Article

Moist exposed burn therapy in recovery of patients with immature, red hypertrophic scars successfully treated with a pulsed dye laser in combination with a fractional CO 2 laser

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Abstract

Background The efficacy of pulsed dye laser combined (PDL) and UltraPulse fractional CO2 in treatment of hypertrophic scars is well documented. The present study investigates the efficacy of moist exposed burn ointment (MEBO)/moist exposed burn therapy (MEBT) in postlaser wound management. Methods Sixty‐one patients with immature, red hypertrophic scars were enrolled in this clinical trial. Patients were randomly divided into two groups: (a) the MEBO treatment group (n = 30) and (b) the control group (n = 31) treated with chlortetracycline hydrochloride ointment. Demographic data such as age, gender, and cause of scars were recorded. A visual analogue score (VAS) was collected to measure pain at 1, 6, 24, 72 hours, and 7 days post‐treatment. The Vancouver Scar Scale (VSS) was used to determine the response of the scars before and 3 months after the treatment. The wound healing time and pigmentation scores were also recorded. Results No significant differences were found in age, gender, and etiology of the scars in the two groups. The VAS scores in MEBO group were significantly lower than the control group within the first 3 days after treatment. The wound healing time of the MEBO group was significantly shorter than the control group. For both groups, VSS scores were significantly decreased and the scar markedly improved. However, the VSS scores were significantly lower in the MEBO group compared with the control group 3 months after treatment and pigmentation formation was dramatically lower in MEBO group compared with the control. Conclusion MEBT/MEBO treatment reduced the post‐treatment pain, shortened the wound healing duration, promoted the overall scar condition, and reduced the incidence of pigmentation.

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... This is evidenced by attened and shrunk scars following treatment [14,[43][44][45][46]. PDL to treat hypertrophic scars is on the principle basis of selective photothermolysis [9-12, 38, 39] instead of skin resurfacing like carbon dioxide laser, since improvement of HS is to reduce the proliferation and excessive microvasculature. In addition, 595-nm PDL can create deeper penetration than 585-nm PDL, and destroy extra hemoglobin and blood vessels at the HS and other skin conditions [35][36][37][38]. The effectiveness of 595-nm PDL for HSs has been evaluated and documented in some studies [9][10][11][12][35][36][37][38][39]. ...
... In addition, 595-nm PDL can create deeper penetration than 585-nm PDL, and destroy extra hemoglobin and blood vessels at the HS and other skin conditions [35][36][37][38]. The effectiveness of 595-nm PDL for HSs has been evaluated and documented in some studies [9][10][11][12][35][36][37][38][39]. ...
... Currently, HS still remains a medical problem because of its complex physiologic wound healing cascade, though combined therapeutic strategies have been attempted in its treatment [11,13,37,39,41]. Nevertheless, the role of BMP-7 and Fas expression following by FCO 2 L combined with 595-nm PDL is rarely available. ...
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Background and Objectives Although the treatment of hypertrophic scar (HS) remain challenging, fractional CO 2 laser (FCO 2 L) and 595-nm pulsed-dye laser (PDL) have proved clinical efficacy. Meanwhile, BMP-7 and Fas proteins are demonstrated to promote wound healing and inhibit scar formation, yet few reports on the effect of the two proteins on hypertrophic scarring are available, and their molecular mechanisms remain unclear. In current study, we attempted to observe the effect of combined use of FCO 2 L with 595-nm PDL in HS animal models through determining the expression of BMP-7 and Fas in scar inhibition.Materials and Methods Twenty New Zealand white rabbits were randomized to control group, FCO2L group, PDL group and combined treatment group. Four HS samples were developed at each ear of individual rabbit. FCO 2 L was respectively applied to simple FCO 2 L and combined treatment group, and simple 595-nm PDL and combined treatment group. Totally, 3 sessions of treatments were carried out once every 14 days. Then, the changes of fibroblasts and collagens in HSs and expression of BMP-7 and Fas proteins in the scar tissues were determined via histological and immunohistochemical studies, ELISA, CCK8 test, RT-PCR and Western blot assay.ResultsHSs were flattened and shrunk after treatment, especially in rabbits treated by FCO 2 L plus 595-nm PDL group, in which obviously decreased abnormal fibroblast and collagen were noted. The deference was significant compared to other groups( P < 0.001). Moreover, expression of BMP-7 and Fas was both increased in the combined treatment group compared to single FCO 2 L or 595-nm PDL therapy group ( P < 0.001) .ConclusionsFCO 2 L combined with 595-nm PDL can improve HSs in rabbit models by inhibiting excessive fibroblast growth and collagen deposition. This may be associated with increased BMP-7 and Fas expression in the scar tissues. And our findings may pioneer a new therapeutic strategy for alternative treatment of HSs.
... Pulsed dye laser targets hemoglobin to distract blood vessels when dealing with hypertrophic scars and other red lesions [15][16][17]. Pulsed dye laser produces pulses at a wavelength of 585 nm and 595 nm. The later penetrates deeper than the former and brings better outcomes [18]. ...
... Some researchers compared the effects of pulsed dye laser and fractional CO 2 laser on hypertrophic scars, finding that their safety and effects were similar, but pulsed dye laser brought milder pain, smaller wounds, and faster recovery for early hypertrophic scars [13,37,38]. Other studies combined 595-nm pulsed dye laser and fractional CO 2 laser to treat early-stage hypertrophic scars, finding that the clinical scores (VAS, VSS, and POSAS) were significantly lower than those in the control group after treatment [11,17,19,36,37]. Our findings also verified these results. ...
Article
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595-nm pulsed dye laser and fractional CO2 laser have been demonstrated effective to treat hypertrophic scar. The underlying mechanism may involve transforming growth factor-beta1 (TGFβ1) and proliferating cell nuclear antigen (PCNA), but remains to be clarified. Our study was performed to investigate how 595-nm pulsed dye laser combined with fractional CO2 laser treats hypertrophic scars in a rabbit model through regulating the expression of TGFβ1 and PCNA. Twenty-four New Zealand white rabbits were randomly divided into control group, pulsed dye laser group, fractional CO2 laser group, and pulsed dye laser + fractional CO2 laser (combination) group. Surgical wounds were made and allowed to grow into hypertrophic scars at day 28. Next, 595-nm pulsed dye laser (fluence: 15 J/cm2; square: 7 mm; pulse duration: 10 ms) was used in pulsed dye laser and combination group, while fractional CO2 laser (combo mode, deep energy: 12.5 mJ; super energy: 90 mJ) in fractional CO2 laser and combination groups, once every 4 weeks for 3 times. The appearance and thickness of hypertrophic scar samples were measured with hematoxylin-eosin and Van Gieson’s straining. The expressions of TGFβ1 and PCNA were evaluated by immunohistochemical and western blot analysis. A significant improvement was noted in the thickness, size, hardness, and histopathology of hypertrophic scar samples after laser treatment, especially in combination group. Scar Elevation Index (SEI), fiber density (NA), and collagen fiber content (AA) decreased most significantly in combination group (2.10 ± 0.14; 2506 ± 383.00; 22.98 ± 2.80%) compared to 595-nm pulsed dye laser group (3.35 ± 0.28; 4857 ± 209.40; 42.83 ± 1.71%) and fractional CO2 laser group (2.60 ± 0.25; 3995 ± 224.20; 38.33 ± 3.01%) (P < 0.001). Furthermore, TGFβ1 and PCNA expressions were more suppressed in combination group (8.78 ± 1.03; 7.81 ± 1.51) than in 595-nm pulsed dye laser (14.91 ± 1.68; 15.73 ± 2.53) and fractional CO2 laser alone group (15.96 ± 1.56; 16.13 ± 1.72) (P < 0.001). The combination of 595-nm pulsed dye laser with fractional CO2 laser can improve the morphology and histology of hypertrophic scars in a rabbit model through inhibiting the expression of TGFβ1 and PCNA protein. Our findings can pave the way for new clinical treatment strategies for hypertrophic scars.
Article
To analyze and evaluate the clinical efficacy of Chinese and Western medical techniques in the treatment of severe diabetic foot ulcers complicated with necrotizing fasciitis of the lower leg and summarize the treatment experience of such patients to identify a new method of limb salvage treatment. A total of 46 patients with severe diabetic foot ulcers and necrotizing fasciitis of the lower leg were treated with such techniques as surgical debridement, bone drilling, open joint fusion, and microskin implantation. Wounds were treated with moisture-exposed burn therapy (a regenerative medical treatment for burns, wounds, and ulcers) and moisture-exposed burn ointment (a traditional Chinese medicine); underlying diseases were also treated effectively. The wound healing time, rate of high amputation, and mortality of these patients were summarized, and the clinical efficacy of such treatments was evaluated. Of the 46 patients enrolled, 38 patients were cured, with a cure rate of 82.61%. The average wound healing time was 130 ± 74.37 days. Two patients underwent high amputations, with an amputation rate of 4.35%, and 4 deaths occurred, with a mortality rate of 8.70%. The combination of Chinese and Western medical techniques in the treatment of severe diabetic foot ulcers complicated with necrotizing fasciitis of the lower leg not only effectively saved patients' lives and promoted wound healing but also greatly reduced the rates of high amputation and disability.
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Background: Cleft lip and/or palate (CL/P) are congenital cleft facial deformities that are abnormal developments caused by errors in the fusion process of the embryo's face. Surgery is an important treatment, but postoperative scars will still cause psychological shadows to patients. This study aimed to systematically evaluate the efficacy of Botulinum toxin type A (BTXA) in preventing and treating postoperative CL/P scars and improving scar quality. Methods: A systematic review was performed by searching PubMed, EMBASE, the Cochrane Library and Web of Science for relevant trials. All relevant trials were performed before June 30, 2021. The data were entered into Revman 5.3 software, and a meta-analysis was conducted by using the random-effects model or fixed-effects model. Results: Four randomized controlled trials involving 161 cases were included. Through quantitative analysis, BTXA showed significant differences in preventing and treating postoperative CL/P scars in terms of scar width (MD: -0.20; [95% CI, -0.30, -0.10], p<0.0001) and the Visual Analog Scale (VAS) (MD: 1.30; [95% CI, 1.06, 1.55], p<0.0001), although no significant difference was noted on the Vancouver Scar Scale (VSS) (MD: -0.75; [95% CI, -1.68, 0.19], p=0.12) between the two groups. Conclusion: In preventing and treating postoperative CL/P scar hypertrophy, we found that BTXA injection can show better results. There was no statistically significant difference between the results after omitting Navarro's study or Chang's study because of the time of injection-before/during surgery or adult CL/P scars.
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Background and objectives: Single-use of artesunate (ART) or 595-nm pulsed-dye laser (PDL) has proven clinical efficacy in the treatment of hypertrophic scars (HSs), yet little research has been done on the combined use of ART and PDL. Bone morphogenetic protein-7 (BMP-7) and Fas are recognized to be two important proteins in reducing scar formation. This study was designed to observe the effect of ART combined with 595-nm PDL in the treatment of HS in rabbit models, and investigate the effect of such protocol on the expression of BMP-7 and Fas in rabbit models. Study design/materials and methods: Twenty-four New Zealand white rabbits were randomly divided into the control group, ART group, PDL group, and combined treatment (ART + PDL) group. ART was respectively applied to the ART group and combined treatment group. Treatment was once every 2-week for a total of three sessions for both groups. Animals in the PDL group were simply treated with 595-nm PDL. Then, hematoxylin & eosin and Van Gieson straining, immunohistochemical study, enzyme-linked immunosorbent assay (ELISA), Cell counting kit-8 test, western blot assay, and real-time polymerase chain reaction (RT-PCR) were carried out to observe the development of HS samples and expression of BMP-7 and Fas proteins in the sample tissues. Results: After treatment, the scar samples grew lower and flatter, which was particularly evident in the combined treatment group, with notably inhibited fibroblast and collagen compared to other groups (p < 0.001). Western blot assay and RT-PCR demonstrated that the expression of BMP-7 was most increased in scar samples treated by ART + PDL. BMP-7 level was correspondingly and notably upregulated in treatment groups, especially in the ART + PDL group. In addition, relevant expression of Fas was also higher after treatment, especially in the ART + PDL group compared to either ART or 595-nm PDL group. The difference was significant among groups (p < 0.001). Conclusions: Combined use of ART and 595-nm PDL can inhibit HSs in rabbit models via inhibiting extra fibroblast and collagens. The potential mechanism may be involved in enhanced BMP-7 and Fas expression. Our observations may create an alternative therapeutic strategy for HSs in the clinic.
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Background and Objective The use of fractional CO2 laser and pulsed dye laser (PDL) therapy to treat and/or prevent scarring following burn injury is becoming more widespread with a number of studies reporting reduction in scar erythema and pruritus following treatment with lasers. The objective of this study was to directly compare the efficacy of PDL, fractional CO2, and PDL and fractional CO2 laser therapy in immature red hypertrophic scars in a standardized animal model. Methods Ten New Zealand big-eared rabbits were used to make rabbit ear hypertrophic scar models. A total of 80 hypertrophic scar models were obtained and randomly divided into groups: control (Group A), Fractional CO2 laser (Group B), pulse dye laser (Group C), combined (Group D), 20 in each group. Wound sites were treated with PDL, Fractional CO2 laser, or both at 28 days post-grafting. Grafts receiving no laser therapy served as controls. Hypertrophic scar appearance, morphology, size, and erythema were assessed, and punch biopsies were collected. At days 7 and 28, additional tissue was collected for biomechanical analyses and markers for HE staining, Masson staining, immunohistochemical method to determine the CD31 content in the scar; Western blot to detect the expression of VEGF protein in scars. After the day 7 and 28, the scars were collected. Histomorphological change in scars was observed by hematoxylin-eosin staining, Masson staining. The expression of CD31, VEGF protein, and the cell apoptosis rate was detected by immunohistochemical method. Results (i) In morphological observation, HE staining and Masson staining, both the number of fibroblasts and amount of collagen fibrils in the experimental group were significantly reduced compared with those in control group. (ii) Micro-vessel Density (MVD) value can be found much smaller in the experimental groups than the control (p < 0.05). Among the four experimental groups, there was a significant difference among 14d, 21d, and 28d groups (p < 0.05). (iii) On days 7 and 28 after treatment, expression of VEGF could be regulated in experimental group (p < 0.05). Among the three experimental groups, the decrease of VEGF in the combined group was significantly stronger than that of the other two. Conclusion The effect of Fractional CO2 laser combined with pulsed dye laser treatment was shown to be better than that of Fractional CO2 laser or pulsed dye laser alone and inhibits the early hypertrophic scar in rabbit ears.
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Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. The latter is characterized by continuous and histologically localized inflammation. As a result, the reticular layer of keloids and hypertrophic scars contains inflammatory cells, increased numbers of fibroblasts, newly formed blood vessels, and collagen deposits. Moreover, proinflammatory factors, such as interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-α are upregulated in keloid tissues, which suggests that, in patients with keloids, proinflammatory genes in the skin are sensitive to trauma. This may promote chronic inflammation, which in turn may cause the invasive growth of keloids. In addition, the upregulation of proinflammatory factors in pathological scars suggests that, rather than being skin tumors, keloids and hypertrophic scars are inflammatory disorders of skin, specifically inflammatory disorders of the reticular dermis. Various external and internal post-wounding stimuli may promote reticular inflammation. The nature of these stimuli most likely shapes the characteristics, quantity, and course of keloids and hypertrophic scars. Specifically, it is likely that the intensity, frequency, and duration of these stimuli determine how quickly the scars appear, the direction and speed of growth, and the intensity of symptoms. These proinflammatory stimuli include a variety of local, systemic, and genetic factors. These observations together suggest that the clinical differences between keloids and hypertrophic scars merely reflect differences in the intensity, frequency, and duration of the inflammation of the reticular dermis. At present, physicians cannot (or at least find it very difficult to) control systemic and genetic risk factors of keloids and hypertrophic scars. However, they can use a number of treatment modalities that all, interestingly, act by reducing inflammation. They include corticosteroid injection/tape/ointment, radiotherapy, cryotherapy, compression therapy, stabilization therapy, 5-fluorouracil (5-FU) therapy, and surgical methods that reduce skin tension.
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Moist Exposed Burn Ointment (MEBO®) is widely used topical agent applied on skin burn. This study investigated the effect of MEBO topical application on activation and proliferation of epidermal stem cells through the immunohistochemical localization of cytokeratin 19 (CK19) as a known marker expressed in epidermal stem cells. Biopsies from normal skin and burn wounds were taken from 21 patients with partial thickness burn 1, 4, 7, 14, 21, and 28 days after treatment with MEBO. Tissue sections were prepared for histological study and for CK19 immunohistochemical localization. In control skin, only few cells showed a positive CK19immune-reaction. Burned skin showed necrosis of full thickness epidermis that extended to dermis. Gradual regeneration of skin accompanied with an enhancement in CK19 immune-reactivity was noted 4, 7, 14 and 21 days after treatment with MEBO. On day 28, a complete regeneration of skin was observed with a return of CK19 immune-reactivity to the basal pattern again. In conclusion, the enhancement of epidermal stem cell marker CK19 after treatment of partial thickness burn injuries with MEBO suggested the role of MEBO in promoting epidermal stem cell activation and proliferation during burn wound healing.
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Cutaneous delayed wounds are a challenging clinical problem, and vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) exhibit key roles in wound healing. Moist exposed burn ointment (MEBO), a Chinese burn ointment with a USA patented formulation, has been reported to promote chronic ischemic and neurogenic ulcer healing in patients; however, the underlying mechanisms remain unclear. In the present study, MEBO significantly promoted the formation of granulation tissue in cutaneous excisional wounds, shortened the time of wound healing, and increased neovascularization and the number of fibroblasts. Furthermore, as well as enhancing the protein expression, MEBO application also increased the gene expression of VEGF and bFGF. The results indicate that MEBO promotes cutaneous excisional wound healing by at least partially enhancing VEGF and bFGF production, implicating the potential uses of MEBO for delayed cutaneous wound healing.
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The purpose of this review is to investigate the use of Pulsed Dye Laser (PDL) as a therapeutic tool for hypertrophic burns scarring. The difference between keloids and hypertrophic scars is first described. The review then outlines the progress and assessment of hypertrophic scars for burns patients and the problem of their clinical management. The assessment using both objective and subjective measurements for complete account of hypertrophic scars is explained. The efficacy of PDL for both prevention and treatment is summarised for all hypertrophic scarring and the various laser treatment protocols in previous research is studied. The differentiation between prevention and treatment is discussed in relation to scar duration and the need for prevention rather than treatment is then proposed for intervention using PDL. The paper concludes with recommendations for future research through a prospective randomised, controlled study using 595nm PDL in the prevention of scars with less than 6 month duration.
Article
Although differing in clinical presentation and prognosis, keloids and hypertrophic scars are generally characterized by abnormally proliferative scar tissue and are extremely debilitating. Several intralesional therapies have been studied in attempts to find a universally safe and effective modality, of which there are currently none. To provide a comprehensive review of current intralesional treatment modalities for keloids and hypertrophic scars. A PubMed search was performed for literature pertaining to intralesional treatment modalities for keloids and hypertrophic scars. References from retrieved articles were also considered for review. Many intralesional therapies for keloids and hypertrophic scars are currently available to physicians and patients. Mechanisms of action and side effect profiles vary between these agents, and new approaches to keloids and hypertrophic scars are frequently being explored. Randomized controlled trials are needed to assess these new and promising modalities fully.
Article
This study investigated the combined effect of fractional CO2 laser irradiation and fluoride on treatment of enamel caries. Sixty intact premolars were randomly assigned into four groups and then stored in a demineralizing solution to induce white spot lesions. Tooth color was determined at baseline (T1) and after demineralization (T2). Afterwards, the teeth in group 1 remained untreated (control), while group 2 was exposed to an acidulated phosphate fluoride (APF) gel for 4 min. In groups 3 and 4, a fractional CO2 laser was applied (10 mJ, 200 Hz, 10 s) either before (group 3) or through (group 4) the APF gel. The teeth were then immersed in artificial saliva for 90 days while subjected to daily fluoride mouthrinse and weekly brushing. Color examinations were repeated after topical fluoride application (T3) and 90 days later (T4). Finally, the teeth were sectioned, and microhardness was measured at the enamel surface and at 30 and 60 μ from the surface. In both lased groups, the color change between T1 and T4 stages (∆E T1–T4) was significantly lower than those of the other groups (p < 0.05). Laser irradiation followed by fluoride application (group 3) caused a significant increase in surface microhardness compared to APF alone and control groups (p < 0.05). Microhardness at depths of 30 and 60 μ was also significantly greater in group 3 compared to those of all other groups (p < 0.05). Application of a fractional CO2 laser before fluoride therapy is suggested for recovering the color and rehardening of demineralized enamel.
Article
Background and objectives: Childhood hemangioma is the most common soft tissue tumor of infancy, occurring in 10% of children younger than 1 year old. Ten percent of these infantile hemangiomas involute yearly without intervention. Treatment with the pulsed dye laser (PDL) is the criterion standard for treating vascular lesions. It is well established as the most effective, safest treatment for port-wine stains. Previous studies of the use of PDL treatment in superficial hemangioma showed inconsistent results. Main objectives were to compare the efficacy and adverse effects of PDL treatment with those of observation in the treatment of superficial hemangiomas. Parental quality of life was also assessed. Materials and methods: This was a prospective, randomized, controlled trial in which we enrolled 22 infants aged 1.5 to 5 months old with early hemangiomas with a maximum diameter of 5 cm. We assigned the infants to PDL treatment (n = 11) or observation (n = 11), and followed up until the age of 1 year. Patients in the intervention group were treated using a 595-nm PDL (VBEAM, Candela Corp., Wayland, MA) with a 7-mm spot diameter, 30/10 to 40/10-ms epidermal cooling, a 7- to 15-J/cm(2) fluence range, and a pulse duration of 0.45 to 40.0 ms. During follow-up, color measurements were made (Colori meter; Minolta, Tokyo, Japan), and surface area and echo depth of the hemangioma were determined. Results: No significant differences were seen between the groups at time of inclusion or at the age of 1 year in echo depth (p = .66) or surface area (p = .62). Results were significant for color difference (p = .03) between PDL treatment and observation. Cosmetic outcome judged by an independent panel consisting of a dermatologist, physician assistant, dermatology resident, dermatology nurse, and plastic surgery resident was significantly better in the PDL treatment group (46%) than in the observation group (18%) (p = .006). Conclusions: Pulsed dye laser is only to be considered as an alternative treatment up to the age of 6 months, at which time parents and physicians consider cosmetic outcome to be a relevant factor, but laser therapy plays a major role in the treatment of residual lesions at older ages.
Article
Background. Carbon dioxide (CO2) laser resurfacing has become an increasingly popular procedure for the treatment of facial rhytides and solar damage. Yet despite ongoing advancements in laser technology, CO2 laser resurfacing is still a risk-laden procedure that may lead to complications such as infection. Occlusive dressings increase the healing rate and decrease pain intensity in patients who receive full face laser resurfacing. It has been said that the use of occlusive dressings in postresurfacing patients may increase the risk of infection, which typically presents 2–10 days after the procedure.Objective. The purpose of this article is to report the incidence of infection following full-face CO2 laser resurfacing of 354 patients who were treated with occlusive dressings. In addition, factors which may have contributed to the delayed onset in three of the four infections are discussed.Methods. Three hundred fifty-four patients received full-face CO2 laser resurfacing. Either a continuous wave CO2 laser with a computer-generated scanner (396 μsec dwell time, 18 W) or a pulsed CO2 laser (500 mJ pulse energy, 90 μsec pulse duration) were used in all cases of resurfacing. Postoperatively all patients were treated with occlusive dressings and empiric oral cephalexin. Postoperatively patients were monitored at weekly intervals during the first month and then at 3 and 6 months.Results. Of the 354 patients who received full-face laser resurfacing, there were 4 cases of culture-proven infection, which translates to an infection rate of 1.13%. Three of the four infections developed 3–5 weeks after the procedure.Conclusion. This study reports an infection rate of 1.13% following full-face CO2 laser resurfacing and occlusive dressing use in 354 patients. Because infection may develop many weeks after the procedure, patients should be educated to maintain proper wound care hygiene and to avoid “double dipping” of wound care products until wounds are completely healed.
Article
  Numerous reports have been published on skin rejuvenation by the so-called fractional laser device that delivers a laser beam in a dot form over a grid pattern.   In this study, we characterized the effects of a fractional CO(2) laser on atrophic acne scars at the clinical and ultrastructural levels.   Seven healthy adult Japanese volunteers (aged 32-46 years, mean 37.6, five men and two women of Fitzpatrick skin type III) were recruited for this study. A fractional CO(2) laser device, SmartXide DOT (DEKA, Florence, Italy), was used with irradiation parameters set as follows: output power 10 W, pulse width 600 μs, dot spacing 800 μm, and stack 2 (irradiation output power 0.91 J/cm(2) ). A clinical examination and punch biopsy of each subject was performed before and just after the irradiation, and also at week 3 after three irradiation sessions. The biopsy specimens were stained with toluidine blue and were examined ultrastructurally.   Clinical improvement of the atrophic acne scars was observed at week 3 after the third irradiation session in all cases compared with the condition before treatment. Histologically, outgrowths of many degenerated elastic fibers were observed as irregular rod-shaped masses in the superficial dermis prior to the treatment in the region of the acne scars. At week 3 after the third irradiation, the degenerated elastic fibers were no longer observed, and the elastic fibers were elaunin-like.   The fractional CO(2) laser is considered to be very effective for treating atrophic acne scars.
Article
Many surgeons recommend postoperative scar massage to improve aesthetic outcome, although scar massage regimens vary greatly. To review the regimens and efficacy of scar massage. PubMed was searched using the following key words: "massage" in combination with "scar," or "linear," "hypertrophic," "keloid," "diasta*," "atrophic." Information on study type, scar type, number of patients, scar location, time to onset of massage therapy, treatment protocol, treatment duration, outcomes measured, and response to treatment was tabulated. Ten publications including 144 patients who received scar massage were examined in this review. Time to treatment onset ranged from after suture removal to longer than 2 years. Treatment protocols ranged from 10 minutes twice daily to 30 minutes twice weekly. Treatment duration varied from one treatment to 6 months. Overall, 65 patients (45.7%) experienced clinical improvement based on Patient Observer Scar Assessment Scale score, Vancouver Scar Scale score, range of motion, pruritus, pain, mood, depression, or anxiety. Of 30 surgical scars treated with massage, 27 (90%) had improved appearance or Patient Observer Scar Assessment Scale score. The evidence for the use of scar massage is weak, regimens used are varied, and outcomes measured are neither standardized nor reliably objective, although its efficacy appears to be greater in postsurgical scars than traumatic or postburn scars. Although scar massage is anecdotally effective, there is scarce scientific data in the literature to support it.
Article
Wound healing in burn wounds presents a challenge in healthcare, and there is still a lack of alternatives in topical burn wound treatments. - The purpose of this study was to evaluate the efficacy of a new therapeutic ointment (MEBO) in the treatment of partial thickness burns. 40 patients received either topical treatment with Moist Exposed Burn Ointment (MEBO) or standard Flammazine treatment. All patients suffered from partial-thickness burn injuries (< 20% TBSA). Wounds were evaluated for 60 up to days regarding wound healing, water loss, inflammation, and pain alleviation. For transepidermal water loss, there was a difference of 2.3 gr/m2/h between MEBO, and Flammazine, favoring MEBO. However, this difference was not statistically significant (p=0.78). For all secondary efficacy parameter results were similar. - This study showed that MEBO ointment for topical treatment of burn injuries presents an attractive alternative for the topical treatment of limited partial thickness thermal burns.
Article
Fourteen patients with erythematous and/or hypertrophic scars resulting from remote surgical excision or trauma were evaluated and subsequently treated with one to two flashlamp-pumped pulsed dye (585 nm) laser treatments over a 2-month period. Clinical assessments were performed before commencement and at the end of the study in all 14 patients. Skin surface texture analyses using optical profilometry were obtained from 5 of the patients before and after laser irradiation. A 57% to 83% clinical improvement was seen in the scars after one to two dye laser treatments, respectively. In addition, a change in the skin texture with return of skin markings approximating those of normal skin measured by optical profilometry was observed in the scars after the pulsed dye laser treatments. The degree of clinical improvement seen at the end of the study continued to be evident in each patient at the 6-month follow-up examination.
Article
During the last 5 years, 640 patients had treatment to their port wine stains (PWS) with a flashlamp-pumped pulsed dye laser. One hundred and fifty-six patients have been discharged for varying reasons, of which 59 (38%) achieved excellent (at least 75%) lightening of their birthmark. Of the remaining patients, those who attended the clinic for the sixth and 12th time for treatment were also assessed to determine the degree of fading achieved in the port wine stain. Our findings confirm that flashlamp-pumped dye laser treatment is safe and effective for the treatment of PWS and that complications are rare. However, the degree of fading achieved is variable and often unpredictable. Fifty-two per cent of facial lesions of different colours achieved over 75% fading as against 18% of non-facial lesions. Sixty-four per cent of those over the age of 50 years had an excellent response whereas only 19% of those below the age of 5 years were able to achieve a similar result. The colour of the port wine stain was found to be of no prognostic value. A search for an accurate and non-invasive method to predict the outcome of flashlamp-pumped pulsed dye laser therapy for PWS is warranted.
Article
Carbon dioxide (CO2) laser resurfacing has become an increasingly popular procedure for the treatment of facial rhytides and solar damage. Yet despite ongoing advancements in laser technology, CO2 laser resurfacing is still a risk-laden procedure that may lead to complications such as infection. Occlusive dressings increase the healing rate and decrease pain intensity in patients who receive full face laser resurfacing. It has been said that the use of occlusive dressings in postresurfacing patients may increase the risk of infection, which typically presents 2-10 days after the procedure. The purpose of this article is to report the incidence of infection following full-face CO2 laser resurfacing of 354 patients who were treated with occlusive dressings. In addition, factors which may have contributed to the delayed onset in three of the four infections are discussed. Three hundred fifty-four patients received full-face CO2 laser resurfacing. Either a continuous wave CO2 laser with a computer-generated scanner (396 microseconds dwell time, 18 W) or a pulsed CO2 laser (500 mJ pulse energy, 90 microseconds pulse duration) were used in all cases of resurfacing. Postoperatively all patients were treated with occlusive dressings and empiric oral cephalexin. Postoperatively patients were monitored at weekly intervals during the first month and then at 3 and 6 months. Of the 354 patients who received full-face laser resurfacing, there were 4 cases of culture-proven infection, which translates to an infection rate of 1.13%. Three of the four infections developed 3-5 weeks after the procedure. This study reports an infection rate of 1.13% following full-face CO2 laser resurfacing and occlusive dressing use in 354 patients. Because infection may develop many weeks after the procedure, patients should be educated to maintain proper wound care hygiene and to avoid "double dipping" of wound care products until wounds are completely healed.
Article
Hypertrophic scarring after burns remains a major problem and is considered to be "common". Pressure garments are commonly used as treatment even though there is little sound data that they reduce the prevalence or magnitude of the scarring. In 1999 we began a study of the efficacy of pressure garments on forearm burns. After studying 30 patients, mainly white adults, we found no hypertrophic scar in either those treated with pressure or without. This prompted us to review the literature on the prevalence of hypertrophic scarring after burns and found only four articles with a relatively small number of patients and only three geographical locations. It became clear that the prevalence of hypertrophic scarring is really unknown. We then did a retrospective study of 110 burn survivors and counted all hypertrophic scars of all sizes and locations in all races and found the prevalence hypertrophic scarring to be 67% which conflicts with the published reports and our prospective study and suggests that further research is necessary. We concluded that a worldwide, prospective survey is necessary to establish the prevalence of hypertrophic scarring after burns. In this article we are calling for and offering to organize this survey.
Article
Laser resurfacing has now become an accepted and important component of facial rejuvenation. With the introduction of computerized scanning systems, the actual laser resurfacing technique has been greatly simplified; however, the final outcome still depends to a large extent on the efficiency of the postlaser wound care in promoting wound healing and preventing early and late complications. It has been repeatedly confirmed that a moist environment is the single most important external factor affecting the rate of re-epithelialization. Occlusive moisture-retentive dressings, however, are difficult to apply and maintain in position and may as well be complicated by serious infections. Moist exposed burn ointment has been shown to maintain adequate moisture for optimal healing by frequent ointment application without the need for a secondary overlying dressing. It would be ideal for postoperative laser care. Twenty-eight consecutive patients treated with coherent ultrapulse CO2 laser in Toulouse, France, were included in the trial. Moisture-retentive ointment was applied over the treated areas every 4 to 6 hours. Healing was assessed clinically and with repeated transepidermal water loss measurements. Swab cultures were taken, and pain was evaluated with a visual analog scale. Colorimetric analysis of pictures taken was statistically compared with picture analysis of 20 patients treated earlier with an occlusive dressing. Uneventful timely healing occurred in all patients with minimal pain and discomfort. Healing with moist exposed therapy resulted in faster recovery of cutaneous erythema, as evidenced by colorometry. Moist exposed burn ointment application can be safely considered a good and valid alternative to occlusive dressings for postoperative laser care.
Article
Keloids and hypertrophic scars are benign growths of dermal collagen that usually cause major physical, psychological, and cosmetic problems. In this 12-week single-blinded clinical trial, 69 patients were randomly assigned into three study groups. In Group 1, intralesional triamcinolone acetonide (TAC, 10 mg/mL) was injected at weekly intervals for a total of 8 weeks. In Group 2 [TAC+5-fluorouracil (5-FU)], 0.1 mL of 40 mg/mL TAC was added to 0.9 mL of 5-FU (50 mg/mL). This combination was injected weekly for 8 weeks. In Group 3, in addition to weekly TAC+5-FU injection for 8 weeks, lesions were irradiated by 585-nm flashlamp-pumped pulsed-dye laser (PDL, 5-7.5 J/cm2) at the 1st, 4th, and 8th weeks. Lesions were assessed for erythema, pruritus, pliability, height, length, and width. Sixty patients completed the study. At the 8- and 12-week follow-up visits, all groups showed an acceptable improvement in nearly all measures, but in comparison between groups, these were statistically more significant in the TAC+5-FU and TAC+5-FU+PDL groups (p<.05 for all). At the end of the study, the erythema score was significantly lower, and itch reduction was statistically higher in the TAC+5-FU+PDL group (p<.05 for both). Good to excellent improvements (>50% improvement) were reported by the patients as follows: 20% in Group 1, 55% in Group 2, and 75% in Group 3, all of which were significantly different (p<.05). Good to excellent responses were reported by the blinded observer as follows: 15% in Group 1, 40% in Group 2, and 70% in Group 3. Their differences were statistically significant (p<.05). Atrophy and telangiectasia were seen in 37% of patients in TAC group. Overall efficacy of TAC+5-FU was comparable with TAC+5-FU+PDL, but the TAC+5-FU+PDL combination was more acceptable by the patients and produced better results. Its effect on lightening of the lesion was promising. The TAC+5-FU+PDL combination seems to be the best approach for treatment of keloid and hypertrophic scars.
Analysis of MEBO Cream Institute of Science and Forensic Medicine. Department of Scientific Services Health Science Division Singapore
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Update on hypertrophic scar treatment
  • FB Rabello
  • CD Souza
  • JAF Júnior