The efficacy and safety of low‐energy carbon dioxide fractional laser use in the treatment of early‐stage pediatric hypertrophic scars: A prospective, randomized, split‐scar study

Abstract Background Various laser therapies have been introduced in scar management. However, pain during treatment has limited the application of laser therapy in pediatrics. Objectives To evaluate whether the use of the low‐energy mode of a carbon dioxide (CO 2 ) laser improves hypertrophic scars in a pediatric population. Methods This prospective, randomized, split‐scar trial was designed to assess the safety and efficacy of low‐energy CO 2 laser use. Patients aged <12 years with hypertrophic scars were enrolled. Each hypertrophic scar was equally divided into three parts: the two ends of each scar were randomly assigned to control and experimental groups, and the center portion was considered a transition zone and was not included in the analysis. A total of three laser treatments were performed at 1‐month intervals. Scar scale scores 6 months after the final treatment was the primary outcome. Additionally, the Visual Analog Scale (VAS) was used to evaluate pain after each treatment. Results Of the 23 patients enrolled, 20 completed the study. The total Patient and Observer Scar Assessment Scale (POSAS) score at the 6‐month follow‐up was significantly lower for the treated site (44.95 for the treated group vs. 64.85 for the control group, p < 0.0001). Both the patient and observer POSAS scores showed an obvious difference between the treated and control groups (19.95 vs. 29.95 for patient scores, respectively, p < 0.0001, and 26.00 vs. 34.90 for observer scores, respectively, p < 0.0001). All observer and patient scores describing pain, pruritus, color, stiffness, and thickness were statistically different and favored the treated site. No significant difference was found in patient score of irregularity. The average VAS therapeutic pain score was 3.5 ± 1.43 out of 10. Conclusions Low‐energy CO 2 fractional laser therapy improved hypertrophic scars in a pediatric population. Therefore, for children with hypertrophic scar, low‐energy CO 2 laser with less procedure pain may be more appropriate.