Evaluate the influence of patient age on laser therapy outcomes for burn hypertrophic scars (HTS), with a specific focus on assessing differences in scar quality, pain, and itch across stratified age groups. A single-institution, retrospective cohort study analyzing outcomes of fractional ablative CO2 laser treatments among patients grouped into younger, middle-aged, and older cohorts using k-means clustering. Patients (n = 119) receiving three or more fractional ablative CO2 laser treatments were included. Scar metrics were evaluated pre-treatment and after each laser session using the Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale (VSS), and durometer measurements. Statistical analyses were performed to compare within- and between-group outcomes using ANOVA with corrections for multiple comparisons. The study cohort included 119 patients, with 49.58% female participants and an average age of 44.86 years (±16.4). The patients were predominantly African American (38.7%), followed by White (28.6%), Hispanic (10.9%), Asian (5.9%), Native American (1.7%), and 14.3% unspecified. Fitzpatrick skin type classifications were most common in Type V (32.8%) and Type II (20.2%), with lower representation in Types VI (4.2%) and I (1.7%). Laser treatment led to significant improvements across all age groups in POSAS metrics, though the timing and extent varied. The older cohort showed significant improvement in POSAS observer pliability after just one session (p < 0.05), while the younger and middle-aged groups required two or more sessions (p < 0.001). Middle-aged patients reported the highest baseline pain and itch levels, with mean scores of 6.17/10 and 6.64/10, respectively, compared to younger (4.26 and 4.97) and older (4.26 and 4.74) groups (p < 0.05). Pain and itch significantly decreased across all groups, with the middle-aged cohort showing the most consistent improvements (p < 0.05). VSS scores improved significantly for all groups, while durometer measurements showed significant changes only in the middle-aged cohort (p < 0.05). Age significantly influences laser therapy outcomes for burn HTS, with older patients experiencing earlier and more pronounced improvements in POSAS observer scales. Different age groups also reported varying levels of pain and itch throughout their laser treatment sessions. Importantly, considerable improvements were noted post-laser treatment across all age groups. These findings emphasize the importance of personalizing laser therapy to address age-specific physiological changes to optimize treatment timelines and outcomes for burn HTS patients.
Slavinsky et al. (Sat,) studied this question.