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The efficacy, satisfaction, and safety of carbon dioxide (CO2) fractional laser in combination with pulsed dye laser (PDL) versus each one alone in the treatment of hypertrophic burn scars: a single-blinded randomized controlled trial

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Abstract

The tendency to use less-invasive laser-based methods with far more obvious effectiveness has been taken into consideration today for improvement of burning scars. The present study thus aimed to assess the efficacy of two laser-based techniques including pulsed dye laser (PDL) and ablative fractional CO2 laser (AFCL) and its combination on improving different aspects of burning scars regardless of the types of scar as hypertrophic or keloid scars. This randomized single-blinded clinical trial was performed on patients suffering hypertrophic or keloid burning scars. The patients were randomly assigned into three groups scheduling for treatment with PDL alone, AFCL alone, or its combination. All patients were visited before and 40 days after the last treatment session, and their scars were assessed. In all groups, significant improvement was revealed in the Vancouver scar scale (VSS) score, the color of scar, vascular bed in the scar, the and height of scar and its pliability; however, the improvement in each item was more highlighted in the group receiving a combination therapy with PDL and AFCL techniques. In this regard, the highest improvement was found in vascular bed and pliability in the combination therapy group as compared to other groups. Although the superiority of the combined group was not statistically significant, due to the high percentage of improvement in total VSS and most of its indicators, it can be clinically significant. The efficacy of the treatment protocols was different considering subgroups of mature and immature scars (less than 1 year), so that more improvement in pliability of scar, vascularity, and color of scar was found in the group scheduling for PDL + AFCL as compared to those who were treated with PDL alone in immature scar group but not in mature scar group. Combined treatment can be much more effective in improving the appearance and pathological characteristics of scars than each individual treatment. This effectiveness can be seen mainly in immature scars.

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Abbreviations

PDL:

pulsed dye laser

AFCL:

ablative fractional CO2 laser

VSS:

Vancouver scar scale

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Acknowledgements

The authors would like to thank the staff of the Rasool Akram Medical Complex Clinical Research Development Center (RCRDC) and the Dermatology and Stem Cell Research Center of Tehran University of Medical Sciences for their technical assistance in writing, editing, and improving quality of the paper.

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Author notes

  1. Maedeh Karimi Kivi and Alireza Jafarzadeh equally contributed to this study and are co-first authors.

Authors and Affiliations

  1. Medical Students Association, Iran University of Medical Sciences (IUMS), Tehran, Iran

    Maedeh Karimi Kivi & Sadaf Salehi

  2. Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran

    Alireza Jafarzadeh & Azadeh Goodarzi

  3. Minimally Invasive Surgery Research Center & Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

    Fatemeh Sadat Hosseini-Baharanchi

Authors
  1. Maedeh Karimi Kivi
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  2. Alireza Jafarzadeh
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  3. Fatemeh Sadat Hosseini-Baharanchi
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  4. Sadaf Salehi
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  5. Azadeh Goodarzi
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Contributions

A.G. conceived the manuscript topic and developed the study design. M.K.K. and A.J. conducted the data collection and interpretation of results as well as drafted the final manuscript. F.S.B. and S.S. performed the data analysis. M.K.K., A.J., and A.G. reviewed and commented on the final and revised manuscript draft. M.K.K. and A.J. contributed in finalizing the revised paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Azadeh Goodarzi.

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Conflict of interest

The authors declare no competing interests.

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Publisher's Note

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What is already known about this topic?

Laser therapy holds a unique role in the treatment of skin lesions.

particularly hypertrophic and keloid scars.

with two notable laser types being pulsed dye laser (PDL) and ablative fractional laser (AFCL).

Despite the fact that the effectiveness of each of the above lasers has been demonstrated in the literature.

there is a limited number of comprehensive clinical studies comparing the effectiveness of using the combination of these two lasers versus using each one individually.

What does this study add?

We demonstrated that although each of the targeted techniques improved different characteristics of scars.

the combination therapy was more effective and resulted in higher overall patient satisfaction compared to using PDL and fractional CO2 techniques alone.

We also made an interesting finding that the combined treatment of lasers showed significantly better results in treating immature scars compared to other types of scars.

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Kivi, M.K., Jafarzadeh, A., Hosseini-Baharanchi, F.S. et al. The efficacy, satisfaction, and safety of carbon dioxide (CO2) fractional laser in combination with pulsed dye laser (PDL) versus each one alone in the treatment of hypertrophic burn scars: a single-blinded randomized controlled trial. Lasers Med Sci 39, 69 (2024). https://doi.org/10.1007/s10103-024-03976-6

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