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

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.