The effectiveness of fractional laser-assisted photodynamic therapy utilizing methylene blue for the treatment of keloids

Abstract

Keloids represent a therapeutic challenge due to lack of satisfactory treatment and high rate of recurrence. Various treatment modalities exist, including intralesional steroids, photodynamic therapy (PDT), lasers and different combinations have been used to reach better results. This study assessed the efficacy and safety of fractional carbon dioxide-assisted delivery of Methylene blue in treatment of keloids to provide an additional treatment option for keloids. A total of 20 previously-untreated keloids have been treated with 3 monthly sessions of fractional carbon dioxide (CO₂) laser and methylene blue PDT using intense pulsed light (IPL). In the first session debulking of the keloid’s height by at least 50% with ablative CO2 was performed. Patients were photographed and assessed before treatment and 2 months after the last session, clinically using patient and observer scar assessment scale (POSAS), histopathologically by H&E and Masson trichrome. The follow up showed significant reduction in total POSAS scores. Histopathologically, collagen improved from 3.45 ± 1.05to 2.65 ± 0.875. Side effects were tolerable & included pain, burning sensation, erythema, desquamation, slight edema, slight exudation, and hyperpigmentation. Clinical and histopathological improvements were seen after methylene blue-PDT, and it could be a potential treatment option for keloids. However, further controlled studies are needed to compare its effectiveness with other established modalities along with determination of ideal parameters of IPL & fractional CO2.