Fractional Ablative Laser Therapy is an Effective Treatment for Hypertrophic Burn Scars: A Prospective Study of Objective and Subjective Outcomes

Abstract

Background: Scarring causes severe long-term morbidity in many survivors of burn injury. Fractional laser treatment has been reported to improve burn scars, with increasing clinical use despite a paucity of controlled, prospective clinical studies using objective measures of improvement. We conducted a site-controlled, prospective open-label study to determine objective and subjective changes in mature hypertrophic burn scars treated with a fractional ablative carbon dioxide (CO2) laser. Methods: A multicenter, prospective cohort study was conducted in subjects with hypertrophic burn scars, who received three treatment sessions with an ablative fractionated CO2 laser. Repeated measures employed were: mechanical skin rheology to measure viscoelastic properties; ultrasonic imaging to measure scar thickness; and reflectometry to measure erythema and pigmentation for 6 months after treatment. Stability of scars was documented for three months prior to laser treatment. Subjective measures included health-related quality of life, patient and investigator scar assessment scales, and blinded scoring of digital photographs. Findings: Twenty-nine subjects were enrolled, of whom 26 received at least one fractional CO2 laser treatment and 22 received 3 treatments. Mean age of those completing all three treatments was 28 years. Major, statistically significant objective improvements in elastic stretch (P<0.01), elastic recovery (P<0.01), extensibility (P<0.01), and thickness (P<0.01) were noted. Subjectively, health-related quality of life, appearance and pain/pruritus were significantly improved (P<0.01). There was no significant regression of improvement for at least 6 months after treatment. Interpretation: Fractional ablative laser treatment provides significant, sustained improvement of elasticity, thickness, appearance and symptoms of mature hypertrophic burn scars. Funding: Funding for this study was provided by the Department of Defense, award number FA8650-11-2-6241. Declaration of Interest: Lumenis has donated equipment for patient care that was used in this study. Dr. Anderson has consulted with Lumenis in the past, with the consultancy ending prior to the conceptualization of this study. Lumenis played no role in financial support, design, performance, data analysis, or reporting of this study. Ethical Approval: This study was approved by the Partners Healthcare IRB and listed on www.clinicaltrials.gov with identifier NCT02115646.