A systematic review of procedural treatments for burn scars in children: Evaluating efficacy, safety, standard protocols, average sessions and tolerability based on clinical studies

Abstract

Managing burn scars in children presents significant challenges. This study investigates effective treatment methods for burn scars, focusing on efficacy, safety, standard protocols and tolerability. Major databases such as PubMed, Scopus and Web of Science were thoroughly searched up to August 2024, emphasizing procedural treatments for burn scars in children. Key data collected included participant demographics, sample sizes, intervention methods, follow‐up protocols, treatment effectiveness and reported adverse events. A total of 256 children were assessed, with all procedural treatments yielding satisfactory outcomes. Among the various methods, trapeze‐flap plasty and percutaneous collagen induction showed improvements in all patients. In the laser treatment group, which included 161 children, the Vancouver Scar Scale (VSS) score reduction ranged from 55.55% to 76.31%, with outcomes rated as good (24.61%) to excellent (60%). Laser treatment using local anaesthesia proved to be well tolerated by children. Our findings indicate that various methods—including trapeze‐flap plasty, percutaneous collagen induction, phototherapy and fractional CO₂ laser—demonstrate a relatively good response and an acceptable safety profile. Notably, light‐based therapies/lasers may serve as safe, effective and tolerable options for scar treatment in this age group, often eliminating the need for general anaesthesia.

Key Messages.

What is already known about this topic?

• Burn injuries in children lead to significant physical and psychological harm, with long‐term complications such as hypertrophic scars (HTSs) posing challenges for treatment and affecting quality of life.

• Managing HTS is particularly difficult in children due to limited effective treatment options, unique psychological and physical considerations, and the common occurrence of HTS in young burn survivors.

• There is a lack of comprehensive data on the safety and efficacy of scar treatments in children, highlighting the necessity for a systematic review to identify suitable interventions and improve management strategies for burn scars in this vulnerable population.

What does this study add?

• The systematic review analysed nine clinical trials involving 256 children with burn scars, with a mean age of 7.3 years and an average scar duration of 3.29 years prior to treatment. The treatments varied widely in location and involved different anaesthesia methods, primarily local anaesthesia.

• A variety of treatment approaches were employed, including fractional CO₂ laser, artificial skin and phototherapy. Notably, laser therapy showed significant effectiveness, with the highest reduction in scar severity (76.31%) reported for electrophotobiomodulation.

• While 66.66% of studies recorded mild adverse effects related to treatment, no patients experienced worsening of their condition post‐treatment. Notably, laser treatments using local anaesthesia were particularly well tolerated by children, emphasizing their practicality in paediatric care.

1. INTRODUCTION

Burn injuries are among the most devastating causes of physical and psychological harm to children worldwide. While mortality rates among burn patients have decreased over recent decades due to advancements in treatment and knowledge, post‐traumatic complications such as hypertrophic scars (HTSs), keloid formation and contractures often result in long‐term discomfort and functional deficits. ¹ Scars and burn injuries have significant impacts on patients' lives and the healthcare system. ²

HTSs develop when the natural healing process is disrupted, characterized by increased inflammation and excessive collagen accumulation, leading to prominent, hard, itchy, painful and erythematous lesions. ³ Various treatment methods are employed to manage HTSs, including silicone or hydrogel sheets, compression therapy, ultrasound, surgical incision, tissue expansion, intralesional steroids, chemotherapy with interferon injections, cryotherapy, radiation therapy and photothermolysis. ⁴ , ⁵ Despite the diversity of medical interventions and the introduction of advanced skin treatment alternatives, managing HTS remains a clinical challenge that often necessitates long‐term interventions. ⁶ , ⁷

Moreover, effective treatment options for HTSs in children are limited, with no ideal solution currently available. ⁸ Scar revision and postoperative management present significant challenges in reconstructive surgery, particularly for infants who may not comprehend treatment protocols and for children who face unique psychological burdens and skin characteristics compared to adults. ⁹ , ¹⁰ Children represent a critical demographic within the burn population, with HTSs occurring in 20% of children under 5 years of age who suffer from burns. ¹¹ However, finding procedural treatments that are tolerable for this age group is complicated.

Additionally, available information regarding the effectiveness and safety of treatments for children remains scarce compared to adults. With no systematic review conducted on treatments for burn scars in children, gathering data on procedural treatments tailored for this age group is essential for identifying appropriate interventions. Thus, this study presents a systematic review of original clinical studies focusing on efficacy, safety, standard protocols and tolerability to introduce effective treatment methods for burn scars in children.

2. MATERIALS AND METHODS

2.1. Search strategy and databases

This systematic review adhered to the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) (Figure 1). A thorough literature review was conducted to pinpoint relevant keywords related to various procedural treatments, including laser therapy, phototherapy and needling for burn scars in children. Additionally, a careful review of the references in selected articles was performed to ensure all pertinent research was included. The search covered studies published up to 3 August 2024. The specific search syntaxes used across different databases are detailed in Table 1.

FIGURE 1.

Preferred reporting items for systematic reviews and meta‐analyses flow diagram.

TABLE 1.

Search syntax across databases.

PubMed	(‘procedural treatments’ [Title/Abstract] OR ‘laser therapy’ [Title/Abstract] OR ‘laser’ [Title/Abstract] OR ‘phototherapy’ [Title/Abstract] OR ‘needling’ [Title/Abstract]) AND (‘burn scar’ [Title/Abstract]) AND (2000:2024[pdat])
Scopus	(TITLE‐ABS‐KEY (‘procedural treatments’ OR ‘laser therapy’ OR ‘laser’ OR ‘phototherapy’ OR ‘needling’)) AND TITLE‐ABS‐KEY (‘burn scar’) AND PUBYEAR > 2000 AND PUBYEAR < 2025
Web of science	TS = (‘procedural treatments’ OR ‘laser therapy’ OR ‘laser’ OR ‘phototherapy’ OR ‘needling’ AND TS = (‘burn scar’)

2.2. Inclusion and exclusion criteria

The inclusion criteria were tailored to include studies that evaluate the effectiveness of procedural treatments for burn scars in children. The exclusion criteria focused on review articles and interventions that are not considered procedural treatments (such as topical therapies or traditional pharmacotherapy) and those not relevant to children under the age of 12. Furthermore, non‐human studies (including animal research and in vitro investigations), experimental studies and trials without clear outcome measures were excluded. Articles not written in English or lacking accessible full texts were also disregarded.

2.3. Study selection and data extraction

Two evaluators, A. J. and E. B., examined the titles and abstracts of the collected records according to the established inclusion criteria. They evaluated each study on several factors, including study design, participant demographics, sample sizes, methods of intervention, follow‐up procedures, treatment effectiveness and reported adverse events. To streamline the article screening and data extraction, they used EndNote® X8 and Google Sheets™. This process was conducted independently by the two investigators, with any disagreements resolved by consulting a senior researcher, A. G.

3. RESULTS

In this systematic review, a total of nine original clinical trials were systematically reviewed to evaluate different treatment modalities for burn scars in children. The types of studies included were one randomized clinical trial (11.11%), one prospective study (11.11%), one observational study (11.11%), one randomized controlled trial (11.11%), one retrospective study (11.11%) and one open‐label study. Notably, the design of three articles was not specified, which limited their inclusion in the quantitative analysis, ultimately resulting in the utilization of six studies for further evaluation.

Among the included studies, a total of 256 children were treated, comprised 120 boys and 98 girls, yielding a mean age of 7.3 years for participants. The locations of the scars varied widely, encompassing areas such as the neck, torso, legs, hands, face and arms. The duration of these scars prior to receiving treatment averaged 3.29 years, indicating persistence before intervention. Regarding anaesthesia practices during procedures, general anaesthesia was employed in two articles (22.2%), while local anaesthesia was utilized in four articles (44.4%). The anaesthesia method was not explicitly reported in the remaining studies, highlighting a gap in procedural documentation. Tolerability of treatment methods was explicitly reported in only two studies (22.2%), suggesting that further research may be needed in this area to assess patient comfort and acceptance comprehensively.

The treatment modalities explored across the reviewed articles included a variety of approaches: fractional CO₂ laser, Integra artificial skin, trapeze‐flap plasty, percutaneous collagen induction, photobiomodulation and electrophotobiomodulation. Detailed treatment methods and their respective outcomes are elaborated in Table 2.

TABLE 2.

Summary of reviewed articles.

Reference	Study design	Population/age/method	Dosage/consumption/follow‐up	Summary of results/complications/treatment efficacy
Branski et al. 10	Randomized controlled clinical trial	Twenty children with an average of 73% burns on the entire body surface were randomly treated with Integra or autograft‐allograft method. They were divided into control groups (mean age 6.2 years) and treatment group (mean age 7.4 years). TBSA was 70% in the treated group and 74% in the control group. Examinations were performed at 12, 18 and 24 months after injury.	In a study involving burn treatment, patients underwent their first surgery 24 to 48 h after admission. Unmeshed Integra sheets were applied to the scars after removing burned tissue, with silver nitrate and sulfamylon used to prevent infection. After 14–21 days, the Silastic layer was replaced with a thin epidermal autograft. In the control group, an expanded autograft (mesh 4:1) was used with allograft coating, while other areas were covered with expanded allograft. Donor sites were later treated with autograft skin after excision of the allograft. Burn scars were evaluated using the Hamilton burn scar grading system, and follow‐up lasted 2 years.	In the Integra group, long‐term follow‐up improved the scar in terms of height, thickness, arteries and pigment (12 months and 18–24). According to the results, 12 months after the injury for the Integra group, Hamilton score was 5.4 with a 29.88% reduction (7.7 in the control group), and 18 to 24 months after injury, Hamilton score was 4.3, with a 34.85% reduction (6.6 in the control group).
Stiefel et al. 9	Unknown	17 patients (11 girls and 7 boys) with contractures after burns, scars or hypertrophic colloids were treated with Integra. Total body surface area (TBSA) was between 1 and 4 (mean 2). The age range of patients was from 6.4 to 17.65 years (mean 13.15 years). In 47% of patients, scars were observed in the lower limbs, in 35% in the face or mentosternal area, and in 18% in the trunk.	The study involved treating scars by removing them down to non‐scar tissues and applying unmeshed Integra. This was secured with sutures or clips, and patients were either dressed with tie‐over dressings or a Vacuum‐Assisted Closure System. To limit movement, patients were fed via nasogastric tubes during rest. Wounds were monitored weekly after implantation, and Integra's effectiveness was assessed based on skin vascularization approximately 3 weeks later. The silicone layer was eventually removed, and a bond was applied with fibrin adhesive. Patients were regularly evaluated using a qualitative grading system over a follow‐up period averaging 3.6 years.	The use of Integra was technically successful in all patients. The final mean of Integra usage was 99.7%. Outcome was assessed as ‘excellent’ in 52% of patients, ‘good’ in 36%, ‘moderate’ in 12% and ‘poor’ in 0%. Integra‐related complications occurred in 17.6% of patients. Seroma and extensive hematoma were observed among patients. No disease showed objective signs of a skin graft infection.
Lapidoth et al. 12	Prospective study	24 children aged 2–16 years (mean age 4.2 years) were treated with fractional CO2 laser resurfacing. All patients had mild to severe facial wounds, including six with burn scars. None of the patients had undergone skin resurfacing before this treatment. In 20 patients out of 24, general anaesthesia was performed by an anaesthesiologist. In four patients with localized lesions, treatment was performed after topical infusion of 1% lidocaine.	Fractional ablative photothermolysis was performed with a 7 × 7 splitting handpiece (49 dots) mounted on a standard CO2 laser. Treatments were performed at a pulse duration of 200 milliseconds with 25 watts, at which 102 mJ/pulse was generated. In each treatment session, two courses were performed. Follow‐up examinations were performed by physicians at 3 days, 1 week, 1 month, 2 months and 6 months after the last treatment to monitor improvement and subsequent complications. The results were graded on a five‐point scale: ‘Excellent’ with 75%–100% improvement; ‘good’ with 50%–75% improvement; ‘moderate’ with 25%–50% improvement; ‘weak’ with <25% recovery, or worsening, when the end result was worse than the obtained results before treatment.	This treatment was well tolerated by all patients. No permanent side effects were observed. Temporary complications included erythema and mild swelling. Evaluation of the results showed that in 14 patients (58%) the results were ‘excellent’, in seven (29%) were ‘good’, and in three (13%) ‘moderate’. No cases were rated as ‘weak’. Evaluation of 18 patients who referred for follow‐up, 6 months after the final treatment, showed that the clinical results were preserved and there was a significant change in skin tissue.
Grishkevich et al. 13	Unknown	11 children (six girls and five boys) with anterior neck contracture after burns, aged between 5 and 14 years, underwent trapeze‐flap plasty surgery. All patients had deep or minor burns on 9%–35% of total body surface area (TBSA).	This operation was performed 1–5 years after the injury. During the operation, the anatomy of the contracture and the possibility of using a scar flap were examined. Cervical local scar‐fascial trapezoid flaps were used in all cases. Follow‐up results were observed from 6 months to 9 years. The results were evaluated based on two factors: contracture removal (complete or partial) and recurrence of cervical contours (including mentocervical angle).	In a study of 11 patients with severe neck contractures, full resolution of the condition was achieved through surgical intervention. Measures taken included skin grafting and trapeze‐flap plasty, resulting in restored head movement and functional outcomes. The procedure effectively addressed contractures while minimizing complications, particularly in cases where more complex methods were not suitable. Early surgery was emphasized as key to preventing further issues.
Żądkowski et al. 11	Observational study	47 patients (26 girls and 21 boys) between 7 and 17 years old The average time after the burn was 7.5 years. The average level of total body burn was 8.8%. The minimum and maximum values were 1% and 42% respectively. 57 laser sessions were performed for patients. In the follow‐up period, evaluations were performed 1, 4 and 8 months after laser therapy. Also, before treatment and during control visits, scar thickness assessment was performed using US assessment.	The procedure involved using a US device with an L12‐5 linear head for laser therapy on small areas. Topical prilocaine/lidocaine (5%) was applied 75 min before surgery, along with intravenous paracetamol (15 mg/kg) and morphine (0.15 mg/kg). Midazolam (0.1 g/kg) was also given, and patients received 2–3 L of oxygen. The treatment used the Lumenis UltraPulse Encore CO2 laser in three stages: scar edge abrasion with CPG Active FX mode at 30–40 mJ and 300–450 Hz, FX SCAAR deep mode at 119 mJ at a 45‐degree angle to the skin and a mild abrasion mode at 60–100 mJ and 75–125 Hz. This method effectively combined various laser techniques for treatment.	After surgery, 37% of treated areas had complications, which decreased to 9% by 8 months. Erythema was the most common issue, reported in 67% of complications. Initially, there were 28 erythema cases, with only two persisting after 8 months. Scar pigmentation improved in 81% of patients, with no cases worsening, while scar height improved in 88% and pliability in 98%. However, there was no significant improvement in vascularity.
Kubiak and Lange 1	Retrospective study	47 patients with scars caused by heat injuries (28 girls and 19 boys with a mean age of 8.3 years) Percutaneous collagen induction (PCI) treatment was performed under general anaesthesia. Burns and scars on the feet, head, trunk, arms and neck. A total of 99 operations (PCI) were performed on 47 patients. Eighteen patients (38.3%) had one treatment, and 29 patients (61.7%) underwent two or more PCI treatments. PCI therapy was performed with at least 3 months' intervals. PCI was performed 12 months after the injury.	In this study, a medical roller device with 2.5 mm needles was used to treat scars by inducing controlled inflammation through multi‐directional rolling. Patients received intravenous analgesics (metamizole) and had vitamin A and C oils applied immediately post‐treatment. The wounds were then covered with a lactate ringer's solution for 1–2 h for cooling. Patients were discharged the next day and instructed to use ENVIRON oil three times daily for 4 weeks. Treatments were often repeated with at least 3 months between each session. The average follow‐up was 20 months, and scar improvement was assessed using the Vancouver Scar Scale (VSS) based on pigmentation, vascularity, height and pliability.	In general, progress was observed in all patients and they were generally satisfied with PCI. Minor postoperative complications occurred in two patients (4.3%), including itching and redness of the skin in the operated area, which discontinued after some time. VSS decreased by 26.45% for vascularity, 20.53% for pliability and 28.57% for height. But statistically, the treatment had no effect on pigmentation (7.30% decreases in VSS number).
Majid and Imran 8	Open label study	10 children aged 5–12 years (mean 9.7 years) with hypertrophic scars after burns were treated with fractional CO2 laser resurfacing with topical steroids for 3–5 sessions. Laser sessions were performed at 1‐month intervals under the influence of local anaesthetics. No patient underwent general anaesthesia because in all cases the treated area was less than 5% of the body surface. There were seven girls and three boys in the treatment group and the skin photo types were type III or IV with one patient being type II. The age of the wounds varied from 1 to 6 years with an average of 3.2 years.	The laser treatment for scar reduction involved parents holding the child, with both wearing protective glasses. Energy settings ranged from 90 to 150 mJ at 30 W, tailored to the scar's thickness, with a single pulse delivered across the scar without overlapping. After the procedure, a topical triamcinolone suspension was applied, and the patient rested for 10 min. Post‐treatment care included applying clobetasol propionate gel twice daily for a week and using broad‐spectrum sunscreen if the scars were sun‐exposed. Treatment response was evaluated 3 months later, focusing on decreases in the VSS and PGA, with improvement grades categorized as ‘excellent’ (≥75%), ‘good’ (50%–75%) and ‘poor’ (<50%).	Out of 10 children, six had excellent results, three had good and one had poor response. The average VSS improved by 4.2, with the most notable change being a 7‐point reduction in a burn scar from the youngest participant. While seven children experienced temporary dyspigmentation or hyperpigmentation, it resolved post‐treatment. Scar thickness improved in nine children, and vascularity increased in six, with some still showing redness. Side effects were minimal, primarily involving pain and fear during the procedure.
Alsharnoubi and Mohamed 14	Randomized controlled study	15 patients between 2 and 10 years old with type II to IV burn scars Patients' scars were divided into two halves, one group of patients were topically treated (dimethicone + EMU oil + wax + almond oil) in addition to Ga‐As LLLT for the study area and in the other group of patients, which were the control group, only topical treatment was used.	Ga‐As Giotto MED SPA laser with the following parameters: wavelength 905 nm, energy density 16.2 J/cm2, pulse mode with a frequency of 3000 Hz and maximum output power of 30 W. Method of use: circular cluster probe containing three output beams with a power of 30 W; duration of usage: the irradiation time varied with the size of the scar; Treatment interval: twice a week for 12 weeks.	The study found significant differences in hypertrophic scars before and after ultrasound treatment, showing a 28% reduction in scar thickness in the treatment area. Skin perfusion also decreased significantly by 32.62%, but no notable change was observed between control and study areas post‐treatment. The VSS showed a significant decrease: from a mean of nine pre‐treatment to six (33.33% reduction) in the control area and four (55.55% reduction) in the study area. Overall, the study area demonstrated greater improvement, particularly in pigmentation and height, after 12 weeks.
Elmelegy et al. 15	Unknown	In this study, 65 children (2–12 years old) with hypertrophic facial scars after burns were included in the study. 49 of them were boys and 16 were girls. The Fitzpatrick skin type classification was used; two cases were type I, 2 cases were type II, 33 cases were type III, 20 cases were type IV and 8 cases were type V. In this study, a two‐handles beauty machine was used. Prior to the E‐light session, local anaesthesia was performed using Xylocaine cream (2.5%) for 30 min in the treatment area. All patients received sessions every 2–4 weeks. Evaluations were performed according to the VSS system.	In order to prevent complications, the intense pulsed light (IPL) element of E‐light was used with different filters according to skin colour; 530, 560, 580, 630 and 755 nm. IPL currents varied between 40 and 44 J. Spot diameter was 8–32 mm. Pulse durations lasted from 2 to 7 ms and pulse delays from 15 to 30 ms. The current of RF element of E‐light varied between 10 and 12 J. A sedative lotion was used three to four times a day for 2–3 days to control the itching and oedema expected after treatment. VSS photography and evaluation of the patient after treatment was performed 1 month after their last treatment session. Patients were followed up monthly. The follow‐up period in the patients was at least 1 year after their last treatment session.	43 parents (approximately 66.15%) rated their satisfaction as ‘excellent’, 16 (approximately 24.61%) rated it as ‘good’ and six (approximately 9.23%) rated it as ‘moderate’, and there were no ‘poor’ results regarding the satisfaction of parents with the end result. The mean VSS score for the patients was 7.6 before treatment and 1.8 after treatment (76.31% decrease). The mean reduction in total VSS score for all patients was 5.8. There was a significant difference in VSS score before and after E‐light treatment.

Adverse effects were recorded in 66.66% of the reviewed studies. Importantly, these side effects were predominantly mild and resolved over time, with common issues reported including erythema, discoloration, sensitization, overgrowth, post‐inflammatory hyperpigmentation, seroma and extensive hematoma. The mean number of treatment sessions across the studies was 22, reflecting the intensive nature of scar management, and the mean follow‐up period was 25.7 months, allowing for a thorough assessment of treatment efficacy over time. Additionally, the mean burn level and total body surface area (TBSA) affected by the scars was reported as 43.45%, indicating a significant degree of injury that necessitated careful management.

The reviewed articles demonstrated a diverse application of treatment techniques; four articles (44.44%) utilized surgical interventions, including artificial skin and collagen injections, while five articles (55.55%) implemented laser therapy and phototherapy to improve scar appearance. All reviewed studies reported satisfactory outcomes from these procedural treatments, with no instances of patients experiencing deterioration in their condition post‐treatment. The Vancouver Scar Scale (VSS) was employed in most studies as a standard measure for assessing scar severity, with one article also using the Hamilton scale for additional evaluation.

In a notable finding for the Integra treatment group, a reduction of 29.88% in Hamilton scores was reported after 12 months, with further improvement noted at 18–21 months, showing a 34.85% reduction. The VSS scores indicated that the highest reduction (76.31%) was associated with the electrophotobiomodulation method, indicating its potential as a highly effective treatment option. Conversely, the lowest reduction (20.53%) was recorded for percutaneous collagen induction.

When comparing the effectiveness of different treatment methods, both trapeze‐flap plasty and percutaneous collagen induction demonstrated improvements across all patients. Moreover, laser therapy exhibited a robust response, with documented improvements exceeding 50% in various studies. Importantly, laser treatment using local anaesthesia was highlighted as particularly well tolerated by children, underscoring its practicality and acceptability as a treatment option in paediatric populations.

4. DISCUSSION

Heat‐related injuries, including burns from hot liquids or steam, are prevalent in infants and children, comprising approximately two‐thirds of all paediatric burn cases. ¹⁶ Managing scars resulting from burn injuries poses significant challenges for patients, caregivers and healthcare professionals. ¹ , ¹² Scarring is the body's natural response to damage to the epidermis and dermis, with the scar's final appearance influenced by both the wound bed and the surrounding environment. For example, scars that experience infection may lead to poor healing outcomes, chronic inflammation, and hypertrophic scarring. Mechanical factors, such as traction, also play a critical role in the signalling pathways that contribute to HTS formation. ¹³

Despite numerous studies on scarring, many aspects remain poorly understood. Children's immune systems, which are less developed than those of adults, may result in fewer HTSs in this population. ¹⁴ Treatment options aimed at improving the appearance and function of HTSs in children include a wide range of conservative methods such as massage, physiotherapy, intralesional corticosteroid injections, silicone application and radiotherapy. ¹ , ⁸ However, certain treatments may be impractical or unsafe. For instance, corticosteroid injections carry the risk of long‐term side effects and are often associated with significant pain and anxiety in children. ⁸ Moreover, some procedures necessitate general anaesthesia, raising concerns about potential long‐term effects on the developing brain. ¹ There is also a lack of clinical data on the safety and efficacy of various treatment options for hypertrophic burn scars in the paediatric population. ⁸

Recent advancements in laser technology have broadened its application in medical treatments, particularly for HTSs. The use of pulsed dye lasers (PDL) and CO₂ lasers has shown promising results in various clinical studies. ¹³ , ¹⁵ The fractional CO₂ laser, in particular, has emerged as a novel approach that alleviates the tension in HTSs while stimulating collagen production and the wound healing process. By breaking down thick, irregular collagen fibres, this method facilitates more organized healing of scarred tissue. ¹⁷

The results of this systematic review categorize treatment methods into two main groups: surgical techniques (44.44%, which include surgeries and the use of artificial skin or collagen injections) and laser therapy/phototherapy (55.55%). The surgical group comprised 95 patients, while the laser and phototherapy group included 161 patients. Reported side effects in both groups were mild and transient. Notably, all patients treated with trapeze‐flap plasty and percutaneous collagen induction demonstrated improvement. Among those receiving the Integra artificial skin treatment, 52% showed favourable outcomes, while 100% improvement was recorded in patients treated with trapeze‐flap plasty, and favourable progress was noted in all receiving percutaneous collagen induction. In contrast, treatment with laser therapy and phototherapy yielded more than 50% improvement across various studies. The reduction in VSS scores ranged from 55.55% (photobiomodulation method) to 76.31% (electrophotobiomodulation method), with reported outcomes ranging from good (24.61%) to excellent (60%). This treatment was well tolerated among patients, with fractional CO₂ laser therapy providing a suitable alternative without the risks associated with general anaesthesia.

Żądkowski et al. ¹¹ have reported significant effectiveness of CO₂ lasers in treating HTSs, demonstrating a maximum improvement of 59% in scar thickness after 8 months. Alsharnoubi and Mohamed ¹⁴ found that low‐level laser therapy (LLL) over 12 weeks beneficially affected the thickness, perfusion and appearance of burn scars in paediatric patients aged 2 to 10 years, leading to significant reductions in VSS scores. They posited that topical treatments, particularly those involving dimethicone, could effectively hydrate the skin and reduce transepidermal water loss, thereby improving scar appearance.

Artzi et al. ³ noted that laser‐assisted corticosteroid delivery was less painful and yielded encouraging clinical results, effectively transferring corticosteroids through microscopic channels created by ablative fractional laser treatment. Elmelegy et al. found significant reductions in VSS scores following E‐light treatment, although factors influencing scar healing, such as race and wound characteristics, complicate the assessment of treatment efficacy.

Furthermore, research indicates that a combination of fractional CO₂ laser treatment with topical corticosteroids can enhance outcomes, as the latter allows for more uniform distribution of medication without the pain associated with injections. ⁸ The potential of combining various treatment modalities is supported by studies showing that microneedling in conjunction with laser therapy can activate the skin repair process and promote the synthesis of collagen and elastin. ¹⁸ , ¹⁹ , ²⁰ , ²¹

5. CONCLUSION

This study reviewed treatment options for burn scars in children from 2000 to 2024, focusing on efficiency, safety and tolerability. Both surgical techniques and laser/phototherapy were analysed, with mild side effects reported that resolved over time. Notably, trapeze‐flap plasty and percutaneous collagen induction showed significant improvements, yielding excellent results in 52% of cases. Laser therapy and phototherapy also demonstrated effectiveness, with VSS score reductions ranging from 55.55% to 76.31%, and were well tolerated, requiring only local anaesthesia.

Overall, the findings indicate that laser therapy and phototherapy are effective, safe and tolerable treatment options for paediatric burn scars, minimizing the risks associated with general anaesthesia. However, it is essential to note that three out of the nine studies reviewed had unknown designs, and only two were randomized controlled trials with high evidence bases. Thus, further high‐quality studies are needed to substantiate these conclusions.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Roohaninasab M, Najar Nobari N, Ghassemi M, et al. A systematic review of procedural treatments for burn scars in children: Evaluating efficacy, safety, standard protocols, average sessions and tolerability based on clinical studies. Int Wound J. 2024;21(10):e70091. doi: 10.1111/iwj.70091

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.