Publication:

Combined short-pulsed Nd:YAG laser therapy with intralesional triamcinolone injection for hypertrophic scar and keloid treatment

Background Hypertrophic scars and keloids are difficult to treat and are associated with pain, pruritus, functional impairment, and cosmetic burden. This study evaluated the effectiveness of combining short-pulsed 1064 nm Nd:YAG laser therapy with intralesional triamcinolone injection compared with conventional treatment approaches.

Methods Between October 2016 and March 2021, 52 patients with hypertrophic scars or keloids were treated at Hautärzte Köln Mülheim, Buchheimer Str. 53-55, 51063 Cologne, Germany, a private dermatology practice specializing in dermatology and laser medicine. Patients were classified into three treatment cohorts according to the treatment received: triamcinolone acetonide (TAC) monotherapy (n=13), TAC plus 5-fluorouracil (5-FU) (n=13), and combination therapy with short-pulsed 1064 nm Nd:YAG laser plus intralesional TAC in the same session (n=26). Laser treatment was performed in Genesis mode using a pulse duration of 0.33 ms, fluence of 4.4 J/cm², and repetition rate of 6 to 8 Hz. Spot size from 4 to 8 mm was adjusted according to scar thickness. Outcomes were assessed using the patient and observer scar assessment scale (POSAS) at baseline and at 3 and 12 months after treatment.

Results The combination group required fewer treatment sessions than the TAC+ 5-FU group and the TAC monotherapy group (mean 7.2 versus 10.6 and 12.2 sessions, respectively). At 12 months, the combination group showed significantly better POSAS scores than TAC monotherapy on both the patient scale (20.65 versus 30.08, p=0.006) and observer scale (17.81 versus 28.15, p=0.001). No dropouts or serious adverse events occurred.

Conclusions Short-pulsed 1064 nm Nd:YAG laser combined with intralesional triamcinolone is an effective, safe, and time-efficient treatment for hypertrophic scars and keloids, with superior outcomes compared with steroid monotherapy.