Burn scars are a significant cause of morbidity that manifests as body disfigurement, contractures, and itching, along with a severe emotional burden that negatively affects patients’ quality of life. Laser therapy has been proven to be efficient in this scenario. This is more effective than treatments that are applied topically and are able to be employed in conjunction with surgical procedures to decrease morbidity. Lasers are utilized in dermatology clinics of hospitals. However, they are restricted. Carbon dioxide lasers are the most frequently used device to reduce scar thickness, improve the appearance of textural irregularities, and treat contractures associated with them, which can help restore the mobility of these patients if it’s changed. Laser treatments using pulsed dyes are especially effective in decreasing erythema caused by the burn scar and stopping subsequent hypertrophy. Laser treatments that treat pigmentation using shorter pulse durations (nanoseconds as well as picoseconds) will improve hyperpigmentation. This article will analyze the evidence supporting the application of laser therapy to treat burn scars and then propose an algorithm for treatment.

Burn scars can cause a significant mortality rate in the form of contractures, body disfigurement, and pruritus. It also results in a significant emotional burden that affects the quality of life for those suffering from them. Lasers have been proven to be effective in treatment over other treatments that are applied to the skin and complement surgical procedures, but without causing any morbidity. However, their application in the dermatology department of hospitals is only sometimes used. The most commonly utilized laser used is called CO 2 laser. CO 2 laser.to treat the size of the wound, changes in its texture as well as the potential contracture, and to restore the patient’s mobility in the event of an alteration. Lasers that pulse dye are beneficial for burn scars that have recently developed that have an erythematous component and to avoid the formation of hypertrophic scars. Hyperpigmentation may be improved using dye lasers that produce short pulses (nano and picosecond) methods. We analyze the evidence supporting these devices in the treatment of burn scars and offer the possibility of a therapeutic procedure.

Introduction

Lasers have proved beneficial in treating scars. 1. The use of lasers has been extensively investigated in the specific kinds of scars, like ones caused by acne, surgery, or injuries, as well as Keloids. 1 & 2 However, treatment with lasers for burns that have recurred has not received as much attention and isn’t accessible in the majority of hospitals.

The global rate of burns was more than 1,000 per 100,000 people. The majority of burns impacted 20 percent of the body’s area and mainly involved the skin, which highlights the importance of dermatologists. 

Burn scars-related complications could have a significant impact on the quality of life of patients. 4 The disfigurement and contractures can affect a great deal on functionality, decrease mobility, and may cause itching and pain. In addition, the intense emotional aspect of these kinds of injuries can be demeaning, particularly with neck and face injuries. Neck. They can cause depression, anxiety, and lower self-esteem. 

A range of non-invasive treatments are traditionally used to reduce burn scars which include the use of silicone gels, injections with corticosteroid pressure therapy, and therapeutic massages. 6. These methods must usually be paired with surgery, including scar resection, wound closure to the transverse cut, Z-plastic flaps, and skin transplantation. 

Lasers

In recent times, lasers have proved efficient in treating burn injuries. They are not invasive and carry a low chance of adverse effects, and can result in quick recovery. This is why they are used in specific treatment plans alongside more moderately successful conservative strategies and surgical procedures, which can be very effective; however, they are also associated with higher mortality. 8 Although lasers don’t necessarily replace surgery, they do cut down the area to be treated, leading to fewer post-surgical complications. 9

Lasers are classified according to their mechanism of action as ablative/nonablative and fractional/nonfractional. 10. The most commonly used devices to treat burn scars are listed in Table 1.

The most common result of burn scars is irregular healing to the skin in over 70 percent of instances due to irregularities in texture, thickness pigmentation, and erythema. 11 This is the situation of burns that affect the deeper dermis’s layers such as third-degree or second-degree burns that may need laser therapy. The superficial burns that don’t get to the reticular dermis do not usually cause abnormal scarring and are not usually a cause of complications. 12

In terms of their thickness, scars may be classified as hypertrophic, keloids, and atrophic scars. Concerning the degree of pigmentation, they are classified as hyperpigmented or hypopigmented concerning the healthy skin around them. Additionally, erythema is common, particularly in active and recently-scarred areas. eleven

The extent of the scar needs to be evaluated before initiating and monitoring treatment. The most commonly used method is the Vancouver Scar Scale, 13, which assesses the scar’s thickness, vascularization, flexibility, and appearance. However, the Patient and Score for Observers (POSAS) is considered to be the most comprehensive, as it also incorporates subjective symptoms like itching and pain. 14 An appropriate evaluation will allow you to choose the best laser to treat. In addition, to select the appropriate kind of device and the appropriate parameters, it is essential to be aware of the specific characteristics of the individual patient (e.g., skin type, phototype, co-morbidities) and the site of the scar (e.g., neck, head, or leg).

Vascular Lasers

Pulsed dye lasers (PDLs) are blood-based lasers with 585 and 595 nm wavelengths. 15 Utilizing selective photothermolysis, they trigger coagulation and necrosis of blood vessels using oxyhemoglobin as the primary chemical (chromophore). 16 PDLs are regarded as the preferred laser to treat the vascular component of burn scars. They also have a low chance of adverse effects.

Numerous studies have demonstrated that PDLs are efficient in treating scar erythema resulting from excessive Neovascularization in the process of scarring. 17. It has also been proven beneficial in the treatment of hypertrophic scars due to the destruction of collagen caused by hypoxia of the tissue caused by the coagulation of vessels. 18 Allison et al. 19 also observed a reduction in itching after treatment of the part of the vascular system. While it isn’t fully understood, this process is thought to be related to changes in cytokines, neuropeptides, and histamine resulting from the effects of hypoxia and local heat after treatment with lasers.

The frequency is usually minimal, ranging from 4-8J/cm2 with beam size (spot size) 7-10mm and short time intervals (0.5-2more). 8. The final or immediate result is a mild purpura. Overtreatment may cause pigmentation issues. Patients with skin phototypes I to III are the most suitable candidates for PDL since they are less deficient in melanin, which competes with hemoglobin to remove energy. The treatment is typically administered in a series of sessions, separated by a 6 to 8-week interval until intended therapeutic effects are reached. A minimum of four sessions is typical. fifteen

Its ability to penetrate about 1.2mm in the skin indicates that its usage in large hypertrophic scars is restricted. It is often coupled with ablative fractional Lasers (AFLs) in the thick scars to produce a synergic effect.