Subjects:~Seventy-six Patients from both genders who have post burn hypertrophic scar will participate in this study. Their ages will be ranged 20 to 40 years.~Design of the study:~In this study the patients will be randomly assigned into two equal groups (38 patients for each group):~Group A (Study group):~This group includes 38 patients who will receive botulinum toxin type A iontophoresis once monthly for 3 months, in additional to traditional physical therapy (Positioning, Stretching exercises, Pressure Therapy and Massage) 2 sessions per week for 3 months.~Group B (Control group):~This group includes 38 patients who will receive traditional physical therapy (Positioning, Stretching exercises, Pressure Therapy and Massage) 2 sessions per week for 3 months.~- Equipments:~Measurement equipments:~Sonography:~It is high-resolution B-image sonogram which allows a good penetration depth of up to 40 mm into the skin and a resolution of around 158 micro m. It has been successfully utilized for objectively measuring pathological scars.~Patient and Observer Scar Assessment Scale (POSAS):~It consists of two parts; one for the patient (Patient scale; POSAS Patient) and one for the physician (Observer scale; POSAS Observer). Both contain six items on a 10-point rating scale and an extra category Overall Opinion. All characteristic features of the pathological scars are covered by the questionnaire: vascularity, pigmentation disorders, relief/texture, thickness, pliability, surface area, pain, and itching/pruritus. The latter items, in particular, concern the well-being of the patients.~Sonography:~• High frequency ultrasound is the most common used technique for scar assessment.~• The working mechanism is based on refection of sound waves of structures with different acoustic impedances and the analysis of the refection time to determine the depth of the structure.~• The penetration depth ranges from the upper dermal layers to full-thickness skin and subcutaneous structures, depending on the employed frequency b. Patient and Observer scar Assessment Scale (POSAS):~• The scar will be rated numerically on a ten-step scale by both the patient and doctor.~• Six items on the Observer Scale: vascularity, pigmentation, thickness, relief, pliability, and surface area.~• The Patient Scale consists of pain, itchiness, color, stiffness, thickness, and irregularity of the scar.~One of the reasons POSAS was chosen for scar evaluation is because it is the only scar assessment tool to include a component for patients to fill in.~Furthermore, its distinctive feature of reflecting subjective symptoms like pain and pruritus and because of its appropriateness for everyday practice.~Both sonography and POSAS will be used for assessment of hypertrophic scar pre-treatment and post treatment (after 3 months then after 6 months as follow up).~Procedures of iontophoresis drug delivery device:~the iontophoresis group will receive botulinum toxin type A iontophoresis using an iontophoretic drug delivery system (Phoresor IIAuto,Model PM850, IOMED.) - Procedures of botulinum toxin type A iontophoresis:~• Botulinum toxin type A (Botox Allergan ®, Irvine, CA, USA) will be used.~• 100 U vacuum-dried powder in a single-use vial for reconstitution diluted in 2 mL of sterile, preservative-free 0.9% saline to constitute a solution at a concentration of 4 U/0.1 mL) will be administered once a month for a total period of three months.~The dose will be adjusted to 2.5 U/cm2 of the lesion.~The dose shouldn't exceed 100 units per session.~Physical therapy program for both groups:~traditional physical therapy (Positioning, Stretching exercises, Pressure Therapy and Massage) 2 sessions per week for 3 months
The goal of this clinical trial study: is to determine the effect Botulinum toxin type A iontophoresis in hypertrophic scars for post burned patients. The main question is it aims to answer is:~Does Botulinum toxin type A iontophoresis may help in minimizing postburn hypertrophic scars?~Participants will receive the treatment for 3 months.~Assessment will be done before and after treatment.