Cutaneous scarring is often the epicenter of patient-related concerns. The introduction of the concept of fractional photothermolysis started a new era in the repair of damaged skin, with its ability to affect collagen formation and mimic the normal process of tissue repair via generating microscopic columns of coagulated tissue through the epidermis and dermis to evoke a wound healing response.
In this clinical study 25 patients with 28 non hypertrophic scars, 9 females and 14 males aged between 6-37 years were subjected to treatment with fractional CO2 laser with varying energies, pulse durations, number of passes and number of treatments. Patients were assessed objectively by means of clinical photography taken before treatment and one month after last session by the investigator, 2 double-blinded dermatologists and subjectively by patient satisfaction. Statistical analysis was used to analyze results to compensate for the lack of objective scales in evaluating the results of scar treatment.
All patients showed clinical improvement. According to the investigator: 21.42% of scars showed excellent improvement (grade 3), 53.57% of scars showed good improvement (grade 2) and 25% of scars showed fair improvement (grade1) at one month follow- up after the last session. The clinical improvement according to blinded dermatologist assessment revealed that there was no significant difference between it and investigator assessment. There was overall improvement in erythematous and hyperpigmented scars. Hypopigmented scars showed also improvement in color in relation to the normal surrounding skin.
Significance correlation was found between age of patient and clinical improvement being better with younger age. No significance correlation was found between clinical improvement and sex of patient, site, color, shape or duration of scars.
As regard patient satisfaction, it varied from one patient to another. Eight percent of patients were not satisfied, 24% were slightly satisfied, 36% were satisfied, 20% were very satisfied and 12% were extremely satisfied. Significance difference was found between physicians’ evaluation and patient’s satisfaction. Unrealistic expectations as well as lack of proper patient education prior to treatment were main causes for such difference.
All patients tolerated the procedure with topical anaesthesia. Side effects were minimal and transient, including transient edema, erythema and crust formation. No permanent hyper- or hypopigmentation were recorded. No pruritus or petechiae or any other side effects.
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