Burn scars and the utility of laser therapy in their management

Hypertrophic scars are a well-known complication affecting between 32 and 94% of burn survivors. They are characterized by altered vascularization, dyschromia, structural changes, increased tension, and abnormalities in healthy perilesional skin. These alterations generate pain, itching, debilitating contractures and disfigurement, with the consequent functional and psychosocial deterioration that, in addition to stigmatization, can profoundly reduce the quality of life of those affected. Consideration must also be given to the significant costs created for our health systems. Advances in laser therapy, especially the introduction of fractional ablative lasers, could even replace surgery in some cases, or be used prior to surgery to soften scars and thus potentially improve surgical and cosmetic outcomes. CO2 fractional ablative lasers, by themselves, can produce a clinical improvement in scars, by specifically destroying dermal components allowing scar remodeling and improving itching, pain, and flexibility. Even as monotherapy, statistically significant improvement in scar evaluation scales, such as Vancouver Scar Scale and Patient and Observer Scar Assessment, can be seen. This literature review aims to provide an updated view of the management of burn scars, highlighting the usefulness and benefits of laser therapy, particularly delving into CO2 fractional ablative lasers, as therapeutic tools in constant development and with growing scientific evidence supporting their recommendations.