The efficacy and safety of low‐energy carbon dioxide fractional laser use in the treatment of early‐stage pediatric hypertrophic scars: A prospective, randomized, split‐scar study

Abstract

Background: Various laser therapies have been introduced in scar management. However, pain during treatment has limited the application of laser therapy in pediatrics.Objectives: To evaluate whether the use of the low-energy mode of a carbon dioxide (CO 2 ) laser improves hypertrophic scars in a pediatric population. Methods: This prospective, randomized, split-scar trial was designed to assess the safety and efficacy of low-energy CO 2 laser use. Patients aged <12 years with hypertrophic scars were enrolled. Each hypertrophic scar was equally divided into three parts: the two ends of each scar were randomly assigned to control and experimental groups, and the center portion was considered a transition zone and was not included in the analysis. A total of three laser treatments were performed at 1-month intervals. Scar scale scores 6 months after the final treatment was the primary outcome. Additionally, the Visual Analog Scale (VAS) was used to evaluate pain after each treatment. Results: Of the 23 patients enrolled, 20 completed the study. The total Patient and Observer Scar Assessment Scale (POSAS) score at the 6-month follow-up was significantly lower for the treated site (44.95 for the treated group vs. 64.85 for the control group, p < 0.0001). Both the patient and observer POSAS scores showed an obvious difference between the treated and control groups (19.95 vs. 29.95 for patient scores, respectively, p < 0.0001, and 26.00 vs. 34.90 for observer scores, respectively, p < 0.0001). All observer and patient scores describing pain, pruritus, color, stiffness, and thickness were statistically different and favored the treated site. No significant difference was found in patient score of irregularity. The average VAS therapeutic pain score was 3.5 ± 1.43 out of 10. Conclusions: Low-energy CO 2 fractional laser therapy improved hypertrophic scars in a pediatric population. Therefore, for children with hypertrophic scar, low-energy CO 2 laser with less procedure pain may be more appropriate.

Clinical efficacy of CO2 fractional laser in treating post‐burn hypertrophic scars in children: A meta‐analysis

“…A total of 945 literature was retrieved through database retrieval, of which 75 replication studies as well as 345 systematic reviews, case reports and other studies were excluded. Studies without clear diagnostic criteria and no comparative data before and after treatment were excluded, and 10 pieces of literature were finally included for Meta-analysis [17][18][19][20][21][22][23][24][25][26] (Figure 1).…”

Fractional microneedle radiofrequency versus fractional carbon dioxide laser in the treatment of postburn hypertrophic scars

“…Won et al 29 found low-energy CO 2 fractional laser therapy improved POSAS scores of hypertrophic scars in children. 29 A retrospective study of 221 hypertrophic scars patients found significantly decreased VSS scores after fractional laser treatment. 30 Several mechanisms lie behind the success of fractional CO 2 .…”

“…El‐Zawahry et al 28 found hypertrophic scars showed textural improvement and a significant decrease of VSS and POSAS scores after three fractional CO 2 laser sessions. Won et al 29 found low‐energy CO 2 fractional laser therapy improved POSAS scores of hypertrophic scars in children 29 . A retrospective study of 221 hypertrophic scars patients found significantly decreased VSS scores after fractional laser treatment 30 …”

Optimal Timing of Fractional CO2 Laser on Cleft Lip Scars: A Single-Blind Randomized Controlled Cohort Study

“…13,14 Early treatment to prevent hypertrophic scar formation has been the main point of view in recent years. 15,16 Generally, CO 2 fractional laser therapy for scars has been applied at least 2 to 3 months after the surgery because scars are stable at this phase. 17 A recent study showed that early intervention with CO 2 fractional laser treatment significantly reduced scar formation less than 3 months after injury.…”