Laser treatment improves burn scars of "Napalm Girl"

09/12/2018

By Will Boggs MD

NEW YORK (Reuters Health) - More than four decades after sustaining extensive napalm burns, the Vietnamese woman who became known as "Napalm Girl" experienced significant improvement in her pain and burn scars with laser treatment.

"The main challenge throughout treating Mrs. Phuc was to make sure her 10 out of 10 pain, a debilitating side effect of her scars, would drastically decrease (so that she could) live the life she deserved," Dr. Jill S. Waibel from Miami Dermatology and Laser Institute, in Miami, Florida, told Reuters Health by email. "After a series of laser treatments, she now reports that pain has reduced to a 3 out of 10."

One of the iconic images of the Vietnam War shows 9-year-old Kim Phuc running naked along a road in Trang Bang, Vietnam, screaming in pain, her clothes having been incinerated by a napalm bomb.

She sustained third- and fourth-degree napalm burns to her left arm, neck, shoulder, back, and right hand. Despite treatment, she was left with severe pain and reduced range of motion and function due to scarring.

Dr. Waibel began treating Kim Phuc Phan Thi in 2015 with a variety of lasers, focusing on improving scar texture and range of motion and flattening the hypertrophic scars.

Kim Phuc also received injections of triamcinolone acetonide solution, poly-L-lactic acid and botulinum toxin, according to the new report online September 5 in JAMA Dermatology, on which she is listed as a co-author.

After these treatments, she reported softening of the scars, increased range of motion, nerve regeneration (enabling her to feel sensations like her grandson hugging her arm) and, most importantly, a reduction in her chronic pain to 3/10.

"Such a little girl endured so much suffering from traumatic burn scars and yet has now, through faith in God and strength from within, triumphed over suffering," Dr. Waibel said.

"As doctors, treating patients like Kim Phuc requires a multispecialty team of physicians and surgeons," she said. "Lasers have emerged as the gold standard for scars to return the skin as close to normal as possible. It is vital that physicians understand the sheer power of these lasers. And with this power - there needs to be expertise."

"Lasers are magnificent healers but, in untrained hands, they have the potential to wound as well," Dr. Waibel said. "It is crucial for the physicians to adequately enhance their expertise to fully encompass the breadth of laser therapies, scars, and the way they interact. This interplay is what leads to results like that of Kim Phuc, and we want that knowledge to reach the patients in deciding what line of treatment to pursue."

Co-author Dr. Leonard J. Hoenig, who is in private practice in Pembroke Pines, Florida, told Reuters Health by email, "Both the doctor and patient are helping to provide medical care to persons who otherwise could not afford it (Dr. Waibel has been treating Mrs. Phuc at no charge. Mrs. Phuc runs the Kim Foundation International that helps to fund international organizations that provide free medical care to children all over the world who were wounded in wars or acts of terror). This story hopefully will inspire other physicians and persons to do the same."

Dr. Shilpi Khetarpal, a cosmetic dermatologic surgeon from the Cleveland Clinic Foundation in Ohio, recently reviewed laser advances in the treatment of burns and traumatic scars. She told Reuters Health by email, "There are many tools, treatments, and approaches when it comes to treating scars. Physicians must consider individual scar characteristics like location, age, thickness, and color to guide optimal therapy. The treatment of these scars not only improves cosmesis, but also improves functionality and symptom relief."

"Our knowledge of treating scars has increased dramatically in the 21st century," said Dr. Khetarpal, who was not involved in the new work. "Our goal now is tissue rehabilitation rather than tissue replacement."

Dr. Imran Majid from CUTIS Institute of Dermatology, in Srinagar, India, who is chief editor of the Journal of Cutaneous and Aesthetic Surgery, recently described laser treatment of hypertrophic burn scars in children. He told Reuters Health by email, "Hypertrophic scar treatment is a challenge, but with the advent of lasers, especially fractional lasers, the outlook for these scars has definitely improved. It is important to treat the scars as early as possible."

"There is still no ideal and guaranteed treatment for such scars," said Dr. Majid, who also was not involved with the report. "It is only a team effort and at times with the use of multiple technologies that one can get a significant improvement in these scars."

SOURCE: https://bit.ly/2NbrZOE

JAMA Dermatol 2018.

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