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Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach

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Abstract

In this study, we aimed to quantify the effects of fractional ablative carbon dioxide laser therapy in the treatment of widespread hypertrophic burn scars. While many different pilot studies have described the potential of the technology and expert groups and current guidelines, alike, recommend its use, the level of evidence for the efficacy of fractional CO2-laser treatment for burn scars is currently very low. Ten patients (three male, seven female) with hypertrophic burn scars were treated with a single course of fractional CO2-laser therapy in an in-patient controlled setup, using a standardized treatment paradigm. Documentation was based on modern scar scales and questionnaires, like the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), and Dermatology Life Quality Index (DLQI), as well as state of the art clinical measurements (PRIMOS, Cutometer). Over the course of 6 months after treatment, VSS and POSAS scores showed significant improvement in the rating of scar parameters, as did the quality of life rating according to the DLQI. In the treated scars, surface relief improved significantly, as S max decreased by 1893 μm (−36.92%) (p = 0.0273) and S z by 1615 μm (−36.37%) (p = 0.0488). Scar firmness in treated scars could be reduced by 30% after one treatment session, as R 0 improved by 0.0797 mm (+30.38%) (p = 0.0212). Fractional ablative CO2-laser treatment is a safe and efficacious option for the treatment of hypertrophic burn scars. While more treatment sessions are required for satisfying results, significant improvement is already apparent after a single course of treatment.

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References

  1. American Burn Association (2016) Burn incidence and treatment in the United States: http://www.ameriburn.org

  2. Gangemi E, Gregori D, Berchialla P et al (2008) Epidemiology and risk factors for pathologic scarring after burn wounds. Arch Facial Plast Surg 10:93–102

    Article  PubMed  Google Scholar 

  3. Gauglitz GG (2013) Management of keloids and hypertrophic scars: current and emerging options. Clin Cosmet Investig Dermatol 6:103–114

    Article  PubMed  PubMed Central  Google Scholar 

  4. Clayton NA, Ward EC, Maitz PK (2015) Full thickness facial burns: outcomes following orofacial rehabilitation. Burns : journal of the International Society for Burn Injuries. 41:1599–1606

    Article  CAS  Google Scholar 

  5. Kowalske KJ (2011) Hand burns. Phys Med Rehabil Clin N Am 22:249–259 vi

    Article  PubMed  Google Scholar 

  6. Miller T, Bhattacharya S, Zamula W, Lezotte D, Kowalske K, Herndon D et al (2013) Quality-of-life loss of people admitted to burn centers, United States. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 22:2293–2305

    Article  Google Scholar 

  7. Park YS, Lee JW, Huh GY, Koh JH, Seo DK, Choi JK et al (2012) Algorithm for primary full-thickness skin grafting in pediatric hand burns. Archives of plastic surgery 39:483–488

    Article  PubMed  PubMed Central  Google Scholar 

  8. Philp L, Umraw N, Cartotto R (2012) Late outcomes after grafting of the severely burned face: a quality improvement initiative. Journal of burn care & research : official publication of the American Burn Association 33:46–56

    Article  Google Scholar 

  9. Anzarut A, Olson J, Singh P, Rowe BH, Tredget EE (2009) The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis. J Plast Reconstr Aesthet Surg 62:77–84

    Article  PubMed  Google Scholar 

  10. Gold MH, Berman B, Clementoni MT, Gauglitz GG, Nahai F, Murcia C (2014) Updated international clinical recommendations on scar management: part 1—evaluating the evidence. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al] 40:817–824

    CAS  Google Scholar 

  11. Gold MH, McGuire M, Mustoe TA, Pusic A, Sachdev M, Waibel J et al (2014) Updated international clinical recommendations on scar management: part 2—algorithms for scar prevention and treatment. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al] 40:825–831

    CAS  Google Scholar 

  12. Anderson RR, Donelan MB, Hivnor C, Greeson E, Ross EV, Shumaker PR et al (2014) Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report. JAMA dermatology. 150:187–193

    Article  PubMed  Google Scholar 

  13. Dams SD, de Liefde-van Beest M, Nuijs AM, Oomens CW, Baaijens FP (2010) Pulsed heat shocks enhance procollagen type I and procollagen type III expression in human dermal fibroblasts. Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI) 16:354–364

    CAS  Google Scholar 

  14. Helbig D, Paasch U (2011) Molecular changes during skin aging and wound healing after fractional ablative photothermolysis. Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI) 17:119–128

    Article  Google Scholar 

  15. Ozog DM, Liu A, Chaffins ML, Ormsby AH, Fincher EF, Chipps LK et al (2013) Evaluation of clinical results, histological architecture, and collagen expression following treatment of mature burn scars with a fractional carbon dioxide laser. JAMA dermatology 149:50–57

    Article  PubMed  Google Scholar 

  16. Han JY, Nam GW, Lee HK, Kim MJ, Kim EJ (2015) New analysis methods for skin fine-structure via optical image and development of 3D skin Cycloscan(™). Skin research and technology: official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI) 21:387–391

  17. Prager W, Steinkraus V (2010) A prospective, rater-blind, randomized comparison of the effectiveness and tolerability of Belotero (R) basic versus Restylane (R) for correction of nasolabial folds. European journal of dermatology : EJD 20:748–752

    PubMed  Google Scholar 

  18. Chapas AM, Brightman L, Sukal S, Hale E, Daniel D, Bernstein LJ et al (2008) Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing. Lasers Surg Med 40:381–386

    Article  PubMed  Google Scholar 

  19. Friedman PM, Skover GR, Payonk G, Geronemus RG (2002) Quantitative evaluation of nonablative laser technology. Seminars in cutaneous medicine and surgery 21:266–273

    Article  PubMed  Google Scholar 

  20. Gauglitz GG, Bureik D, Dombrowski Y, Pavicic T, Ruzicka T, Schauber J (2012) Botulinum toxin A for the treatment of keloids. Skin Pharmacol Physiol 25:313–318

    Article  CAS  PubMed  Google Scholar 

  21. Reinholz M, Schwaiger H, Heppt MV, Poetschke J, Tietze J, Epple A et al (2015) Comparison of two kinds of lasers in the treatment of acne scars. Facial plastic surgery : FPS 31:523–531

    Article  CAS  PubMed  Google Scholar 

  22. Akhtar N, Zaman SU, Khan BA, Amir MN, Ebrahimzadeh MA (2011) Calendula extract: effects on mechanical parameters of human skin. Acta Pol Pharm 68:693–701

    PubMed  Google Scholar 

  23. Held M, Rahmanian-Schwarz A, Rothenberger J, Schiefer J, Janghorban Esfahani B, Schaller HE et al (2015) Alteration of biomechanical properties of burned skin. Burns : journal of the International Society for Burn Injuries 41:789–795

    Article  CAS  Google Scholar 

  24. Luebberding S, Krueger N, Kerscher M (2014) Mechanical properties of human skin in vivo: a comparative evaluation in 300 men and women. Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI) 20:127–135

    Article  CAS  Google Scholar 

  25. Ohshima H, Kinoshita S, Oyobikawa M, Futagawa M, Takiwaki H, Ishiko A et al (2013) Use of Cutometer area parameters in evaluating age-related changes in the skin elasticity of the cheek. Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI) 19:e238–e242

    Article  Google Scholar 

  26. Draaijers LJ, Tempelman FR, Botman YA, Tuinebreijer WE, Middelkoop E, Kreis RW et al (2004) The Patient and Observer Scar Assessment Scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113:1960–1965 discussion 1966-1967

    Article  PubMed  Google Scholar 

  27. Bianchi FA, Roccia F, Fiorini P, Berrone S (2010) Use of Patient and Observer Scar Assessment Scale for evaluation of facial scars treated with self-drying silicone gel. The Journal of craniofacial surgery. 21:719–723

    Article  PubMed  Google Scholar 

  28. Jina H, Simcock J (2011) Median sternotomy scar assessment. The New Zealand medical journal 124:57–62

    PubMed  Google Scholar 

  29. Maher SF, Dorko L, Saliga S (2012) Linear scar reduction using silicone gel sheets in individuals with normal healing. J Wound Care 21(602):604–606 608-609

    Google Scholar 

  30. van der Wal MB, Tuinebreijer WE, Bloemen MC, Verhaegen PD, Middelkoop E, van Zuijlen PP (2012) Rasch analysis of the Patient and Observer Scar Assessment Scale (POSAS) in burn scars. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 21:13–23

    Article  Google Scholar 

  31. Vercelli S, Ferriero G, Sartorio F, Stissi V, Franchignoni F (2009) How to assess postsurgical scars: a review of outcome measures. Disabil Rehabil 31:2055–2063

    Article  PubMed  Google Scholar 

  32. Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ (1990) Rating the burn scar. The Journal of burn care & rehabilitation 11:256–260

    Article  CAS  Google Scholar 

  33. Akita S, Akino K, Yakabe A, Imaizumi T, Tanaka K, Anraku K et al (2007) Combined surgical excision and radiation therapy for keloid treatment. The Journal of craniofacial surgery 18:1164–1169

    Article  PubMed  Google Scholar 

  34. Cassuto DA, Scrimali L, Sirago P (2010) Treatment of hypertrophic scars and keloids with an LBO laser (532 nm) and silicone gel sheeting. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology 12:32–37

    Article  Google Scholar 

  35. Cromi A, Ghezzi F, Gottardi A, Cherubino M, Uccella S, Valdatta L (2010) Cosmetic outcomes of various skin closure methods following cesarean delivery: a randomized trial. Am J Obstet Gynecol 203(36):e31–e38

    Google Scholar 

  36. Balci DD, Inandi T, Dogramaci CA, Celik E (2009) DLQI scores in patients with keloids and hypertrophic scars: a prospective case control study. Journal der Deutschen Dermatologischen Gesellschaft =. Journal of the German Society of Dermatology : JDDG 7:688–692

    PubMed  Google Scholar 

  37. Bock O, Schmid-Ott G, Malewski P, Mrowietz U (2006) Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res 297:433–438

    Article  PubMed  Google Scholar 

  38. Cresce ND, Davis SA, Huang WW, Feldman SR (2014) The quality of life impact of acne and rosacea compared to other major medical conditions. Journal of drugs in dermatology : JDD 13:692–697

    PubMed  Google Scholar 

  39. Finlay AY, Khan GK (1994) Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use. Clin Exp Dermatol 19:210–216

    Article  CAS  PubMed  Google Scholar 

  40. Reinholz M, Poetschke J, Schwaiger H, Epple A, Ruzicka T, Gauglitz GG (2015) The dermatology life quality index as a means to assess life quality in patients with different scar types. J Eur Acad Dermatol Venereol 29:2112–2119

  41. Poetschke J, Schwaiger H, Gauglitz GG (2017) Current and emerging options for documenting scars and evaluating therapeutic progress. Dermatol Surg 43(Suppl 1):S25–s36

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Authors and Affiliations

  1. Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Frauenlobstr. 9-11, 80337, Munich, Germany

    Julian Poetschke, Markus Reinholz, Hannah Schwaiger, Stephanie Steckmeier, Thomas Ruzicka & Gerd G. Gauglitz

  2. Department of Plastic, Reconstructive, Hand, and Burn Surgery, Bogenhausen Academic Hospital, Munich, Germany

    Ulf Dornseifer

  3. Skin House, Milan, Italy

    Matteo Tretti Clementoni

Authors
  1. Julian Poetschke
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  2. Ulf Dornseifer
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  3. Matteo Tretti Clementoni
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  4. Markus Reinholz
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  5. Hannah Schwaiger
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  6. Stephanie Steckmeier
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  7. Thomas Ruzicka
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  8. Gerd G. Gauglitz
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Corresponding author

Correspondence to Gerd G. Gauglitz.

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Conflict of interest

Gerd G. Gauglitz serves as speaker and advisor for Lumenis. All other authors declare no conflict of interest.

Role of founding source

No outside funding was received for this study.

Ethical approval

This study was approved by the ethics committee of the medical faculty of the Ludwig-Maximilian-University (LMU), Munich, Germany, and it complies with the standards set within the Helsinki Declaration of 1964 and its consecutive revisions.

Informed consent

Informed consent regarding participation in the study, laser treatment, and study-related documentation was obtained from all individual participants included in the study.

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Poetschke, J., Dornseifer, U., Clementoni, M.T. et al. Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach. Lasers Med Sci 32, 1031–1040 (2017). https://doi.org/10.1007/s10103-017-2204-z

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  • DOI: https://doi.org/10.1007/s10103-017-2204-z

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