Efficacy of fractional carbon dioxide laser therapy for burn scars: a meta-analysis

Abstract

Background: The present study evaluates the effectiveness of fractional carbon dioxide (CO₂) laser for the treatment of burn scars.

Method: Literature search was conducted in electronic databases and studies were selected by following pre-determined eligibility criteria. Random effect meta-analyses were performed to achieve the effect size of the changes (mean difference (MD) between post-treatment and pretreatment values) in selected scar assessment scale scores and other important outcome measures.

Results: 14 studies were included. Treatment of burn scars with fractional CO₂ laser significantly improved Vancouver Scar Scale (MD -3.01 [95% confidence interval (CI) -3.79, -2.22]; p ˂ .00001), Patient and Observer Scar Assessment Scale (POSAS)- Patient (MD -14.38 [95% CI -17.62, -11.13]; p ˂ .00001, POSAS - Observer (MD -8.81 [9% CI -11.60, -6.02]; p ˂ .00001 and Scar Assessment Scale (MD 1.64 [95% CI 0.49, 2.78]; p = .005) scores especially with regards to pigmentation, vascularity, pliability, and height of scar. Pain and pruritis also improved with this treatment. Scar thickness measured with ultrasonography decreased non-significantly (MD -0.48 [95% CI -1.04, 0.09]; p = .1) whereas cutometer measures, R0 (scar firmness) and R2 (scar elasticity) did not change meaningfully.

Conclusion: Fractional CO₂ laser therapy is a valuable tool for the treatment of burn scars which has potential for reducing scar severity.

Keywords: Burn scars; fractional carbon dioxide laser; hypertrophic; keloidal.