Dr Sam Hamilton1, Dr Katherine Davis1, Mr Nanda Kandamany1
1Royal Hobart Hospital, Hobart, Australia
Scarring from burns causes considerable morbidity, often resulting in contractions impacting range of motion at joints, suboptimal aesthetics and causing troublesome itch (Willows BM et al, 2017). Lasers are becoming more common place in plastic surgery and burns departments and show great promise when it comes to managing burn scars and their sequel.
Pubmed was searched using the terms ‘laser’, ‘burn’, ‘scar’ and ‘management’ from 2015 onwards. 9 out of the 43 articles were included following exclusion of non-human studies and those that were not specific to burn scar management.
A literature review by Willows et al (2017) published in Burns, concluded that lasers have great potential in scar management in burns, showing that they were effective in managing pigmentation, vascularity, pliability and thickness, with ablative fraction lasers being particularly effective. Ebid et al (2017) conducted a randomised control trial showing improvement in itch severity scoring systems and quality of life with high-intensity laser therapy. There was improvement in patient satisfaction and UNC 4P Scar scale with the use of Erbium-Yag laser when treating burn scars in a cohort of 49 patients (Madni TD et al, 2018). Pulse dye laser is particularly effective in the management of erythematous and pruritic scars (Sorkin M et al, 2017). Fractional CO2 laser has also been shown to be effective in sequel management especially is raised hypertrophic and uneven scars (Sorkin M et al, 2017; Issler-Fisher AC et al, 2017). Other studies have shown histological benefit with newly formed dermal papilla and reduced collagen bundle thickness when using fractional CO2 laser therapy for scar treatment (El-Zawahry BM et al, 2015; Lee SJ et al, 2016; Taudorf EH et al 2015). Lasers are also effective in anatomically important locations such as hands (Sorkin et al, 2017).
Laser therapy shows great promise, but there is still a need for further robust clinical trials (Zuccaro J et al, 2017). Type of laser, side effects, characteristics of the scar and patient and necessity for repeated sessions are considerations that should be deliberated when managing burn scars with laser therapy.
Sam is a surgical resident medical officer at the Royal Hobart Hospital, with a keen interest in plastic surgery and burns management.