Carbon dioxide laser treatment of burn-related scarring: Results of the ELIPSE (Early Laser Intervention Promotes Scar Evolution) prospective randomised controlled trial

Christopher Lewis¹, Helen Douglas¹, Lisa Martin², Zhenjun Deng², Philip Melton^3,4, Mark Fear², Suzanne Rea^1,2, Fiona Wood^1,2,
¹State Burn Service of Western Australia, Perth, WA, Australia
²Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
³Menzies Institute for Medical Research, University of Tasmania, Hobart Tasmania
⁴School of Global and Population Health, University of Western Australia, Perth, WA, Australia

Abstract

Aim: To investigate the impact of ablative fractional carbon dioxide laser (AFCO₂L) on patient reported outcomes measures, dermal architecture, and gene transcription in early burn scars.

Methods: Fifteen adult patients with a burn-related scar were recruited. Inclusion criteria were two non-contiguous scar areas of 1% TBSA, similar baseline Vancouver scar scale (VSS) score and 3 months since the time of injury. All participants acted as their own control. Scars were randomised to treatment or control. Treatment scars received three AFCO₂L treatments at 6-week intervals. Outcome measures were recorded at baseline, 3, 6 and 12-months post-treatment. Measures included blinded VSS, Patient Observer Scar Assessment Scale (POSAS), Brisbane Burn Scar Impact Profile (BBSIP), blinded scar photo assessment, histological tissue analysis and RNA sequencing analysis.

Results: No significant difference was found in VSS, scar erythema or pigmentation. Patient POSAS improved in scar thickness and texture following AFCO₂L. All elements of BBSIP improved in control and laser groups. AFCO₂L-treated scars were scored better than control scars by blinded raters. RNA sequencing illustrated that AFCO₂L induced sustained changes in fibroblast gene expression.

Conclusions: AFCO₂L significantly improved scar thickness, texture, and appearance 3 months post-treatment. RNASeq results suggest laser treatment alters the transcriptome of treated fibroblasts for at least 3 months after treatment. Expansion of this research, particularly to increase participant numbers and study in more depth fibroblast changes in response to laser, as well as assessing the impact on daily activity and quality of life, will be beneficial.

Biography

Chris Lewis is a Consultant Burn Surgeon at the Northern Regional Burn Centre in Newcastle upon Tyne, UK. He was previously the burns fellow at the State Burn Service of Western Australia, Perth.