Cochrane · systematic review · CD011642
Laser therapy for treating hypertrophic and keloid scars
Leszczynski, R, da Silva, CAP, Pinto, ACPereira Nunes, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
WoundsAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
49
current version
GRADE rated
49
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 48 · 98%Low 1 · 2%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Laser therapy compared with no treatment for treating hypertrophic and keloid scars
Population: patients with hypertrophic and keloid scars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Scar severity ‐ 585‐nm Pulsed‐Dye Laser (PDL) versus no treatment ‐ patient self‐assessment of scar improvement of 50% or higher ‐ hypertrophic and keloid scars ‐ Laser therapy vs no treatment | RR 1.96 [1.11, 3.45] | NR | Low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus no treatment ‐ mild to moderate discomfort or pain related to treatment ‐ hypertrophic and keloid scars ‐ Laser therapy vs no treatment | OR 8.62 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus no treatment ‐ purpura ‐ hypertrophic and keloid scars ‐ Laser therapy vs no treatment | RR 21.32 | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ Non‐Ablative Fractional Laser (NAFL) versus no treatment ‐ health professional global assessment measured on a visual analogue scale (VAS) ranging from 0 to 100 mm (0 = as normal skin and 100 = worst possible scar) ‐ hypertrophic s... Laser therapy vs no treatment | RR 2 [0.85, 4.69] | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ NAFL versus no treatment ‐ patient global assessment measured on a VAS ranging from 0 to 100 mm (0 = as normal skin and 100 = worst possible scar) ‐ hypertrophic scars ‐ Laser therapy vs no treatment | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ NAFL versus no treatment ‐ Patient and Observer Scar Assessment Scale (POSAS) (higher scores = worse scar appearance) ‐ hypertrophic scars ‐ Laser therapy vs no treatment | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ NAFL versus no treatment ‐ scar worsening ‐ hypertrophic scars ‐ Laser therapy vs no treatment | RR 7 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ NAFL versus no treatment ‐ hyperpigmentation ‐ hypertrophic scars ‐ Laser therapy vs no treatment | RR 3 | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ Fractional Carbon Dioxide (CO2) Laser versus no treatment ‐ Vancouver Burn Scar (VBS) scale (higher scores = worse scar appearance) ‐ hypertrophic scars ‐ Laser therapy vs no treatment | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ Fractional CO2 Laser versus no treatment ‐ VBS (higher scores = worse scar appearance) ‐ keloid scars ‐ Laser therapy vs no treatment | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ Fractional CO2 Laser versus no treatment ‐ POSAS scale (higher scores = worse scar appearance) ‐ hypertrophic scars ‐ Laser therapy vs no treatment | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Laser therapy compared with other treatments for treating hypertrophic and keloid scars
Population: participants with hypertrophic and keloid scars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Scar severity ‐ 585‐nm Pulsed‐Dye Laser (PDL) versus Triamcinolone acetonide (TAC) ‐ Vancouver Burn Scar (VBS) (Higher score = worse scar appearance) ‐ hypertrophic scars ‐ Laser therapy vs other treatments | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ 585‐nm PDL versus TAC ‐ patient self‐assessment of scar improvement of 50% or higher, or patients considering the scar better or much better ‐ hypertrophic and keloid scars ‐ Laser therapy vs other treatments | OR 0.81 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus TAC: sequelae ‐ hypertrophic and keloid scars ‐ Laser therapy vs other treatments | RR 0.09 [0.01, 1.45] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus TAC ‐ mild to moderate pain related to treatment ‐ hypertrophic and keloid scars ‐ Laser therapy vs other treatments | RR 0.9 | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ 585‐nm PDL versus 5‐FU ‐ patient self‐assessment of scar improvement of 50% or higher ‐ hypertrophic and keloid scars ‐ Laser therapy vs other treatments | OR 0.81 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus 5‐FU ‐ mild to moderate pain related to treatment ‐ hypertrophic and keloid scars ‐ Laser therapy vs other treatments | RR 0.9 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus 5‐FU ‐ purpura ‐ hypertrophic and keloid scars ‐ Laser therapy vs other treatments | RR 4.2 | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ 585‐nm PDL versus TAC plus 5‐FU ‐ patient self‐assessment of scar improvement of 50% or higher ‐ hypertrophic and keloid scars ‐ Laser therapy vs other treatments | RR 0.89 [0.61, 1.29] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus TAC plus 5‐FU ‐ mild to moderate pain related to treatment ‐ hypertrophic and keloid scars ‐ Laser therapy vs other treatments | RR 0.9 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus TAC plus 5‐FU ‐ purpura ‐ hypertrophic and keloid scars ‐ Laser therapy vs other treatments | RR 3 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus silicone gel sheeting ‐ pain during laser treatments ‐ hypertrophic scars ‐ Laser therapy vs other treatments | RR 3 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ 585‐nm PDL versus silicone gel sheeting ‐ skin irritation ‐ hypertrophic scars ‐ Laser therapy vs other treatments | RR 0.33 | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ erbium laser versus TAC ‐ VBS (Higher scores = worse scar appearance) ‐ hypertrophic scars ‐ Laser therapy vs other treatments | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ erbium laser versus TAC ‐ patient self‐assessment ‐ patients considering the scar much better ‐ hypertrophic scars ‐ Laser therapy vs other treatments | RR 2.17 [1.28, 3.66] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ fractional carbon dioxide (CO2) laser versus TAC ‐ pain at injection site ‐ keloid scars ‐ Laser therapy vs other treatments | RR 0.25 [0.06, 1.03] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ fractional CO2 laser versus TAC ‐ telangectasia ‐ keloid scars ‐ Laser therapy vs other treatments | RR 0.2 [0.01, 3.92] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ fractional CO2 laser versus TAC ‐ skin atrophy ‐ keloid scars ‐ Laser therapy vs other treatments | RR 0.33 [0.01, 7.72] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ fractional CO2 laser versus TAC ‐ charring ‐ keloid scars ‐ Laser therapy vs other treatments | RR 7 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ fractional CO2 laser versus verapamil ‐ pain at injection site ‐ keloid scars ‐ Laser therapy vs other treatments | RR 5 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects ‐ fractional CO2 laser versus verapamil ‐ charring ‐ keloid scars ‐ Laser therapy vs other treatments | RR 7 | NR | Very low Downgraded: risk of bias, imprecision |
Laser therapy plus other treatment compared with other treatment for treating hypertrophic and keloid scars
Population: participants with hypertrophic and keloid scars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Scar severity ‐ 585‐nm pulsed‐dye laser (PDL) plus triamcinolone acetonide (TAC) plus 5‐Fluorouracil (5‐FU) versus TAC plus 5‐FU ‐ blinded observer assessment of good to excellent scar improvement ‐ hypertrophic and keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 1.75 [0.95, 3.22] | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ 585‐nm PDL plus TAC plus 5 FU versus TAC plus 5‐FU ‐ patient self‐assessment of good to excellent scar improvement ‐ hypertrophic and keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 1.36 [0.85, 2.18] | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ carbon dioxide (CO2) laser plus TAC versus cryosurgery plus TAC. Mean percentage reduction ‐ blinded observer assessment ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ CO2 laser plus TAC versus cryosurgery plus TAC Mean percentage reduction ‐ patient self‐assessment score (higher scores = worse scar appearance) ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects: CO2 laser plus TAC versus cryosurgery plus TAC ‐ atrophy ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 1.13 [0.7, 1.82] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects ‐ CO2 laser plus TAC versus cryosurgery plus TAC ‐ erythema ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 1.5 [0.47, 4.78] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects ‐ CO2 laser plus TAC versus cryosurgery plus TAC ‐ telangiectasia ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 0.33 [0.07, 1.52] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects ‐ CO2 laser plus TAC versus cryosurgery plus TAC ‐ hypopigmentation ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 0.6 [0.16, 2.29] | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ Neodymium‐doped yttrium aluminium garnet (Nd:YAG) laser plus Diprospan plus 5‐FU versus Diprospan plus 5‐FU ‐ blinded observer assessment of good to excellent scar improvement ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 1.45 [0.88, 2.41] | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity: Nd:YAG laser plus Diprospan plus 5‐FU versus Diprospan plus 5‐FU ‐ patient self‐assessment of scar improvement of 50% or higher ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 1.38 [0.91, 2.1] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence and severity of treatment‐related adverse effects: Nd:YAG laser plus Diprospan plus 5‐FU versus Diprospan plus 5‐FU ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | 7 | NR | Very low Downgraded: risk of bias, imprecision |
Scar severity ‐ Helium‐Neon (He‐Ne) laser plus decamethyltetrasiloxane, polydimethylsiloxane and cyclopentasiloxane cream versus decamethyltetrasiloxane, polydimethylsiloxane and cyclopentasiloxane cream ‐ Vancouver Scar scale (VSS) (higher scores... Laser therapy plus other treatment vs other treatment | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects ‐ 595‐nm PDL plus verapamil versus verapamil ‐ regrowth ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 1.5 [0.27, 8.22] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects ‐ 595‐nm PDL plus verapamil versus verapamil ‐ pain related to treatment ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 3 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects ‐ 595‐nm PDL plus verapamil versus verapamil ‐ hyperpigmentation ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 5 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects ‐ 595‐nm PDL plus verapamil versus verapamil ‐ depigmentation ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 1 [0.07, 15.12] | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects ‐ 595‐nm PDL plus verapamil versus verapamil ‐ purpura ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 15 | NR | Very low Downgraded: risk of bias, imprecision |
Incidence of treatment‐related adverse effects ‐ 595‐nm PDL plus verapamil versus verapamil ‐ total ‐ keloid scars ‐ Laser therapy plus other treatment vs other treatment | RR 4.67 [1.53, 14.26] | NR | Very low Downgraded: risk of bias, imprecision |