High-resolution ultrasound for keloids and hypertrophic scar assessment

Most of the widely used scales to evaluate scars are subjective relying on clinical observations. There is a growing need to find out a noninvasive objective tool for this purpose. The study is aimed at evaluating the value of the high-resolution ultrasound in the assessment of the scars when compared with a clinical evaluation scoring system, the Vancouver Scar Scale (VSS). The study included 22 patients with hypertrophic scars or keloids. At baseline, scars were assessed using the Vancouver Scar Scale and high-resolution ultrasound (13-MHz probe). Patients received three Nd:YAG laser sessions (100 J/cm2 fluence, pulse width 50 ms, frequency rate 2 Hz, and spot size 7 mm) at 1-month intervals. Pulses were applied in a painting motion till reaching the clinical end point which is mild erythema. After the 3rd session, lesions were evaluated again using the VSS and the high-resolution ultrasound. The Vancouver Scar Scale decreased significantly after treatment in both treatment groups. Radiological evaluations showed significant improvement in lesion thickness and echogenicity, but not the lesion vascularity. There was a significant difference between the improvement percent measured by the VSS and high-resolution ultrasound (p = 0.001). The percent of HTS improvement was higher than that of keloid improvement. Among all the studied variables, it seems that female sex is the only factor which predicts better treatment outcome. The combined clinical and radiological assessment of scars is helpful in assessing these lesions and comparing the efficacy of different treatment modalities.