SMOOTH

A prospective intra-patient Single-blinded randomised trial to examine the Mechanistic basis of fractiOnal ablative carbOn dioxide laser Therapy in treating adult burns and/or trauma patients with Hypertrophic scarring

Aim

To assess the kinetics of the response to fractionated CO2 laser therapy in hypertrophic scars, in particular to test the hypothesis that a positive effect on the scar (assessed through objective and subjective measures) is associated with reduced number of myofibroblasts and the increased presence of senescent skin cells.

Background/method

Burn injury is the fourth most common type of trauma after road traffic accidents, falls and interpersonal intentional injury. In 2004 it was estimated that worldwide 11 million people suffered fire-related burn injury with 265,000 deaths annually. Burns are also one of the leading causes of disability-adjusted life-years lost. Crucially, up to 90% of the patients who survive a burn injury suffer significant scarring, with hypertrophic scars predominating. Burn care during the last 30 years has seen a step change in survival and this increased survival has been paralleled by improved acute care and durable wound cover resulting in less deformity and scarring. However, there remains an urgent need for improvements in post-burn scar assessment, management and the treatment of historic scars. We suggest that improved understanding of the mechanisms that mediate scar reduction with laser treatment, combined with standardised assessment of scarring and rigorous RCT design, will enable better design of laser treatment regimens and thus benefit those living with hypertrophic scarring.