Initial Scar Evaluation
What type of scar is it?
It's important to determine the type of scar present before coming up with a treatment plan. The type of scar dictates the type of laser used for treatment. Correct diagnosis of the type of scar also plays a role in determining the number of laser treatments required and the expected response that the scar will have toward the treatment.
When did the scar appear?
The age of a scar is also important in determining the course of treatment. Older scars are often less erythematous. Younger scars that are less than a year old may not require laser intervention if the scar is only erythematous without showing signs of other scar types. If the scar is hypertrophic in its younger stages, better clinical outcomes have been demonstrated with treatment early on.
Has the scar been treated before?
Scars that have been treated before may tend to be more fibrotic, especially if the treatment involved cryotherapy, surgical excision, or electrocautery. Excess fibrous tissues can make scars that have been treated before more difficult to treat effectively the second time around. Several treatments may be required when dealing with a scar that has been treated before using a different protocol.
Prior silicone and corticosteroid treatments don't tend to create problems for subsequent laser treatments. Typically the tissues that have been treated with silicone and corticosteroids respond similarly to laser therapy as tissues that have not.
What other symptoms are associated with the Scar?
Some scars cause problems like itchiness or burning that necessitates the use of oral antihistamines. These symptoms may become worse as the scar ages.
Is the patient prone to developing keloid scars?
Patients that show a propensity for developing keloid scars are not good candidates for cutaneous laser resurfacing. Cutaneous laser resurfacing can actually cause the development of more keloid scars in patients prone to developing this type of scar tissue. Rather a 585-nm pulsed dye laser is a better choice, permitting treatment that will not cause the keloid scar to worsen.
What type of skin does the patient have?
Patients who have darker skin have more melanin which can cause problems with a 585-nm laser. A CO2 laser can cause pigment loss during the process of deepithelialization. Though pigmentation often returns to normal, patients should be aware of the possibility of hyperpigmentation that can occur when the skin becomes repigmented.
Has isotretinoin been used to treat the scar?
Isotretinoin has reportedly caused hypertrophic scarring among patients who have undergone dermabrasion. Thus, most experts believe it is prudent to wait 6 to 12 months after using isotretinoin before doing a laser resurfacing treatment. Isotretinoin has been shown to effect the metabolism of collagen and thus the healing of wounds, which is why it probably tends to have a negative impact on the skin in these situations.
What are the treatment expectations of the patient?
Patients who expect for their scar to look exactly like the surrounding, normal skin following treatment are likely to be disappointed even if there are some very noticeable aesthetic improvements. Scars are typically not "erased", but rather their appearance can be significantly "improved". Most patients can expect to see about 50% improvement in the appearance of their scar or in the symptoms associated with the scar.