Sharma Yasharth, Jain Pradeep, Gottam Suman Babu, Sarkar Arnab, Prasad Nikhil
Plastic and Reconstructive Surgery, Moti Lal Nehru Medical College, Prayagraj, IND.
Plastic and Reconstructive Surgery, Banaras Hindu University, Varanasi, IND.
Cureus. 2024 Apr 16;16(4):e58358. doi: 10.7759/cureus.58358. eCollection 2024 Apr.
Annually, around 100 million patients worldwide acquire scars, some of which can cause significant problems. Various treatment interventions, such as topical scar creams, steroids, laser therapy, and surgery, have been developed to manage these scars. This study was conducted to evaluate the effectiveness of fractional CO laser treatment by assessing outcomes using the Patient Observer Scar Assessment Scale (POSAS) and clinical photographs.
A total of 47 patients were included in the study, divided into three groups: a post-acne scar group with 14 patients, a post-burn scar group with 17 patients, and a post-traumatic scar group with 16 patients. Detailed histories were taken, and clinical examinations were performed and recorded on a prepared proforma. Aesthetic outcomes were evaluated based on clinical photographs, and total patient and observer scores were recorded using POSAS at baseline, and after one and three months. POSAS comprises two components: the observer scale (POSAS-O) and the patient scale (POSAS-P). Fractional CO laser treatments were performed in each group, with sessions repeated every four weeks for three consecutive sessions. Data were analyzed using the paired t-test for before-and-after comparisons in each study group. Welch's ANOVA test was used for comparisons among the three groups at a significance level of p=0.05, using MS Excel (Microsoft Corporation, Redmond, Washington) and IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York).
The mean age for men was 26.38 ± 8.19 years and for women 22.21 ± 6.38 years. The study comprised 34 female patients (72.34%) and 13 male patients (27.66%). The mean POSAS observer and patient scales were recorded and compared for all three types of scars from baseline to three months. The mean percentage change in POSAS-O and POSAS-P (total score) in relation to different scar sites was recorded. The most significant difference in mean percentage change, statistically significant (p-value < 0.05), was observed for facial scars, followed by scars on the neck, and was minimal for scars on the hand, in both observer and patient groups. Even a single session of fractional CO laser therapy had profound effects on the overall quality of scars.
Fractional carbon dioxide laser therapy improves the quality of scars and produces significant improvements in skin texture, with better effects on post-traumatic scars than on post-burn and post-acne scars. Future studies are needed to better understand the mechanism of action and to optimize the doses and timing of therapy.
全球每年约有1亿患者形成瘢痕，其中一些会引发严重问题。已开发出多种治疗干预措施，如外用瘢痕霜、类固醇、激光治疗和手术，用于处理这些瘢痕。本研究旨在通过使用患者观察者瘢痕评估量表（POSAS）和临床照片评估结果，来评价分次二氧化碳激光治疗的有效性。
本研究共纳入47例患者，分为三组：痤疮后瘢痕组14例，烧伤后瘢痕组17例，创伤后瘢痕组16例。详细记录病史，并按照预先准备的表格进行临床检查和记录。基于临床照片评估美学效果，并在基线、1个月和3个月时使用POSAS记录患者和观察者的总分。POSAS包括两个部分：观察者量表（POSAS - O）和患者量表（POSAS - P）。对每组患者进行分次二氧化碳激光治疗，每四周重复一次，连续进行三次治疗。使用配对t检验对每个研究组治疗前后的数据进行分析。使用MS Excel（微软公司，华盛顿州雷德蒙德）和IBM SPSS Statistics for Windows 20版（2011年发布；IBM公司，纽约州阿蒙克），采用韦尔奇方差分析检验对三组进行显著性水平为p = 0.05的比较。
男性的平均年龄为26.38 ± 8.19岁，女性为22.21 ± 6.38岁。本研究包括34例女性患者（72.34%）和13例男性患者（27.66%）。记录并比较了从基线到三个月所有三种类型瘢痕的POSAS观察者量表和患者量表的平均分。记录了不同瘢痕部位的POSAS - O和POSAS - P（总分）的平均百分比变化。在观察者组和患者组中，面部瘢痕的平均百分比变化差异最为显著，具有统计学意义（p值 < 0.05），其次是颈部瘢痕，手部瘢痕的差异最小。即使单次分次二氧化碳激光治疗也对瘢痕的整体质量有显著影响。
分次二氧化碳激光治疗可改善瘢痕质量，显著改善皮肤质地，对创伤后瘢痕的效果优于烧伤后瘢痕和痤疮后瘢痕。未来需要进一步研究以更好地理解其作用机制，并优化治疗剂量和时间。
