Journal of Clinical and Aesthetic Dermatology

DEC 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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36 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY December 2017 • Volume 10 • Number 12 O R I G I N A L R E S E A R C H B Burn scars represent a major challenge in clinical and aesthetic dermatology. In addition to their significant morbidity, the side effects and lengthy courses of many therapeutic modalities for the treatment of burn scars place an additional burden on the patients. 1 Conventional ablative lasers, particularly conventional erbium-doped yttrium aluminium garnet laser, erbium YAG (Er:YAG) and conventional CO₂ lasers have been proven to be very effective in scar treatment by ablating the bulk of the tissue and inducing collagen remodeling and regenerative mechanisms. 2 However, the associated side effects and prolonged recovery period can limit patient satisfaction with these devices. 3 With the introduction of fractional photothermolysis, fractional ablative lasers have combined the impressive results of ablative lasers with the low side effects profile of nonablative lasers. 3 The use of fractional ablative CO₂ laser in treating burn scars has increased, with some investigators considering it to be the treatment of choice, particularly for scars due to third-degree burns. Fractional ablative CO₂ lasers are considered superior to fractional nonablative lasers due to their ability to release contracted scars and their unique chemical pathways that contribute to proper healing. 4 The aim of this present study was to assess the efficacy of fractional ablative CO₂ lasers in the treatment of mature burn scars according to clinical, histopathological, and histochemical perspectives. METHODS This uncontrolled, open-label clinical trial was approved by the Dermatology Department Research Ethical Committee (DermaREC) of the Cairo University in Cairo, Egypt, and informed consent forms were signed by enrolled subjects. Subjects. Subjects with burn scars presenting to the outpatient clinic of the Dermatology Department at Cairo University from March 2014 to August 2014 were screened for eligibility of enrollment in the trial. Included in the trial were subjects with at least 20cm 2 burn scars that were at least one year old. Subjects who received any form of treatment (specifically systemic retinoids) within the past A B S T R A C T OBJECTIVE: The purpose of this study was to evaluate the efficacy of fractional carbon dioxide laser use in the treatment of mature burn scars. DESIGN: This was an uncontrolled, open-label clinical trial. SETTING: The setting for this study was Dermatology Department at Cairo University in Cairo, Egypt. PARTICIPANTS: Twenty patients with mature burn scars were included in the study. MEASUREMENTS: Three fractional carbon dioxide laser sessions were given, 4 to 8 weeks apart. Primary outcome was measured using two scar scales, the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale. Secondary outcomes included evaluation of collagen and elastic fibers using routine hematoxylin and eosin, Masson's trichrome, and orcein stains. Outcomes were measured two months after the last laser session. RESULTS: Both Vancouver Scar Scale and Patient and Observer Scar Assessment Scale showed significant reduction following treatment (p<0.001). Scar relief and pliability improved most followed by vascularity. Pigmentation improved the least. Percent improvement in Patient and Observer Scar Assessment Scale patients' overall assessment was 44.44 percent. The pattern and arrangement of collagen and elastic fibers showed significant improvement (p<0.001, p=0.001, respectively), together with significant improvement in their amounts (p=0.020, p<0.001, respectively). No significant correlation existed between clinical and histopathological/ histochemical scores. Side effects and complications were mild and tolerable. CONCLUSION: Fractional carbon dioxide laser use is an effective and safe method for treating burn scars with a significant change in the opinion of the patients about their scar appearance. KEYWORDS: Fractional carbon dioxide (CO₂) laser, burn scars, collagen, elastic fibers, Masson's trichrome, orcein Efficacy of Fractional Carbon Dioxide Laser in the Treatment of Mature Burn Scars: A Clinical, Histopathological, and Histochemical Study by KHALED EL-HOSHY, MD, FAAD; MONA R. E. ABDEL-HALIM, MD; DINA DORGHAM, MD; SAFINAZ SALAH EL-DIN SAYED, MD; and MONA EL-KALIOBY, MSc Dr. El-Hoshy is Professor of Dermatology, Dr. Abdel-Halim is Diplomate of Dermatopathology and Professor of Dermatology, Dr. Dorgham is Lecturer of Dermatology, Dr. El-Din Sayed is Professor of Histology. and Ms. El-Kalioby is Assistant Lecturer of Dermatology with Cairo University in Cairo, Egypt. J Clin Aesthet Dermatol. 2017;10(12):36–43 FUNDING: No funding was received. DISCLOSURES: The authors have no financial conflicts relevant to the content of this article. CORRESPONDENCE: Mona R.E. Abdel-Halim, MD; Email:

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