Objective and subjective treatment evaluation of scars using optical coherence tomography, sonography, photography, and standardised questionnaires.

BACKGROUND: Currently, different types of treatments for pathological scars are available, however, to date, there is no established method of measurement to objectively assess therapeutic outcome. Treatment success is usually evaluated clinically by the physician and patient. Non-invasive imaging techniques, such as HD-OCT (high-definition optical coherence tomography), may represent a valuable diagnostic tool to objectively measure therapeutic outcome. OBJECTIVES: To compare HD-OCT with ultrasound and subjective evaluation tools, such as questionnaires. MATERIALS & METHODS: In total, eight patients with pathological scars were treated in this pilot study with cryotherapy and intralesional steroid injections, and evaluated pre- and post-treatment using clinical examination, photography, sonography, and HD-OCT. The analysis of objective and subjective measuring methods was used to draw direct comparisons. RESULTS: HD-OCT revealed reduced epidermal and dermal thickness of the scar after four treatments with triamcinolone acetonide and cryotherapy. Based on sonography, a total reduction in scar height and reduction in scar depth was demonstrated. Both methods correlated well with the injected amount of triamcinolone acetonide. In addition, a positive correlation between well-established subjective and objective evaluation methods was found. CONCLUSION: We demonstrate that HD-OCT may be used as an objective diagnostic instrument to evaluate skin thickness under therapy for pathological scars, and serves as a valuable adjunctive device in combination with ultrasound and subjective evaluation tools. This provides additional information for the therapist concerning the quality and success of the applied treatment.

DLQI and POSAS Scores in Keloid Patients.

The treatment of keloids remains complex and challenging. A multitude of different treatment options exists. While current guidelines frequently promote the combination of intralesional triamcinolone acetonide (TAC) and cryotherapy as a first-line therapy for keloids, its efficacy has mainly been proven clinically and objective evaluation is widely missing. Here, we aimed to evaluate the efficacy of TAC and cryotherapy for the improvement of keloids by employing two well-recognized questionnaires for the evaluation of scar appearance and patient's quality of life. Twenty keloid patients from our outpatient scar clinic were treated with individual doses of TAC and cryotherapy in four consecutive sessions. Retrospectively, Patient and Observer Scar Assessment Scale (POSAS) and Dermatology Life Quality Index (DLQI) questionnaire data from those patients were analyzed to evaluate changes over five visits (one baseline, four after treatment). Both overall patient and observer scores of the POSAS significantly decreased (41.10 ± 9.771 to 29.85 ± 11.42 [p < 0.001] and 33.75 ± 6.231 to 22.70 ± 5.992 [p < 0.001], respectively), while DLQI scores significantly declined over the time period studied, indicating significant improvements in scar appearance. Objective evaluation confirmed the clinically demonstrated improvements of scar appearance and symptoms after treatments with TAC and cryotherapy which was associated with significant improvements in quality of life as indicated by DLQI measures. Standardized questionnaires help in objectifying clinical improvements; however, more detailed options for scar documentation, such as objective imaging, may be additionally required for an in-depth analysis of treatment progress.

Comparison of Two Kinds of Lasers in the Treatment of Acne Scars.

Acne scars are common and stigmatizing for the affected patients. Besides surgery, chemical peels, microdermabrasion, and microneedling, the treatment with fractional laser is a standard therapy. The results of reducing acne scars treated either with a fractional Er:YAG (erbium-doped yttrium-aluminum-garnet [Er:Y3Al5O1]) or a carbon dioxide (CO 2 ) laser at different wavelengths were compared and evaluated in the pilot study presented here. Fourteen patients with severe scars on both cheeks were treated four times in a random split-face approach: on one side with Er:YAG laser and on the contralateral side with CO2 laser following a standardized protocol. Therapeutic success was evaluated through the use of a high-resolution, 3D small-field capture system (PRIMOS), digital photography, and the Patient and Observer Scar Assessment Scale (POSAS) questionnaire. The evaluation was performed by a blinded investigator. Treatment results displayed a higher efficacy of the fractional CO2 laser compared with the Er:YAG laser as displayed by digital photographs. Additionally, objective (high-resolution, 3D small-field capture; PRIMOS) and subjective (POSAS) measuring results correlated positively in certain qualities (color, stiffness, thickness, surface, overall opinion). Using a novel scientific approach, we evaluated the therapeutic efficacy of different fractional lasers on acne scars using a rater-blinded approach. Compared with an Er:YAG laser, better skin smoothening was achieved by fractional CO2 laser treatment.