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Abstract
Background: keloids have beleaguered patients and clinicians alike. They can be aesthetically disfiguring, functionally debilitating, and emotionally distressing. Despite an array of therapeutic approaches, no single method provides complete benefit. Lasers have introduced new ways to manage keloids that may result in improved aesthetic and symptomatic outcomes and decreased keloid recurrence. Aim of work: Comparing the efficacy of fractional CO2 laser, long pulsed Nd YAG non contact mode laser and their combination in treatment of keloids clinically, histopathologically, biochemically and morphometrically. Methodology: Thirty patients with keloid scars were enrolled in the study. Three keloidal areas in each patient were randomly assigned to treatment modalities. Four laser sessions, 4-6 weeks apart were performed utilizing three laser modalities. Evaluation was performed before and 1 month following the sessions. Two scar assessment scales, the vancouver scar scale (VSS) and the patient and observer scar assessment scale (POSAS) were used for clinical evaluation. Routine H and E, Masson’s trichrome and orcein stains were used to evaluate the appearance and pattern of dermal collagen and elastic fibers. Image analysis was used to quantitatively assess the density of collagen and elastic fibers. Biochemical evaluation of tissue level of TGF-{u0243}I and TGF-{u0243}III was performed using ELISA studies