Immediate post-treatment care included application of triamcinolone 0. Tacrolimus 0. The laser treatments were very well-tolerated with no downtime, with minor pain during the procedure being the only adverse effect.
The patient also reported improved mood and decreased pain and pruritus associated with her scars and was able to discontinue gabapentin therapy. The patient, a sanitation worker, sustained an occupational second-degree chemical burn injury four months prior after being accidentally splashed on the job with potassium phosphate.
He reported intermittent pain and itching of the scarred areas as well as significant emotional distress due to the appearance of his scars. Additionally, the patient noted new areas of hair loss on the scalp, which he believed resulted from the chemical splash. He had no personal or family history of autoimmune disease. He received two treatments with the PDL 5 mm spot size, energy 7. All treatments targeted the left upper extremities and neck.
Topical EMLA cream was applied under occlusion to the treatment area 1 h before the procedure. At two of his sessions, both non-ablative lasers and wavelengths were used sequentially over the affected areas. Treatments were spaced approximately one month apart and were well-tolerated. Post-treatment care included application of triamcinolone 0. Adjuvant therapy included continued scar massage. There was vast improvement in the appearance of the scars with regard to both texture and skin colour Figure 3b.
There is increasing demand for better non-surgical options in scar management.
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The use of fractional laser devices represents a major advancement in the treatment of scars. Fractional resurfacing lasers insert hundreds of evenly distributed columns of thermal injury, referred to as microscopic treatment zones MTZinto the dermis. Fractional resurfacing lasers have shown efficacy in improving thickness, pliability, pigmentary changes and textural abnormalities in both early and mature scars.
NAFL is a type of fractional laser that produces a more superficial injury to the dermis while sparing the overlying epidermis compared to ablative fractional lasers AFL that cause injury to both the epidermis and dermis. The nm wavelength injures the dermis to stimulate collagen remodelling while the nm wavelength targets dyspigmentation by shuttling melanin into collections of microscopic epidermal necrotic debris just above the MTZs which are subsequently shed after one to two weeks.
This device may be especially advantageous in patients with skin of colour who tend to develop more pigmented burn scars and are at an increased risk of developing PIH after resurfacing treatments, a side effect that may last several years.
The darkly pigmented scars on the lower extremities of our first case improved dramatically using the thulium laser. Previous literature has discussed the utilisation of the nm thulium laser in treating many different hyperpigmentation disorders.
The thulium laser is frequently used to treat melasma with minimal side effects; however, many patients had experienced some recurrence and required repeat sessions. Another study found that acquired facial hyperpigmentation can be managed using a combination of topical anti-inflammatory agents and the thulium laser. To our knowledge, our case series is the first report using the nm thulium laser to as part of a multimodal approach to specifically address burn scar hyperpigmentation.
In our first case, tacrolimus ointment was used in conjunction with the laser treatments to address hyperpigmentation and reduce scarring in the bilateral lower extremities. Tacrolimus is a calcineurin inhibitor that prevents the activation of T-cells. Kim et al report of a keloid that resolved after application of topical tacrolimus, possibly due to its ability to inhibit gli -1 signal transduction, which is overexpressed in keloids.
The thulium laser specifically addresses hyperpigmentation, which is advantageous in patients with skin of colour who are more prone to developing PIH. Further studies are needed to optimise settings and establish treatment guidelines. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Ethical approval: The authors confirm that the necessary written, informed consent was obtained from patients for this article.
National Center for Biotechnology InformationU. Journal List Scars Burn Heal v. Scars Burn Heal. Published online Feb Author information Copyright and License information Disclaimer.
Email: moc. Abstract Introduction: Burn scars cause cosmetic disfigurement and psychosocial distress. Keywords: nm erbium:glass, nm thulium, alopecia areata, burn scars, Fitzpatrick phototype III, Fraxel Dual, non-ablative fractional resurfacing lasers, pulsed dye laser, tacrolimus. Lay Summary While all scars can be bothersome, burn scars can be particularly troubling. Introduction Burn scars cause significant morbidity due to cosmetic disfigurement, contractures and associated symptoms such as pain and pruritus, and psychosocial distress.
Case presentations Case 1: A year-old, Fitzpatrick phototype FP III woman was referred for treatment of extensive burn scars on the upper and lower extremities. Open in a separate window. Figure 1. Figure 2. Figure 3. Figure 4. Discussion There is increasing demand for better non-surgical options in scar management.
References 1. Laser in the management of burn scars. Burns ; 43 : — Psychopathology and psychological problems in patients with burn scars: epidemiology and management. Am J Clin Dermatol ; 4 : — Burn rehabilitation: state of the science. Am J Phys Med Rehabil ; 85 : — Prevention or treatment of hypertrophic burn scarring: a review of when and how to treat with the pulsed dye laser.
Burns ; 40 : — Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report. JAMA Dermatol ; : — Bogdan Allemann I, Kaufman J. Fractional photothermolysis—an update. Lasers Med Sci ; 25 : — Alam M, Warycha M. Complications of lasers and light treatments. Dermatol Ther ; 24 : — The spectrum of laser skin resurfacing: Nonablative, fractional, and ablative laser resurfacing.
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J Am Acad Dermatol ; 58 : —; quiz — Laser modulation of hypertrophic scars technique and practice. Clin Plast Surg ; 44 : — Such as shock after severe, deep burns and prevent septicemia. Inflammation of skin and celluler tissue with extreme tenderuess and pain.
Pattend does not want to approach and tell every one present they are all right and wants to be left alone. Arsenicum 3 - Deep burns with vesicles and infected flesh that turn black showing tendency towards gangrene, Inflammatory swelling, with burning, lancinating pains.
Infection from dead tissue remaining in the wound great anguish and restlessness, changes place constantly. Fents death and being left above. Thinks it is useless to take medicine. Prostration which may seem out of proportion with the situation colic after severe burn. Calendula 2 - This remedy is useful for minor superficial burns caused by fire or the sun.
Skin pigmentation after burn
Calendula also prevents gangrene and promotes granulation as well as prevents disfiguring scars. Prevents loss of blood and excessive pain. It is a good remedy to use to promote healing after specific acute remedies have removed the shock, pain and immediate symptoms.
Use this remedy internally in potency and externally as a lotion.
Cantharis 3 - If used early it will prevent the formation of blisters. This is the most used remedy for scalds, burn and sunburns with vesicular character, blisters and superficial ulceration. Small blisters coalesce to form large blisters. Tetanic or epileptiform convulsions followed by coma. Extensive burns cause a renal complication.
Use internally and externally in lotion. Chemical burns and scalds.