1
|
Haghsay Khashechi E, Afaghmehr A, Heydari N, Barfar A, Shokri J. Laser-mediated Solutions: Breaking Barriers in Transdermal Drug Delivery. AAPS PharmSciTech 2024; 25:142. [PMID: 38898170 DOI: 10.1208/s12249-024-02849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Skin diseases pose challenges in treatment due to the skin's complex structure and protective functions. Topical drug delivery has emerged as a preferred method for treating these conditions, offering localized therapy with minimal systemic side effects. However, the skin's barrier properties frequently limit topical treatments' efficacy by preventing drug penetration into deeper skin layers. In recent years, laser-assisted drug delivery (LADD) has gained attention as a promising strategy to overcome these limitations. LADD involves using lasers to create microchannels in the skin, facilitating the deposition of drugs and enhancing their penetration into the target tissue. Several lasers, such as fractional CO2, have been tested to see how well they work at delivering drugs. Despite the promising outcomes demonstrated in preclinical and clinical studies, several challenges persist in implementing LADD, including limited penetration depth, potential tissue damage, and the cost of LADD systems. Furthermore, selecting appropriate laser parameters and drug formulations is crucial to ensuring optimal therapeutic outcomes. Nevertheless, LADD holds significant potential for improving treatment efficacy for various skin conditions, including skin cancers, scars, and dermatological disorders. Future research efforts should focus on optimizing LADD techniques, addressing safety concerns, and exploring novel drug formulations to maximize the therapeutic benefits of this innovative approach. With continued advancements in laser technology and pharmaceutical science, LADD has the potential to revolutionize the field of dermatology and enhance patient care.
Collapse
Affiliation(s)
| | | | - Niloofar Heydari
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ashkan Barfar
- Faculty of Pharmacy, Tabriz University of Medical Science, Tabriz, Iran
- Department of pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Shokri
- Department of pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
2
|
Bronte J, Zhou C, Vempati A, Tam C, Khong J, Hazany S, Hazany S. A Comprehensive Review of Non-Surgical Treatments for Hypertrophic and Keloid Scars in Skin of Color. Clin Cosmet Investig Dermatol 2024; 17:1459-1469. [PMID: 38911337 PMCID: PMC11193462 DOI: 10.2147/ccid.s470997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/02/2024] [Indexed: 06/25/2024]
Abstract
Hypertrophic and keloid scars are fibroproliferative growths resulting from aberrant wound healing. Individuals with Fitzpatrick skin types (FSTs) IV-VI are particularly predisposed to hypertrophic and keloid scarring, yet specific guidelines for these populations are still lacking within the literature. Therefore, this comprehensive review provides a list of various treatments and considerations for hypertrophic and keloid scarring in patients with skin of color. We constructed a comprehensive PubMed search term and performed quadruple-blinded screening on all resulting studies to achieve this objective. Our findings demonstrate 1) the lack of efficacious treatments for raised scars within this population and 2) the need to empirically investigate individualized and multimodal therapeutic options for those with skin of color.
Collapse
Affiliation(s)
- Joshua Bronte
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Crystal Zhou
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Abhinav Vempati
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Curtis Tam
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Khong
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sanam Hazany
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Salar Hazany
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| |
Collapse
|
3
|
King A, Guirguis M, Satkunanathan S, Saad M, Bose R. Intralesional 5-Fluorouracil for Keloids: A Systematic Review. J Cutan Med Surg 2024:12034754241256346. [PMID: 38807454 DOI: 10.1177/12034754241256346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Keloids are benign, fibroproliferative dermal tumours, often arising after trauma, that are more common in darker skin types. Numerous therapeutic options have been employed for the treatment of keloids; however, there is no one gold standard approach. Five-fluorouracil, a potent chemotherapeutic agent, has emerged as a promising therapeutic option. Therefore, this systematic review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focused on providing a broad overview of the use of 5-fluorouracil for the management of keloids. Forty studies (2325 patients) met inclusion criteria and investigated 5-fluorouracil for keloid management, with 19 studies (1043 patients) including a 5-fluorouracil monotherapy group. Five-fluorouracil monotherapy demonstrated consistent keloid improvement with >254 keloids injected across various anatomical regions. Five-fluorouracil monotherapy was most often compared to intralesional triamcinolone acetonide, utilizing the Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale. The most common keloid parameters assessed were height, size, volume, width, length, induration, pruritus, and erythema. Five-fluorouracil monotherapy exhibited substantial improvements, with weight averages of 73% of patients experiencing >25% improvement and 67% achieving >50% improvement. Relapse rate was 16% at 27 weeks after 5-fluorouracil monotherapy treatment. Limitations included potential selection bias, language restrictions, and heterogenous data analysis among studies. Overall, our findings underscore the potential effectiveness of 5-fluorouracil monotherapy in the management of keloids, with an encouraging safety profile. Larger prospective trials are needed to determine optimal therapy or combination therapy for the management of keloids. This detailed compilation of treatment protocols, outcomes, and relapse rates stand as a valuable resource for further research and clinical applications.
Collapse
Affiliation(s)
- Aliyah King
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marina Guirguis
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Mysa Saad
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Reetesh Bose
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
4
|
Van Nguyen L, Ly HQ, Vo HT, Pham TT, Nguyen NK, Vo TV, Phan TQ, Tran PTN, Ly HHV, Mai HTT. Clinical Features and the Outcome Evaluations of Keloid and Hypertrophic Scar Treatment with Triamcinolone Injection in Mekong Delta, Vietnam - A Cross-Sectional Study. Clin Cosmet Investig Dermatol 2023; 16:3341-3348. [PMID: 38021426 PMCID: PMC10661894 DOI: 10.2147/ccid.s432735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Background Excessive scarring is a common problem that can have significant cosmetic and psychological consequences for patients. Intralesional injection therapy, such as the use of triamcinolone, has emerged as an effective treatment option for hypertrophic scars. The objective of this study was to describe the morphological features of hypertrophic scars, categorize them, and evaluate the efficacy of triamcinolone injection therapy in treating these scars. Materials and Methods A cross-sectional descriptive study of 80 patients with hypertrophic scars treated with triamcinolone intralesional injection at Can Tho University of Medicine and Pharmacy Hospital from 5/2018 to 5/2021. Results There were 80 patients in all, with a male/female ratio of 1/1.05 and a median age of 15-35. There were 129 scars in all, with scar age >1 year accounting for 83%, keloid scars accounting for 64%, and hypertrophic scars accounting for the remaining 36%. Scars are most commonly seen on the trunk, accounting for 53.5% of all scars, particularly on the anterior chest wall. When the source of scars was discovered, trauma and acne accounted for 24% and 23%, respectively, while the rest were predominantly spontaneous scars, accounting for 49%. Scarring and discomfort of mild to moderate severity were common clinical symptoms; scars larger than 5cm in size had more symptoms than scars smaller than 5cm. Prior to the therapy, the mean Vancouver Score Scale-VSS was 6.55±2.13. After 24 weeks of the therapy, 96.7% of patients had entirely improved itching symptoms, 75% had completely improved pain, and 25% still had minimal pain. After therapy, the mean Vancouver Score Scale-VSS was 2.55±1.81 (p<0.05). At week 24, 3.75% of patients experienced skin shrinkage, 3.75% experienced depigmentation, and 13.75% experienced vasodilation. Conclusion Triamcinolone intralesional injection should be utilized as a first-line therapy for hypertrophic scarring.
Collapse
Affiliation(s)
- Lam Van Nguyen
- Department of Cosmetic Plastic Surgery, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Huy Quang Ly
- Department of Cosmetic Plastic Surgery, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Hau Thi Vo
- Department of Cosmetic Plastic Surgery, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thao Thanh Pham
- Department of Dermato-Venereology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Nam Ky Nguyen
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thi Van Vo
- Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Trung Quoc Phan
- Department of Cosmetic Plastic Surgery, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Phuong Thi Ngoc Tran
- Department of Cosmetic Plastic Surgery, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Hung Huynh Vinh Ly
- Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Ha Thi Thao Mai
- Department of Cosmetic Plastic Surgery, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| |
Collapse
|
5
|
Muskat A, Kost Y, Balazic E, Cohen JL, Kobets K. Laser-Assisted Drug Delivery in the Treatment of Scars, Rhytids, and Melasma: A Comprehensive Review of the Literature. Aesthet Surg J 2023; 43:NP181-NP198. [PMID: 36325715 DOI: 10.1093/asj/sjac286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Although broad reviews on laser-assisted drug delivery (LADD) have been published in the past, an updated focused examination of its utility in the context of common, treatment-resistant, dermatologic conditions has not been published. This article reports a comprehensive scoping review of the potential benefits of LADD compared to laser or drug monotherapy for the treatment of 3 such conditions: scars, rhytids, and melasma. A PubMed (National Institutes of Health; Bethesda, MD) search was conducted for keywords including "laser-assisted drug delivery," "scar," "rhytid," and "melasma." Out-of-scope studies were excluded. To evaluate the efficacy of LADD for the treatment of scars, relevant articles were categorized by scar type: hypertrophic/keloid, atrophic, and hypopigmented. LADD, with both ablative and nonablative laser types, was studied in combination with corticosteroids, botulinum toxin-A (BTX-A), 5-fluorouracil, 5-aminolevulinic acid photodynamic therapy, stem cells, platelet-rich plasma, and prostaglandin analogs for the treatment of scars. Some randomized controlled trials demonstrated the efficacy of LADD, whereas others showed no significant differences in clinical outcomes but demonstrated reduced adverse effects. Regarding rhytids, laser treatment has been combined with various cosmeceuticals, including poly-L-lactic acid, topical retinaldehyde, and topical BTX-A. The studies reviewed supported the use of LADD with these drugs over monotherapy. Some studies showed that LADD was effective for the absorption of drugs such as poly-L-lactic acid and BTX-A which are often not effective topically. For melasma treatment, LADD with tranexamic acid and hydroquinone was superior in some studies, but not significantly different than monotherapy in other studies. LADD with certain drugs could be considered to treat scars, rhytids, and melasma. LEVEL OF EVIDENCE: 5
Collapse
Affiliation(s)
- Ahava Muskat
- Albert Einstein College of Medicine, Division of Dermatology, Bronx, NY, USA
| | - Yana Kost
- Albert Einstein College of Medicine, Division of Dermatology, Bronx, NY, USA
| | - Eliza Balazic
- Albert Einstein College of Medicine, Division of Dermatology, Bronx, NY, USA
| | | | - Kseniya Kobets
- Montefiore Einstein Advanced Care Center, Division of Dermatology, Bronx, NY, USA
| |
Collapse
|
6
|
Yang Y, Liu L, Wu X, Wang X, Lu Q, Zhang Z. CO 2 fractional laser-assisted transdermal delivery of silk nanofiber carriers in a rabbit ear hypertrophic scar model. BURNS & TRAUMA 2022; 10:tkac040. [PMID: 36380852 PMCID: PMC9650785 DOI: 10.1093/burnst/tkac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Hypertrophic scars are skin fibrotic diseases, characterized by fibroblast hyperproliferation and excessive accumulation of extracellular matrix. However, topical drug application for hypertrophic scars are unsatisfactory. The purpose of this study was to explore the permeability of silk nanofiber hydrogels (SNFs) loaded with rhodamine 6G (R6G) and rhodamine 110 (R110) mediated by CO2 fractional laser irradiation into hypertrophic scar tissues. METHODS In this work, R6G and R110 were chosen as hydrophilic and hydrophobic model molecules. They were loaded inside SNFs. In vivo rabbit ear hypertrophic scars were treated with CO2 fractional laser irradiation and then R6G/R110-laden SNFs were applied to the scars to evaluate their synergetic effect on drug penetration efficiency. Their permeability was quantified by fluorescence intensity and measured by confocal laser scanning microscopy on days 1, 3, 5 and 7. More specifically, the thermal coagulation zone (CZ) and its surrounding area (peri-CZ) caused by the thermal coagulation of the laser were discussed separately. RESULTS Our data indicated that the SNFs promoted the penetration of R6G but not that of R110 in the peri-CZ on day 1 when combined with laser irradiation. Interestingly, both R6G and R110 were abundant in the CZ and remained stable on days 1, 3 and 5. Moreover, rapid re-epithelialization hindered the long-term permeability of both drugs. CONCLUSION Combining CO2 fractional laser irradiation with SNF drug delivery could improve the efficiency of hydrophilic drug delivery within 24 h before total re-epithelialization.
Collapse
Affiliation(s)
- Yan Yang
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
| | - Lutong Liu
- National Engineering Laboratory for Modern Silk and Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University, Suzhou 215213, P. R. China
| | - Xiaojin Wu
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
| | - Xue Wang
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
| | - Qiang Lu
- National Engineering Laboratory for Modern Silk and Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University, Suzhou 215213, P. R. China
| | | |
Collapse
|
7
|
Pulse-Dye Laser Followed by Betamethasone-Calcipotriol and Fractional Ablative CO2-Laser-Assisted Delivery for Nail Psoriasis. Dermatol Surg 2021; 47:e111-e116. [PMID: 33795567 DOI: 10.1097/dss.0000000000002835] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nail psoriasis is a common and potentially debilitating condition for which no effective and safe nonsystemic therapy is currently available. Recently, laser-assisted drug delivery (LADD) is being increasingly used to facilitate transcutaneous penetration of topical treatments. OBJECTIVES We set to assess the efficacy and safety of combined pulse-dye laser and fractional CO2 laser-assisted betamethasonecalcipotriol gel delivery for the treatment of nail psoriasis. MATERIAL AND METHODS We conducted a prospective, intrapatient comparative study in a series of 22 patients with bilateral fingernail psoriasis. Nails on the randomized hand were treated with 3 monthly sessions of pulse-dye laser to the proximal and lateral nail folds followed by fractional ablative CO2 laser to the nail plate. Between treatments and one month following the last treatment, the participants applied betamethasone propionate-calcipotriol gel once daily to the nail plate. Clinical outcome was ascertained using nails photography, the Nail Psoriasis Severity Index (NAPSI) and patient satisfaction. RESULTS Seventeen completed the study. Three participants withdrew from the study because of treatment-associated pain. Treatment was associated with a statistically significant improvement of the NAPSI scale (p < .002). Patient satisfaction was high. CONCLUSION Combined PDL and fractional ablative CO2-LADD of betamethasone-calcipotriol gel should be considered for the treatment of nail psoriasis.
Collapse
|
8
|
Kaushal V, Kumar S, Brar BK, Singh A. Comparative evaluation of therapeutic efficacy and safety of intralesional triamcinolone acetonide injection vs intralesional radiofrequency with intralesional triamcinolone acetonide in treatment of keloids. Dermatol Ther 2020; 33:e13919. [DOI: 10.1111/dth.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Vishw Kaushal
- Guru gobind Singh Medical College and Hospital Faridkot Punjab India
| | - Sumir Kumar
- Guru gobind Singh Medical College and Hospital Faridkot Punjab India
| | | | - Amarbir Singh
- Guru gobind Singh Medical College and Hospital Faridkot Punjab India
| |
Collapse
|