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Etude de l’effet de l’hyperthermie sélective induite par laser diode 1210 nm sur les cicatrices chéloïdes : étude expérimentale et clinique

Abstract : Introduction Keloid scars (KS) are pathologies of skin healing causing often functional and aesthetic disturbances. They are linked to excess production and disorganization of collagen mostly due to TGF bêta; overproduction. The thermal lasers can improve healing through a modification of the inflammatory response. Indeed, a rise of temperature between 45 and 53 ° C leads to an overexpression of HSP 70, which causes a change in the expression of TGF bêta;. The 810nm laser diode has already proven to be effective but its wavelength cannot used on dark phototypes who are prone to developing KS.The objective of this study was to evaluate the effect of a thermal laser on keloids in animal and in the context of a clinical study.Determination of laser parameters Studies on skin explants, and on healthy volunteers have shown that 1210 nm was the most suitable wavelength for this indication because it is poorly absorbed by melanin. The laser parameters were also carefully determined in order to control the skin temperature elevation. For a 1210 nm laser diode, an irradiance of 5.1W/cm² for 10 seconds leads to a maximum temperature of 53 ° C.Development of a KS animal model. Since, there was no KS animal model of DC , an innovative one was developed for this specific study. Fragments of human KS including the dermis and epidermis were transplanted in 40 nude mice. A clinical and histological evaluation confirmed the successful integration of the graft. At 4 months, it was proven that the KS remained unchanged. Study of the 1210nm diode laser in an KS animal modelThe 1210 nm laser was evaluated on our KS animal model. Laser irradiation was performed on the grafts. Clinical and histological evaluations have shown no adverse reactions. A 45 ° C mean temperature was recorded during laser irradiation .Study of l the 1210nm diode laser after intrakeloid excision. Parallel to the animal study, a pilot study was performed to assess the feasibility and safety of a 1210nm diode laser irradiation. An intrakeloid excision was achieved; the suture was then irradiated for about 10 seconds. 20 patients were included in the study. The study is still ongoing. A 2-year follow up is scheduled. So far, it was noted that no harmful effects of the laser. 8 patients received injections of corticosteroids due to of keloid recurrence at six months.conclusionAn original KS animal model was developed for the first time to study of the in vivo effects of laser irradiation. It was demonstrated that a 1210nm diode laser (5.1W/cm², for 10 seconds) led to a 45°C skin temperature without any deleterious effect. The 1210 nm diode laser after intrakeloid excision showed no signs of toxicity in humans. In humans, the maximum temperature was 48 ° C +/- 3°C . A long term follow-up on a large series of patients is still necessary to confirm the effectiveness of this promising treatment.
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Cécile Philandrianos. Etude de l’effet de l’hyperthermie sélective induite par laser diode 1210 nm sur les cicatrices chéloïdes : étude expérimentale et clinique. Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2012. Français. ⟨NNT : 2012LIL2S050⟩. ⟨tel-01881807⟩



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