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A retrospective study to identify the optimal parameters for pulsed dye laser in the treatment of hypertrophic burn scars in Chinese children with Fitzpatrick skin types III and IV

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Abstract

For over several decades, 595-nm pulsed dye laser (PDL) has been used effectively, reducing erythema and improving the pliability and texture of burn scars. Children usually tolerate PDL treatment as it is non-invasive and causes only mild pain compared to other laser treatments. However, currently, there are limited data on scar management in children who underwent PDL treatment, especially for Fitzpatrick skin types III and IV. The objective of the study was to identify the optimal parameters for the PDL treatment that induce inhibitory effects on scar tissue in children with Fitzpatrick skin types III and IV. Besides, the study assessed the usefulness of high-frequency ultrasound (20 MHz) and laser Doppler flowmetry in assessing these lesions. A total of 165 (79 males and 86 females) children with hypertrophic scars treated by PDL were assessed by the Vancouver scar scale (VSS), high-frequency ultrasound (20 MHz), and laser Doppler flowmetry. The parameters used for the 595-nm PDL treatment were pulse duration of 0.45 ms, fluence between 5 and 9 J/cm2, a spot size of 7 mm, and treatment intervals from 3 to 8 weeks. There were no significant differences between pretreatment and post-treatment in terms of the distribution of sex, type of skin color, and low and high fluences. While the mean scores of all scar parameters based on VSS, except thickness and pliability between pre and post-treatment, showed significant differences in ≤3-year-old children vs. to >3-year-old children, except for the subscore, a significant improvement was observed when PDL was initiated within 4 to 6 months of the scar age. In Chinese children with Fitzpatrick skin types III and IV, early intervention, appropriate treatment intervals, and low fluence of PDL were optimal parameters in treating hypertrophic burn scars. The combined high-frequency ultrasound and laser Doppler flowmetry assessment of scars helped assess these lesions and compare the efficacy of different treatment modalities.

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Acknowledgments

We thank Mrs Aiping Guo for her help in field measurements and statistics analyses, and Medjaden Bioscience Limited Corporation significantly improved English writing this manuscript.

Funding

The study was funded by Xijing Hospital Clinical Foundation.

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Author notes

  1. Na Li and Li Yang contributed equally to this work.

Authors and Affiliations

  1. Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi’an, Shaanxi Province, China

    Na Li, Li Yang, Jing Cheng, Juntao Han, Xuekang Yang, Zhao Zheng, Hao Guan & Dahai Hu

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  1. Na Li
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  2. Li Yang
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Contributions

Na Li, Li Yang, Jing Cheng: PDL treatment, data statistics, and paper writing.

Xuekang Yang, Zhao Zheng, Hao Guan, Dahai Hu: all hypertrophic scar cases provided.

Juntao Han and Dahai Hu: making research approach and article structure.

Corresponding author

Correspondence to Juntao Han.

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Conflict of interest

The authors declared that they have no conflicts of interest in this work.

Statement of ethics

The study was approved by the Ethics Committee of Xijing Hospital, Xi’an, China. All guardians of the patients have provided written informed consent, including permission for publishing their images.

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Li, N., Yang, L., Cheng, J. et al. A retrospective study to identify the optimal parameters for pulsed dye laser in the treatment of hypertrophic burn scars in Chinese children with Fitzpatrick skin types III and IV. Lasers Med Sci 36, 1671–1679 (2021). https://doi.org/10.1007/s10103-021-03252-x

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  • DOI: https://doi.org/10.1007/s10103-021-03252-x

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