Fractional CO2 laser treatment for burn scar improvement: A systematic review and meta-analysis

Choi, Kyu-Myung; Williams, Eva; Pham, Christopher H; Collier, Zachary J; Dang, Justin; Yenikomshian, Haig A; Gillenwater, T Justin

doi:10.1016/j.burns.2020.10.026

Cited by 28 publications

(28 citation statements)

References 21 publications

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“…Although several studies report laser therapy's efficacy in improving scar characteristics such as itch and tightness exist, few discuss adverse effects 14,15 . For example, a recent systematic review investigating the efficacy of FCL found that only 4 studies reported adverse events 11 . Of these 4 studies, 2 studies reported single incidents of biopsy site infection and allergic contact dermatitis secondary to surgical disinfectant, and these adverse effects are not directly associated with laser therapy 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Nonablative laser therapy such as pulse dye laser uses selective thermolysis for scar treatment and may be efficacious in improving scar characteristics such as texture, pigmentation, and pliability 11 . Ablative laser therapy such as fractional CO 2 laser (FCL) uses energy transfer principles to create specific areas of therapeutic healing by reducing proinflammatory cytokines and inducing alterations in scar collagen composition 11 . This fractional photothermolysis has been shown to potentially reduce scar thickness and improve pliability and dyschromia.…”

mentioning

confidence: 99%

“…11 Ablative laser therapy such as fractional CO 2 laser (FCL) uses energy transfer principles to create specific areas of therapeutic healing by reducing proinflammatory cytokines and inducing alterations in scar collagen composition. 11 This fractional photothermolysis has been shown to potentially reduce scar thickness and improve pliability and dyschromia. Significant improvements in scar appearance, tightness, and pruritis have been shown in patients undergoing FCL for scars after burn injury.…”

mentioning

confidence: 99%

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Treatment of Hypertrophic Burn Scars With Laser Therapy

Won,

Cooper,

Gillenwater

et al. 2023

Ann Plast Surg

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Hypertrophic scarring, characterized by excessive scar tissue formation, is a debilitating outcome that significantly impairs physical and psychosocial recovery after burn injury. Hypertrophic scarring affects a substantial proportion of burn survivors, with reported prevalence as high as 70%. Fractional CO2 laser (FCL) therapy, a therapy commonly used in acne scar treatment or skin rejuvenation, has become popular in treating hypertrophic scars. Little is known regarding FCL's adverse events for burn scar treatment. We hypothesize that FCL is a safe treatment modality with minimal adverse events in the management of hypertrophic burn scars. This is a retrospective chart review of adverse events after FCL at 2 centers within a single institution. Burn patients undergoing FCL between May 1, 2019, and June 1, 2021 were included. Demographics, injury etiology, laser treatment details, and adverse events were collected. A total of 170 patients, 77 (45.3%) males and 93 (54.7%) females, underwent 544 FCL therapies for burn scars. The average number of treatments per patient was 3 ± 2.23, with a range of 1 to 17 sessions. From the total 544 laser therapy sessions, 13 adverse events (2.4%) were reported. There were 5 reports (0.9%) of increased postprocedural pain and 1 report (0.2%) of increased paresthesia/numbness to laser site. Three instances (0.6%) of increased erythema and 4 reports (0.7%) of epidermal sloughing or blistering were reported. All but 5 patients (2.9%) reported improvements to scar symptoms. This study demonstrates minimal adverse events associated with FCL for hypertrophic burn scar treatment.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Treatment of Hypertrophic Burn Scars With Laser Therapy

Won,

Cooper,

Gillenwater

et al. 2023

Ann Plast Surg

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“…Fractional ablative laser is well studied and effective at decreasing pruritus and neuropathic pain [48]. Collagen remodeling leads to improvements in scar pliability, color, and texture.…”

Section: Scar Revisionmentioning

confidence: 99%

“…Collagen remodeling leads to improvements in scar pliability, color, and texture. Contractures are also improved with fractional ablative laser, although improvement is inferior to surgery, which remains first-line therapy for contractures [48]. Scar revision with fractional ablative laser often requires multiple treatments, although clinical benefit can be seen after one treatment [48,49].…”

Section: Scar Revisionmentioning

confidence: 99%

Update on lasers in pediatric dermatology: how primary care providers can help patients and families navigate appropriate treatment options and timelines

Osborn

Nieman

2023

Current Opinion in Pediatrics

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Purpose of review The use of lasers in pediatric dermatology is well established, but recent literature has expanded the evidence for specific timelines of treatment. Additionally, new devices and combinations with medical therapy have improved outcomes and treatment options for various conditions. Recent findings Pulsed dye laser remains the first-line laser for vascular lesions. Recent guidelines support early initiation of laser treatment in port-wine birthmarks to optimize outcomes. For hemangiomas, laser treatment can offer a meaningful addition to oral propranolol therapy. Lasers with shorter wavelengths offer improved outcomes with decreased downtime for pigmented lesions. General anesthesia in the pediatric population continues to be a controversial topic, and the decision to perform laser under general versus topical anesthesia requires discussion with family of risks and benefits. Summary Primary care providers can benefit their patients by prompt referral to dermatology for discussion of laser treatment. Port-wine birthmarks require referral in the first weeks of life so that laser treatment can be initiated if appropriate. Although many dermatologic conditions cannot be completely cleared or cured with laser, treatment can offer meaningful outcomes and benefit for patients and families.

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Altering CO₂ Laser Pulse Energy Settings Did Not Influence Differential Gene Transcription in Normal Skin in a Red Duroc Pig Model

Hussein,

Travis,

Moffatt

et al. 2024

Lasers Surg Med

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ObjectivesFractional ablative CO2 lasers are used clinically to treat cutaneous burn scars with reported varying degrees of effectiveness. It was hypothesized that different laser pulse energy settings may lead to differential gene transcription in a porcine model.MethodsUninjured skin from red Duroc pigs was treated with a fractional ablative CO2 laser set to 70, 100, or 120 mJ across the abdomen (n = 4 areas per treatment). Punch biopsies of both treated and untreated sites were taken before treatment (baseline), at 30 min, and at each hour for 6 h and stored in All‐Protect tissue reagent. The biopsies were then used to isolate RNA, which was subsequently used in qRT‐PCR for eight genes associated with wound healing and the extracellular matrix: CCL2, IL6, FGF2, TIMP1, TIMP3, COL1A2, MMP2, and DCN. RPL13a was used as a housekeeping gene to normalize the eight genes of interest. One‐way ANOVA tests were used to assess for differences among laser pulse energies and two‐way ANOVA tests were used to assess the differences between treated and untreated areas.ResultsWhile six of the eight genes were upregulated after treatment (p < 0.05), there were no significant differences in gene expression between the different laser pulse energies for any of the eight genes.ConclusionWhile laser treatment is correlated with a positive and significant upregulation for six of the eight genes 4 h after intervention, the pulse energy settings of the laser did not lead to a statistically significant difference in gene transcription among the treatment areas. Different laser pulse energies may not be required to induce similar cellular responses in a clinical setting.

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Fractional CO2 laser treatment for burn scar improvement: A systematic review and meta-analysis

Cited by 28 publications

References 21 publications

Treatment of Hypertrophic Burn Scars With Laser Therapy

Treatment of Hypertrophic Burn Scars With Laser Therapy

Update on lasers in pediatric dermatology: how primary care providers can help patients and families navigate appropriate treatment options and timelines

Altering CO₂ Laser Pulse Energy Settings Did Not Influence Differential Gene Transcription in Normal Skin in a Red Duroc Pig Model

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Fractional CO2 laser treatment for burn scar improvement: A systematic review and meta-analysis

Cited by 28 publications

References 21 publications

Treatment of Hypertrophic Burn Scars With Laser Therapy

Treatment of Hypertrophic Burn Scars With Laser Therapy

Update on lasers in pediatric dermatology: how primary care providers can help patients and families navigate appropriate treatment options and timelines

Altering CO2 Laser Pulse Energy Settings Did Not Influence Differential Gene Transcription in Normal Skin in a Red Duroc Pig Model

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Altering CO₂ Laser Pulse Energy Settings Did Not Influence Differential Gene Transcription in Normal Skin in a Red Duroc Pig Model