SUMMARY
Multi-center study performed by four private dermatological services (Skin Center, L’Aquila, Avezzano, Pescara and Catania, Italy) aimed to test the effectiveness of a combined protocol of CO2 laser + Dye laser + Blue LED Light Photobiomodulation (EmoLED) in the treatment of keloids.
An excessive proliferation of fibroblasts and collagen synthesis after an injury may lead to a benign fibrous tumor, known as keloid, which does not regress spontaneously and can be disfiguring. Earlobes are a very frequent site of onset, since after a trauma (i.e., piercing) keloids may develop either on the helix and on the anterior or posterior lobe, from a few months up to several years after the injury. Keloids have a high tendency to recur following surgical excision (45% up to 100%), thus leading to the need of new treatments. Among the past decades, many treatments have been proposed to approach keloids, with different degrees of reported success and different percentages of recurrences but a gold standard treatment for keloids is yet to be discovered. In recent years interesting results have been achieved with the combination of different types of lasers, by considering their different therapeutic target. The Authors report a remarkable outcome of a combined treatment for earlobe keloids where the combination of CO2 and Dye Laser led to a 14.6% of keloids recurrence. The combined treatment was performed in the same session: CO2 laser for removing keloids, Dye laser to reduce the vascularization. By considering its therapeutic mechanism, EmoLED was added as a third step, in the aim to improve wound healing after the lasers injury and to inhibit recurrences. EmoLED treatment was performed for procedure for 3 up to 6 min (depending on the size of the lesion) after CO2 laser and Dye laser. If the lesion was greater than 2,5 cm in-diameter, an adjunctive Pulsed Dye Laser session has been performed 40 days earlier with the aim to lead the lesion to become smaller, softer, and less vascularized. In all cases, patients applied a pressure earring for two weeks after combined treatment. A monthly follow-up has been performed for a period between 6 months and 2 years. In case of signs of inflammation adjunctive EmoLED sessions have been performed with the aim to prevent any recurrences. In selected cases, when dermoscopy had highlighted any sign of neo-angiogenesis, a further pulsed Dye laser session have been required.
52 patients with earlobe keloids were enrolled, 36 males (11-78 years, mean 38,6 years) and 16 females (17-77 years, mean 40,5 years) with a total count of 56 keloids, classified according the modified Chang- Park classification as follows: 16 (28.6%) type I (pedunculated), 21 (37.5%) type II (sessile with single nodular pattern, 4 (7.1%), type III (sessile with multi nodular pattern, 3 (5.4%) type VI (buried), 12 (21.4%) type V (mixed). Of the 56 total lesions, 50 lesions (89.3%) did not recur at all (46 lesions followed up for 36 months, 2 lesions with a follow up to 18 months, 2 lesions with a 12-month follow up), whilst a total of 6 keloids (10.7%) recurred.
In Authors’ experience, the three-steps combined protocol CO2 laser + Dye laser + Blue LED Light (EmoLED) led to only a 10.7% of keloid recurrence, which is to be considered a significant result in this field.
