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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38 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 embedded in paraffin blocks. Sections were prepared for routine hematoxylin and eosin (H&E) staining, Masson's trichrome staining for collagen fibers, and orcein staining for elastic fibers. All sections were examined using a Primo Star™ microscope (Carl Zeiss AG, Oberkochen, Germany) with an integrated camera by which photomicrographs depicting the various histopathological and histochemical findings were obtained. Routinely stained H&E sections and orcein stained sections were blindly graded with regard to the appearance and pattern of dermal collagen and the appearance of dermal elastic tissue (Table 2). 7 Collagen fibers in Masson's trichrome-stained sections and elastic fibers in orcein-stained sections were quantitatively evaluated using image analysis by measuring the area percent of blue color and black color at magnification x 100 in five nonoverlapping fields using the Leica QWin image analysis software (Leica Microsystems, Wetzlar, Germany). Monitoring of side effects or complications. Patients were assessed at each laser session and at the end of the study for any side effects, including prolonged erythema (erythema lasting more than 3 days), pain (using a 0–10 visual analog scale, where 0=no pain and 10=worst imaginable pain, with mild pain scored 1–3, moderate pain scored 4–6, and severe pain scored 7–10), swelling, infection, hyperpigmentation, and hypopigmentation. Statistical methods. Data were statistically described in terms of mean ± SD and range or frequencies (number of cases) and percentages, when appropriate. Comparison between pre- and post-treatment values was done using paired t-tests in normally distributed data and the Wilcoxon signed-rank test for paired (matched) samples, when data were not normally distributed. The comparison between VSS and POSAS items was done using the Freidman test with post-hoc multiple pairwise comparison tests. The comparison between different scar sites was done using Kruskal- Wallis test. Correlation between various variables was evaluated using the Pearson moment correlation equation for linear relation in normally distributed variables and Spearman's rank correlation equation for non-normal variables/non-linear monotonic relation. P values less than 0.05 were considered to be statistically significant. All statistical TABLE 3. Clinical data of the patients NO. AGE (years) SEX SCAR DURATION (years) BURN TYPE SITE FITZPATRICK SKIN TYPE PREVIOUS TREATMENT 1 30 F 3 Scald Thigh III none 2 23 F 10 Fire Arm III none 3 20 F 3 Scald Arm IV Intralesional steroids 4 31 F 2 Fire Arm II Intralesional steroids 5 15 M 2 Scald Arm V none 6 29 F 19 Fire Arm III none 7 46 M 2 Fire Arm IV Intralesional steroids 8 19 F 17 Scald Arm IV none 9 27 F 1 Fire Breast III none 10 18 F 10 Scald Abdomen III none 11 22 M 15 Scald Arm IV Topical therapies 12 40 F 5 Fire Chest IV none 13 32 F 30 Scald Arm II Grafting 14 27 F 12 Fire Arm III none 15 26 F 21 Fire Thigh III none 16 13 F 12 Scald Arm III Surgical release 17 18 F 17 Scald Arm III none 18 20 F 20 Scald Arm II none 19 50 F 24 Fire Chest III none 20 21 M 21 Scald Arm IV none TABLE 2. Scoring of collagen fibers (routine H&E stain) and elastic fibers (Orcein stain) 7 SCORE COLLAGEN FIBERS ELASTIC FIBERS 0 Normal Normal 1 Collagen is fine and fibrillar Short fragmented elastic fibers 2 Combination of 1 and 3 Intermediate between 1 and 3 3 Collagen is fibrotic, vessels are perpendicular to the epidermis Fibrillar eleastic fibers, parallel to the epidermis 4 Combination of 3 and 5 Intermediate between 3 and 5 5 Collagen is extremely sclerotic and compacted in thick bundles Absent or nearly absent

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