Restoration of form and function after burn injury remains challenging, but emerging laser and pulsed light technologies now offer hope for patients with hypertrophic scars, which may be associated with persistent hyperemia, chronic folliculitis, intense pruritis, and neuropathic pain. In addition to impairing body image, these scars may limit functional recovery, compromise activities of daily living, and prevent return to work. Three different platforms are now poised to alter our reconstructive algorithm: (1) vascular-specific pulsed dye laser (PDL) to reduce hyperemia, (2) ablative fractional CO2 laser to improve texture and pliability of the burn scar, and (3) intense pulsed light (IPL) to correct burn scar dyschromia and alleviate chronic folliculitis. In this paper, we will provide an overview of our work in this area, which includes a systematic review, a retrospective analysis of our preliminary experience, and interim data from our on-going, prospective, before-after cohort trial. We will demonstrate that laser- and light-based therapies can be combined with each other safely to yield superior results, often at lower cost, by reducing the need for reconstructive surgery. Modulating the burn scar, through minimally invasive modalities, may replace conventional methods of burn scar excision and yield outcomes not previously possible or conceivable. “Remember when you were young, you shone like the sun.” Roger Waters 1. Background Restoration of form and function after burn injury remains challenging, but traditional and emerging laser- and light-based technologies may offer new hope for patients with burn scars. In addition to serving as a visible reminder of the burn injury and compromising self-esteem and self-image, burn scars produce considerable functional morbidity, including contractures, hypertrophic changes, and keloid formation. Furthermore, burn scars often result in persistent hyperemia, chronic folliculitis, intense and unrelenting pruritis, and neuropathic pain. The loss of sweat glands, hair follicles, and melanocytes compromises the ability of skin, the body’s largest organ, to provide thermoregulation, to resist mechanical trauma, and to protect from UV radiation. The stigmata of burn scars are plainly visible, but the injury to the patient is often more than skin deep. Depending upon the constellation of patient symptoms and functional deficits, treatment of the burn scar involves a number of modalities [1], which may include massage and moisturizing agents, pressure garments, silicone sheeting, topical and intralesional
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