Journal of Clinical and Aesthetic Dermatology

DEC 2017

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

Issue link: https://jcadonline.epubxp.com/i/918586

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40 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 improved with the application of topical bleaching creams. Hypopigmentation developed in two patients (11.8%) and was persistent at the two-month follow-up visit. One patient experienced lightening of her scar, where the treated area appeared lighter as a consequence of rejuvenation of the skin. Histopathological and histochemical results. After treatment, both the H&E grading score of collagen fibers and the area percentage of collagen fibers (stained with Masson's trichrome) showed a significant reduction (i.e., improvement) (p<0.001 and p=0.020, respectively) (Table 8, Figures 4 and 5). The orcein stain grading score showed a significant reduction (i.e., improvement) and the mean area percentage of elastic fibers (based on orcein stain results) showed a significant increase (i.e., improvement) after treatment (p=0.001 and p<0.001 respectively) (Table 9, Figure 6). Clinicopathological correlations. The percentage improvement in the H&E grading score of collagen fibers and the percentage improvement in the mean area percentage of collagen showed no significant correlation with the percentage improvement in VSS (r= -0.268, p=0.313 and r= -0.084, p=0.749, respectively) or total POSAS (r= 0.169, p=0.517 and r= -0.112, p=0.669, respectively). Similarly, the percentage improvement in elastic fibers grading score and the percentage improvement in mean area percentage of elastic fibers showed no significant correlation with the percentage improvement in VSS (r=0.28, p=0.276 and r=0.212, p=0.414, respectively) or total POSAS (r=0.393, p=0.119 and r=0.476, p=0.053, respectively). DISCUSSION Objective measures showed significant improvement of the burn scars following fractional CO₂ laser treatment and a significant change in the opinion of the patients about their scar appearance. This was in agreement with the findings of several researchers using different parameters. 4, 7–10 In the current study, improvement was significantly higher for relief and pliability, followed by vascularity and pigmentation. This was similar to the finding by Kim et al, 11 who reported that ablative fractional CO₂ laser use was more effective in improving pliability and TABLE 8. Comparison of H&E grading score and mean area percent of collagen (Masson's trichrome) before and after treatment STAIN RANGE MEAN±SD H&E grading score of collagen fibers Before treatment 2–5 4.12±0.78 After treatment 2–4 2.71±0.92 p value* < 0.001 Mean area % of collagen (Masson's trichrome) Before treatment 6.44–35.19 18.69±7.70 After treatment 2.62–21.64 11.52±6.16 p value* 0.020 H&E: haemotoxylin and eosin; SD: standard deviation *p value significant if <0.05. TABLE 4. Results of VSS, total POSAS, and POSAS patients' overall assessment before and after treatment SCALE RANGE MEAN±SD Total POSAS Before treatment 5–11 7.76±2.07 After treatment 2.5–7 5.18±1.18 P value* <0.001 Total POSAS Before treatment 51–87 65.71±11.23 After treatment 26–56 38.35±9.92 P value* <0.001 POSAS patient overall assessment Before treatment 6–10 3–7 After treatment 9.12 ± 1.26 5.12±1.16 P value* <0.001 VSS: Vancouver Scar Scale: POSAS: Patient and Observer Scar Assessment Scale; SD: standard deviation *p value significant if less than 0.05 TABLE 5. Percentage improvement in VSS, total POSAS, and POSAS patients' overall assessment SCALE RANGE MEAN±SD VSS 0–38.46 19.90±12.17 Total POSAS 12.12–40.91 27.62±7.75 POSAS patient overall assessment 11.11–66.66 44.44±12.42 VSS: Vancouver Scar Scale; POSAS: Patient and Observer Scar Assessment Scale; SD: standard deviation TABLE 6. Percentage improvement in each variable in Vancouver Scar Scale (VSS) VARIABLE RANGE MEAN±SD Pigmentation 0.0–0.0 0.00±0.00 Vascularity -(50.0)–100.0 39.21±46.00 Pliability 0–100.0 53.43±22.26 Height 0–100.0 29.4±30.92 p value* < 0.0001 SD: standard deviation *p value significant if <0.05 TABLE 7. Percentage improvement in each variable in Patient and Observer Scar Assessment Scale Observer Scale VARIABLE RANGE MEAN±SD Vascularity -(50.0)–80.0 38.25±31.43 Pigmentation -(10.0)–66.7 37.07±19.81 Thickness 10.0–66.7 47.42 ± 14.66 Relief 21.4–66.7 53.43±11.18 Pliability 33.3–78.6 49.06±13.99 p value* 0.0071 SD: standard deviation *p value significant if <0.05

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