Photobiomodulation therapy in keloid management: a comprehensive review

Keloid formation is a pathological scarring process marked by excessive fibroblast activity, overproduction of extracellular matrix (ECM), and chronic inflammation, presenting significant challenges in management despite existing treatments like corticosteroid injections, surgical excision, and cryotherapy. This review evaluates Photobiomodulation Therapy (PBMT) as a promising non-invasive approach for keloid treatment. PBMT utilizes non-thermal light in the red to near-infrared spectrum, which enhances mitochondrial activity, reduces reactive oxygen species (ROS), and regulates fibroblast proliferation and apoptosis. It also exhibits anti-fibrotic properties by inhibiting TGF-β1 expression, collagen synthesis, and Smad signaling, while modulating inflammation through reduced pro-inflammatory cytokines (IL-6, TNF-α) and enhanced macrophage activity. Preclinical evidence in animal models and fibroblast cultures demonstrates PBMT's ability to reduce scar size, collagen deposition, and fibroblast activity. Clinical studies, including randomized controlled trials (RCTs) and case reports, show significant improvements in keloid height, elasticity, and texture, with reductions in pain and pruritus, as well as lower recurrence rates compared to conventional therapies. PBMT is well-tolerated with minimal adverse effects, such as transient redness or mild itching, and is safe for all skin types, including those with darker pigmentation. In conclusion, PBMT offers a promising, safe, and effective alternative for keloid management by targeting key fibrotic, inflammatory, and angiogenic processes. However, further large-scale randomized controlled trials with standardized protocols are necessary to confirm its long-term efficacy and integrate it into clinical practice.