What is the proper treatment for a laser beam burn?

Treatment for Laser Beam Burns

The proper treatment for a laser beam burn is immediate cooling with clean running water for 5-20 minutes to limit burn depth progression and reduce pain. 1, 2, 3

Immediate First Aid Steps

• Remove the victim from the laser source and ensure the laser is turned off or redirected to prevent further injury 2
• Cool the burn immediately with tap water at room temperature (15°C to 25°C) for 5-20 minutes 1
• Do not use ice or ice water for cooling as this can increase tissue damage 1
• Monitor for signs of hypothermia during cooling, especially in children or with large burns 1, 2
• Remove jewelry and constrictive items before swelling occurs 2
• Consider over-the-counter pain medications (acetaminophen or NSAIDs) for pain management 2, 3

Wound Assessment and Care

• Assess the burn for size, depth, and location to determine appropriate management 2
• Clean the wound with tap water, isotonic saline, or an antiseptic solution 1, 2
• Leave burn blisters intact as this improves healing and reduces pain 1
• For small burns, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 2, 3
• Cover with a clean non-adherent dressing 2
• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 1
• Monitor distal perfusion in case of circular dressings 1

Pain Management

• Multimodal analgesia can be used with medications titrated based on validated pain assessment scales 1
• For severe burn pain, titrated intravenous ketamine can be combined with other analgesics 1
• Non-pharmacological techniques such as virtual reality or hypnosis may help reduce pain and anxiety 1
• Cold air skin cooling may be used to reduce discomfort during subsequent laser treatments for healing 1

Special Considerations for Laser Burns

• Laser burns may have deeper tissue damage than appears on the surface due to the concentrated energy 4
• Patients with higher Fitzpatrick skin types must be handled with care to avoid complications of blistering and hypopigmentation 4
• Monitor for signs of infection including increasing pain, redness, swelling, or purulent discharge 5
• Topical antibiotics should not be used as first-line treatment but reserved for infected wounds only 1

When to Seek Medical Attention

• Burns involving the face, hands, feet, or genitals require immediate medical attention 2, 3
• All full-thickness burns require medical attention 2
• Burns covering >10% body surface area in adults or >5% in children require medical attention 2, 3
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) require immediate medical attention 2, 3
• Eye exposure to laser beams requires immediate ophthalmologic evaluation 1

Long-term Management of Laser Burn Scars

• For hypertrophic scars resulting from laser burns, treatment with pulsed dye laser and fractional CO2 laser may improve symptoms 4, 6
• Laser therapy is effective for improving scar appearance, including pigmentation, vascularity, pliability, and thickness 6, 7
• Ablative fractional laser therapy shows significant potential for the release of contractures allowing for improved range of motion 6, 8
• The overall complication rate for laser treatments of burn scars is minimal (1.4-2.2%) 8

Pitfalls to Avoid

• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to risk of hypothermia 1
• Do not delay other resuscitation interventions for dressing application in severe burns 1
• Avoid routine antibiotic prophylaxis for burn patients unless infection is present 1, 5
• Do not cool large burns without the ability to monitor the victim's core temperature 1