Patient-reported levels of pain and itch in hypertrophic scar before and after fractional ablative laser treatment

Skin fibrosis, especially hypertrophic scars (HTS), remains understudied with few effective treatments. Studying HTS is challenging due to its natural tendency to improve over time, making it hard to separate intervention effects. This study evaluated fractional ablative laser treatment for symptomatic HTSs, focusing on variability in patient response. It was hypothesized that pain and itch would decrease post-treatment, and that demographic or injury characteristics might predict responders. A retrospective chart review analyzed pre-treatment and six post-laser sessions using the Patient Scar Assessment Scale (POSAS) for pain and itch (1 = low, 10 = high). Patients showing a ≥ 3 point improvement were classified as "responders" (n = 48 for pain, n = 62 for itch); those with ≤2 point improvement or worsening were "non-responders" (n = 62 for pain, n = 76 for itch). In total, 110 patients were analyzed for pain and 138 for itch. Most patients were non-responders for both pain (56.4%) and itch (55.1%). Responders experienced significant reductions in pain and itch after the first session, with stable scores thereafter (p<.0001). Non-responders showed no significant improvement in pain and, for itch, even a significant worsening after the first session. No significant differences were found between groups based on sex, skin type, race, scar age, scar size, or patient age. Responders had higher baseline pain and itch scores than non-responders. The greatest symptom relief occurred after the first treatment. Demographic and injury characteristics did not predict treatment response.