Laser therapy in the treatment of post-burn scars in children

Abstract

Burns are one of the most common injuries in the paediatric population. Despite improved medical care, many burn patients develop permanent scars, which are a serious cosmetic, functional and psychological burden. We present the possible use of a pulsed dye laser (PDL) and an ablative fractional CO2 laser (AFCL) in the treatment of post-burn scars, with particular emphasis on the paediatric population. PDL is intended to reduce scar redness through selective photothermolysis of blood vessels to reduce local hypervascularity. This type of laser can be also used to reduce pruritus, most likely by modifying local cytochemical reactions. Ablative fractional carbon dioxide laser therapy (AFCL) may be optionally used to improve scar texture and reduce its thickness. AFCL can also restore normal function of the scarred area. It causes vaporisation of scar tissue fragments, thereby stimulating collagen reconstruction. The fact that PDL and AFCL can be safely combined during the same procedure is an important advantage of using laser therapy in the treatment of hypertrophic scars. Combined therapy allows to reduce the overall number of sessions. The use of two lasers during one session also allows to reduce the amount of anaesthesia. The combined use of PDL and AFCL is safe. No serious complications were reported during combined therapy. Doctors treating patients with burn scars should consider the use of laser therapy as a modern standard for the treatment of hypertrophic scars. Scars that cause contractures and significantly impair motor functions may require multi-stage surgical treatment, supported by laser therapy, rehabilitation and conservative treatment.