Laser Therapy for Pediatric Burn Scars: Focusing on a Combined Treatment Approach

Abstract

Treatment with laser therapy has the potential to greatly improve hypertrophic scarring in individuals who have sustained burn injuries. More specifically, recent research has demonstrated the success of using pulsed dye laser therapy to help reduce redness and postburn pruritus and using ablative fractional CO2 laser therapy to improve scar texture and thickness. This study describes our early experience using laser therapy in our pediatric burn program and details our specific treatment approach when using each laser individually and in combination during the same procedure. A retrospective before-after study of patients with hypertrophic burn scars who were treated with laser therapy at our pediatric institution was performed. One hundred and twenty-five patients were treated over a total of 289 laser sessions with more than 50% of patients under the age of 5 years at the first treatment. The majority of procedures were performed using both the pulsed dye and CO2 lasers in combination. Before-after Vancouver Scar Scale scores decreased from 7.37 (SD, 2.46) to 5.76 (SD, 2.29) after a single treatment. The results obtained from this study support the use of laser therapy to improve hypertrophic burn scars in the pediatric population. Rigorous randomized controlled trials are needed to confirm the effectiveness of this therapy.

Burn Hypertrophic Scar in Pediatric Patients: Clinical Case

“…Lasers initiate an inflammatory response and induce moderate damage to local vasculature, resulting in local hypoxia and remodeling [3,4]. This, in turn, results in reduced scar erythema, pruritus, pain, and scar texture and stiffness [5]. Lasers can be further subdivided into ablative or nonablative types.…”

“…As a result, traditional ablative lasers are no longer used. However, an exception is the fractional carbon dioxide (fCO 2 ) laser, which is regarded as an ablative laser but can be considered as an alternative to the conventional ablative CO 2 laser [5]. Alternatively, nonablative lasers can target dermal chromophores while preserving the epidermis, minimizing complications.…”

“…However, these nonablative lasers have a relatively shallow penetration depth, limiting their use to certain anatomical locations or shallow scars in the case of Nd:YAG and NAFL. Decision for which type of laser to use is dependent on scar characteristics, pain, and scar texture and stiffness [5]. The procedure itself is short and requires minimal additional rehabilitation, an advantage over surgical interventions, especially in younger patients.…”

Fractional CO2 laser combined with 595-nm PDL inhibiting hypertrophic scars via measuring BMP-7 and Fas expression in rabbit models

“…Both FCO2L and 595-nm PDL have been validated to be conventional treatment options for HSs with clinical safety and e cacy [9][10][11][12][13][14]. FCO2L for HS is based on fractional and micro-holes with almost identical density and depth, and suppresses abnormal and irregulated brosis and collagen, thus reducing scar formation at the HSs [40][41][42][43][44][45][46]. This is evidenced by attened and shrunk scars following treatment [14,[43][44][45][46].…”

“…Currently, HS still remains a medical problem because of its complex physiologic wound healing cascade, though combined therapeutic strategies have been attempted in its treatment [11,13,37,39,41]. Nevertheless, the role of BMP-7 and Fas expression following by FCO 2 L combined with 595-nm PDL is rarely available.…”