• David M Ozog, Austin Liu, Marsha L Chaffins, Adrian H Ormsby, Edgar F Fincher, Lisa K Chipps, Qing-Sheng Mi, Peter H Grossman, John C Pui, and Ronald L Moy.
• Department of Dermatology, Henry Ford Hospital, Detroit, Michigan 48202, USA. dozog1@hfhs.org
• JAMA Dermatol. 2013 Jan 1;149(1):50-7.

ObjectiveTo assess mature burn scars treated with a fractional carbon dioxide laser for changes in histological architecture, type I to III collagen ratios, density of elastic tissue, and subjective measures of clinical improvements.DesignUncontrolled, prospective study of patients with mature burn scars, from a clinical and histological perspective. Biopsy specimens were obtained before and 2 months after 3 treatment sessions. The tissue was prepared with Verhoff von Giesen (VVG) stain to discern elastic tissue and Herovici stain to differentiate types I and III collagen.SettingSubjects were recruited from the Grossman Burn Centers.ParticipantsOf 18 patients with mature burn scars, 10 completed the entire treatment protocol.InterventionParticipants received 3 treatments with a fractional carbon dioxide laser.Main Outcome MeasuresVancouver Scar Scale and Patient and Observer Scar Assessment Scale survey scores. In histological analysis, imaging software was used to measure changes in collagen subtype and elastic tissue. A rating scale was developed to assess normal vs scar architecture.ResultsThe first hypothesis that significant histological improvement would occur and the second hypothesis of a statistically significant increase in type III collagen expression or a decrease in type I collagen expression were confirmed. There were no significant changes in elastic tissue. Statistically significant improvements were seen in all survey data.ConclusionsTreatment with a fractional carbon dioxide laser improved the appearance of mature burn scars and resulted in a significant improvement in collagen architecture following treatment. Furthermore, in treated skin specimens, a collagen subtype (types I and III collagen) profile resembling that of nonwounded skin was found.

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