Photodynamic Therapy for the Treatment of Scars

Shokrollahi, Kayvan; Hardman, Charlotte A.

doi:10.1007/978-3-030-52919-2_13

Cited by 2 publications

(19 citation statements)

References 22 publications

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“…However, the question remains as to whether the natural regression of hypertrophic scars is the primary mechanism by which the outcome was achieved given the most common outcome in hypertrophic scars is resolution within one year of the initial scar formation. 11,31–33 Given the potential for spontaneous improvement, the present study is limited as we did not compare laser treatment to outcomes of similar scars that did not receive CO 2 laser.…”

Section: Discussionmentioning

confidence: 99%

“…The literature suggests that CO 2 laser therapy benefits are equivocal independent of scar age in burn patients but patients undergoing surgical scar laser therapy within three weeks of the procedure demonstrated superior results compared with delayed intervention. 11,18 Another important consideration for future clinical studies evaluating hypertrophic scar outcomes should also include a non-intervention arm given the fact that the natural course of hypertrophic scars is complete regression within one year. 11,31–33 Quality of life scales were not used to assess the psychosocial impact of scar improvements.…”

Section: Discussionmentioning

confidence: 99%

“…11,18 Another important consideration for future clinical studies evaluating hypertrophic scar outcomes should also include a non-intervention arm given the fact that the natural course of hypertrophic scars is complete regression within one year. 11,31–33 Quality of life scales were not used to assess the psychosocial impact of scar improvements. Psychosocial measures, coupled with the VSS and POSAS, may provide a more complete picture of scar outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…This phenomenon is consistent with the literature where surgical scars may receive intervention in as soon as three weeks compared with burns where first treatment after a burn occurs at approximately 18 months. 11,25 Another challenge posed to researchers and clinicians treating hypertrophic scars is generating objective photographic imaging to track progression of scars from visit to visit. Two dimensional photographs are the most common assessment tool to evaluate scar progression, but plain photographs alone may introduce bias due to logistical constraints and provides inconsistent objective analysis compared to other means of assessments (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…3,7 Hypertrophic, burn, keloid, pigmented and acne scars have all shown improvement when treated with CO 2 laser. [8][9][10][11] McGoldrick et al published a two-part review article detailing over 20 years of experience treating a wide variety of scar types using lasers in conjunction with a variety of other treatments. 8,9 While they reported subjective improvement in these scars and high rates of patient satisfaction, there was no standardised measure of this subjective improvement.…”

Section: Introductionmentioning

confidence: 99%

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CO₂ laser resurfacing for burn and traumatic scars of the hand and upper extremity

Cox

Bettiol

et al. 2022

Scars, Burns & Healing

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Background Scar formation is a normal part of the proliferative phase in wound healing where collagen is remodelled to better approximate normal skin. When collagen is not effectively redistributed, excessive scarring may occur. Recently, CO2 laser has emerged as an adjunct in improving scar quality via remodelling and redistribution of dermal collagen fibres. Due to the paucity of literature related to its use in the hands and upper extremities, we created a study to examine its effects on hypertrophic scars focused on the hands and upper extremities. Methods Patients treated with CO2 laser for hypertrophic scars of the hand and upper extremity were included. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to assess the progression of scar quality. Unpaired t-tests were performed to determine statistical difference between pre- and post-treatment scores on each scale. Pearson correlation coefficients were used to understand the relationship between number of treatments and scar quality. Results Of the 90 patients enrolled, 54 patients completed serial scar assessment forms. All patient and observer-reported POSAS domains showed improvement ( P < 0.05) apart from Itching. All VSS domains showed improvement ( P < 0.05). There was moderate correlation between overall patient-reported opinion of scar quality and Discoloration, Stiffness and Thickness, and strong correlation between overall patient opinion and Irregularity (r = 0.715). All observer-reported domains were strongly correlated (r = 7.56–8.74) with overall observer opinion of scar quality. Conclusion The results of this study may further substantiate CO2 laser as a treatment modality for excessive scarring in a variety of surgical subspecialties. Lay Summary Complex trauma and burns that impact the skin sometimes result in abnormal healing of the skin called, “hypertrophic scarring”. In our study we assessed how using focused CO2 laser therapy impacts patients and health care provider assessment of wound progression. Our results were based upon patient reported and healthcare provider observations based upon two standardized forms the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). What we found is that after CO2 Laser Therapy, our 64 patients with 77 treated scars received on average almost 3 treatments and these treatments helped them with physical function and improved aesthetic appearance of their scars. The health care providers also found that the treatments improved functional and aesthetic end points. Overall, our study helps substantiate the body of evidence that using CO2 laser therapy improves aesthetics and function of hypertrophic scars in the upper extremity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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CO₂ laser resurfacing for burn and traumatic scars of the hand and upper extremity

Cox

Bettiol

et al. 2022

Scars, Burns & Healing

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The use of carbon dioxide and intense pulsed light laser for the treatment of hypertrophic burn scars: A case series

Dahm,

Lee,

Cleland

et al. 2023

Scars, Burns & Healing

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Introduction Hypertrophic scarring is a common and debilitating consequence of burn scars. While there is limited evidence for current treatment options, laser therapy has been shown to be effective, low risk and minimally invasive. This study assesses the use of carbon dioxide lasers and intense pulsed light devices in the treatment of hypertrophic burn scars. Methods In this case series, patients were recruited from a hypertrophic burn scar waitlist and completed a Patient and Observer Scar Assessment Scale prior to and six weeks after laser therapy. The Nordlys (intense pulsed light) and CO2RE (carbon dioxide) systems from Candela Medical were used, with a range of settings used depending on the assessment of the burn scar. The differences between scores were calculated for the total Patient and Observer Scar Assessment Scale score, pain, itch, colour, stiffness, thickness, irregularity and the overall opinion of the scar. Statistical analysis was completed using a paired, two-tailed student T test. Results A total of 31 patients were recruited for this trial with a range of scar locations, surface areas and mechanism of burn injury. The calculated difference in mean showed a significant reduction for the overall Patient and Observer Scar Assessment Scale score (1.93, p < 0.0001), pain (1.39, p = 0.0002), itch (1.84, p = 0.0002), colour (1.97, p < 0.0001), stiffness (2.47, p < 0.0001), thickness (2.1, p < 0.0001), irregularity (1.89, p < 0.0001) and overall opinion (1.58, p = 0.0003). Conclusion Current management options for hypertrophic scarring have limited evidence. Laser therapy presents a minimally invasive procedure that can be completed under topical anaesthetic and has shown to be effective following a single treatment of combined carbon dioxide laser and intense pulsed light device therapy. Lay Summary Many people will suffer a burn injury throughout their life and up to almost 3 out of 4 people with burn injuries will suffer from hypertrophic scars (a thickened, red and itchy scar). These scars cause distress both due to their appearance and their reduction of function, particularly over a joint or muscle. Laser therapy, in which different wave lengths of light (pulsed light) or gas (carbon dioxide) target the scar, has been found to be effective and have minimal side effects in the management of hypertrophic scars. While individual lasers have been assessed and found to be effective and low risk, the combined use of multiple lasers on the same scar has not been extensively studied. We studied the effectiveness of both light and gas laser therapies on hypertrophic scars. Patients with hypertrophic scars completed a questionnaire that focused on their perspective of their scar (pain, itch, stiffness, thickness, irregularity, overall opinion) prior to the treatment. The patients then underwent laser therapy (with local anaesthetic gel) with either pulsed light and/or carbon dioxide (gas) laser. The type of laser used was decided by the clinician performing the therapy depending on scar location and thickness. Patients then re-completed the subjective survey six weeks following the laser therapy, and the results compared. We learnt that laser therapy (both light, gas and a combination of both) are effective (and low risk) in reducing the subjective burden of the scar for the patient.

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Photodynamic Therapy for the Treatment of Scars

Cited by 2 publications

References 22 publications

CO₂ laser resurfacing for burn and traumatic scars of the hand and upper extremity

CO₂ laser resurfacing for burn and traumatic scars of the hand and upper extremity

The use of carbon dioxide and intense pulsed light laser for the treatment of hypertrophic burn scars: A case series

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Photodynamic Therapy for the Treatment of Scars

Cited by 2 publications

References 22 publications

CO2 laser resurfacing for burn and traumatic scars of the hand and upper extremity

CO2 laser resurfacing for burn and traumatic scars of the hand and upper extremity

The use of carbon dioxide and intense pulsed light laser for the treatment of hypertrophic burn scars: A case series

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Product

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CO₂ laser resurfacing for burn and traumatic scars of the hand and upper extremity

CO₂ laser resurfacing for burn and traumatic scars of the hand and upper extremity