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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42 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 noticeably. 17 This is mostly due to the effect of cytokines and growth factors that influence fibroblast activity early on in wound healing. On the other hand, neither the age of the patient, nor the scar site have been found to influence the percentage of clinical improvement. Haedersdal et al 18 found no differences in the efficacy of treatment with respect to subject age, anatomical location of the scar, or duration of the scar. In treating different types of scar, El Taweel and Abd El-Rahman found that clinical improvement was better in younger patients. 19 Regarding side effects and complications, the pain was generally tolerable. Hyperpigmentation was observed in three patients (17.6%), with skin type III. This was mostly attributed to the close spacing and non-adjuvant use of bleaching agents. El Taweel and Abd El-Rahman 19 reported the development of hyperpigmentation in three out of 25 patients with mature scars (12%) treated by fractional CO₂ laser. As in our cases, hyperpigmentation improved with bleaching agents. In the current study, one patient experienced a significant lightening of her scar, which can be a consequence of skin rejuvenation. 20 Actual hypopigmentation developed in only two cases (11.7%). In one patient, it was in the form of a widening of an initially hypopigmented area, which may have been attributed to deep stacking causing thermal injury. The other case developed hypopigmentation following early removal of the crust by the patient. The incidence of hypopigmentation in the current study is much lower than that reported by Salles et al. 21 Generally, the developed side effects did not affect patients' satisfaction with the achieved results as indicated by significant reduction in POSAS patients' overall assessment scores. In conclusion, fractional CO₂ laser can be an effective and safe modality in the treatment of post-burn scars. It achieves significant change in the opinion of the patients about their scar appearance. Limitations of our study included its small sample size and the relatively short follow-up period. More sessions are needed to reach the ultimate response. Wider spacing can be used to avoid confluent thermal damage and reduce side effects. The concomitant use of bleaching creams can also reduce the incidence of hyperpigmentation. REFERENCES 1. Brusselaers N, Pirayesh A, Hoeksema H, et al. Burn scar assessment: a systematic review of different scar scales. J Surg Res. 2010; 164(1):e115–e123. 2. Tanzi EL, Alster TS. Single-pass carbon dioxide versus multiple-pass Er:YAG laser skin resurfacing: a comparison of postoperative wound healing and side-effect rates. Dermatol Surg. 2003; 29(1):80–84. 3. Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol. 2008; 58(5):719–737. 4. Waibel J, Beer K. Ablative fractional laser resurfacing for the treatment of a third-degree burn. J Drug Dermatol. 2009;8(3):294–297. 5. Sullivan T, Smith J, Kermode J, et al. Courtemanche DJ. Rating the burn scar. J Burn Care Rehabil. 1990;11(3):256–260. TABLE 9. Comparison of orcein stain grading score and the mean area % of elastic fibers (orcein stain) before and after treatment. STAIN RANGE MEAN ± SD Orcein stain grading score Before treatment 2–5 3.71±1.26 After treatment 1–5 2.88± 1.31 p value* 0.001 Mean area % of elastic fibres (orcein stain) Before treatment 0.17–3.65 1.41±0.97 After treatment 2.46–13.75 7.06±3.30 p value* <0.001 SD: standard deviation *p value significant if <0.05. FIGURE 6. Photomicrographs representing results of orcein staining for elastic fibers for the same case presented in Figure 4, before treatment (A) and after treatment (B). Elastic fibers were completely absent from the scar tissue before treatment (Grade 5). Following treatment, elastic fibers started to appear as a combination of short fragmented and fibrillar fibers (Grade 2) (Orcein stain, original magnification x 40). A B

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