A systematic review of randomised controlled trials investigating laser assisted drug delivery for the treatment of keloid and hypertrophic scars

Principles and clinical applications of transcutaneous laser-assisted drug delivery: A narrative review

Introduction

Transcutaneous laser-assisted drug delivery (LADD) is recognized as a developing therapy for skin disorders.

Method

Current literature was reviewed to summarize current applications for LADD.

Discussion

12 clinical applications for this therapy are currently reported.

Conclusion

LADD has potential for wide application in skin disorder treatment.

Lay Summary

Laser assisted drug delivery improves drug bioavailability for treatment of skin disorders. This technique is being assessed clinically in disorders ranging from skin cancers to alopecia.

Hypertrophic Scars and Keloids: Advances in Treatment and Review of Established Therapies

Hypertrophic scars and keloids can have significant detrimental effects on patients both psychosocially and functionally. A careful identification of patient risk factors and a comprehensive management plan are necessary to optimize outcomes. Patients with a history of dystrophic scarring should avoid unnecessary procedures and enhance the wound-healing process using various preventive strategies. As there is no single, fully efficacious treatment modality, prevention remains the best approach in reducing aberrant scar formation. When prevention therapies fail, keloids have been shown to be respond to a variety of therapies including topical and injectable corticosteroids, 5-fluorouracil, radiotherapy, lasers, and surgical excision, all with varying efficacies. As such, management should be tailored to the individual patient's risk factors with the use of combination therapies to reduce recurrence rates. Still, keloid and hypertrophic scar therapies are widely diverse with novel treatment modalities providing alternatives for recurring lesions. Laser-assisted drug delivery, skin priming, and novel topical therapies may provide alternative options for the management of hypertrophic scars and keloids.

CO2 fractional laser combined with triamcinolone acetonide injection for the hypertrophic scars: which is first?

The aim of this study is to investigate and analyze the effect of different application sequences of CO2 fractional laser and triamcinolone acetonide injection on the application effect of hypertrophic scar in one operation. Patients with hypertrophic scars who received CO2 lattice laser combined with triamcinolone acetonide injection from January 2021 to December 2022 were retrospectively analyzed. According to the different initial operations, they were divided into CO2 FL-TA group and TA-CO2 FL group. The Vancouver Scar Scale score and scar thickness of the two groups before and after treatment were analyzed. The complications occurred in the two groups during the treatment period. The clinical efficacy of the two groups before and after the treatment was calculated. Before treatment, there was no difference in scar thickness and VSS score between the two groups (P > 0.05). After treatment, the above indexes in CO2 FL-TA group were significantly better than those in TA-CO2 FL group (P < 0.05); the incidence of adverse reactions in CO2 FL-TA group was 9.38%, which was significantly lower than that in TA-CO2 FL group (18.75%) (P < 0.05); the total effective rate of CO2 FL-TA group was 90.63%, which was significantly higher than that in TA-CO2 FL group (65.63%) (P < 0.05). In the process of combined CO2 fractional laser and triamcinolone acetonide injection in the treatment of hypertrophic scars, CO2 fractional laser treatment first, and then triamcinolone acetonide injection can reduce the number of treatments, reduce the incidence of adverse reactions, and achieve more satisfactory treatment effect.

Laser-Assisted Drug Delivery: A Systematic Review of Safety and Adverse Events

Laser-assisted drug delivery (LADD) is an increasingly studied and applied methodology for drug delivery. It has been used in a wide variety of clinical applications. Given the relatively low barrier to entry for clinicians as well as ongoing research in this area, the authors aimed to review outcomes relating to safety in laser-assisted drug delivery. A systematic review was conducted, with the databases PubMed, Medline and Embase searched in September 2022. Included articles were those that mentioned laser-assisted drug delivery in human subjects that also reported adverse effects or safety outcomes. There were no language-based exclusions. Conference abstracts and literature reviews were excluded. The results were then tabulated and categorized according to the application of LADD. In total, 501 articles were obtained. Following deduplication, screening, and full text review 70 articles of various study designs were included. Common findings were erythema, oedema, pain, and crusting following LADD. Several notably more severe adverse effects such as generalized urticaria, infection, scarring and dyspigmentation were noted. However, these events were varied depending on the clinical use of LADD. Relevant negatives were also noted whereby no studies reported life-threatening adverse effects. Limitations included limited details regarding the adverse effects within the full texts, lack of follow-up, and risk of bias. In conclusion, there were multiple adverse effects that clinicians should consider prior to carrying out LADD, where treatment goals and patient tolerability should be considered. Further evidence is needed to quantitatively determine these risks.

Skin scarring: Latest update on objective assessment and optimal management

Although skin scarring is considered by some to be a minor, unavoidable consequence in response to skin injury, for many patients, cosmetically unsightly scars may cause uncomfortable symptoms and loss of function plus significant psycho-social distress. Despite their high prevalence and commonality, defining skin scars and their optimal management has proven problematic. Therefore, a literature search to assess the current evidence-base for scarring treatment options was conducted, and only those deemed Levels of Evidence 1 or 2 were included. Understanding the spectrum of skin scarring in the first instance is imperative, and is mainly comprised of four distinct endotypes; Stretched (flat), Contracted, Atrophic, and Raised for which the acronym S.C.A.R. may be used. Traditionally, scar assessment and response to therapy has employed the use of subjective scar scales, although these are now being superseded by non-invasive, objective and quantitative measurement devices. Treatment options will vary depending on the specific scar endotype, but fall under one of 3 main categories: (1) Leave alone, (2) Non-invasive, (3) Invasive management. Non-invasive (mostly topical) management of skin scarring remains the most accessible, as many formulations are over-the-counter, and include silicone-based, onion extract-based, and green tea-based, however out of the 52 studies identified, only 28 had statistically significant positive outcomes. Invasive treatment options includes intralesional injections with steroids, 5-FU, PDT, and laser with surgical scar excision as a last resort especially in keloid scar management unless combined with an appropriate adjuvant therapy. In summary, scar management is a rapidly changing field with an unmet need to date for a structured and validated approach.