Fractional co2 laser with Bleomycin Versus Fractional co2 Laser with Triamcinolone acetonide in the treatment of Hypertrophic scar and Keloid
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Keywords
Hypertrophic scars; keloids; fractional co2 laser; bleomycin; triamcinolone
Abstract
Background: Due to deformity, discomfort, and pruritis, hypertrophic scars and keloids are dermal fibroproliferative illnesses that cause patients to feel misery and have a worse quality of life. They continue to be difficult to manage since there is no approved therapy. Scarring is reduced by fractional co2 laser without any negative side effects. The treatment of hypertrophic scars and keloids continues to rely heavily on corticosteroids, most often triamcinolone. An anti-cancer drug having an antifibrotic action is
bleomycin.
Objective: Comparison between the effectiveness and safety of the combinations of fractional co2 with bleomycin versus fractional co2 with triamcinolone in keloids and hypertrophic scar.
Methods: Forty patients were included and split into: group A that included fractional co2 laser with topical bleomycin and group B included fractional co2 laser with topical triamcinolone for four sessions with 4 weeks apart. Digital photography, the Vancouver scar scale, and dermoscopy were utilized to assess the effectiveness of the therapy before, after, and three months after each session.
Results: With no discernible variation between the two groups, both medicines significantly increased the total Vancouver, vascularity, and pigmentation ratings of hypertrophic scars and keloids. Both drugs improved pliability score but bleomycin showed better improvement. Both drugs improved height score but triamcinolone showed better improvement. The score improvement was significantly higher in hypertrophic scars than keloids in both groups. Hyperpigmentation was reported in bleomycin. Telangiectasia and hypopigmentation were reported in triamcinolone. By dermoscopy, arborizing, linear and comma shaped vessels have been showed significant improvement in both groups.
Conclusion: Bleomycin should be included among the therapeutic options; it deserves better positioning against keloids and hypertrophic scar. This combination technique offered safe and effective treatment of keloids and hypertrophic scar.
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