title: Incidence and management of adverse events after the use of laser therapies for the treatment of hypertrophic burn scars.
abstract: BACKGROUND
  Hypertrophic burn scars may generate significant morbidity, due to intense pruritus, persistent dysesthesias, and contracture. Although treatment with pulsed dye laser and fractional CO2 laser may improve symptoms, incidence of secondary wound complications is not well known. We examined the adverse event profile of laser therapies for the treatment of hypertrophic burn scars.
  
  
  METHODS
  We performed a descriptive, retrospective, 6-month study of all patients who underwent laser therapies, at an accredited regional burn center, to improve the vascularity, texture, thickness, and stiffness of symptomatic burn scars. Data regarding skin type, mechanism, area treated, and laser parameters were collected. Main outcome measures included pigmentation changes, blistering, rash, infection. χ analysis and Student t test were used to evaluate associations between variables.
  
  
  RESULTS
  A total of 95 patients underwent 163 treatment sessions (mean, 2.7 sessions/patient) with pulsed dye laser (71%), CO2 laser (22%), and other lasers (7%). Forty-one adverse events were recorded: hyperpigmentation (2%), hypopigmentation (12%), mild blistering (27%), pain (37%), rash (7%), fever (10%), and infection (2%). Patients with scald burns were more likely to develop blistering, rash, and fever after treatment (all P < 0.05). Higher Fitzpatrick skin type was associated with hypopigmentation and blistering, whereas CO2 laser was associated with increased postoperative pain (all P < 0.05)
  
  
  CONCLUSIONS
  Despite the frequent occurrence of pain and mild blistering after laser treatment of hypertrophic burn scars, major adverse effects were exceedingly rare, with improvement noted in all patients. Patients with higher Fitzpatrick skin types must be handled with care, to avoid complications of blistering and hypopigmentation.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of North Carolina Health Care System, Chapel Hill, NC 27516-7195, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Clayton
authors.forename: Renee
authors.initials: R
authors.lastname: Edkins
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.forename: Charles Scott
authors.initials: CS
authors.lastname: Hultman
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000150:complications*; D002648:Child; D017439:Cicatrix, Hypertrophic / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D054025:Lasers, Dye / Q000627:therapeutic use*; D054020:Lasers, Gas / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult