Comparative Effect of Ablative Fractional CO2 Laser Plus Triamcinolone Acetonide Cream Versus Intralesional Injection of Triamcinolone Acetonide in Keloid and Hypertrophic Scars: A Randomized Clinical Trial

Background: The current study was performed to compare the effects of ablative fractional CO2 laser plus triamcinolone acetonide cream versus intralesional injection of triamcinolone acetonide in the treatment of hypertrophic and keloid scars. Methods: This quasi-experimental study was performed among 33 patients visiting dermatology clinics of two referral teaching hospitals during 2013 - 2014.A lesion of these patients was divided in to two equal parts, one half was injected with triamcinolone acetonide at a dose of 10 - 20 mg/mL, and in the combination treatment, we administered ablative fractional CO2 laser treatment (level: 15, point of shot: 5, PW: 5, pitch: 0.5; Unixel, Korea) with topical triamcinolone acetonide in the other half. The settings of the laser device for each session were set according to the thickness of the scar. Immediately after laser treatment (in the first two seconds) and up to one week later, the triamcinolone acetonide 0.1% cream was applied twice a day. Each patient underwent 3 - 5 treatment sessions of laser treatment at 4-week intervals for one lesion. One hour before each session, the local anesthetic, lidocaine-p gel, was administered around the lesion. Results: The general appearance of the wound was better in the intralesional triamcinolone group (1.53 vs. 2.15, P < 0.0001). Dyschromia showed more improvement in the combination treatment (1.13 vs. 1.47, P < 0.0001), while hypertrophy improved more as a result of intralesional triamcinolone acetonide injection (2.19 vs. 1.52, P < 0.0001). Additionally, combination treatment was more effective on texture (1.61 vs. 2.11, P < 0.0001). The improvement of symptoms scores was 2.73 out of a total of three. Conclusions: It can be concluded that topical corticosteroids plus fractional laser therapy is more effective than intralesional injection of corticosteroids for the amelioration of dyschromia and texture of hypertrophic and keloid scars. However, general appearance and hypertrophy showed a better response to intralesional injection of triamcinolone. Accordingly, in non-homogenous lesions with dyschromia, the use of local corticosteroids plus fractional laser is recommended.