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    Help for patients with life-altering scars

    Kim Phuc knows how scars and the traumatic experiences that cause them can haunt a person for a lifetime. But thanks to a dermatologist’s commitment to treat her scars, Phuc is not only recovering from her infamous wounds but also is helping others like her.

    Many know Phuc from an iconic photograph, showing her and her brothers and cousins fleeing from a Napalm bombing in Trang Bang, June 1972. More than 40 years later, Phuc, the crying, naked child in the middle of the black and white image, still lives with scars that cover 65 percent of her body.

    “For many years, my heart was full of hatred, and I wanted to give up. Now, I view my picture from that day as a gift, as it provides me with a larger purpose,” Phuc says. “Through my experiences, I have grown to view my journey as a true gift. I have the opportunity to spread my personal story with others to help inspire and assist other children who have been touched by war.”

    Phuc started The Kim Foundation International for child war victims, and she was honorary speaker in March this year at the launch of the Restoring Heroes Foundation, a charity focused on providing America’s wounded warriors with access to world-class medical care for physical and emotional trauma. Lumenis helps support the Restoring Heroes Foundation with research and technology, according to Lumenis’s CEO Tzipi Ozer-Armon. And dermatologists, including Jill Waibel, M.D., of Miami, Fla., are providing what is often free care.

    More than cosmetic

    Phuc started treatment to address her scars with Dr. Waibel in September 2015. Dr. Waibel, assistant voluntary faculty at University of Miami and chief of dermatology at Baptist Hospital, spoke on using lasers for trauma rehabilitation at the January 2016 Orlando Dermatology Aesthetic and Clinical Conference (Orlando Derm), and was honored during that meeting with a Journal of Drugs in Dermatology (JDD) Humanitarian Award for her work in using lasers to treat patients with traumatic burn injuries.

    Burn and trauma survivors have possibly the most painful injuries and the most complex recovery in all of medicine, Dr. Waibel says.

    “Of all of these injuries, napalm is certainly one of the worst because it is both a chemical and fire injury at the same time and goes very deep into the skin. Napalm is a flammable liquid used in warfare. It is a mixture of a gelling agent and petroleum or a similar fuel. It was initially used as an incendiary device against buildings and later primarily as an anti-personnel weapon, as it sticks to skin and causes severe burns when on fire,” Dr. Waibel says.

    The dermatologist says her treatment for Phuc has focused on multiple laser treatments to improve her pain, pigmentary dyschromias, and to work on texture and flattening the hypertrophic scars.

    “Kim has had four laser treatment sessions … in our office, and we treated with a range of laser therapy. The main device we use in treatment of scars is the Ultrapulse fractional ablative laser. Due to Kim Phuc’s deep scars we have used the SCAAR FX, which penetrates 4,000 microns,” Dr. Waibel says. “We measured the depth of her scars using OCT machine to match the depth of her scars with treatment. Additional improvement will be seen in the next six months, as the collagen remodels.”

    Phuc’s greatest pain and loss of motion is in her shoulder, where the napalm presumably landed. Most patients with such scarring report substantial improvement in sensory symptoms, including pain, burning and itching, as well as physical mobility, within days to weeks after each treatment, Dr. Waibel says.

    “Typically there is rapid improvement in dyspigmentation, followed by gradual improvement in texture,” she says. “Fractional lasers produce tiny injuries in the skin which vaporize the scar tissue and then within a few months these areas heal with new normal collagen. Because we are treating small amounts of skin … it takes a series of treatments. I tell patients it is like boiling water on the stove for tea — you see the steam. We are literally vaporizing off the scar tissue— out with the bad skin and then new skin heals the scarred areas.”

    Phuc also is having laser assisted delivery, during which Dr. Waibel uses fractional channels to deliver poly-l-lactic acid (Sculptra, Galderma).

    “New collagen synthesis is strongly stimulated by fractional laser therapy. Poly-L-lactic acid is an injectable filler, which is typically injected into the subcutaneous plane for the purpose of facial volume correction. Once implanted the material stimulates fibroblast proliferation and neocollagenesis. By using both laser and, at the same time, Sculptra, we will get a robust renewal of Kim’s healthy collagen,” Dr. Waibel says.

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    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.

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