Redefining scar quality: A synergistic approach with micro-needling and photodynamic therapy using methylene blue as a photosensitizer: a randomized clinical trial

IF 2.6 3区医学 Q2 ONCOLOGY

Photodiagnosis and Photodynamic Therapy Pub Date : 2025-08-28 DOI:10.1016/j.pdpdt.2025.104787

Mahshid Sabetghadam , Behzad Imani , Amir Derakhshan Far , Fatemeh Shahbazi , Zahra Farahani Nik

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引用次数: 0

Abstract

Background

Hypertrophic and keloid scars are challenging to treat and can cause both aesthetic and functional problems. Traditional treatments such as laser therapy and corticosteroids have limited effectiveness and high recurrence rates. However, the emergence of photodynamic therapy (PDT) combined with micro-needling, especially when using methylene blue as a photosensitizer (PS) at different concentrations, offers a promising approach for scar treatment.

Objective

This study evaluates the effectiveness of combining PDT, micro-needling, and methylene blue at 1% and 0.1% concentrations to improve the quality of hypertrophic and keloid scars.

Methods

Novel Study Design: a randomized, double-blind clinical trial was conducted on 37 patients with 94 hypertrophic and keloid scars. Patients were divided into four groups based on scar type and methylene blue concentration. Each group underwent five treatment sessions, and scars were assessed using the Japan Scar Scale (JSS) and the Patient and Observer Scar Assessment Scale (POSAS).

Results

Significant Improvements: after five treatment sessions, we observed substantial improvements in various scar parameters. The Evaluation part of Japan Scar Scale (JSS) scores decreased from an average of 14.69 ± 2.81 at baseline to 4.69 ± 0.92 after six months, indicating a significant reduction in scar severity. The patient-observer scar assessment scale results show a notable improvement in Flexibility and thickness, with a 71% reduction in stiffness and a 69% reduction in pain. Overall, patient satisfaction increased by 60%, and visible improvements in pigmentation and vascularity were reported. The use of 1% methylene blue led to better outcomes than 0.1%, possibly due to enhanced light penetration and reactive oxygen species (ROS) generation. Importantly, no severe side effects were observed, and patient compliance remained high throughout the study.

Conclusion

Combining PDT and micro-needling using 1% methylene blue improves scar quality and prevents it from worsening, particularly for keloid scars. Further studies are recommended to confirm these findings and explore long-term effects.

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重新定义疤痕质量：使用亚甲基蓝作为光敏剂的微针和光动力疗法的协同方法：一项随机临床试验。

背景：增生性瘢痕和瘢痕疙瘩是具有挑战性的治疗，可引起美观和功能问题。传统的治疗方法如激光治疗和皮质类固醇治疗效果有限，复发率高。然而，光动力疗法（PDT）结合微针的出现，特别是当使用亚甲基蓝作为不同浓度的光敏剂（PS）时，为疤痕治疗提供了一种很有前途的方法。目的：本研究评估1%和0.1%浓度的PDT、微针和亚甲基蓝联合应用对改善增生性瘢痕和瘢痕疙瘩质量的效果。方法：新颖的研究设计：对37例94例增生性瘢痕和瘢痕疙瘩进行随机、双盲临床试验。根据疤痕类型和亚甲蓝浓度将患者分为四组。每组接受5次治疗，使用日本疤痕量表（JSS）和患者和观察者疤痕评估量表（POSAS）评估疤痕。结果：显著改善：经过五次治疗，我们观察到各种疤痕参数的显著改善。日本疤痕量表（JSS）评估部分评分从基线时的平均14.69±2.81分下降到6个月后的4.69±0.92分，表明疤痕严重程度显著降低。患者-观察者疤痕评估量表结果显示柔韧性和厚度显著改善，僵硬度降低71%，疼痛度降低69%。总体而言，患者满意度提高了60%，色素沉着和血管状况也有明显改善。使用1%的亚甲基蓝比0.1%的效果更好，可能是由于增强了光穿透和活性氧（ROS）的产生。重要的是，没有观察到严重的副作用，并且在整个研究中患者的依从性仍然很高。结论：PDT联合1%亚甲基蓝微针可改善瘢痕质量，防止瘢痕恶化，尤其适用于瘢痕疙瘩疤痕。建议进一步研究以证实这些发现并探索长期影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Photodiagnosis and Photodynamic Therapy ONCOLOGY-

CiteScore

5.80

自引率

24.20%

发文量

509

审稿时长

50 days

期刊介绍： Photodiagnosis and Photodynamic Therapy is an international journal for the dissemination of scientific knowledge and clinical developments of Photodiagnosis and Photodynamic Therapy in all medical specialties. The journal publishes original articles, review articles, case presentations, "how-to-do-it" articles, Letters to the Editor, short communications and relevant images with short descriptions. All submitted material is subject to a strict peer-review process.