Efficacy and safety of laser combination therapy and laser alone therapy for keloid: a systematic review and meta-analysis.

To evaluate the efficacy and safety of laser alone therapy and laser combination therapy (mainly combined with other kinds of laser or steroids) for keloid. PubMed, Embase and Web of Science were searched for relevant articles from inception to June 2020. Comprehensive Meta-Analysis software 2.0 (CMA) was used to perform the meta-analysis. A total of 29 articles were included in this meta-analysis. During the mean follow-up of 14 (1–84) months, the overall improvement rates of baseline Vancouver scar scale (VSS) score and itch were 0.454 (95%CI 0.351–0.561, I2 = 0) and 0.786 (95%CI 0.613–0.895, I2 = 0) in the laser combination therapy group. The improvement rates of scar height and flexibility in the laser combination therapy group were 0.629 (95%CI 0.519–0.727, I2 = 52.089) and 0.784 (95%CI 0.251–0.975, I2 = 89.420). The average improvement rate of the scar score in laser combination therapy was 0.338 (0.201–0.510); however, there were insufficient data for laser alone therapy comparison. The laser combination therapy had a greater pain improvement rate, 0.580 (0.389–0.750) versus 0.420 (0.224–0.645), compared to laser alone therapy, and a greater degree of good or excellent (> 50%) improvement in the overall scar, 0.636 (95%CI 0.347–0.852) versus 0.149 (95%CI 0.032–0.482), with laser alone therapy. Moreover, a lower regrowth rate of 0.187 (0.129–0.263) versus 0.249 (0.060–0.631), a lower post-treatment pigmentation rate of 0.125 (0.091–0.169) versus 0.135 (0.058–0.282), and a lower infection rate of 0.047 (0.009–0.209) versus 0.076 (0.012–0.351) were observed in the laser combination therapy compared with those rates in the laser alone therapy. The overall effect of laser combination therapy was better than that of laser alone therapy, and the incidence of adverse reactions was lower in laser combination therapy than in laser alone therapy.