Laser Therapy for Burn Scars

What Is a Laser?

A laser is a device that creates a special, single color of light. Unlike a flashlight, the kind of light a laser creates is focused and full of energy. People use lasers for many things. They use lasers to read barcodes at a store, play music on a CD, measure temperature, and even for medical treatments. Each of these uses requires a specific and different kind of laser. In patients with burns, doctors use lasers to make burn scars look and feel more like normal skin.

What Is a Hypertrophic Scar?

• Any injury to the skin creates a scar. The kind of scar that forms depends on many factors. These include where the injury is on the body, how it gets treated, and the patient’s genes. A hypertrophic scar is thick, stiff, and raised above the level of the skin around it. These scars can be mild or severe and may even change how the body moves when they form near joints.
• Burns that are deep, need a long time to heal, or are on parts of the body that move a lot are more likely to develop hypertrophic scars. But these scars can develop anywhere on the body where skin gets injured, including an area where there was a skin graft.
• These scars often appear 2–6 weeks after the skin injury. They continue to develop over the next 6–12 months. These scars often stop growing around 1 year after the injury.
• While growing, hypertrophic scars may be pink, purple, or red. As they get older, they often become dark and brown.
• Hypertrophic scars can look like keloids and their treatments are similar. Unlike keloids, hypertrophic scars do not invade into healthy tissue.
• To learn more about hypertrophic scars, please refer to the Scar Management After Burn Injury factsheet at https://msktc.org/burn/factsheets/scar-management-after-burn-injury.

What Are the Symptoms of a Hypertrophic Scar?

People often have the following symptoms:

• Pain. People describe this pain as feeling like electricity, stinging, or burning.
• Itching. Patients often have an intense desire to scratch these scars, which can create new open wounds that create new scars.
• A tight feeling. This often happens when hypertrophic scars develop over parts of the body that move.

Non-Laser Management for Hypertrophic Scars

You can use the following methods with or without laser treatment. Talk to your doctor about what options are best for you.

Types of Lasers for Hypertrophic Scars

There are multiple types of lasers used for scars, but these are the two most common:

• A carbon dioxide (CO2) laser creates very small holes in the thick hypertrophic scar. These holes break up the abnormal scar and give the body a chance to grow a new, softer scar. Because a CO2 laser makes holes in a scar, it can be uncomfortable. As a result, you may need anesthesia.
• A pulsed dye laser (PDL) targets and destroys pink and red colors in burn scars. This lets the scars fade and have a better color match to unburned skin. This process involves less scar damage and is often less painful for patients.

Doctors can use these lasers alone or together to treat hypertrophic burn scars. Their approach depends on what a patient needs.

How Does the Laser Process Work?

Talk to your health care provider about the following:

• Laser treatment for burn scars is noninvasive and usually starts 3 months after the burns have healed.
• For the pulsed dye laser, patients often describe the pain of treatment as feeling like snapping a rubber band against the skin. For the CO2 laser, they describe the pain as feeling like a bee sting. Depending on the size and location of the scar and the age of the patient, patients may need local or general anesthesia for these treatments. Most patients do not need opioid pain medicine after treatment.
• After they treat the scar with a laser, some doctors may apply topical or injectable medicines like steroids.
• Doctors usually cover the treated areas with antibacterial ointment and gauze. Please talk to your doctor about posttreatment care. They can give you instructions on how and when to remove these dressings.
• Treated areas will usually heal in 1–3 days.
• Improvements in pain, itchiness, and tightness are often gradual. Patients may need three to six treatments to see results.
• Laser treatments are well tolerated. Treatment complications include local infections, skin that is dark or light compared to unburned skin, and irritation at the site of treatment.

Is Laser Therapy Covered by Insurance?

• Not all insurance providers cover laser treatment, and they often require an authorization process to approve treatment.
• To get approval from your health insurer, the hypertrophic scars must affect how the body functions. Also, a doctor with experience in burn care must state that laser treatment would help.
• Your health care provider will request approval from your insurance company.

Summary

Hypertrophic burn scars can be painful, tight, and itchy. Standard methods to treat these scars include steroid injections and compression garments. Laser therapy is a new form of treatment that may help. Most people need three to six sessions of laser therapy to get the most benefit. Working with doctors with experience in treating burn scars is the most important step to getting proper treatment with lasers.

References

Buta, M. R., Hultman, C. S., Bojovic, B., Schulz, J. T., & Goverman, J. M. (2023). Laser therapy of burn scars: CPT coding and reimbursement challenges. Lasers in Surgery and Medicine, 55(5), 443. https://doi.org/10.1002/lsm.23674

Hultman, C. S., Friedstat, J. S., Edkins, R. E., Cairns, B. A., & Meyer, A. A. (2014). Laser resurfacing and remodeling of hypertrophic burn scars: The results of a large, prospective, before-after cohort study, with long-term follow-up. Annals of Surgery, 260(3), 519–529; discussion 529–532. https://doi.org/10.1097/SLA.0000000000000893.

Won, P., Cooper, M., Gillenwater, T. J., & Yenikomshian, H. A. (2023). Treatment of hypertrophic burn scars with laser therapy: A review of adverse events. Annals of Plastic Surgery, 91(6), 715–719. https://doi.org/10.1097/SAP.0000000000003712.

Authorship

Laser Therapy for Burn Scars was developed by Maxwell Johnson, MD, Jeremy Goverman, MD, and Haig Yenikomshian, MD, in collaboration with the Model Systems Knowledge Translation Center (MSKTC).

Source: The content in this factsheet is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Burn Model System (BMS) centers, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider about specific medical concerns or treatment. The contents of this factsheet were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Recommended citation: Johnson, M., Goverman, J., & Yenikomshian, H. (2024). Laser Therapy for Burn Scars. Model Systems Knowledge Translation Center. https://msktc.org/burn/factsheets/laser-therapy-burn-scars

Copyright © 2024 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.