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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37 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 six months, with a previous history of adverse outcomes related to laser therapy, or with a contraindication to treatment with fractional CO₂ laser were excluded. Also, subjects with burn scars present only in the head and neck areas were excluded. Ultimately, twenty patients (16 women [80%] and 4 men [20%]; mean ± standard deviation [SD] age: 26.35±9.85 years, range: 13–50 years) were enrolled. Information on cause, site, duration of the burn scars, and previous treatment modalities used was documented for each subject. Laser treatment. The target scars underwent three treatment sessions using a fractional ablative 10,600 nm CO₂ laser (SmartXide DOT®; DEKA, Florence, Italy). Sessions were performed 4 to 8 weeks apart. Topical anesthesia (lidocaine 2.5% and prilocaine 2.5%) was applied to the target area 30 to 60 minutes before the procedure, and then the area was washed off and properly dried before laser application. The following parameters were used in a single pass (in all cases): stacking, 3; power, 18 Watts; dwell time, 600µsec; and spacing, 200µm. Post-laser home treatment included topical application of panthenol 2% twice daily for four weeks. Patients were also instructed to use sunscreen regularly (for scars in sun-exposed sites) and to avoid removal of the crust. Primary outcome measures. The Vancouver Scar Scale (VSS) (Table 1) 1,5 and the Patient and Observer Scar Assessment Scale (POSAS) (Figure 1) 6,7 were used for measuring primary outcome. Both were calculated at baseline and two months after the last laser treatment. The principal investigator calculated the VSS score and the observer's portion of the POSAS. Each participating subject completed the patient's portion of the POSAS. Patient overall assessment scores on a scale from 1 to 10 were also calculated. 6 Total POSAS scores were then calculated. Secondary outcome measures. Secondary outcomes included histological and histochemical evaluation of collagen and elastic fibers. A pre-treatment, 4mm punch biopsy was taken from the target scar of each subject and the site of the biopsy was marked and photographed. A post-treatment biopsy was taken adjacent to the pre-treatment biopsy two months after the last laser treatment. Biopsies were fixed in 10% neutral buffered formalin and TABLE 1. Vancouver Scar Scale (VSS) 1 1. PIGMENTATION 2. VASCULARITY 0= Normal color (resembles nearby skin) 1= Hypopigmentation 2= Hyperpigmentation 0= Normal 1= Pink 2= Red 3= Purple 3. PLIABILITY 4. HEIGHT (MM) 0= Normal 1= Supple (flexible with minimal resistance) 2= Yielding (giving way to pressure) 3= Firm (solid/inflexible, not easily moved, resistant to manual pressure) 4=Banding (rope-like, blanches with extension of scar, does not limit range of motion) 5=Contracture (permanent shortening of scar producing deformity or distortion, limits range of motion) 0= Normal (flat) 1= <2mm 2= >2mm and <5mm 3= >5 mm FIGURE 1. Patient and Observer Scar Assessment Scale (POSAS)

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