The Therapeutic Effect Of Ultrapulse Manual Fractional CO₂ Laser Combined With Drug Injection On The Treatment Of Keloid

ObjectiveTo study the therapeutic effect of ultrapulse manual fractional CO₂ laser combined with drug injection on the treatment of keloid.To study the effect of ultrapulse manual fractional CO₂ laser on microstructure of keloid,changes in collagen fiber and heat shock protein47.MethodsFrom May 2017 to October 2017,a total of 52 patients with 60 keloid lesions who were diagnosed at the Affiliated Hospital of Nantong University were enrolled in this study according to the inclusion criteria.Among them,there were 30 keloid lesions in the ultrapulse manual fractional CO₂ laser combined with drug injection group and 30keloid lesions in the drug injection group.The evaluation parameters were compared between the initial diagnosis and after three sessions of the ultrapulse manual fractional CO₂ laser combined with drug injection group.Evaluation parameters include the total thickness,surface thickness,hardness,color,pain and itch sensation,patient self-evaluation and doctor evaluation.At the same time,the differences in the evaluation parameters between the initial diagnosis and after three sessions were compared between the ultrapulse manual fractional CO₂ laser combined with drug injection group and the drug injection group.By HE staining,picric acid-Sirius red staining and immunohistochemical staining,the changes inmicrostructure,collagen fiber and heat shock protein 47were compared between the initial diagnosis and after three sessions of the ultrapulse manual fractional CO₂ laser combined with drug injection group.At the same time,the differences in the changes in microstructure,collagen fiber and heat shock protein 47 between the initial diagnosis and after three sessions were compared between the ultrapulse manual fractional CO₂ laser combined with drug injection group and the drug injection group.ResultsExcept no changes in color after three sessions of the ultrapulse manual fractional CO₂ laser combined with drug injection group（P>0.05）,the total thickness,surface thickness,hardness,pain and itch sensation,patient self-evaluation and doctor evaluation were all improved（P<0.05）.Meanwhile,compared with the drug injection group,the other evaluation parameters improved more obviously（P<0.05）except the color（P>0.05）.By HE staining,after three sessions of the ultrapulse manual fractional CO₂ laser combined with drug injection group,there were no changes in epidermis.However,there were a lot of collagen fiber bundles in the dermis,but they became loose and orderly.The dermal collagen fibers in the drug injection group were also loose and orderly,but less obviously than the ultrapulse manual fractional CO₂ laser combined with drug injection group.By Picric acid-Sirius red staining,after three sessions of the ultrapulse manual fractional CO₂ laser combined with drug injection group,type I collagen fiber,type III collagen fiber,total collagen fibers and type I collagen fiber/type III collagen fiber ratio were relatively reduced（P<0.05）.Meanwhile,the reduction was more obvious than that of the drug injection group（P<0.05）.By immunohistochemical staining,after three sessions of the ultrapulse manual fractional CO₂ laser combined with drug injection group,heat shock protein 47 was reduced（P<0.05）,while compared with the drug injection group,the reduction was more obvious（P<0.05）.Heat shock protein 47 in both groups was positively correlated with type I collagen fiber and type III collagen fiber（P<0.05,r>0）.Conclusions 1.ultrapulse manual fractional CO₂laser combined with drug injection has a certain effect on the treatment of keloid,which is better than simple drug injection.2.ultrapulse manual fractional CO₂laser combined with drug injection can reduce HSP47,type I collagen fiber,type III collagen fiber,total collagen fibers,and type I collagen fiber/type III collagen fiber ratio in keloid,which is better than simple drug injection.