| Objective: To study the clinical efficacy,recurrence rate and safety of5-aminolevulinic acid based photodynamic therapy(ALA-PDT),in comparison to intrascar injection of glucocorticoid in the treatment of pathological scar.Method: Sixty patients with pathological scars who attended the Dermatology Clinic of the Air Force Special Medical Center were randomly divided into two groups: 1.ALA photodynamic group,using CO2 dot matrix After laser treatment of the scar surface skin,10% ALA was applied externally,the package was protected from light for 3 hours,and 633 nm red light was irradiated for 20 minutes;2.intrascar injection of glucocorticoid group,use a sterile syringe to draw out 1ml of compound betamethasone injection,mix with 1.5ml of normal saline.Point injection should be made from the base of the scar to the surrounding area and make the skin lesions whitish.All patients received treatment at 1 month interval with total of 3 times.During each treatment,according to the Vancouver Scar Score(VSS)score.The patients were followed up for 1,3 and 6 months after the last treatment to evaluate the recurrence and safety.Results: After 3 sessions of ALA-PDT,there was no statistically significant difference in response rates for hypertrophic scars and keloids(92.86% and 93.75%)compared with intrascar injection of glucocorticoid(89.47% and 90.91%)(P =0.616;P = 0.658).The pigmentation score of hypertrophic scar decreased faster than that of the intrascar injection of glucocorticoid group(P=0.000).There was no significant statistical difference in the height,vascularity and pliability score of hypertrophic scar between the two treatment methods(P=0.07;P=0.376;P=0.162).The decrease of pigmentation score and vascularity score of keloid by photodynamic therapy was faster than that of the intrascar injection of glucocorticoid group(P =0.000;P =0.001),the decrease in keloid hardness score of the intrascar injection of glucocorticoid treatment was faster than that of photodynamic treatment group(P =0.000),and there was no statistically significant difference in the height of keloid between the two treatments(P=0.625).In the hypertrophic scar,there were 0 cases in the photodynamic group and 7 cases in the intrascar injection of glucocorticoid group(recurrence rate36.84%).The recurrence rate in the photodynamic group was significantly lower than that in the intrascar injection of glucocorticoid group(P=0.01 < 0.05).For keloid patients,there was 1 case of recurrence in the photodynamic group(6.25%)and 5cases of recurrence in intrascar injection of glucocorticoid group(45.45%).The recurrence rate in the photodynamic group was significantly lower than that in the intrascar injection of glucocorticoid group(P =0.027 < 0.05).Conclusion: 1.ALA-PDT therapy has a clear therapeutic effect on pathological scar,with an effective rate of 92.86% for hypertrophic scar and 93.75% for keloid,both of which are comparable to the effective rate of traditional intrascar injection of glucocorticoid therapy,and the efficacy increases accumulative with the increase of treatment times.2.The pigmentation improvement of hypertrophic scar by ALA-PDT was better than intrascar injection of glucocorticoid group;The improvement of keloid pigmentation and vascularity distribution was better than intrascar injection of glucocorticoid group.3.The recurrence rate of pathological scar was low in the treatment of ALA-PDT,14 patients with hypertrophic scar were followed up for half a year without recurrence,and 1 patient of 16 keloid patients was followed up for half a year with recurrence.4.Safety: The main adverse reactions of ALA-PDT to pathological scar include pain,erythema,edema and pigmentation,but all adverse reactions could be completely subsided within a certain period of time,without serious and irreversible adverse reactions. |
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