CO2 Fractional Laser With Tranexamic Acid As An Effective Tool For Post Burn Hyperpigmentation.

TITLE:

CO2 FRACTIONAL LASER WITH TRANEXAMIC ACID AS AN EFFECTIVE TOOL FOR POST BURN HYPERPIGMENTATION.

INTRODUCTION Hyperpigmentation is one of the most common sequelae of burns and is due to dysregulation of normal wound healing after burn injury to skin1,2. The proinflammatory cytokine response after a burn stimulates melanocyte proliferation causing increased melanogenesis3. Patients with darker skin are more likely to have hyperpigmented scars. These cosmetically unappealing scars are even more concerning when they involve visible areas of the body, such as the face and hands.

Nonsurgical interventions to prevent or reduce hyperpigmentation of burn scars includes UV protection, hydroquinone application, silicone gel/sheet, nanofat grafting, cryotherapy, and laser and light therapy4. It has also been demonstrated that the earlier the intervention, the better the outcomes are likely to be.

Laser therapy has emerged as a minimally invasive intervention with short post-operative recovery5. Lasers are broadly categorized as ablative or non-ablative, and fractional or non-fractional. Ablative lasers such as the carbon-dioxide (CO2) and Erbium: Yag lasers are generally more effective, but pose a risk of adverse events such as infection, scarring and worsening of pigmentation6. Fractional photo-thermolysis, first described in 2004, leaves columns of non-treated areas between treated columns, thus allowing better wound healing7. Therefore, fractional lasers balance the efficacy of ablative lasers and the safety of non-ablative lasers. Fractional CO2 laser serves to increase dermal pliability, improve abnormal texture, reduce thickness and rehabilitate mature old scars8. A meta-analysis by Zhang et al demonstrated that fractional CO2 laser improved the appearance and pigmentation of post burn scars9.