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This article was written by Bonnie C. Carney, PhD. A study by MedStar Health Research Institute and The Burn Center at MedStar Washington Hospital Center is investigating a new treatment that could help restore natural pigmentation to burn scar tissue in people with skin of color.
For most of human history, survival was the most pressing concern after a severe burn. More than 96% of patients with burns survive, and we can now focus on helping people recovering from burn injuries to live well. Our recent research has revolved around reducing the emotional impacts of burn scars that stand out from the original pigmentation of a patient’s skin, which is particularly noticeable in patients with dark skin tones.
About 70% of patients develop hypertrophic scars following a burn injury. This is a raised area of thick skin that can develop in the months following an injury and can cause itching, irritation, discoloration, and sometimes pain. Studies have shown that patients with darker skin and those who do not get skin grafts are more likely to develop aggressive scarring. The cosmetic disturbance of a scar with pigmentation that differs from the primary skin color (called dyschromia) can lead to psychological and social impacts such as depression and anxiety.
Burn and scarring experts at The Burn Center at MedStar Washington Hospital Center believe correcting skin pigmentation is critical to restoring health. Our researchers are investigating a new way to use lasers and a medication that was first approved for glaucoma to help our patients enjoy a better quality of life following burns.
This will be a first-of-its-kind treatment for hypertrophic scar discoloration if proven effective.
Helping the skin heal with lasers and beyond.
Our small pilot study, supported by the Charles and Mary Latham Fund, involves treating the hypertrophic scars of people with skin of color with the medication bimatoprost, which was originally designed to treat glaucoma, an eye disease than can cause blindness.
Previous physicians observed that patients taking bimatoprost developed periorbital hyperpigmentation—brown circles on the skin around the eyes. Scientists determined this side effect was caused by melanogenesis, which means the drug activated the creation of melanin, the pigment found in skin cells that produces a brown color.
While the skin’s main job is to keep external forces out of the body, some medications can penetrate the skin. In our study, we’ll use a fractional ablative CO2 laser—often used to help make scars more flexible and less painful—to create microscopic channels in our patients’ scars. The goal is to enable bimatoprost to penetrate and recolor the scarred skin more effectively than without the laser.
A unique aspect of this research is in its study design which will allow us to determine whether the treatment has been effective. Scars can change over time, so for this research, each patient will have scars or portions of scars that are treated with medication and some that are not. With this “split scar” design, we can tell whether changes that occur result from our treatment or simply the passage of time.
In our lab, we’ll also conduct parallel studies to learn about how bimatoprost works. We’ll grow and study melanin-producing skin cells in our lab to measure the effects of bimatoprost and gain a deeper understanding of how it changes skin cells in the lab.
Why study pigment restoration?
Cosmetic concerns related to skin pigmentation are well-documented in patients with vitiligo. This condition causes portions of the skin to lose their color, leaving patches and spots of light skin. Research has demonstrated that the psychological burden of vitiligo can cause isolation, depression, and low self-esteem.
Cosmetic changes in scar tissue have also proven to cause significant mental health impacts. One study found that Black patients were more likely than white patients to have worse perceptions of their scars and that their scars more severely affected their appearance, social and psychological health, career, and sex life.
Our burn and scar experts at The Burn Center do not consider a patient’s burn recovery complete when scarring still causes mental and social side effects that interfere with daily living. We are conducting this critical study to help patients heal more fully.
Working together for our patients and community.
This work would not be possible without the leadership of Dr. Taryn Travis, one of our attending physicians at The Burn Center, who runs our laser program. Our entire burn research department, under the direction of Drs. Jeffrey Shupp and Lauren Moffatt are critical to making this vital work a reality, as are our dedicated Clinical Research Coordinators and Clinical Research Program Director, Ms. Melissa McLawhorn.
Together with so many providers and scientists throughout the MedStar Health system, we are helping patients live their healthiest lives. Studies like this are one way we combine our expertise to benefit our patients and the scientific understanding of burn scar treatment.