How lasers rehabilitate trauma-related scarring

Jill Waibel, M.D.The very lasers that dermatologists have in their practices to treat wrinkles, acne scars and pigmented lesions have the power to rehabilitate the most disfiguring of burns and other scars.

Miami, Fla., dermatologist Jill Waibel, M.D., spoke on using lasers for trauma rehabilitation at the Orlando Dermatology Aesthetic and Clinical Conference (Orlando, Fla., January 2016), and was honored during that meeting with a Journal of Drugs in Dermatology (JDD) Humanitarian Award for her work in using lasers to treat patients with traumatic burn injuries.

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Dr. Waibel, assistant voluntary faculty at University of Miami and chief of dermatology at Baptist Hospital, in Miami, says dermatologists who look beyond the use of lasers in the traditional cosmetic sense have the power to make incredible differences in the lives of burn and trauma patients.

The goal of scar therapy is the restoration of the patient to his or her pre-injury state. The surgery not only improves severe scars, but also relieves severe contractures and improves contour abnormalities, according to Dr. Waibel’s presentation.

Treat early to avoid scarring

There’s no question - whether it’s a shark bite or a burn - scars are going to form after a serious trauma, according to Dr. Waibel.

“So, why would you wait and start treating?” she says. “We have seen that early intervention makes the scars almost go away before they form. It’s really powerful.”

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Early treatment is one of the most important messages to send to dermatologists using lasers to treat burn or trauma scars. Traditionally, doctors have been taught to wait at least 12 months to treat burn and trauma scars.

“That’s really counterintuitive, because the scars get worse,” Dr. Waibel says.

The best time to treat a scar is as soon as the epithelium is intact, which is usually around three months. At that point, dermatologists can gently begin laser scar treatment to prevent scar formation, according to Dr. Waibel.

“These patients can have horrific, disfiguring, painful contracture scars that form. And a lot of our patients are children. We’ve seen that when you go in early, they need less surgery and less laser treatment,” she says.

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Dr. Waibel has nearly completed a clinical trial with Lutronics showing early scar treatment with lasers works, and she told Dermatology Times that she has been using this approach in practice and with her work on military personnel with battle scars for the last three to four years.

NEXT: How she does it

How she does it

Dr. Waibel uses several lasers in the same treatment.

The first step is to look at the scar. If it’s a red scar, Dr. Waibel uses one of her vascular lasers, initially in treatment. That might be a pulsed dye laser, intense pulsed light (IPL) or the BBL (BroadBand Light) by Sciton, which Dr. Waibel says is her preference.

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If the scar is brown, she will initially treat it with the thulium 1927 nm wavelength (Fraxel, Solta Medical) or the new Halo 1470 nm laser (Halo Hybrid Fractional Laser, Sciton).

Then, for the main part of treatment, Dr. Waibel will use either the fractional ablative CO₂ or Erbium. Both work well, she says.

Best practices for treating trauma or burn scars with lasers include that dermatologists should match the depth of the fractional laser to the depth of the scar.

“And you want to stay low-density-about 10% density--no matter what device you’re using with the fractional ablative,” Dr. Waibel says. “We know these scars want to be treated gently.”

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As an adjuvant to treatment, Dr. Waibel uses laser-assisted delivery for targeted cutaneous drug delivery. She and colleagues have published on the topic for a variety of treatments, including skin cancer. In essence, Dr. Waibel applies triamcinolone (Kenalog, Bristol-Myers Squibb) or 5-fluorouracil (5FU) to the skin before applying the fractional laser for more optimal and faster results. The trick, she said, is to use only one or two ccs to avoid systemic absorption.

NEXT: Outcomes

Outcomes

Dermatologists using this approach to treat scars can expect dramatic results, according to Dr. Waibel.

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“Every time you treat a scar it gets better. I would say that for a lot of our burn and trauma patients, it takes four to six treatments. And we can get most of these patients back to living a normal life, so that when they go out in public, they’re not embarrassed. They can wear tank tops. People don’t look at them and say what happened to you. It’s pretty exciting and I don’t think anyone would have thought that a laser would have had this type of power,” she says.

Disclosures: Dr. Waibel has done an equipment clinical trial for Alma; is a speaker and researcher for L’Oréal, Sciton/Harvest and Syneron/Candela; is a consultant for Valeant; is a researcher for Lumenis and Sebacia; and she co-invented an intellectual property and might gain royalties from future commercialization of the technology.

Contact for editorial only: jwaibelmd@miamidermlaser.com