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Influence of scar age, laser type and laser treatment intervals on paediatric burn scars: a systematic review and
Yangmyung Ma1, Sabrina P Barnes2, Yung-Yi Chen1
1College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
Insights
Early laser therapy for pediatric burn scars (<12 months) shows better outcomes than later treatment. Non-ablative lasers and shorter intervals (<4 weeks) are most effective for improving scar appearance and function.
Area of Science:
- Dermatology
- Plastic Surgery
- Regenerative Medicine
Background:
- Paediatric burn scars present a significant clinical challenge.
- Laser therapy is a recognized treatment modality, but optimal protocols remain unclear.
- Heterogeneity in existing literature necessitates a comprehensive analysis.
Purpose of the Study:
- To meta-analyze the impact of scar age, laser type, and treatment interval on paediatric burn scar outcomes.
- To identify optimal parameters for laser therapy in children with burn scars.
Main Methods:
- Systematic literature search across seven databases (May 2022).
- Meta-analysis of standardized mean differences (SMD) from seven studies involving 467 paediatric patients.
- Application of fixed or random effects models based on heterogeneity; p-value < 0.05 considered significant.
Main Results:
- Laser therapy significantly improved scar vascularity, pliability, pigmentation, and height (VSS/POSAS scores).
- Early intervention (<12 months) yielded superior VSS/POSAS and vascularity improvements compared to later treatment.
- Non-ablative lasers demonstrated greater efficacy than ablative or pulsed dye lasers; shorter intervals (<4 weeks) were more effective.
Conclusions:
- Scar age, laser type, and treatment interval are critical factors influencing laser therapy outcomes in paediatric burn scars.
- Findings challenge current guidelines regarding the initiation timing of laser treatment for paediatric burn scars.
- Further research is warranted to explore other confounding factors affecting burn scar outcomes post-laser therapy.
Background:
Laser therapy has emerged to play a valuable role in the treatment of paediatric burn scars; however, there is heterogeneity in the literature, particularly concerning optimal timing for initiation of laser therapy. This study aims to investigate the effect of factors such as scar age, type of laser and laser treatment interval on burn scar outcomes in children by meta-analysis of previous studies.
Methods:
A literature search was conducted across seven databases in May 2022 to understand the effects of laser therapy on burn scar outcomes in paediatric patients by metanalysis of standardized mean difference (SMD) between pre- and post-laser intervention. Meta-analyses were performed using the Comprehensive Meta-Analysis software version 4.0. Fixed models were selected when there was no significant heterogeneity, and the random effects model was selected for analysis when significant heterogeneity was identified. For all analyses, a p-value < 0.05 was considered significant.
Results:
Seven studies were included in the meta-analysis with a total of 467 patients. Laser therapy significantly improved Vancouver Scar Scale (VSS)/Total Patient and Observer Scar Assessment Scale (Total POSAS), vascularity, pliability, pigmentation and scar height of burn scars. Significant heterogeneity was found between the studies and thus subgroup analyses were performed. Early laser therapy (<12 months post-injury) significantly improved VSS/POSAS scores compared to latent therapy (>12 months post-injury) {SMD -1.97 [95% confidence interval (CI) = -3.08; -0.87], p < 0.001 vs -0.59 [95%CI = -1.10; -0.07], p = 0.03} as well as vascularity {SMD -3.95 [95%CI = -4.38; -3.53], p < 0.001 vs -0.48 [95%CI = -0.66; -0.30], p < 0.001}. Non-ablative laser was most effective, significantly reducing VSS/POSAS, vascularity, pliability and scar height outcomes compared to ablative, pulse dye laser and a combination of ablative and pulse dye laser. Shorter treatment intervals of <4 weeks significantly reduced VSS/POSAS and scar height outcomes compared to intervals of 4 to 6 weeks.
Conclusions:
Efficacy of laser therapy in the paediatric population is influenced by scar age, type of laser and interval between laser therapy application. The result of this study particularly challenges the currently accepted initiation time for laser treatment. Significant heterogeneity was observed within the studies, which suggests the need to explore other confounding factors influencing burn scar outcomes after laser therapy.
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