A prospective cohort study investigated the efficacy of fractional CO₂ laser therapy in treating mature hypertrophic burn scars in patients with skin of color.
The study enrolled 25 patients aged 15 to 65 years, although the inclusion criteria permitted patients aged 12 to 80 years. All participants underwent four sessions of fractional CO₂ laser therapy spaced 4 to 6 weeks apart.
Published in JAAD International, the findings demonstrated statistically significant reductions in scar severity, as measured by the Vancouver Scar Scale (VSS). The mean total VSS score decreased from 7.37 ± 2.74 to 4.88 ± 2.16 (P < .001). Improvements were noted in scar vascularity (0.85 ± 1.085 to 0.10 ± 0.300; P < .001), pigmentation (2.44 ± 0.673 to 2.12 ± 0.900; P = .008), and pliability (2.29 ± 1.078 to 1.39 ± 0.997; P < .001).
Stratification by Fitzpatrick skin type revealed significant reductions in VSS scores for patients with skin types III (6.11 ± 1.69 to 3.44 ± 1.74; P = .013) and IV (7.90 ± 2.89 to 5.30 ± 2.18; P < .001). Pigmentation scores decreased significantly among those with skin type III, but changes in skin type IV were not statistically significant.
The Patient and Observer Scar Assessment Scale (POSAS) also indicated significant posttreatment improvements. The mean total POSAS score decreased from 86.98 ± 24.08 to 54.90 ± 26.96 (P < .001). Observer-assessed scores dropped from 39.44 ± 13.09 to 25.41 ± 13.61 (P < .001), reflecting improvements in vascularity, pigmentation, relief, pliability, and surface area. Patient-reported scores decreased from 47.54 ± 13.06 to 29.24 ± 14.88 (P < .001), with noted improvements in symptoms such as pain, itching, stiffness, and discoloration.
Two cases of posttreatment hyperpigmentation and two instances of vesicle formation were reported. Several patients experienced transient erythema that resolved within 2 to 3 days. No serious adverse effects were observed.
“Burn survivors commonly encounter enduring physical, psychological, and financial difficulties, largely attributed to the development of hypertrophic scars,” said Samman Khalid, MBBS, of the Department of Plastic and Reconstructive Surgery, Holy Family Hospital, Rawalpindi, Pakistan.
The study concluded that fractional CO₂ laser therapy is a promising treatment for mature hypertrophic burn scars, particularly in individuals with skin of color. The authors emphasized the need for additional longitudinal studies to refine treatment protocols and improve outcomes.
The authors reported no conflicts of interest.
