ORIGINAL ARTICLE High-resolution ultrasound for keloids and hypertrophic scar assessment Asmaa Mohammed Elrefaie 1 & Rehab Mohammed Salem 1 & Mohamed H Faheem 1 Received: 16 April 2019 /Accepted: 11 June 2019 # Springer-Verlag London Ltd., part of Springer Nature 2019 Abstract 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/cm 2 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. Keywords Assessment . Hypertrophic scar . Keloid . Nd:YAG . Ultrasound Introduction Hypertrophic scars (HTS) and keloids are a challenging disfiguring skin problems commonly seen in dermatological practice. Multiple therapeutic approaches for management of these problems have been tried and showed variable efficacy; however, none of them is standardized [1]. One of the rela- tively recent treatment options is laser therapy. Different laser wavelengths including pulsed dye, CO 2 , erbium:YAG, and argon lasers seem to be promising in managing such a problem [2]. Among the effective lasers in managing keloids and hypertrophic scars, Nd:YAG laser treatment is highly ef- fective for both problems, in all age groups, and causes of scar formation, number and site of lesions, and the degree of ten- sion on the scar [3]. The efficacy of lasers in keloids and HTS management could be attributed to the heat generation, which increases vascular permeability in the treated lesions. Moreover, lasers can in- crease collagen degradation via enhanced matrix metallopro- teinase production [4]. The long waves of Nd:YAG laser allow its deep penetration so that the heat produced by it reaches the middermis, the level from where keloids generate. Nd:YAG is considered to be a safe option especially in dark-skinned pa- tients because it is weakly absorbed by melanin and water [5]. Most of the scoring systems used to evaluate scars and assess their degrees of improvement are subjective methods based on clinical parameters such as the lesion thickness, color and pliability, and the symptoms reported by the patient such as pain and itching. These parameters are totally clinician and patient dependent. This raised the need for more objective methods to allow the reliable evaluation of lesions after * Rehab Mohammed Salem rehabsalem122@yahoo.com Asmaa Mohammed Elrefaie asmaa.alrefai@yahoo.com Mohamed H Faheem dr.hosny.rad@gmail.com 1 Faculty of Medicine, Benha University, Banha, Egypt Lasers in Medical Science https://doi.org/10.1007/s10103-019-02830-4