Pulsed dye laser, fractional CO2 laser, or combination for burn scar treatment: a systematic review

Purpose Burn injuries often result in hypertrophic scars, causing functional impairment and aesthetic concerns. Laser therapies, including pulsed dye laser (PDL) and ablative fractional CO2 laser (AFCL), have emerged as promising treatments. This study aimed to evaluate the efficacy and safety of PDL, AFCL, and their combination in treating burn scars through a systematic review and network meta-analysis. Methods A comprehensive literature search was conducted across four databases from inception to August 2024. Randomized controlled trials and observational studies comparing PDL, AFCL, or their combination were included. Two independent reviewers extracted data and assessed study quality. A preliminary network meta-analysis was performed using a random-effects model. Results Eleven studies were included in the systematic review, with two in network meta-analysis. PDL showed a significant reduction in total Vancouver Scar Scale (VSS) scores compared to combination therapy [mean difference (MD) = -0.90, 95% CI: -1.77 to -0.04], while AFCL showed no significant difference. No significant differences were found between treatments for individual VSS components. Qualitative synthesis revealed consistent improvements in scar appearance, texture, pain, and pruritus across studies, with good safety profiles and high patient satisfaction. Conclusion While limited by the small number of studies, our findings suggest potential benefits of PDL for overall scar appearance and comparable efficacy between AFCL and PDL for various scar characteristics. Larger, well-designed randomized controlled trials with longer follow-up periods are needed to provide more definitive evidence on the optimal use of laser therapies in burn scar management. Clinical trial number not applicable.