1992 Volume 4 Issue 4 Pages 155-168
Keloids and hypertrophic scars are often encountered in the course of clinical practice in dermatology or plastic and reconstructive surgery clinics. There is however no precise definition of the hypertrophic scar or the keloid, thus there is no fixed established treatment methodology. The two growth-promotion factors in these lesions are physical, such as excessive motion in the tissue or stagnation of the vascular flow and pressure from the actual tissue growth itself, and chemical, from inflammatory response mediators and hormonal influence. As LLLT has been shown clinically and in scientific studies to have a regulatory effect on all of the above factors, a good therapeutic effect was anticipated from low reactive-level laser therapy applied to keloids and hypertrophic scars. Both the defocused Nd:YAG (1064 nm, 4 W, c/w, noncontact method) and the GaAlAs diode laser (830 nm, 60 mW c/w, contact and noncontact) have been used, with or without other laser or conventional surgery and conservative treatment modalities, with consistently good results, The psychological factors affecting patients are also taken into account. The ability to combine treatment of the physical aspects of such lesions using any or all of the available modalities, with an understanding and treatment of the psychological aspects, on an individualized basis, is essential to achieving consistently good results. This approach is referred to by Ohshiro as the Total Treatment Concept, Although recognizing the need for more detailed histochemical and histological studies, the authors suggest that LLLT offers a noninvasive and well-tolerated single or adjunctive therapeutic method for hypertrophic scars and true keloids.
