title: Dermal Remodeling of Burn Scar by Fractional CO2 Laser.
abstract: BACKGROUND
  Ablative CO2 fractional lasers have recently been introduced for burn scar treatment because of pronounced clinical outcomes with fewer treatment sessions than nonablative fractional laser.
  
  
  OBJECTIVE
  This study was conducted to observe clinical as well as histologic changes of burn scars after treatment with CO2 fractional laser.
  
  
  METHODS
  Eleven patients (one female and 10 males, aged 31-59 years) with skin phototypes III to V with burn scars received 10 sessions of fractional CO2 laser treatments (UltraPulse(®) Encore; Lumenis, Santa Clara, CA, USA) over an average 5-week interval. Two passes were performed using the following parameters: deep FX mode, 12.5-30 mJ, with a density setting of 5-10 %. Clinical evaluations by three blinded dermatologists were obtained at baseline and at 6 months after the final treatment via photographs using the Vancouver scar scale (VSS). Skin biopsies were done on four patients before and after treatment.
  
  
  RESULTS
  All patients showed clinical improvement in their scars with significant decrease in VSS. Histologic findings showed the changes in the upper dermis with newly formed dermal papilla. This characteristic upper dermis change was presented as improvement in surface smoothness and skin tension clinically. Postinflammatory hyperpigmentation and itching sensation were the most common adverse effects.
  
  
  CONCLUSIONS
  Burn scar treatment by fractional CO2 laser is effective by forming new collagen fibers mainly in the upper dermis.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors: Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea.
authors: Sang-Jun
authors: SJ
authors: Lee
authors: Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea.
authors: Dong-Hye
authors: DH
authors: Suh
authors: Department of Dermatology, Korea University College of Medicine, Inchon-ro 73(Anam-dong 5ga), Seongbuk-gu, Seoul, 136-705, Korea.
authors: Ji Min
authors: JM
authors: Lee
authors: Department of Pathology, College of Medicine Chung-Ang University, Seoul, Korea.
authors: Kye-Yong
authors: KY
authors: Song
authors: Department of Dermatology, Korea University College of Medicine, Inchon-ro 73(Anam-dong 5ga), Seongbuk-gu, Seoul, 136-705, Korea. dermhj@naver.com.
authors: Hwa Jung
authors: HJ
authors: Ryu
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D002056:Burns / Q000150:complications / Q000473:pathology*; D002921:Cicatrix / Q000209:etiology / Q000532:radiotherapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D015601:Injury Severity Score; D054020:Lasers, Gas / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012038:Regeneration / Q000502:physiology*; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
keywords: Burn scar; Dermal remodeling; Histology; Laser and light sources