Ablative Fractional Laser-Assisted Delivery of Topical Steroids for Keloid Scars

keloid scar on hand
Scar on human skin keloid on hand.
The therapeutic effect of a combination fractional ablative laser treatment and topical corticosteroid compared favorably with that of standard intralesional steroid injection.

Ablative fractional laser-assisted delivery of topical steroids is as effective as intralesional steroid injection for the treatment of keloid scars, but the ablative fractional laser approach may be a safer and more aesthetically acceptable option compared with injections, according to study research published in the Journal of Cosmetic Dermatology.

A total of 30 patients with keloid scars (mean age, 26.4 years) were enrolled in this split-faced study. On 1 side of the face, the patient received an intralesional corticosteroid injection, whereas the other side of the face was treated with fractional ablative Er: YAG laser emitting light with a wavelength of 2940 nm followed by occluded topical application of a steroid cream. The patients underwent 4 treatment sessions performed at 4-week intervals. Before treatment, a topical lidocaine cream was applied for 30 minutes.

The investigators assessed keloid improvement at each session photographically and with the Vancouver Scar Scale (VSS), which assesses vascularity, height/thickness, pliability, and pigmentation. Patients were followed up to 12 weeks after their final treatment.

Before the start of treatment, the mean keloid VSS score was 6.9±1.9. The mean keloid VSS scores after treatment were 2.63±2.09 for the injection side and 2.07±2.02 for the laser-treated side (P <.001 for both). The mean pain score was 0.9±0.091 out of 10 during the laser procedure and 4.57±2.05 out of 10 for the injection procedure. Although significant improvements in the VSS were observed for both treatments compared with baseline, there was no difference in the treated halves in terms of improvements in VSS scores.

Limitations of the study included the relatively short 12-week follow-up period as well as the small sample size.

The investigators suggested that the combination of “ablative fractional laser therapy with occluded topical corticosteroid delivery presents a new emerging efficient modality to combine 2 valuable and aesthetically proven scar modalities in a simple, cost-effective strategy.”


Abd El-Dayem DH, Nada HA, Hanafy NS, Elsaie ML. Laser-assisted topical steroid application versus steroid injection for treating keloids: A split side study [published online June 2, 2020]. J Cosmet Dermatol. doi: 10.1111/jocd.13521