Combined Fractional Erbuim-YAG Laser With Botulinum Toxin-A Versus Botulinum Toxin-A Alone For The Treatment Of Hypertrophic Scars And Keloids

Background: The treatment of hypertrophic scars (HTS) and keloids remains a challenge. Not all treatment modalities have been adequately tested. Objectives: We aimed to compare the efficacy between combined fractional Er:YAG with intra-lesional botulinum toxin (Botox) and intra-lesional Botox as a monotherapy for the treatment of HTS and keloids. Patients and methods: Thirty patients with HTS and keloids were treated by intra-lesional injection of Botulinum Toxin Type –A (Botox) as a monotherapy and Botox combined with ablative fractional Er:YAG laser. Each lesion was divided into two parts. The allocation of treatment method was randomly selected. One part was treated with Botox intra-lesionally 5 IU/cm2. The other part was subjected to combined intra-lesional Botox and ablative fractional Er:YAG laser (2,940 nm) sessions (4 sessions every 4 weeks). Evaluation of the treatment outcomes was done by the Vancouver Scar Scale (VSS), clinical imaging, and immuno-histochemical studies. Results: There was a significant decline in VSS after treatment with the combined regimen compared to the sites treated with botox injection only (P