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Carbon dioxide laser treatment improved burn scar appearance

Patients with mature burn scars treated with a fractional carbon dioxide laser experienced improved scar appearance and collagen architecture, according to study results.

Researchers evaluated 18 patients with mature burn scars, and 10 patients (aged 20 to 53 years; six women) fulfilled treatment protocol. Burns were caused by fire (n=7), hot water (n=2) and acid (n=1), with scars (age range, 1 to 27 years) covering a mean total body surface area of 30.2%. Patients and physicians completed scar rating scale surveys before treatment and 2 months after final treatment.

Areas with predominantly hypertrophic scarring were treated with an Active FX (Lumenis Ltd.; energy settings, 80-100 mJ [53-mcm to 79-mcm ablation], 200 Hz, 75 microthermal treatment zone (MTZ)/cm² , and 1.3-mm spot size). Thicker, banded areas with scars were treated with Active FX at the same settings and Deep FX (Lumenis Ltd; energy settings, 20 mJ [600-mcm ablation], 300 Hz, 361-520 MTZ/cm², and 0.12-mm spot size). Three treatments were scheduled at 2- to 3-month intervals at sizes ranging from 76 cm² to 560 cm². Follow-up included 4-mm punch biopsies that were processed and stained.

The mean Vancouver Scar Scale was 8.5 at pretreatment and 4.9 post-treatment. (P=.002), which correlated with observed clinical improvements. In the Patient and Observer Scar Assessment Scale, patient initial mean score was 39.7, while the post-treatment score was 22.8 (P=.002). The observer portion of the scale was 32.2 at pretreatment and 19.2 at posttreatment (P=.004).

Type I collagen showed a decrease in posttreatment biopsy specimens (P=.002), while type III collagen showed significant increase in tissue specimens after fractional carbon dioxide laser treatment (P=.01). Elastic tissue had no significant changes.

“Burn scars treated with the fractionated carbon dioxide laser demonstrated a return toward a fetal collagen profile,” the researchers concluded. “Given the excellent tolerability and lack of prolonged adverse effects, the fractional carbon dioxide laser should be further evaluated for the treatment of mature burn scars.”