Deep or upper second-degree burns can leave a residual scar because, in addition to affecting the most superficial layer of the skin (epidermis), they reach the intermediate layer (dermis). Any skin lesion that damages the dermis has the potential to leave a residual scar. Deep second-degree burns are usually caused by hot liquids or solids, or by fire.
Scars are the main reason for morbidity in patients with burns, since they produce a notable and often functional aesthetic impact (pain, pruritus, limitation of mobility). The classic treatment of deep or higher second-degree burns has been surgery, although new therapeutic techniques have now been described, such as the non-ablative fractional laser.
What are the advantages of treating burn scars with non-ablative fractional lasers?
Compared to other devices, the non-ablative fractional laser has a remarkable effectiveness and very high safety profile, since:
– It does not injure the epidermis, so recovery after the laser session is fast and comfortable without the formation of scabs, wounds or exudates. Thus, the patient does not need to take sick or social leave.
– Non-ablative fractional laser treatment is performed on an outpatient basis without the need for hospital admission or medication.
– By keeping the surface layers intact, the risk of infection after treatment is minimal.
– The chances of leaving secondary hyperpigmentation or scarring from the treatment are minimal , and in fact, it is a therapeutic option for residual hyperpigmentation.
– Non-ablative fractional laser sessions are painless, and do not require any type of anesthesia beyond a cream applied prior to treatment.
– According to Waibel et al., the studies show better final results with non-ablative fractional laser treatment of erbium than with pulsed dye or Q switch laser.
What is the mechanism of action of the non-ablative fractional laser?
The non-ablative fractional laser allows it to impinge on the dermis without injuring the overlying epidermis . In this way, its energy impacts the structure that is damaged in the scars (whether by burns or of another origin): collagen. After heating the dermis, there is a stimulus for rearrangement and the creation of new collagen that, in weeks, will produce the progressive improvement of the scar. It is currently used for the treatment of acne scars (you have more information here), keloids (here) and other types of scars (here).
How effective is it in treating burn scars?
According to the Waibel study on scars from atrophic and hypertrophic burns and scarring contractures, 60% of the total number of patients presented a moderate to excellent improvement: 90% experienced improvement in texture; 80% in pigmentation alterations and 80% in the degree of atrophy or hypertrophy.
The satisfaction index of the patients who underwent the treatment was excellent, all of them believing that the degree of improvement after 5 sessions of non-ablative fractional laser was moderate to excellent, with a minimum increase of one point on a scale out of 10 referring to self-esteem.
What type of burn scars is the non-ablative fractional laser useful for?
Studies reveal efficacy with atrophic, hypertrophic and keloid scars, with hypertrophic scars (which are the most frequent) showing a higher degree of improvement.
Can non-ablative fractional laser be combined with other treatments?
Yes. It can be combined with surgery (this would be prior), corticosteroid infiltrations, occlusive dressings, platelet-rich plasma and other options.
REFERENCES
Waibel J, Wulkan AJ, Lupo M, Beer K, Anderson RR. Treatment of burn scars with the 1,550 nm nonablative fractional Erbium Laser. Lasers Surg Med. 2012 Aug; 44(6):441-6.