 |
| 2 | People's Republic of China | 135 | 0.08 | 2004 |
| 3 | South Korea | 104 | 0 | 2000 |
| 4 | Germany | 54 | 0.21 | 2001 |
| 5 | Italy | 44 | 0.17 | 2003 |
| 6 | Egypt | 41 | 0.11 | 2009 |
| 7 | Japan | 28 | 0.01 | 2001 |
| 8 | Brazil | 28 | 0.19 | 2000 |
| 9 | England | 27 | 0.16 | 2000 |
| 10 | India | 25 | 0.06 | 2000 |
| 11 | Thailand | 24 | 0 | 2000 |
| 12 | Turkey | 22 | 0 | 2000 |
| 13 | Taiwan | 19 | 0 | 2003 |
| 14 | Iran | 18 | 0 | 2008 |
| 15 | Israel | 17 | 0.04 | 2004 |
| 16 | Australia | 15 | 0.01 | 2001 |
| 17 | France | 14 | 0 | 2000 |
| 18 | Canada | 14 | 0 | 2001 |
| 19 | Denmark | 13 | 0 | 2009 |
| 20 | Switzerland | 10 | 0.03 | 2007 |
3.2. Institutional analysis
Using the ‘Institution’ in CiteSpace as the analysis object, 515 network nodes and 457 connections with a density of 0.0035 were obtained (Figure 3). A total of 844 articles were published by 515 organisations and 457 partners. According to the size and centrality of the nodes in Table 2, it can be observed that the most prominent institution in the field of scar laser therapy is Harvard University, which has published 17 papers and has the highest centrality. However, the publication of their articles was mainly concentrated in 2009–2014, indicating that the institution has played a foundation role in the field of scar laser therapy. Cairo University has the second largest number of publications and has maintained a high level of research in this field since 2015, but the centrality is 0, which indicates that although Cairo University has a high frequency of publications, it has less cooperation with other institutions. The overall observation of the institutional analysis shows that there is not much inter‐agency cooperation, and some cooperation has obvious regional characteristics. Therefore, it is necessary to strengthen cross‐agency research and cooperation to promote the progress of laser research.
FIGURE 3.
Institutional cooperation analysis.
TABLE 2.
The top 10 institutions with the largest number of publications.
| Rank | Institution | Publications | Centrality | Starting year |
|---|---|---|---|---|
| 1 | Harvard University | 17 | 0.07 | 2000 |
| 2 | Cairo University | 16 | 0 | 2011 |
| 3 | Shanghai Jiao Tong University | 15 | 0.02 | 2010 |
| 4 | Massachusetts Gen Hospital | 11 | 0.04 | 2000 |
| 5 | Yonsei University | 11 | 0 | 2009 |
| 6 | Fudan University | 9 | 0.02 | 2009 |
| 7 | Hallym University | 9 | 0 | 2012 |
| 8 | University of Miami | 9 | 0.01 | 2003 |
| 9 | Chinese Academy of Medical Sciences & Peking Union Medical College | 9 | 0 | 2019 |
| 10 | DermSurgery Associates | 8 | 0.03 | 2002 |
3.3. Author enterprise analysis
Using ‘Author’ in CiteSpace as the analysis object, an institutional analysis map with 653 network nodes, 610 connections and a density of 0.0029 was obtained (Figure 4). A total of 844 articles were published by 653 authors, with 610 collaborations. As can be seen from Figure 4, the three largest nodes of authors are Shumaker, Asawanonda and Anderson, indicating that they are the three most important authors in the field. Shumaker's research in this field focused on 2012–2015, and Shumaker has a close relationship with Anderson and Uebelhoer, with many cooperation and exchanges. Asawanonda has focused on the field of scar laser therapy since 2018 and has published seven articles in 2018–2023, ranking second, but with less cooperation with others.
FIGURE 4.
Analysis diagram of author collaboration network.
3.4. Journal analysis
After counting publications and journal citations through VOSviwer (Figure 5), we found the most authoritative core journals in this field. By observing the node size in Figure 5, we can intuitively see the journals that publish the most articles in this field. Table 3 lists the top 10 journals in the field of scar laser therapy and their citation value. From the comparison of journal publications, citations or impact factors, the core journal of scar laser therapy is Laser in Surgery and Medicine, followed by Dermatologic Surgery. Laser in Surgery and Medicine is a collection of basic and clinical research on laser in medicine. Dermatologic Surgery focuses on skin surgery, and the published articles are biased towards clinical field.
FIGURE 5.
Analysis of journal publications.
TABLE 3.
The number of publications and citations of journals.
| Rank | Journals | Publications | Number of citations |
|---|---|---|---|
| 1 | Lasers in Surgery and Medicine | 102 | 3000 |
| 2 | Dermatologic Surgery | 94 | 3717 |
| 3 | Journal of Cosmetic and Laser Therapy | 53 | 600 |
| 4 | Journal of Cosmetic Dermatology | 46 | 434 |
| 5 | Lasers in Medical Science | 40 | 612 |
| 6 | Journal of Drugs in Dermatology | 36 | 460 |
| 7 | Plastic and Reconstructive Surgery | 24 | 748 |
| 8 | Aesthetic Plastic Surgery | 21 | 284 |
| 9 | Burns | 14 | 527 |
| 10 | Dermatologic Therapy | 14 | 137 |
3.5. Keyword clustering, frontier and trend analysis
3.5.1. Keyword clustering analysis
This article used CiteSpace to cluster keywords. First, cluster option was selected, and pathfinder algorithm was used to cut off the link to ensure the rationality of clustering classification. The results are shown in Figure 6, reflecting the research topics of scar laser therapy since the 21st century. The cluster number is the theme obtained using LLR algorithm to cluster keywords. A total of eight clusters are obtained, and the information of each cluster is shown in the table. It can be seen from Figure 6 that a total of eight research topics were generated in this study, namely, (0) combination therapy; (1) wound healing; (2) fractional photothermolysis; (3) laser treatment; (4 risk); (5) lasers; (6) experience; (7) scar formation. Different clusters cover different keywords. Clusters 3, 5 and 6 mainly describe the clinical application of lasers for scars. Clusters 1 and 7 mainly study the effects of laser therapy on the wound healing process and scar formation. Cluster 0 means the combined applications of laser and other treatments. Cluster 2 describes the mechanism of laser therapy and cluster 4 is about the risk and safety of laser.
FIGURE 6.
Keywords clustering analysis.
3.5.2. Research frontier analysis
In this study, the Bursts detection algorithm of CiteSpace was used to obtain the keyword hotspot evolution map in the field of scar laser therapy on Web of Science, namely, keyword burst. This study generated a total of the top 30 keywords in the field of scar laser therapy. The specific burst intensity and hot spot duration are shown in Figure 7. The time period when an outbreak occurred in the topic category is shown as a red line segment, indicating the start year and end year of the outbreak duration. It can be seen from Figure 7 that the hotspot duration of scar laser therapy is from 2000 to 2023. The research frontiers in the field of laser and scars are ‘acne scar’, ‘fractional co2 laser’, ‘expression’, ‘photodynamic therapy’, ‘efficacy’, ‘facial acne’, ‘picosecond laser’, ‘traumatic scar’, ‘wound healing’, ‘Alexandrite laser’, ‘fractional laser’, ‘surgery’ and ‘management’. The keywords in the field of scar laser therapy were not evenly distributed throughout the time. Nearly half of the keywords have lasted until now, and they all began to break out after 2015. It shows that the research field of scar laser therapy has received more attention from scholars in recent years, and the research is also constantly enriched. During the 13 years from 2000 to 2013, the research hotspots in this stage mainly focused on the exploration of laser types and devices for laser applications on scars. The keywords included ‘complication’, ‘skin’, ‘dermabrasion’, ‘nd yag laser’, ‘1450 nm diode laser’ and ‘carbon dioxide’. A preliminary study and exploration of the mechanisms of scar laser therapy have been carried out. The relevant keywords are ‘fractional photothermolysis’ and ‘photothermolysis’. With the passing of time, 2014 as a time node, new topics and hot spots began to appear, the in‐depth mechanism of scar laser therapy has been researched. In addition, it has gradually begun to pay attention to the medical management of scar laser therapy, which can be seen from the emergence of keywords such as ‘efficacy’, ‘laser therapy’ and ‘management’.
FIGURE 7.
Top 30 keywords with the strongest citation bursts.
3.5.3. Research trends analysis
In this study, ‘Timezone’ was selected as the analysis node through CiteSpace to generate the keyword Timezone map of the field, that is, the change of keywords over time. The specific indicators and thresholds were set as follows: ‘Time slice’ was set to 1, and the keywords with smaller nodes were hidden to generate the current map, as shown in Figure 8. It can be seen from the Timezone diagram that the research studies in the field of scar laser therapy have undergone an obvious and clear process of change. First of all, from the keywords ‘skin’, ‘therapy’, ‘hypertrophic scar’, ‘carbon dioxide laser’, ‘pulsed dye laser’, etc., it can be seen that in the early 21st century, research has mainly focused on the clinical related issues of scar laser therapy. Around 2010, the study began to pay attention to the side effects of laser therapy, such as ‘risk’, ‘safety’ and other keywords. During this time, research studies on medical management and treatment schemes optimisation in the field of scar laser therapy have also become popular, which can be seen from the keywords ‘management’, ‘efficacy’ and ‘experience’. In addition, the study of lasers combined with other drugs in the treatment of scars has also began, which can be proved by ‘combination’, ‘5 fluorouracil’ after 2005. From the perspective of the facial region of laser action, it can be seen that the field has undergone a process from the integral region to the precise local effect, which can be proved by the conversion from the initial ‘dermabrasion’ to the later keywords ‘fractional photothermolysis’, ‘reflective lens array’.
FIGURE 8.
The Timezone chart of keywords in region of laser treatment for scars.
In the first decade, the keywords about the mechanism were ‘photothermolysis’, ‘collagen’, ‘dermabrasion’, ‘expression’, etc., and in the past 5 years, the research on the mechanism has progressively deepened, and the focus has shifted to investigating the laser's impact on the scar formation process and wound healing. This shift suggests the need for prompt laser intervention earlier, as indicated by keywords such as ‘scar formation’, ‘keloid formation’, ‘Nanoparticles’ and ‘cutaneous fibrosis’. However, concerning the Timezone map analysis, it becomes evident that the fundamental mechanisms of scar laser therapy remain somewhat underexplored, leaving substantial room for further development.
3.6. Literature co‐citation analysis
The co‐citation analysis divided the literature in the field of lasers and scars into 11 clusters (Figure 9), namely (0) fractionated lasers, (1) photothermolysis, (2) hypertrophic scar, (3) adverse effect, (4) aesthetic medicine, (5) picosecond lasers, (6) ablative lasers, (7) non‐ablative lasers, (8) safety, (9) laser assisted drug delivery, and (10) scar prevention. Among them, clusters 0, 5, 6 and 7 belong to the common laser types in the field of scar laser therapy. 3 and 8 are the clustering of safety and risk studies in the field. Clusters 2, 4, 9 and 10 are the specific uses of laser on skin. Cluster 1 is the mechanism of scar laser therapy. Articles with intermediary centrality greater than 0.1 have purple outer circles in the figure. The greater the centrality of the intermediary, the more times the article appears with other articles; the greater the role of bridging the article in different themes and directions, the higher the status of the article, and the greater the significance. There are 10 articles with intermediary centrality greater than 0.1 in this topic. The main content is clinical trials or guidelines for various types of scar laser therapy. The clinical effects of exfoliative and non‐exfoliative laser treatments on various types of scars were compared. The top two articles of centrality were Treatment of atrophic facial acne scars with a dual‐mode Er: YAG laser, and Skin responses to fractional photothermolysis, with centrality of 0.24 and 0.13, respectively. These articles linked histological and clinical responses. The most commonly studied laser types in the 10 articles are CO2 laser, Er laser, YAG laser and lattice laser.
FIGURE 9.
Analysis of literature co‐citation clustering.
4. DISCUSSION
This study conducted a comprehensive scientometric study on the literature in the field of scar laser therapy. In addition to analysing and discussing the results of this study, a critical review was also conducted to gain a deeper understanding of the topic of the study. It is worth noting that since the 21st century, a total of 884 journal articles related to this field have been published. The number of articles has steadily increased, but the number of articles published in the past 3 years has shown a downward trend, as shown in Figure 10. Particularly, even though half of this year has already passed, the predicted number of publications for this year may be the lowest in the last 5 years, suggesting that there may be less focus on scar laser therapy. However, this reduction in publications does not necessarily imply that the research field has matured. On the contrary, scar laser therapy encompasses complex and diverse clinical applications. This complexity is reflected in the variety of laser choices, the diversity of scars, the changes in patients' conditions, the timing and cycle of treatments and the adjustments to laser instrument parameters. In addition, within the realm of basic scientific research, an effective research system has not yet been established. Therefore, research efforts in this field still cannot afford to be lax, and scholars need to invest sufficient energy to foster the maturation of the field and ensure the safety of clinical applications.
FIGURE 10.
Articles publishing trend in the field of laser treatment on scars.
In general, despite the growing research on scar laser therapy, cooperation among research institutions appears to be relatively loose, with Asian countries placing limited emphasis on communication and collaboration. The exploration of the mechanism of scar laser therapy has not yet culminated in a fully developed molecular biology theory, and the field lacks well‐established authoritative treatment guidelines. Therefore, it is imperative to conduct further research and continuous observation in this domain to ascertain whether research institutions and scholars in different countries will achieve deeper insights and make more cutting‐edge contributions to these topics. The present research indicates that although promising strides have been taken in this field, challenges persist.
In this study, the results exhibited at least two limitations. First and foremost, due to the relatively limited volume of literature available in this field, the outcomes of the bibliometric analysis are constrained and may not be able to portray a comprehensive picture of all facets of the research domain. Additionally, owing to software design constraints, representing the newly published high‐level literature in visualised analysis results poses challenges in comparison with older studies. Moving forward, we are committed to addressing these limitations to enhance the accuracy of trend prediction.
5. CONCLUSIONS
In this paper, CiteSpace and VOSviewer were employed to visualise the distribution of countries, institutions, journals and authors engaged in scar laser therapy research over the last two decades. The primary countries, institutions, journals and authors contributing to the global discourse on this subject in recent years were systematically reviewed. The study conducted keyword clustering and critically evaluated pivotal topics to consolidate the advancements made in the field. Additionally, the article analysed emerging research frontiers and trends, and assesses the current status of their application in clinical treatments and fundamental research. Collectively, the trajectory of this field highlights a growing trend of interdisciplinary convergence, encompassing clinical medicine, medical cosmetology, applied physics, optics and other fields. Notably, this article introduces novel perspectives for future research and development in the domain of scar laser therapy.
FUNDING INFORMATION
The study was supported by the Xiaohe Sci‐Tech Talents Special Funding under Hunan Provincial Sci‐Tech Talents Sponsorship Program (No. 2023TJ‐X07).
CONFLICT OF INTEREST STATEMENT
The authors declare no potential conflict of interest.
ACKNOWLEDGEMENTS
The present study was supported by the Project of Science and Technology of Hunan Province (No. 2021JJ40932), the Changsha Municipal Natural Science Foundation (No. kq2007038).
Zuo Y, Deng K, Tang F, et al. A bibliometric study: Relevant studies on scar laser therapy since the 21st century. Int Wound J. 2024;21(1):e14410. doi: 10.1111/iwj.14410
Yiwei Zuo and Kexin Deng contributed equally to this work.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available in the supplementary material of this article.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available in the supplementary material of this article.