{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:21:28Z","timestamp":1787066488144,"version":"build-2736575974"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Natural Science Foundation Project of Nanjing University of Chinese Medicine","award":["XZR2024005"],"award-info":[{"award-number":["XZR2024005"]}]},{"name":"Project of Jiangsu Province\u2019s Science and Technology Development Plan for Traditional Chinese Medicine","award":["MS2021015"],"award-info":[{"award-number":["MS2021015"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      This study aims to systematically evaluate the efficacy and safety of fractional CO\n                      <jats:sub>2<\/jats:sub>\n                      laser therapy combined with triamcinolone acetonide (TA) injection for hypertrophic scar (HS).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Randomized controlled trials (RCTs) investigating the combination therapy of fractional CO\u2082 laser and TA injection for HS were identified through systematic searches of PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, Sinomed, and VIP databases from inception to December 2024. The risk of bias was assessed using the Cochrane Collaboration\u2019s Risk of Bias tool. Meta-analysis was performed with RevMan (version 5.3), while sensitivity analysis and publication bias assessment were conducted using Stata (version 14.0). The quality of evidence for outcomes was evaluated with the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nineteen studies involving 1,775 patients were included in this meta-analysis. Compared with TA injection alone, the pooled results showed that fractional CO\u2082 laser combined with TA injection significantly reduced Vancouver Scar Scale scores [MD: \u22122.52, 95% CI: \u22123.07 to \u22121.98,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001], pruritus scores [MD: \u22120.86, 95% CI: \u22120.94 to \u22120.78,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001], pain scores [MD: \u22121.04, 95% CI: \u22121.38 to \u22120.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001], scar thickness [SMD: \u22122.36, 95% CI: \u22123.12 to \u22121.61,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001], serum TGF-\u03b21 level [SMD: \u22122.09, 95% CI: \u22122.71 to \u22121.46,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001], serum VEGF level [SMD: \u22122.03, 95% CI: \u22122.90 to \u22121.17,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001], serum EGF level [MD: \u221217.38, 95% CI: \u221220.94 to \u221213.82,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001], and serum TNF-\n                      <jats:italic>\u03b1<\/jats:italic>\n                      level [SMD: \u22121.81, 95% CI: \u22122.77 to \u22120.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0002]. Regarding safety, the combination of fractional CO\u2082 laser and TA injection reduced the incidence of skin atrophy [RR: 0.52, 95% CI: 0.34 to 0.80,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003] compared to TA injection alone. There was no significant difference between the two groups in the incidence of adverse events, including folliculitis [RR: 0.64, 95% CI: 0.30 to 1.35,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.24], erythematous edema [RR: 1.21, 95% CI: 0.68 to 2.16,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.52], skin allergies [RR: 0.38, 95% CI: 0.14 to 1.05,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.06], pigmentation [RR: 1.12, 95% CI: 0.58 to 2.16,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.73], ulcers [RR: 0.35, 95% CI: 0.11 to 1.16,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.09], infections [RR: 1.45, 95% CI: 0.29 to 7.17,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.65], and blisters [RR: 0.33, 95% CI: 0.01 to 7.88,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.50].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preliminary evidence suggests that fractional CO\u2082 laser combined with TA injection is an effective treatment for HS. However, due to methodological limitations in the included studies, large-scale, rigorously designed RCTs are required to validate these findings. Additionally, all 19 RCTs were conducted in China with Chinese participants; therefore, the current evidence is limited to this population and requires validation in other ethnic groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42025630116<\/jats:ext-link>\n                      , identifier PROSPERO (CRD4202563011).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1671191","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:56:03Z","timestamp":1769064963000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and safety of fractional CO2 laser therapy combined with triamcinolone acetonide injection for hypertrophic scar: a preliminary systematic review and meta-analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Jianfeng","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengke","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochen","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"116","DOI":"10.3892\/etm.2024.12403","article-title":"Expression of macrophage activation-specific factors in hyperplastic scar tissue during hyperplasia phase by antibody array blotting membrane assay and its clinical significance","volume":"27","author":"Zhang","year":"2024","journal-title":"Exp Ther Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"79e","DOI":"10.1097\/PRS.0000000000008667","article-title":"The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago","volume":"149","author":"Ogawa","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"316","DOI":"10.3390\/ijms24010316","article-title":"The role of local 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