The most interesting aspect about the results, Dr. Gauglitz observed, is that 1 month after treatment, across-the-board improvements were documented, but then continued to grow in magnitude through the final 6-month follow-up – despite no further treatment. This was presumably the consequence of the collagen-remodeling process.
For example, scores on the Vancouver Scar Scale – still the most widely used scoring tool in the burn field – improved from roughly 7 at baseline to 2 at 6 months, compared with no change in the control area. Similarly, scores on the POSAS (Patient and Observer Scar Assessment Scale) showed highly significant and steadily growing improvement over 6 months of follow-up in most domains, including scar pigmentation, thickness, surface area, and flexibility.
Skin elasticity as measured by the Cutometer improved steadily by 28% at the 6-month mark. Likewise, evaluation with the PRIMOS device showed a steadily smoother scar surface over time.
Final results on the Dermatology Life Quality Index (DLQI) are still being tabulated, but there clearly is a strong improvement on this score – much of it attributed to the improved function resulting from greater flexibility.
“The results of fractional CO2 laser therapy are actually difficult to visualize, but patients are incredibly happy. For us, it might not be a big difference, but if you smoothen the scar surface and the patient is suddenly able to apply makeup without making the scar too visible, for those patients it’s a big thing,” Dr. Gauglitz said.
It’s clear from the ongoing multitreatment stage of the study that a single laser session is not optimal. “I think it’s going to be three, at least, for maximum benefit,” the dermatologist commented.
Asked if he thinks the fractional CO2 laser is the most effective tool for all aspects of scar treatment, Dr. Gauglitz was quick to say no.
“It depends, really, on the indication you want to treat. When it comes to erythema, a pulsed dye laser is much more effective than a fractional CO2 laser. For hyperpigmentation, a Q-switched ruby laser or the new picosecond laser might be a more interesting approach,” he replied.
Dr. Gauglitz reported serving on advisory boards and speakers’ bureaus for laser manufacturers Lumenis and Candela as well as for Merz Pharmaceuticals and Sinclair Pharma.