Evaluation of Clinical Results, Histological Architecture, and Collagen Expression Following Treatment of Mature Burn Scars With a Fractional Carbon Dioxide Laser
AUTHORS: David M. Ozog, M.D.1; Austin Liu, M.D.1; Marsha L. Chaffins, M.D.2; Adrian H. Ormsby, M.D.2; Edgar F. Fincher, M.D., Ph.D4; Lisa K. Chipps, M.D.4; Qing- Sheng Mi, M.D., Ph.D3; Peter H. Grossman, M.D.5; John C. Pui, M.D.6; Ronald L. Moy, M.D.4
RESEARCH SITES: Department of Dermatology1, Department of Dermatology and Pathology2, and Dermatology Research and Immunology3, Henry Ford Hospital, Detroit, Michigan; Moy-Fincher Medical Group, Los Angeles,California4; Grossman Burn Centers, Sherman Oaks, California5; and Hilbrich Labs, Garden City, Michigan6.
PUBLICATION: JAMA Dermatol. 2013 Jan;149(1):50-7
OBJECTIVE: To assess mature burn scars treated with a fractional carbon dioxide laser for changes in histological architecture, type I to III collagen ratios, density of elastic tissue, and subjective measures of clinical improvements.
DESIGN: Uncontrolled, prospective study of patients with mature burn scars, from a clinical and histological perspective. Biopsy specimens were obtained before and 2 months after 3 treatment sessions. The tissue was prepared with Verhoff von Giesen (VVG) stain to discern elastic tissue and Herovici stain to differentiate types I and III collagen.
SETTING: Subjects were recruited from the Grossman Burn Centers. PARTICIPANTS: Of 18 patients with mature burn scars, 10 completed the entire treatment protocol. Intervention: Participants received 3 treatments with a fractional carbon dioxide laser.
MAIN OUTCOME MEASURES: Vancouver Scar Scale and Patient and Observer Scar Assessment Scale survey scores. In histological analysis, imaging software was used to measure changes in collagen subtype and elastic tissue. A rating scale was developed to assess normal vs scar architecture.
RESULTS: The first hypothesis that significant histological improvement would occur and the second hypothesis of a statistically significant increase in type III collagen expression or a decrease in type I collagen expression were confirmed. There were no significant changes in elastic tissue. Statistically significant improvements were seen in all survey data.
CONCLUSIONS: Treatment with a fractional carbon dioxide laser improved the appearance of mature burn scars and resulted in a significant improvement in collagen architecture following treatment. Furthermore, in treated skin specimens, a collagen subtype (types I and III collagen) profile resembling that of nonwounded skin was found.