Rufus R. Noble The following is a brief introduction to the topic: Laser devices are very effective in treating scars. 1 Lasers are widely used to treat scars, including those caused by acne, surgery, and injuries, as well as keloids. 1,2 Laser treatment for burn scars is less common and not offered in many hospitals.
In 2017, burn injuries in the world exceeded 1000 per 100,000 people. The majority of burns affect 20% of the surface of the body and are primarily skin-related. This highlights the importance of dermatologists. 3
Burn scars are a serious problem that can affect the quality of life for patients. 4 Disfigurement and contractures can have a significant impact on the patient’s quality of life. They reduce mobility and cause pain. This type of injury is also stigmatizing and can lead to depression, anxiety, and low self-esteem. 5
Burn scars can be treated with a variety of conservative methods, such as silicone gel, injections of corticosteroids, pressure therapy, and therapeutic massage. 6 These treatments are often combined with surgical procedures, such as resection and closure of the burn wound, Z-plasty, or flaps. 7
LasersLasers have been proven to be effective in treating burn injuries. Lasers are minimally invasive and have a low chance of side effects. They also promote rapid recovery. They are, therefore, included in certain treatment protocols along with conservative treatments that are modestly effective but have a high level of morbidity. 8 Lasers can be used to reduce the treatment area, resulting in fewer complications after surgery. 9
Lasers are classified according to their mechanism of action as ablative/nonablative and fractional/nonfractional. 10 The most common mechanisms for treating burn scars can be found in Table 1.
Table 1.The main scar abnormalities and the lasers available for treatment.
AbnormalityLasers
Erythema The 585 and 595 nm PDLs, the 500 to 1200 nm IPLs, 1064 nm NdYAG (ms), and 532 nm kTP (ms) are all available.
Thickness AFL10600-nm carbon dioxide2940-nm Er:YAGNAFL1540- and 1550-nm Er:glass
Flexibility 10600-nm carbon dioxide
Pigmentation AFL, NAFL, QS 755-nm alexandrite, QS 1064-nm Nd: YAG, QS 694-nm ruby, QS 532-nm KTP
Abbreviations: AFL, ablative fractional laser; IPL, intense pulsed light; KTP, potassium-titanyl-phosphate; LADD, laser-assisted drug delivery; ms, milliseconds (long pulse); NAFL, nonablative fractional lasers; Nd: YAG, neodymium: yttrium-aluminum-garnet; PDL, pulsed dye laser; QS, Q-switched (nanoseconds/picoseconds, short pulse).
These parameters differ greatly due to the heterogeneous nature of the scars themselves and the wide variety of devices available ( a href=”https://www.actasdermo.org/es-translated-article-laser treatment burn articulo S0001731022008316#tbl0010″>Table 2/a>). These parameters are different due to the heterogeneous scars and the variety of devices that exist ( Table 2).
Table 2.The main lasers used to treat burn scars: Level of evidence and grade of recommendation.
LasersGrades of recommendation evidence level
10600-nm carbon dioxide. You can also find out more about the following: You can also find out more about the company by clicking here.
PDL 585-nm and 595 -nm B You can also find out more about the company by clicking here.
Er: glass 1540- and-1550-nm B I
755-nm alexandrite C The Third Party?
Abbreviations: Erbium, PDL, pulsed-dye laser.
Scar EvaluationIn more than 70% of cases, burn scars result in abnormal skin healing due to irregularities in texture, thickness, erythema, and pigmentation. 11 This is true for burns that affect the deeper layers of the dermis. For example, burns of the second or third degree, which could require laser treatment. Burns that are superficial and don’t reach the reticular layer of the dermis do not usually cause abnormal scarring or complications. 12
The scars are classified according to their thickness: keloids, hypertrophic, and atrophic. They can also be classified according to their pigmentation: hypopigmented and hyperpigmented, depending on the adjacent healthy skin. Erythema can also be seen, particularly in recent and active scars. eleven
Before initiating or monitoring treatment, it is important to assess the severity of scarring. The Vancouver Scar Scale 13 is the most commonly used method. It evaluates vascularization and thickness as well as flexibility and pigmentation. The Patient and Observer Scale (POSAS), however, is the most comprehensive, as it includes subjective symptoms such as itching and pain. 14 An appropriate evaluation is necessary to select the best laser treatment. In order to select the best device and parameters for the treatment, it is important to consider both the characteristics and location of the scar.
Vascular LasersPulsed dye lasers are nonablative vascular lasers with wavelengths between 585nm and 595nm. 15 Oxyhemoglobin is the target molecule for selective photothermolysis. This causes coagulation and necrosis in the blood vessels. 16 The PDLs have been considered to be the best laser for treating burn scars with vascular components. They also carry a very low risk of side effects.
PDLs have been shown to be effective in treating scar erythema. This is due to excess neovascularization occurring during the scarring procedure. 17 The treatment of hypertrophic lesions is also effective through the destruction of collagen due to tissue hypoxia resulting from coagulation. 18 Allison et al. 19 reported an improvement in itch after treatment of the vascular component. This mechanism, while not completely defined, is believed to be related to a change of cytokines and neuropeptides as a result of hypoxia and localized heat after laser treatments.
The fluence is usually low (4-8J/cm2), with a spot size of 7-10mm and a pulse duration of 0.5-2ms. 8 A mild purpura is the immediate effect desired, as overtreatment may lead to pigmentation problems. PDL is best suited for patients with skin phototypes I to III, as they have less pigmentation and hemoglobin competes for energy absorption. The treatment is administered in sessions, separated by 6 to 8-week intervals until the desired effect is reached. The normal is four sessions. fifteen
Due to the fact that it only penetrates 1.2mm deep into the skin, its use is limited in hypertrophic thick scars. It is often combined with ablative-fractional lasers in thick scars to create a potential synergistic effect. We found that AFL treatments are not tolerated well by pediatric patients. PDL monotherapy is very effective, particularly in the early stages of scarring. 1 ).
Figure 1. Before and after treatment example with pulsed dye laser 595-nm (4 sessions).
(0.07MB).In a clinical trial, Al-Mohamady et al. 20 showed that the 1064-nm long-pulse neodymium-doped yttrium aluminum garnet (Nd: YAG) laser is effective in treating hypertrophic scars.
Finally, intense pulsed lasers emit a polychromatic broad-spectrum light beam (500-1200nm), which can be separated using filters. This light beam acts on different types of chromophores through selective photothermolysis. 21 These lasers can also be used to treat the pigmentation and hypertrophy of various scars, such as burns scars. They can provide a viable alternative. There is little evidence that lasers can be used to treat burn scars. 22
Ablative Fractional lasersAFLs form the basis of burn scar treatments. Most commonly used are the 10600 nm carbon dioxide and 2940 nm erbium-doped yttrium aluminum garnet (Er: YAG), which both use water as the chromophore. These lasers work by creating columns of thermal injury in the dermis and epidermis. These columns promote collagen remodeling and improve the thickness, color, and flexibility of scars. The depth of the columns can range from 0.2mm to 4mm. The healthy tissue in between the columns acts as a reservoir to aid in rapid recovery after treatment. 23
Carbon dioxide lasers are less water-addictive than Er: YAG and produce more thermal coagulation on peripheral tissue. Carbon dioxide lasers are widely used and considered most effective because they facilitate collagen repair. Carbon dioxide lasers can deposit energy up to 4mm deep, and they also prevent some bleeding by coagulating vessels. 8
Recent meta-analyses have shown that fractional CO2 lasers can improve the scarring, pigmentation, vascularization, and pain associated with burns. 24.25
The laser can be used to smooth the skin or to relieve tension. It also helps to remodel abnormal collagen. You can use it in combination with 26 other lasers (Fig. 2 ).
