Pulsed dye laser treatment of burn scars. Alleviation or irritation?

Burn scars are very common in both children and adults, causing great morbidity and often pose a difficult management problem. This study investigated the efficacy of the dye laser in patients with symptomatic burn scars and analysed the impact of the laser treatment on scar redness, surface texture and pruritus.

Patients were placed into four groups-adult new scar (n=8), adult old scar (n=10), children new scar (n=5) and children old scar (n=15). The area of scar was divided randomly into treatment and control. Photography, histology, surface textural analysis, Vancouver and pruritus scores were made. Each selected area received three laser treatments at monthly intervals (wavelength of 585 nm with a 5 mm diameter spot at 5-6J/cm(2)). Further assessments were made at 6 and 12 months.

Pruritus improved significantly between treatment and control areas (P<0.001). Vancouver scores improved in all groups and sites (P<0.001), but not significantly between treatment and control at 6 (P=0.876) or 12 months (P=0.680). There was no statistical difference between treatment and control in photographic assessment at 6 (P=0.006) or 12 months (P=0.329) and surface profile measurements at 0 (P=0.552), 6 (P=0.107) or 12 months (P=0.227). One patient withdrew from the study because of scar breakdown and three patients were lost to complete follow-up.

The 585 nm flashlamp-pumped pulsed dye laser is an effective treatment for the intense pruritus often experienced during the healing process after a burn injury. This study has not shown other benefits, such as reduction in scar redness, height and textural improvement to be statistically significant. There is evidence that blood vessel diameters in hypertrophic scar tissue are much smaller than the vessels in port wine stains for which this laser was designed to treat. Therefore, by decreasing the pulse width, more vascular specific damage in the scar may be possible. It is likely that the beneficial effects demonstrated thus far result from changes to the chemical signals that regulate the scar growth and symptoms.