中华皮肤科杂志 ›› 2026, Vol. 59 ›› Issue (3): 269-273.doi: 10.35541/cjd.20250395
曾莞欣 文翔
收稿日期:2025-07-16
修回日期:2025-09-07
发布日期:2026-03-03
通讯作者:
文翔
E-mail:xiangwen_wcums@163.com
Zeng Wanxin, Wen Xiang
Received:2025-07-16
Revised:2025-09-07
Published:2026-03-03
Contact:
Wen Xiang
E-mail:xiangwen_wcums@163.com
摘要: 【摘要】 增生性瘢痕是一种在伤口愈合过程中胶原纤维产生与降解失衡而形成的高于皮面但不超出原损伤部位、质地较硬的病理性瘢痕。目前增生性瘢痕的治疗以包括局部敷贴、瘢痕内药物注射、加压治疗、光电治疗、冷冻治疗在内的非手术疗法为主。本文简述增生性瘢痕的特点及发生机制,并总结近年来以激光治疗为主的光电疗法治疗增生性瘢痕的相关进展。
曾莞欣 文翔. 增生性瘢痕的光电治疗进展[J]. 中华皮肤科杂志, 2026,59(3):269-273. doi:10.35541/cjd.20250395
Zeng Wanxin, Wen Xiang. Photoelectric therapy for hypertrophic scars[J]. Chinese Journal of Dermatology, 2026, 59(3): 269-273.doi:10.35541/cjd.20250395
| [1] | Hameedi SG, Saulsbery A, Olutoye OO. The pathophysiology and management of pathologic scarring⁃a contemporary review[J]. Adv Wound Care (New Rochelle), 2025,14(1):48⁃64. DOI: 10.1089/wound.2023.0185. |
| [2] | Gold MH, McGuire M, Mustoe TA, et al. Updated international clinical recommendations on scar management: part 2⁃⁃algorithms for scar prevention and treatment[J]. Dermatol Surg, 2014,40(8):825⁃831. DOI: 10.1111/dsu.0000000000000050. |
| [3] | Gauglitz GG, Korting HC, Pavicic T, et al. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies[J]. Mol Med, 2011,17(1⁃2):113⁃125. DOI: 10.2119/molmed.2009.00153. |
| [4] | Huang C, Ogawa R. Keloidal pathophysiology: current notions[J]. Scars Burn Heal, 2021,7:2059513120980320. DOI: 10. 1177/2059513120980320. |
| [5] | Shi J, Wu Y, Guo S, et al. The efficacy of anti⁃VEGF antibody⁃modified liposomes loaded with paeonol in the prevention and treatment of hypertrophic scars[J]. Drug Dev Ind Pharm, 2019,45(3):439⁃455. DOI: 10.1080/03639045.2018.1546315. |
| [6] | Yang Q, Ma Y, Zhu R, et al. The effect of flashlamp pulsed dye laser on the expression of connective tissue growth factor in keloids[J]. Lasers Surg Med, 2012,44(5):377⁃383. DOI: 10. 1002/lsm.22031. |
| [7] | Deng H, Tan T, Luo G, et al. Vascularity and thickness changes in immature hypertrophic scars treated with a pulsed dye laser[J]. Lasers Surg Med, 2020. DOI: 10.1002/lsm.23366. |
| [8] | Koike S, Akaishi S, Nagashima Y, et al. Nd:YAG laser treatment for keloids and hypertrophic scars: an analysis of 102 cases[J]. Plast Reconstr Surg Glob Open, 2014,2(12):e272. DOI: 10. 1097/GOX.0000000000000231. |
| [9] | Tsai C, Kao H, Akaishi S, et al. Combination of 1,064⁃nm neodymium⁃doped yttrium aluminum garnet laser and steroid tape decreases the total treatment time of hypertrophic scars: an analysis of 40 cases of cesarean⁃section scars[J]. Dermatol Surg, 2020,46(8):1062⁃1067. DOI: 10.1097/DSS.0000000000002235. |
| [10] | Joo SY, Cho YS, Lee SY, et al. Regenerative effect of combined laser and human stem cell⁃conditioned medium therapy on hypertrophic burn scar[J]. Burns, 2023,49(4):870⁃876. DOI: 10.1016/j.burns.2022.06.007. |
| [11] | Keshk ZS, Salah MM, Samy NA. Fractional carbon dioxide laser treatment of hypertrophic scar clinical and histopathological evaluation[J]. Lasers Med Sci, 2025,40(1):137. DOI: 10.1007/s10103⁃025⁃04371⁃5. |
| [12] | Yang Z, Yang Z, Zuo Z. Early intervention of carbon dioxide fractional laser in hypertrophic scar through TGFβ⁃1/ Smad3 signaling pathway[J]. Lasers Med Sci, 2024,39(1):78. DOI: 10.1007/s10103⁃024⁃04026⁃x. |
| [13] | Donnellan KA, Hinson CS, Blevins AC, et al. Treatment of chronic hypertrophic burn scars with a fractional CO2 laser is well tolerated in an outpatient clinic setting[J]. Ann Plast Surg, 2023,90(5):444⁃446. DOI: 10.1097/SAP.0000000000003526. |
| [14] | Miletta N, Siwy K, Hivnor C, et al. Fractional ablative laser therapy is an effective treatment for hypertrophic burn scars: a prospective study of objective and subjective outcomes[J]. Ann Surg, 2021,274(6):e574⁃e580. DOI: 10.1097/SLA.0000000000 003576. |
| [15] | Tan J, Zhou J, Huang L, et al. Hypertrophic scar improvement by early intervention with ablative fractional carbon dioxide laser treatment[J]. Lasers Surg Med, 2021,53(4):450⁃457. DOI: 10.1002/lsm.23301. |
| [16] | Dai Z, Lou X, Shen T, et al. Combination of ablative fractional carbon dioxide laser and platelet⁃rich plasma treatment to improve hypertrophic scars: a retrospective clinical observational study[J]. Burns Trauma, 2021,9:tkab016. DOI: 10.1093/burnst/tkab016. |
| [17] | Sabry HH, Ibrahim EA, Hamed AM. Assessment of laser⁃assisted delivery vs intralesional injection of botulinum toxin A in treatment of hypertrophic scars and keloids[J]. Dermatol Ther, 2020,33(6):e13980. DOI: 10.1111/dth.13980. |
| [18] | Cai Y, Tian J, Li J, et al. A novel combined technology for treating hypertrophic scars: adipose tissue extract combined with fractional CO2 laser[J]. Front Physiol, 2023,14:1284312. DOI: 10.3389/fphys.2023.1284312. |
| [19] | Zhang J, Zhou S, Xia Z, et al. Effectiveness of artesunate combined with fractional CO2 laser in a hypertrophic scar model with underlying mechanism[J]. Burns, 2022,48(3):662⁃671. DOI: 10.1016/j.burns.2021.05.013. |
| [20] | Slavinsky V, Wong JH, Carney BC, et al. Addressing burn hypertrophic scar symptoms earlier: laser scar revision may begin as early as 3⁃6 months after injury[J]. Lasers Surg Med, 2024,56(7):632⁃641. DOI: 10.1002/lsm.23822. |
| [21] | Zhang ZB, Zhou ZL, Xing FX, et al. Analysis of energy and density in treating hypertrophic scar after burn in children with CO2 dot matrix laser[J]. Int J Low Extrem Wounds, 2025,24(4):1068⁃1074. DOI: 10.1177/15347346221144152. |
| [22] | Staubach R, Glosse H, Fennell S, et al. a single⁃institution experience about 10 years with children undergoing fractional ablative carbon dioxide laser treatment after burns: measurement of air pressure⁃induced skin elevation and retraction time (dermalab) including standardized subjective and objective scar evaluation[J]. J Burn Care Res, 2023,44(3):655⁃669. DOI: 10.1093/jbcr/irac125. |
| [23] | Kurup S, Travis TE, Shafy RAE, et al. Treatment of burn hypertrophic scar with fractional ablative laser⁃assisted drug delivery can decrease levels of hyperpigmentation[J]. Lasers Surg Med, 2023,55(5):471⁃479. DOI: 10.1002/lsm.23662. |
| [24] | Zhang J, He Z, Tang Y, et al. CO2 fractional laser combined with triamcinolone acetonide injection for the hypertrophic scars: which is first?[J]. Lasers Med Sci, 2022,38(1):7. DOI: 10.1007/s10103⁃022⁃03693⁃y. |
| [25] | Cenk H, Sarac G. Effectiveness and safety of 2940⁃nm multifractional Er: YAG laser on acne scars[J]. Dermatol Ther, 2020,33(6):e14270. DOI: 10.1111/dth.14270. |
| [26] | Wulkan AJ, Rudnick A, Badiavas E, et al. Treatment of hypertrophic burn and traumatic scars with a 2,940⁃nm fractional ablative erbium⁃doped yttrium aluminium garnet laser: a pilot study[J]. Dermatol Surg, 2020,46(6):789⁃793. DOI: 10.1097/DSS.0000000000002284. |
| [27] | 光电技术治疗皮肤创伤性瘢痕专家共识(2018版)编写组. 光电技术治疗皮肤创伤性瘢痕专家共识(2018版)[J]. 中华烧伤杂志, 2018,34(9):593⁃597. DOI: 10.3760/cma.j.issn.1009⁃2587.2018.09.007. |
| [28] | Kesty CE, Kesty KR. Treatment of porphyria cutanea tarda scarring with combination laser treatment and a pilot use of artificial intelligence to quantify laser results[J]. J Cosmet Dermatol, 2025,24(4):e70056. DOI: 10.1111/jocd.70056. |
| [29] | Yuan B, Upton Z, Leavesley D, et al. Vascular and collagen target: a rational approach to hypertrophic scar management[J]. Adv Wound Care (New Rochelle), 2023,12(1):38⁃55. DOI: 10.1089/wound.2020.1348. |
| [30] | Fu X, Dong J, Wang S, et al. Advances in the treatment of traumatic scars with laser, intense pulsed light, radiofrequency, and ultrasound[J]. Burns Trauma, 2019,7:1. DOI: 10.1186/s41038⁃018⁃0141⁃0. |
| [31] | Chan LKW, Lee KWA, Hung LC, et al. Treating hypertrophic scar, post⁃inflammatory hyperpigmentation, and post⁃inflammatory hypopigmentation with intense pulsed light[J]. Skin Res Technol, 2024,30(6):e13823. DOI: 10.1111/srt.13823. |
| [32] | Daoud AA, Gianatasio C, Rudnick A, et al. Efficacy of combined intense pulsed light (ipl) with fractional CO2⁃laser ablation in the treatment of large hypertrophic scars: a prospective, randomized control trial[J]. Lasers Surg Med, 2019,51(8):678⁃685. DOI: 10.1002/lsm.23092. |
| [33] | Qu Z, Chen Y, Du K, et al. ALA⁃PDT promotes the death and contractile capacity of hypertrophic scar fibroblasts through inhibiting the TGF⁃β1/Smad2/3/4 signaling pathway[J]. Photodiagnosis Photodyn Ther, 2024,45:103915. DOI: 10.1016/j.pdpdt.2023.103915. |
| [34] | Wang X, Cao P, Liu J, et al. 5⁃Aminolaevulinic acid⁃based photodynamic therapy restrains pathological hyperplasia of fibroblasts[J]. Med Sci Monit, 2017,23:46⁃56. DOI: 10.12659/msm.898221. |
| [35] | Yang L, Deng H, Chen Y, et al. 5⁃Aminolevulinic acid⁃hyaluronic acid complexes enhance skin retention of 5⁃aminolevulinic acid and therapeutic efficacy in the treatment of hypertrophic scar[J]. AAPS PharmSciTech, 2022,23(6):216. DOI: 10.1208/s12249⁃022⁃02370⁃1. |
| [36] | Luo XY, Wu XG, Xu AE, et al. The combination of the mini⁃punch technique and photodynamic therapy for the treatment of mandibular keloids and hypertrophic scars[J]. Dermatol Surg, 2022,48(12):1294⁃1298. DOI: 10.1097/DSS.0000000000003621. |
| [37] | Wei J, Du L, Cao Z, et al. 5⁃Aminolevulinic acid photodynamic therapy combined with intralesional triamcinolone and 5⁃fluorouracil to treat acne hypertrophic scar[J]. Clin Cosmet Investig Dermatol, 2023,16:3057⁃3064. DOI: 10.2147/CCID.S427427. |
| [38] | Elmelegy NG. Hypertrophic scars of the hand: the role of electrophotobiomodulation theory as a recent line of treatment[J]. Plast Reconstr Surg, 2023,151(2):375⁃383. DOI: 10.1097/PRS.0000000000009962. |
| [39] | Xu Y, Wang H, Guo L, et al. Combinations of energy⁃based devices plus isotretinoin for management of acne and acne scars: a systematic review[J]. J Cosmet Dermatol, 2024,23(10):3090⁃3101. DOI: 10.1111/jocd.16407. |
| [40] | Tawfic SO, Hassan AS, Aly FES, et al. Fractional microneedle radiofrequency versus fractional carbon dioxide laser in the treatment of postburn hypertrophic scars[J]. Lasers Surg Med, 2022,54(8):1089⁃1098. DOI: 10.1002/lsm.23589. |
| [41] | Zhang J, Zhou S, Xia Z, et al. 595⁃nm Pulsed dye laser combined with fractional CO2 laser reduces hypertrophic scar through down⁃regulating TGFβ1 and PCNA[J]. Lasers Med Sci, 2021,36(8):1625⁃1632. DOI: 10.1007/s10103⁃020⁃03240⁃7. |
| [42] | Kivi MK, Jafarzadeh A, Hosseini⁃Baharanchi FS, et al. The efficacy, satisfaction, and safety of carbon dioxide (CO2) fractional laser in combination with pulsed dye laser (PDL) versus each one alone in the treatment of hypertrophic burn scars: a single⁃blinded randomized controlled trial[J]. Lasers Med Sci, 2024,39(1):69. DOI: 10.1007/s10103⁃024⁃03976⁃6. |
| [43] | Ghassemi M, Mireshghollah P, Jafarzadeh A, et al. Evaluating the combination and comparison of ablative fractional lasers (CO2, Erbium⁃YAG) with pulsed dye laser (PDL) for treating hypertrophic scars: a systematic review[J]. Lasers Med Sci, 2025,40(1):129. DOI: 10.1007/s10103⁃025⁃04382⁃2. |
| [44] | Tawfic SO, El⁃Tawdy A, Shalaby S, et al. Evaluation of fractional CO2 versus long pulsed Nd:YAG lasers in treatment of hypertrophic scars and keloids: a randomized clinical trial[J]. Lasers Surg Med, 2020,52(10):959⁃965. DOI: 10.1002/lsm. 23249. |
| [45] | Osman MA, Kassab AN. Fractional Er:YAG laser versus fractional CO2 laser in the treatment of immature and mature scars: a comparative randomized study[J]. Arch Dermatol Res, 2024,316(2):75. DOI: 10.1007/s00403⁃023⁃02764⁃6. |
| [46] | Liu X, Liu W, Fang S, et al. Lasers and intense pulsed light for the treatment of pathological scars: a network meta⁃analysis[J]. Aesthet Surg J, 2022,42(11):NP675⁃NP687. DOI: 10.1093/asj/sjac175. |
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