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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.
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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.
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2
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Murakami T, Shigeki S. Pharmacotherapy for Keloids and Hypertrophic Scars. Int J Mol Sci 2024; 25:4674. [PMID: 38731893 PMCID: PMC11083137 DOI: 10.3390/ijms25094674] [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: 03/14/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Keloids (KD) and hypertrophic scars (HTS), which are quite raised and pigmented and have increased vascularization and cellularity, are formed due to the impaired healing process of cutaneous injuries in some individuals having family history and genetic factors. These scars decrease the quality of life (QOL) of patients greatly, due to the pain, itching, contracture, cosmetic problems, and so on, depending on the location of the scars. Treatment/prevention that will satisfy patients' QOL is still under development. In this article, we review pharmacotherapy for treating KD and HTS, including the prevention of postsurgical recurrence (especially KD). Pharmacotherapy involves monotherapy using a single drug and combination pharmacotherapy using multiple drugs, where drugs are administered orally, topically and/or through intralesional injection. In addition, pharmacotherapy for KD/HTS is sometimes combined with surgical excision and/or with physical therapy such as cryotherapy, laser therapy, radiotherapy including brachytherapy, and silicone gel/sheeting. The results regarding the clinical effectiveness of each mono-pharmacotherapy for KD/HTS are not always consistent but rather scattered among researchers. Multimodal combination pharmacotherapy that targets multiple sites simultaneously is more effective than mono-pharmacotherapy. The literature was searched using PubMed, Google Scholar, and Online search engines.
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Affiliation(s)
- Teruo Murakami
- Laboratory of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan;
| | - Sadayuki Shigeki
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan
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3
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Rimmer SN, Chandy RJ, Khan D, Feldman SR. Recurrence rates in the treatment of keloids and hypertrophic scars with intralesional triamcinolone combined with other intralesional agents. Arch Dermatol Res 2023; 315:2757-2767. [PMID: 37432467 DOI: 10.1007/s00403-023-02662-x] [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: 02/14/2023] [Revised: 05/10/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
Hypertrophic scars (HTS) and keloids are pathologic scars that are products of a wound healing pathway error attributed to genetic and inflammatory causes (Leventhal et al., Arch Facial Plast Surg 8(6):362-368. https://doi.org/10.1001/archfaci.8.6.362 , 2006). Methods of pathologic scar treatment include intralesional agents, cryotherapy, surgical excision, pressure dressings, topical agents, laser resurfacing, radiotherapy, and other investigational therapies (Leventhal et al. 2006). The recurrence of pathologic scar is high across all treatment modalities, including the use of intralesional agents (Trisliana Perdanasari et al., Arch Plast Surg 41(6):620-629. https://doi.org/10.5999/aps.2014.41.6.620 , 2014). In the treatment of pathologic scar, combination approaches using intralesional agents, such as triamcinolone (TAC), 5-fluorouracil (5FU), verapamil (VER), bleomycin (BLM), and botulinum toxin (BTX), are superior therapies when compared to monotherapy (Yosipovitch et al., J Dermatol Treat 12(2):87-90. https://doi.org/10.1080/095466301317085363 , 2001; Yang et al., Front Med 8:691628. https://doi.org/10.3389/fmed.2021.691628 , 2021; Sun et al., Aesthetic Plast Surg 45(2):791-805. https://doi.org/10.1007/s00266-019-01570-8 , 2021). This review assesses recurrence and the reporting of recurrence in pathologic scar after treatment with intralesional triamcinolone (TAC) in combination with another intralesional agent. A literature review was conducted using research journals from PubMed using the following search terms: [(keloid) AND (triamcinolone) AND (combination) AND (intralesional)], as well as [(keloid) AND (triamcinolone) AND (combination)]. Articles were reviewed and included if the article analyzed or compared intralesional agents for pathologic scar treatment within the last 10 years. The average follow-up period of included articles (n = 14) that utilized combination intralesional therapy (TAC-X) was approximately 11 months (range 1-24 months). Consistent recurrence rate reporting across studies was lacking. The combination agent with the highest recurrence rate was TAC-5FU (23.3%). The range of reported recurrence rates was 7.5-23.3%. Six studies using various intralesional combination regimens reported 0% recurrence over the follow-up period (TAC-5FU, TAC-BTX, TAC-BLM, TAC-CRY). Three studies did not report recurrence rates. While the efficacy of combination therapy is typically assessed via scar scales, the assessment of recurrence across studies of combination therapy is inconsistent and inadequate, with truncated follow-up periods. While scar recurrence can take place during 1-year post-treatment, long-term follow-up (18-24 months) is needed to characterize recurrence in the treatment of pathologic scar using various intralesional agents. Long-term follow-up periods allow patients to receive accurate prognostic information regarding recurrence after combination intralesional therapy. There are limitations to this review in that comparisons were made across studies with varying outcome variables, including scar size, injection concentration and interval, and follow-up period. Standardized follow-up periods and recurrence rate reporting are integral to furthering the understanding of these therapies and enhancing patient care.
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Affiliation(s)
- Sarah N Rimmer
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rithi J Chandy
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Danyaal Khan
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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4
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Piccolo D, Crisman G, Conforti C, Fusco I, Bonan P. Efficacy of a multimodal approach of laser therapy for earlobe keloids management in dark population. Skin Res Technol 2023; 29:e13502. [PMID: 38009015 PMCID: PMC10591025 DOI: 10.1111/srt.13502] [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: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Patients with keloids are often younger than 30 years old and have darker skin. AIM To evaluate the efficacy and safety of CO2 laser therapy in the management of earlobe and helix keloids in dark subjects. METHODS A total of 21 dark patients (five men and 16 women) presented with the earlobe and ear helix keloids, with a mean age of 30.5 (±6.7) years and with phototype between III-VI, were enrolled. In order to improve their earlobe and helix keloids, all patients underwent a single session of CO2 laser therapy immediately followed by a pulsed Dye laser procedure. A single well-experienced doctor performed all treatment sessions and the response to treatment. Patients were followed-up for 6 months after termination of therapy. Clinical images were examined and collected: all patients were examined clinically and with Dermoscopy. RESULTS The majority of the patients treated show complete remission of keloid lesions. Clinical photographs show a visible aesthetic improvement of several types of keloids in dark subjects. CONCLUSIONS Our data demonstrate that this combined laser therapeutic protocol appears to be effective and well tolerated for the management of earlobe and helix keloids in dark subjects, with no high recurrence rate and avoiding the adverse effects and lengthy recovery time.
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Affiliation(s)
| | | | - Claudio Conforti
- Department of Dermatology and VenereologyDermatology ClinicMaggiore HospitalUniversity of TriesteTriesteItaly
- IDI‐IRCCSDermatological Research HospitalRomeItaly
| | | | - Paolo Bonan
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
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Yang R, Wang X, Zheng W, Chen W, Gan W, Qin X, Huang J, Chen X, Zhou S. Bioinformatics analysis and verification of m6A related genes based on the construction of keloid diagnostic model. Int Wound J 2023; 20:2700-2717. [PMID: 36896881 PMCID: PMC10410345 DOI: 10.1111/iwj.14144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
Keloids are formed due to abnormal hyperplasia of the skin connective tissue. We explored the relationship between N6-methyladenosine (m6A)-related genes and keloids. The transcriptomic datasets (GSE44270 and GSE185309) of keloid and normal skin tissues samples were obtained from the Gene Expression Omnibus database. We constructed the m6A landscape and verified the corresponding genes using immunohistochemistry. We extracted hub genes for unsupervised clustering analysis using protein-protein interaction (PPI) network; gene ontology enrichment analysis was performed to determine the biological processes or functions affected by the differentially expressed genes (DEGs). We performed immune infiltration analysis to determine the relationship between keloids and the immune microenvironment using single-sample gene set enrichment analysis and CIBERSORT. Differential expression of several m6A genes was observed between the two groups; insulin-like growth factor 2 mRNA-binding protein 3 (IGF2BP3) was significantly upregulated in keloid patients. PPI analysis elucidated six genes with significant differences between the two keloid sample groups. Enrichment analysis revealed that the DEGs were mainly enriched in cell division, proliferation, and metabolism. Moreover, significant differences in immunity-related pathways were observed. Therefore, the results of this study will provide a reference for the elucidation of the pathogenesis and therapeutic targets of keloids.
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Affiliation(s)
- Ronghua Yang
- Department of Burn and Plastic Surgery, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Xiaoxiang Wang
- The First Clinical Medical CollegeGuangdong Medical UniversityZhanjiangChina
- Department of Burn Surgery and Skin RegenerationThe First People's Hospital of FoshanFoshanChina
| | - Wenlian Zheng
- The First Clinical Medical CollegeGuangdong Medical UniversityZhanjiangChina
| | - Wentao Chen
- The First Clinical Medical CollegeGuangdong Medical UniversityZhanjiangChina
| | - Wenjun Gan
- The First Clinical Medical CollegeGuangdong Medical UniversityZhanjiangChina
| | | | - Jie Huang
- Department of Burn and Plastic Surgery, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Xiaodong Chen
- Department of Burn Surgery and Skin RegenerationThe First People's Hospital of FoshanFoshanChina
| | - Sitong Zhou
- Department of DermatologyThe First People's Hospital of FoshanFoshanChina
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Frech FS, Hernandez L, Urbonas R, Zaken GA, Dreyfuss I, Nouri K. Hypertrophic Scars and Keloids: Advances in Treatment and Review of Established Therapies. Am J Clin Dermatol 2023; 24:225-245. [PMID: 36662366 DOI: 10.1007/s40257-022-00744-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Fabio Stefano Frech
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA.
| | - Loren Hernandez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA
| | - Rebecca Urbonas
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ghufran Abo Zaken
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA
| | - Isabella Dreyfuss
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA
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7
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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
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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
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8
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Zhao Y, Voyer J, Li Y, Kang X, Chen X. Laser microporation facilitates topical drug delivery: a comprehensive review about preclinical development and clinical application. Expert Opin Drug Deliv 2023; 20:31-54. [PMID: 36519356 PMCID: PMC9825102 DOI: 10.1080/17425247.2023.2152002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Topical drug delivery is highly attractive and yet faces tissue barrier challenges. Different physical and chemical methods have been explored to facilitate topical drug delivery. AREAS COVERED Ablative fractional laser (AFL) has been widely explored by the scientific community and dermatologists to facilitate topical drug delivery since its advent less than two decades ago. This review introduces the major efforts in exploration of AFL to facilitate transdermal, transungual, and transocular drug delivery in preclinical and clinical settings. EXPERT OPINION Most of the preclinical and clinical studies find AFL to be safe and highly effective to facilitate topical drug delivery with little restriction on physicochemical properties of drugs. Clinical studies support AFL to enhance drug efficacy, shorten treatment time, reduce pain, improve cosmetic outcomes, reduce systemic drug exposure, and improve safety. Considering most of the clinical trials so far involved a small sample size and were in early phase, future trials will benefit from enrolling a large group of patients for thorough evaluation of the safety and efficacy of AFL-assisted topical drug delivery. The manufacturing of small and less costly AFL devices will also facilitate the translation of AFL-assisted topical drug delivery.
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Affiliation(s)
- Yiwen Zhao
- Biomedical & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Avedisian Hall, Room 480, Kingston, RI 02881, USA
| | - Jewel Voyer
- Biomedical & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Avedisian Hall, Room 480, Kingston, RI 02881, USA
| | - Yibo Li
- Biomedical & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Avedisian Hall, Room 480, Kingston, RI 02881, USA
| | - Xinliang Kang
- Biomedical & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Avedisian Hall, Room 480, Kingston, RI 02881, USA
| | - Xinyuan Chen
- Biomedical & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Avedisian Hall, Room 480, Kingston, RI 02881, USA
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Ng WHS, Smith SD. Laser-Assisted Drug Delivery: A Systematic Review of Safety and Adverse Events. Pharmaceutics 2022; 14:pharmaceutics14122738. [PMID: 36559233 PMCID: PMC9787022 DOI: 10.3390/pharmaceutics14122738] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
| | - Saxon D. Smith
- ANU Medical School, ANU College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia
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10
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Zhuang BY, Hu FC, You Y, Zhang L. Observation of the clinical efficacy of isotope phosphorus-32 dressing combined with diprospan and mucopolysaccharide polysulphate cream in the treatment of keloids. J Cosmet Dermatol 2022; 21:7140-7146. [PMID: 36169608 DOI: 10.1111/jocd.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/22/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The present study aims to investigate the effectiveness, recurrence, and adverse reaction rates of isotope phosphorus-32 dressings combined with diprospan and mucopolysaccharide polysulphate cream in the treatment of keloids. METHODS A total of 80 patients with keloids admitted to the Dermatology Clinic of the Fourth Affiliated Hospital of Harbin Medical University between June 2019 and June 2021 were included in the present study and randomly divided into three groups: Control Group 1 (n = 27), Control Group 2 (n = 25), and the treatment group (n = 28). Patients in Control Group 1 were treated with diprospan combined with mucopolysaccharide polysulphate cream, patients in Control Group 2 were treated with an isotopic phosphorus-32 dressing combined with mucopolysaccharide polysulphate cream, and patients in the treatment group were treated with an isotopic phosphorus-32 dressing combined with diprospan and mucopolysaccharide polysulphate cream. The effectiveness, recurrence, and adverse reaction rates were observed in all three groups. RESULTS The treatment group had the most significant decrease in the itching scores. The respective effectiveness, recurrence, and adverse reaction rates were 81.4%, 43.6%, and 74.1% in Control Group 1; 56%, 38.7%, and 64% in Control Group 2; and 96.7%, 11.2%, and 41% in the treatment group. The differences were statistically significant (p < 0.05). CONCLUSION An isotope phosphorus-32 dressing combined with diprospan and mucopolysaccharide polysulphate cream keloid treatment delivers a fast onset, good effectiveness, and low recurrence and adverse effect rates.
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Affiliation(s)
- Bin-Yu Zhuang
- Department of Dermatology, The Fourth Affiliated Hospital of Harbin Medical University, Haerbin, China
| | - Fang-Chi Hu
- Department of Orthopeadic Surgery, Harbin First Hospital, Haerbin, China
| | - Yan You
- Department of Dermatology, The Fourth Affiliated Hospital of Harbin Medical University, Haerbin, China
| | - Liang Zhang
- Department of Dermatology, The Fourth Affiliated Hospital of Harbin Medical University, Haerbin, China
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11
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Drozhdina MB, Bobro VA, Sennikova YA, Kornilova EI. Post-acne symptom complex. Approaches to therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Postacne-persistent skin changes that appear as a result of long-term acne, inadequate therapy and manipulations performed in the management of this group of patients. The post-acne symptom complex is stable skin changes that appear as a result of long-term acne inadequate therapy and manipulations performed during the management of this group of patients. The pathogenetic mechanisms underlying the launch of acne currently look as follows: androgens cause hyperseborrhea, sebum lipids activate innate immunity; pathological keratinization due to the production of IL-1 inflammatory mediator and androgen hyperproduction; Cutibacterium acnes activate innate immune responses through toll-like receptors and metalloproteinases, stimulate the production of antimicrobial peptides and sebum production. The subsequent rupture of the follicles activates the wound healing process. Depending on the genetically determined features of the course of the inflammatory process, various individual postacne changes of the skin will prevail in different patients. The article highlights the main factors influencing the formation of post-acne, pathogenetic mechanisms underlying the formation of these changes, systematizes modern data on the classification, morphological and pathohistological characteristics of scars. Quantitative and qualitative scales of assessment of post-acne scars for determining the severity of the pathological process are presented, differentiated approaches to modern methods of therapy are discussed in detail, including the advantages and disadvantages of the most common methods of treating patients based on the principles of evidence-based medicine using a number of personalized methods.
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12
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Khalighi HR, Anbari F, Mojahedi SM, Forouzani G. Evaluating the Efficacy of the Er,Cr:YSGG Fractional Laser Before Treatment With Triamcinolone NN Ointment in Oral Lichen Planus Lesions. J Lasers Med Sci 2022; 13:e23. [PMID: 35996491 PMCID: PMC9392885 DOI: 10.34172/jlms.2022.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/10/2022] [Indexed: 08/11/2024]
Abstract
Introduction: It has been demonstrated that laser technology can enhance topical drug absorption. This study aimed to determine the effects of Er,Cr:YSGG laser radiation before the application of topical corticosteroids in the healing of oral lichen planus. Methods: In this double-blind split-mouth clinical trial, 32 lesions were chosen from eight patients affected by oral lichen planus (OLP). The oral lesions were randomly categorized into two groups. The first group had topical treatment with triamcinolone NN ointment and the second group had laser radiation (Er,Cr:YSGG) for eight weeks before starting the ointment. For each lesion, the irritating level based on the VAS score, the lesion level based on the Thongprasom scale score, and the healing time were measured, and the collected data were analyzed by the Friedman test and the Wilcoxon's statistical test. Results: The mean healing time based on the verbal analog scale (VAS) score was not significantly different between the two treatment groups (P>0.05). The mean healing time based on Thongprasom scale scores did not show any significant difference between the two treatment groups (P>0.05). Conclusion: The application of the Er,Cr:YSGG laser before treatment with triamcinolone NN ointment did not show any advantage for the average healing time compared to a medicine regimen with only triamcinolone NN ointment.
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Affiliation(s)
- Hamid Reza Khalighi
- Department of Oral Medicine, Dental Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Anbari
- Department of Oral Medicine, Dental Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Gelareh Forouzani
- Department of Oral Medicine, Dental Faculty, Aja University of Medical Sciences, Tehran, Iran
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13
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Tawaranurak N, Pliensiri P, Tawaranurak K. Combination of fractional carbon dioxide laser and topical triamcinolone vs intralesional triamcinolone for keloid treatment: A randomised clinical trial. Int Wound J 2022; 19:1729-1735. [PMID: 35166029 PMCID: PMC9615274 DOI: 10.1111/iwj.13775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
To compare the therapeutic effect of fractional carbon dioxide (CO2) laser + topical triamcinolone (TA) with intralesional TA on keloids. Twenty‐two participants were randomised into two groups: group A, treated with fractional CO2 laser + topical TA, and group B, treated with intralesional TA. The interventions were performed at every 4‐week interval until the keloids were resolved or at the completion of 1 year. At each session, the scar volume, Vancouver Scar Scale (VSS) were assessed. Recurrence was observed for 1 year. The mean scar volumes and VSS scores were not significantly different between the two groups. After 1 year, the scar volume change in group B was greater than group A (86.5% vs 59.1%, P‐value = .016). The mean VSS scores were significantly decreased in group A (8.0 ± 1.5 to 4.8 ± 1.6, P‐value <.001) and group B (8.4 ± 0.8 to 4.8 ± 1.6, P‐value <.001). The keloids were completely resolved in 63.6% and 72.7% of the patients, and recurrence was observed in 9.1% and 18.2% of the patients in groups A and B, respectively. The combination of fractional CO2 laser with topical TA was an alternative option for the treatment of keloids.
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Affiliation(s)
- Niti Tawaranurak
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pitchaya Pliensiri
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Krongthong Tawaranurak
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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14
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Truong K, Prasidha I, Wain T. A systematic review of randomised controlled trials investigating laser assisted drug delivery for the treatment of keloid and hypertrophic scars. Lasers Med Sci 2022; 37:47-59. [PMID: 33763827 DOI: 10.1007/s10103-021-03296-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/19/2021] [Indexed: 11/24/2022]
Abstract
The objective of this article is to study the clinical efficacy and adverse events of laser-assisted drug delivery in the treatment of hypertrophic and keloid scars. We searched the following databases up to 22 October 2020: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, and reference lists of articles for randomised clinical trials (RCTs) of laser-assisted drug delivery for the treatment of hypertrophic and keloid scars. We also searched online trials registries for ongoing trials and contacted trial authors where appropriate. Our outcomes of interest were objective clinical evaluation of scars, participant satisfaction, and adverse effects of the treatments. Two authors independently extracted data and assessed trial quality using Cochrane Risk of Bias 2. Two authors independently abstracted data. We included 10 RCTs involving a total of 329 participants: six trials utilised parallel-arm RCTs whilst four employed split-scar design. Three trials had high risk of bias with the remaining seven rated as having some concerns. The interventions and outcomes were too varied to be combined statistically. High-quality randomised controlled trials assessing laser-assisted delivery for drugs in the context of hypertrophic and/or keloid scarring are needed. Studies with a larger number of participants, with longer follow-up times, and standardised evaluation of outcome and adverse effects are warranted.
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Affiliation(s)
- Kelvin Truong
- Department of Dermatology, Westmead Hospital, Sydney, NSW, Australia.
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Ines Prasidha
- Department of Plastic Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Tevi Wain
- Department of Dermatology, Westmead Hospital, Sydney, NSW, Australia
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15
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Manuskiatti W, Yan C, Artzi O, Gervasio MKR, Wanitphakdeedecha R. Efficacy and safety of thermomechanical fractional injury-assisted corticosteroid delivery versus intralesional corticosteroid injection for the treatment of hypertrophic scars: A randomized split-scar trial. Lasers Surg Med 2021; 54:483-489. [PMID: 34913497 DOI: 10.1002/lsm.23511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/28/2021] [Accepted: 12/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Disruption of the natural skin barrier in a controlled manner may be used to deliver drugs that enhance scar resolution. OBJECTIVE To compare the efficacy and safety of thermomechanical fractional injury (TMFI)-assisted topical corticosteroid delivery with corticosteroid injection in the treatment of hypertrophic scar (HTS). MATERIALS AND METHODS This was a randomized, split-scar, double-blinded study. Twenty-one subjects with HTS on the abdomen received five split-scar treatments of TMFI + Steroid and steroid injection alone. Changes in scar thickness, scar volume, and Vancouver Scar Scale (VSS) were analyzed. Patient self-assessment, VAS scores, and adverse effects were also evaluated. RESULTS Scar thickness, volume, and VSS scores of both segments improved significantly compared to baseline. On every follow-up visit, there were no significant differences in mean scar thickness reduction between the two treatment groups except at the 6-month follow-up where the mean scar thickness reduction of the steroid injection segment was significantly lower than that of the TMFI + Steroid segment (95% confidence interval [CI], 0.09-0.35; p = 0.002). Scar volume, VSS scores, and patient self-assessment also showed no significant differences between both segments on all visits. The steroid injection segment was significantly more painful than the TMFI + Steroid segment (95% CI, -2.16 to -1.29; p < 0.001). Adverse effects of skin atrophy, telangiectasia, and post-inflammatory hyperpigmentation were noted in the steroid injection segment, while no adverse effects were observed at the TMFI + Steroid segment. CONCLUSIONS TMFI-assisted topical corticosteroid delivery is an effective treatment for HTS with a lower risk of adverse effects compared with corticosteroid injection.
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Affiliation(s)
- Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mia Katrina R Gervasio
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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16
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Alhamzawi NK. Efficacy of Fractional Carbon Dioxide Laser (FCO 2) with Intralesional 5-Fluorouracil (5-FU) in the Treatment of Keloids. J Cutan Aesthet Surg 2021; 14:323-329. [PMID: 34908775 PMCID: PMC8611703 DOI: 10.4103/jcas.jcas_153_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Managing keloids remains a challenge in clinical practice. Many therapeutic options are available, but none is universally accepted or without recurrence. Therefore, an effort is required to choose the treatment with maximal outcomes. Aims: To evaluate the effectiveness of combining fractional carbon dioxide (FCO2) laser and intralesional 5-fluorouracil (5-FU) for the treatment of keloids. Materials and Methods: In this prospective open-label study, 24 patients received FCO2 laser treatment, started at baseline, for a total of six sittings. The patients also received 1 mL/cm2/keloid of 5-FU (50 mg/mL) intralesionally, following irradiation, at identical time points. The primary outcome evaluated was the clinical response concerning height, pliability, vascularity, and pigmentation, using the Vancouver Score Scale (VSS). Adverse reactions and recurrences were recorded as secondary outcomes. Results: A significant reduction was observed in the VSS in terms of pliability and height after three treatment sessions. The mean VSS reduction was 65%, from 8.45 ± SD 0.93 at baseline to 3 ± SD 1.8 one month after the last treatment (P < 0.05). Most patients (79.1%; n = 19) showed a satisfactory response to treatment, with 57.8% (n = 11) achieving an excellent result. Adverse reactions included post-inflammatory hyperpigmentation in four patients and ulceration in two. Recurrences were reported in 21% of the patients who responded well. Conclusions: Combination therapy with FCO2 laser and intralesional 5-FU showed a promising effect in the treatment of resistant keloids, with an acceptable safety profile and low recurrence rate.
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17
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Chen J, Chen A, Zhang J, Wang F, Fang Q, He Z, Chen X, Ma W, Hu F. Efficacy and safety of laser combination therapy and laser alone therapy for keloid: a systematic review and meta-analysis. Lasers Med Sci 2021; 37:1127-1138. [PMID: 34283306 DOI: 10.1007/s10103-021-03364-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
To evaluate the efficacy and safety of laser alone therapy and laser combination therapy (mainly combined with other kinds of laser or steroids) for keloid.PubMed, Embase and Web of Science were searched for relevant articles from inception to June 2020. Comprehensive Meta-Analysis software 2.0 (CMA) was used to perform the meta-analysis.A total of 29 articles were included in this meta-analysis. During the mean follow-up of 14 (1-84) months, the overall improvement rates of baseline Vancouver scar scale (VSS) score and itch were 0.454 (95%CI 0.351-0.561, I2 = 0) and 0.786 (95%CI 0.613-0.895, I2 = 0) in the laser combination therapy group. The improvement rates of scar height and flexibility in the laser combination therapy group were 0.629 (95%CI 0.519-0.727, I2 = 52.089) and 0.784 (95%CI 0.251-0.975, I2 = 89.420). The average improvement rate of the scar score in laser combination therapy was 0.338 (0.201-0.510); however, there were insufficient data for laser alone therapy comparison. The laser combination therapy had a greater pain improvement rate, 0.580 (0.389-0.750) versus 0.420 (0.224-0.645), compared to laser alone therapy, and a greater degree of good or excellent (> 50%) improvement in the overall scar, 0.636 (95%CI 0.347-0.852) versus 0.149 (95%CI 0.032-0.482), with laser alone therapy. Moreover, a lower regrowth rate of 0.187 (0.129-0.263) versus 0.249 (0.060-0.631), a lower post-treatment pigmentation rate of 0.125 (0.091-0.169) versus 0.135 (0.058-0.282), and a lower infection rate of 0.047 (0.009-0.209) versus 0.076 (0.012-0.351) were observed in the laser combination therapy compared with those rates in the laser alone therapy.The overall effect of laser combination therapy was better than that of laser alone therapy, and the incidence of adverse reactions was lower in laser combination therapy than in laser alone therapy.
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Affiliation(s)
- Jiahui Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Aiyue Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Jianhao Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Feipeng Wang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Qiongfang Fang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Ziwei He
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
- 2017 Clinical Medicine, Shenzhen University Health Science Center, Shenzhen, Guandong, People's Republic of China
| | - Xi Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Wancheng Ma
- Department of Non-Communicable Disease Prevention and Control, Shenzhen Luohu Center for Chronic Disease, Shenzhen, Guangdong, People's Republic of China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.
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18
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Yan D, Zhao H, Li C, Xia A, Zhang J, Zhang S, Yun Q, Li X, Huang F, Tian Y. A clinical study of carbon dioxide lattice laser-assisted or microneedle-assisted 5-aminolevulinic acid-based photodynamic therapy for the treatment of hypertrophic acne scars. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 38:53-59. [PMID: 34273202 DOI: 10.1111/phpp.12716] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 06/05/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the clinical efficacy, recurrence rate and safety of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) combined with microneedle or CO2 lattice laser (CO2FL), in comparison with intrascar betamethasone injection in the treatment of hypertrophic acne scar. METHODS Fifty-two patients with hypertrophic acne scars at the mandibular angle were enrolled and assigned to different therapy groups. Sixteen patients were treated with microneedle-assisted incorporation of ALA. Twenty-eight patients underwent CO2FL-assisted incorporation of ALA. Eight patients received standard therapy with intrascar injection of glucocorticoid. Two dermatologists, blinded to the therapy groups, independently evaluated the scars in all patients using the average value of the Vancouver Scar Scale score, which was treated as an integer variable. RESULTS After three rounds of treatment, there was no significant difference in therapeutic effective rate among the microneedle, laser and topical glucocorticoid groups (93.75% vs 100% vs 100%, P = .855). One out of 16 patients (6.25%) in the microneedle group, no patient (0%) in the laser group and two out of eight patients (25%) in the topical glucocorticoid group had recurrence. The laser group showed a higher rate of adverse effects, which were usually mild and reversible, except for pigmentation. Adverse reactions could be completely subsided within 3 weeks. CONCLUSIONS Either CO2FL or microneedle combined ALA-PDT for hypertrophic scar, as to topical glucocorticoid therapy, showed equivalent clinical effects but lower recurrence rate within 6 months of follow-up period.
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Affiliation(s)
- Dongmei Yan
- General Hospital of Air Force, PLA, Beijing, China
| | - Hongyi Zhao
- Plastic Surgery of Beijing Hospital, National Center for Geriatrics, Chinese Academy of Medical Sciences Institute of Geriatrics, Beijing, China
| | - Chenxi Li
- General Hospital of Air Force, PLA, Beijing, China
| | - Aiting Xia
- General Hospital of Air Force, PLA, Beijing, China
| | | | - Si Zhang
- General Hospital of Air Force, PLA, Beijing, China
| | - Qing Yun
- General Hospital of Air Force, PLA, Beijing, China
| | - Xiaoxin Li
- General Hospital of Air Force, PLA, Beijing, China
| | - Feng Huang
- General Hospital of Air Force, PLA, Beijing, China
| | - Yan Tian
- General Hospital of Air Force, PLA, Beijing, China
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19
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Hendel K, Hansen ACN, Bik L, Bagger C, van Doorn MBA, Janfelt C, Olesen UH, Haedersdal M, Lerche CM. Bleomycin administered by laser-assisted drug delivery or intradermal needle-injection results in distinct biodistribution patterns in skin: in vivo investigations with mass spectrometry imaging. Drug Deliv 2021; 28:1141-1149. [PMID: 34121567 PMCID: PMC8205002 DOI: 10.1080/10717544.2021.1933649] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Bleomycin (BLM) is being repositioned in dermato-oncology for intralesional and intra-tumoural use. Although conventionally administered by local needle injections (NIs), ablative fractional lasers (AFLs) can facilitate topical BLM delivery. Adding local electroporation (EP) can augment intracellular uptake in the target tissue. Here, we characterize and compare BLM biodistribution patterns, cutaneous pharmacokinetic profiles, and tolerability in an in vivo pig model following fractional laser-assisted topical drug delivery and intradermal NI, with and without subsequent EP. In vivo pig skin was treated with AFL and topical BLM or NI with BLM, alone or with additional EP, and followed for 1, 2 and 4 h and eventually up to 9 d. BLM biodistribution was assessed by spatiotemporal mass spectrometry imaging. Cutaneous pharmacokinetics were assessed by mass spectrometry quantification and temporal imaging. Tolerability was evaluated by local skin reactions (LSRs) and skin integrity measurements. AFL and NI resulted in distinct BLM biodistributions: AFL resulted in a horizontal belt-shaped BLM distribution along the skin surface, and NI resulted in BLM radiating from the injection site. Cutaneous pharmacokinetic analyses and temporal imaging showed a substantial reduction in BLM concentration within the first few hours following administration. LSRs were tolerable overall, and all interventions permitted almost complete recovery of skin integrity within 9 d. In conclusion, AFL and NI result in distinct cutaneous biodistribution patterns and pharmacokinetic profiles for BLM applied to in vivo skin. Evaluation of LSRs showed that both methods were similarly tolerable, and each method has potential for individualized approaches in a clinical setting.
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Affiliation(s)
- Kristoffer Hendel
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anders C N Hansen
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Liora Bik
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charlotte Bagger
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christian Janfelt
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Uffe H Olesen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
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20
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Issler-Fisher AC, Fisher OM, Haertsch PA, Li Z, Maitz PKM. Effectiveness and safety of ablative fractional CO 2 laser for the treatment of burn scars: A case-control study. Burns 2021; 47:785-795. [PMID: 33121852 DOI: 10.1016/j.burns.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Burn scars are a major clinical challenge. The aim of this study was to determine the effectiveness and safety of one treatment with the ablative fractional CO2 laser (AFL-CO2) compared to standard burn scar treatment. METHOD From December 2014 to October 2018 patients were prospectively recruited and treatment effects analyzed by assessing various outcome parameters from the date of first consultation and after treatment. A case control study was conducted looking at the impact of one AFL-CO2 treatment compared to a cohort subjected to conventional conservative treatment. Adverse effects were noted at follow up. RESULTS 187 patients were included, with 167 in the AFL-CO2, and 20 in the control cohort. Baseline demographics and scar characteristics showed no significant differences. Ultrasound measured scar thickness as well as the Vancouver Scar Scale (VSS) revealed a significant reduction in the treatment cohort, but no significant improvement in the control group. The POSAS-O was significantly improved in both cohorts. Subjective parameters (POSAS-P, DN4-Pain, and modified D4Pruritus scores) decreased significantly in the AFL-CO2 cohort but remained unchanged in the control group. The BSHS-B quality of life score increased significantly in the AFL-CO2 group, but worsened at the follow up of the untreated patients. Sub-domain analyses found the biggest differences in Affect, Body Image, Heat Sensitivity, Treatment and Work. Complications occurred in 5 patients (2.9%). CONCLUSIONS This study demonstrates that AFL-CO2 is an effective and safe treatment modality for burn scars improving thickness, symptoms and quality of life of burn survivors when compared to conventional scar treatment.
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Affiliation(s)
- Andrea C Issler-Fisher
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia.
| | - Oliver M Fisher
- School of Medicine, University of Notre Dame, Sydney, NSW 2010, Australia; University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia
| | - Peter A Haertsch
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Zhe Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
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21
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Zawadiuk LRR, Van Slyke AC, Bone J, Redfern B, Carr NJ, Arneja JS. What Do We Know About Treating Recalcitrant Auricular Keloids? A Systematic Review and Meta-Analysis. Plast Surg (Oakv) 2021; 30:49-58. [PMID: 35096693 PMCID: PMC8793758 DOI: 10.1177/2292550321995746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Recalcitrant auricular keloids are keloids that have recurred after any previous treatment. They have been shown to have an increased likelihood of recurrence. There is no consensus on how best to treat recalcitrant auricular keloids. Here, we perform the first systematic review and meta-analysis investigating the evidence for treating recalcitrant auricular keloids. Methods: We searched MEDLINE, EMBASE, CINAHL, and EBM Reviews using specific keywords. Prespecified inclusion and exclusion criteria were used to assess article eligibility. Data were extracted for number of recalcitrant keloids, treatment modality, recurrence, and minimum follow-up time. Included articles were stratified by treatment and assigned a level of evidence (LOE) based on the Oxford Centre for Evidence-Based Medicine guidelines. A meta-analysis was performed to estimate recurrence rates with 95% confidence intervals for each treatment modality. Results: A total of 887 unique articles were identified and 13 included. Eleven were LOE III and 2 were LOE IV. Recurrence rates were found to be 9% (95% CI: 3%-25%) for excision with adjuvant brachytherapy, 14% (95% CI: 12%-17%) for excision with adjuvant compression therapy, 17% (95% CI: 3%-56%) for excision with adjuvant external beam radiation, and 18% (95% CI: 4%-53%) for excision with adjuvant steroid injections. No statistical significant difference was found. Conclusions: Data for treatment of auricular keloids are heterogeneous with few high-quality studies. Excision with adjuvant brachytherapy has the lowest recurrence rate in our analysis. Narrow confidence intervals reported here for brachytherapy and compression therapy may help surgeons more confidently recommend either of these treatment modalities to patients.
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Affiliation(s)
- Luke R. R. Zawadiuk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron C. Van Slyke
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey Bone
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Baillie Redfern
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas J. Carr
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jugpal S. Arneja
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Searle T, Ali FR, Al-Niaimi F. Lessons Learned from the First Decade of Laser-Assisted Drug Delivery. Dermatol Ther (Heidelb) 2021; 11:93-104. [PMID: 33464473 PMCID: PMC7858718 DOI: 10.1007/s13555-020-00478-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Indexed: 11/29/2022] Open
Abstract
Laser-assisted drug delivery augments the distribution and penetration of topically applied treatments, leading to enhanced delivery and bioavailability. We discuss the therapeutic application of laser-assisted drug delivery in clinical practice in cases of non-melanoma skin cancer, vitiligo, melasma, scarring, and alopecia (female pattern hair loss, male pattern hair loss, alopecia areata) as well as for vaccination, local anaesthesia, analgesia, viral warts, infantile haemangiomas and cosmetic uses, and we review clinical studies that have used this technique over the last decade. Our review shows that the application of laser-assisted drug delivery enhances topical agent efficacy, potentially reducing the agent concentration and duration of topical treatment required. Future research into the use of laser-assisted drug delivery before topical therapies is needed to establish the optimal techniques to enhance drug delivery and thus improve patient outcomes.
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Affiliation(s)
| | - Faisal R Ali
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Vernova Healthcare CIC, Macclesfield, UK
| | - Firas Al-Niaimi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK. .,Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark.
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23
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Hsieh CH, Lin KC, Wu SC, Chi SY, Lin HP, Lin CH, Tsai YJ, Hsieh MH, Hsu SY. Facilitated delivery of topical steroids after fractional ablative carbon dioxide laser failed to prevent the postthyroidectomy hypertrophic scar. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Wang J, Wu J, Xu M, Gao Q, Chen B, Wang F, Song H. Combination therapy of refractory keloid with ultrapulse fractional carbon dioxide (CO 2 ) laser and topical triamcinolone in Asians-long-term prevention of keloid recurrence. Dermatol Ther 2020; 33:e14359. [PMID: 33002270 DOI: 10.1111/dth.14359] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/03/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022]
Abstract
Keloid often recur after treatment, and recent studies in keloid management favor the combination therapy of laser-assisted drug delivery over monotherapy. Unfortunately, the previous researches lack long-term follow-up. In this prospective study, 41 individuals with refractory keloids underwent eight treatment sessions at 4 weeks intervals consisting of ultrapulse fractional carbon dioxide laser (UFCL), followed by postoperative application topical triamcinolone acetonide (40 mg/ml). Four follow-up moments were chosen, with follow-up of 24 months. The effects of combination therapy on scar pliability, thickness, relief, vascularization, surface area, pain, and itchiness were examined by means of the Patient and Observer Scar Assessment Scale (POSAS). 38 patients completed the full 24 months of follow-up after the whole treatment. The results reveal a fast and abiding improvement of keloid scars after the combination therapy. The mean keloid POSAS scores showed a decreasing trend in subsequent times. All POSAS components improved significantly between baseline and 24 months after start of therapy (P < .05). Long-term follow-up results demonstrate that combination keloid therapy using UFCL and tropical triamcinolone has overall significant improvement and low recurrence rate with a long-term stable results.
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Affiliation(s)
- Jue Wang
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiang Wu
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Minghuo Xu
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Quanwen Gao
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Baoguo Chen
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fang Wang
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Huifeng Song
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Akinbiyi T, Kozak GM, Davis HD, Barrette LX, Rios-Diaz AJ, Maxwell R, Tilahun ED, Jones JA, Broach RB, Butler PD. Contemporary treatment of keloids: A 10-year institutional experience with medical management, surgical excision, and radiation therapy. Am J Surg 2020; 221:689-696. [PMID: 32878694 DOI: 10.1016/j.amjsurg.2020.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/29/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We evaluate a single center's, decade-long experience utilizing 3 approaches to keloid treatment: corticosteroid medical management (MM), surgical excision (SE), and surgical excision + radiation therapy (SE + RT). STUDY DESIGN Patients undergoing keloid treatment were identified (2008-2017). Outcomes were symptomatology/cosmesis for MM, and recurrence and complications for SE and SE + RT. Logistic regression was used to determine factors associated with recurrence and complications. RESULTS 284 keloids (95 MM, 94 SE, 95 S E + RT) corresponded to patients with a median age of 39.1 (IQR: 26.1-53), 68.1% Black, and followed-up for 15.4 months (IQR: 5.6-30.7). For MM, 84.6% and 72.5% reported improvement in cosmesis and symptoms, respectively. SE and SE + RT recurrence were 37.2 and 37.9%, respectively. In adjusted analyses, higher radiation doses were associated with decreased recurrence whereas male gender (OR 3.3) and postoperative steroids (OR 9.5) were associated with increased recurrence (p < 0.01). There were more complications in the SE + RT group. CONCLUSIONS MM resulted in at least some improvement. Recurrence rates after SE and SE + RT were similar. Female sex is protective, race does not affect outcomes.
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Affiliation(s)
- Takintope Akinbiyi
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Geoffrey M Kozak
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Surgery, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Harrison D Davis
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Louis-Xavier Barrette
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Arturo J Rios-Diaz
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Surgery, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Russell Maxwell
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Estifanos D Tilahun
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Joshua A Jones
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robyn B Broach
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Paris D Butler
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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26
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Levenberg A, Vinshtok Y, Artzi O. Potentials for implementing pressure-controlled jet injection in management of keloids with intralesional 5FU and corticosteroids. J Cosmet Dermatol 2020; 19:1966-1972. [PMID: 32603031 DOI: 10.1111/jocd.13522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Needle-free jet injection implements kinetic energy of liquid jet for transcutaneous delivery of drugs into soft tissues. Combination therapy of intralesional 5-fluorouracil and triamcinolone offers efficacious treatment for keloids with a reduced adverse effect of the drug monotherapy. This study evaluates safety and efficacy of the drug combination administered to keloid scars via intralesional jet injections. METHODS A retrospective analysis of the keloid treatments was performed. Efficacy was assessed by reviewing pre- and post-treatment scores of the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) and by comparing baseline and photographs taken 3 months after the treatments. Safety and tolerability were collected and analyzed. RESULTS Twenty-one subjects (M/F = 11/10) with 39 keloids received the treatments. Treatments were well-tolerated by all patients at mean injection pain of 2.0 ± 1.0 per Numeric Pain Rating Scale (NPRS). Self-resolved lesion ulceration was observed in 4 patients. Post-treatment evaluation demonstrated a 53% decrease in total VSS score (P < 0.05) and in all sub-categories. Mean patient score of POSAS decreased in the color, stiffness, thickness, and irregularity components. Pain and pruritus lessened by 69% and 79% (P < 0.05 in both), respectively, among the patients with complaints prior to the treatment. Independent reviewers reported an average 51%-75% reduction in keloids. CONCLUSIONS Improved appearance of keloids and symptomatic relief was achieved by intralesional administration of combined 5-fluorouracil and corticosteroid through the high-pressure jet injections. The synergy between the drug combination and the jet physical impact provided clinical effect.
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Affiliation(s)
- Alex Levenberg
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Ofir Artzi
- Center for Aesthetic Dermatology, Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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27
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Abd El-Dayem DH, Nada HA, Hanafy NS, Elsaie ML. Laser-assisted topical steroid application versus steroid injection for treating keloids: A split side study. J Cosmet Dermatol 2020; 20:138-142. [PMID: 32485049 DOI: 10.1111/jocd.13521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Approaches to improve keloid scars include intralesional corticosteroid injections and fractional lasers exclusively. The combinative use of ablative fractional laser therapy and occluded topical corticosteroid as a drug delivery method enhances therapeutic outcome of two efficient scar therapy modules into one simple synergistic module. AIM To compare the therapeutic effect of combining two modalities of scar treatment, the first is fractional ablative laser treatment and the other is occluded topical corticosteroid to the standard use of intralesional steroid injection. METHODS Keloids from thirty suffering patients were split faced into two identical parts; one part received an intralesional corticosteroid injection while the other part was treated first with fractional ablative 2940 nm Er: YAG laser followed by occluded topical application of steroid cream. Four treatment sessions were performed with 4-week interval between sessions. Every session was assessed photographically and using the Vancouver Scar Scale (VSS). RESULTS The mean keloid VSS before treatment was 6.9 ± 1.9. After treatment, the mean keloid VSS of the injection side became 2.63 ± 2.09, and mean keloid VSS of the laser-treated side became 2.07 ± 2.02. Each of the treated halves showed a statistically significant improvement in their VSS. However, no statistically significant differences were observed for either of the treated halves over the other one. CONCLUSION Although intralesional steroids injection is the standard procedure for treatment of keloid scars, the use of ablative fractional laser-assisted delivery of topical steroid can offer a safer and a better aesthetic treatment option.
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Affiliation(s)
- Dina H Abd El-Dayem
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hesham A Nada
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Noha S Hanafy
- Department of Dermatology and Venereology, National Research Centre, Giza, Egypt
| | - Mohamed L Elsaie
- Department of Dermatology and Venereology, National Research Centre, Giza, Egypt
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28
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New Developments for Fractional CO2 Resurfacing for Skin Rejuvenation and Scar Reduction. Facial Plast Surg Clin North Am 2020; 28:17-28. [DOI: 10.1016/j.fsc.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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29
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Klifto KM, Asif M, Hultman CS. Laser management of hypertrophic burn scars: a comprehensive review. BURNS & TRAUMA 2020; 8:tkz002. [PMID: 32346540 PMCID: PMC7175764 DOI: 10.1093/burnst/tkz002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/28/2019] [Indexed: 12/15/2022]
Abstract
Hypertrophic scars often develop following burn-related injuries. These scars can be cosmetically unappealing, but associated symptoms of pruritus, pain and restricted range of motion can impair a person’s quality of life. Laser and light therapies offer a minimally invasive, low-risk approach to treatment, with a short postoperative recovery period. As laser technology developed, studies have shown decreased scar thickness, neuropathic pain and need for surgical excision, as well as improved scar pigmentation, erythema, pliability, texture, height and pruritus. In this review, we present the evolution of laser therapy for hypertrophic burn scars, how different types of lasers work, indications, perioperative considerations and guidelines for practice management.
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Affiliation(s)
- Kevin M Klifto
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, Maryland, USA, 21205.,Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, Maryland, USA, 21224
| | - Mohammed Asif
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, Maryland, USA, 21205.,Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, Maryland, USA, 21224
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, Maryland, USA, 21205.,Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, Maryland, USA, 21224
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30
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Benzaquen M, Collet-Villette AM, Delaporte E. Combined treatment of hypertrophic and keloid scars with intralesional injection of corticosteroids and laser-assisted corticosteroid delivery. Dermatol Ther 2019; 32:e13126. [PMID: 31628774 DOI: 10.1111/dth.13126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/21/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Benzaquen
- Department of Dermatology, Aix Marseille University, APHM, Hôpital Nord, Marseille, France
| | | | - Emmanuel Delaporte
- Department of Dermatology, Aix Marseille University, APHM, Hôpital Nord, Marseille, France
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31
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Al Janahi S, Lee M, Lam C, Chung HJ. Laser-assisted drug delivery in the treatment of keloids: A case of extensive refractory keloids successfully treated with fractional carbon dioxide laser followed by topical application and intralesional injection of steroid suspension. JAAD Case Rep 2019; 5:840-843. [PMID: 31646158 PMCID: PMC6804451 DOI: 10.1016/j.jdcr.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sara Al Janahi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Ming Lee
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Christina Lam
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Hye Jin Chung
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
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32
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Artzi O, Koren A, Niv R, Mehrabi JN, Mashiah J, Friedman O. A new approach in the treatment of pediatric hypertrophic burn scars: Tixel‐associated topical triamcinolone acetonide and 5‐fluorouracil delivery. J Cosmet Dermatol 2019; 19:131-134. [DOI: 10.1111/jocd.13192] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ofir Artzi
- Department of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Dr. Artzi Treatment and Research Center Tel Aviv Israel
| | - Amir Koren
- Department of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Dr. Artzi Treatment and Research Center Tel Aviv Israel
| | - Roni Niv
- Dr. Artzi Treatment and Research Center Tel Aviv Israel
| | | | - Jacob Mashiah
- Department of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Pediatric Dermatology Clinic Dana‐Dwek Children's Hospital Tel Aviv Sourasky medical center Tel Aviv Israel
| | - Or Friedman
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- The Plastic Reconstructive Surgery Department Tel Aviv Sourasky Medical Center Tel Aviv Israel
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33
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Hsiao CY, Yang SC, Alalaiwe A, Fang JY. Laser ablation and topical drug delivery: a review of recent advances. Expert Opin Drug Deliv 2019; 16:937-952. [DOI: 10.1080/17425247.2019.1649655] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Chien-Yu Hsiao
- Department of Nutrition and Health Sciences, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Research Center for Food and Cosmetic Safety and Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Aesthetic Medical Center, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Chun Yang
- Department of Cosmetic Science, Providence University, Taichung, Taiwan
| | - Ahmed Alalaiwe
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Jia-You Fang
- Research Center for Food and Cosmetic Safety and Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Pharmaceutics Laboratory, Graduate Institute of Natural Products, Chang Gung University, Taoyuan, Taiwan
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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34
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The Scar Bane, Without the Pain: A New Approach in the Treatment of Elevated Scars: Thermomechanical Delivery of Topical Triamcinolone Acetonide and 5-Fluorouracil. Dermatol Ther (Heidelb) 2019; 9:321-326. [PMID: 31041665 PMCID: PMC6522605 DOI: 10.1007/s13555-019-0298-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Indexed: 02/08/2023] Open
Abstract
Introduction Keloids are challenging to treat due to their inadequate response to treatment and high recurrence rate. Intralesional triamcinolone acetonide (TAC) injection with or without 5-fluorouracil (5FU) is considered the first-line treatment for keloids. Three significant disadvantages of intralesional injections are the pain associated with the procedure, the uneven topography, and epidermal atrophy. Fractionated ablative carbon dioxide (CO2) laser-assisted drug delivery (LADD) of the topical solution can help facilitate transdermal drug delivery and shows promise in scar remodeling. This study examined the use of a thermomechanical device (Tixel, Novoxel) to facilitate the transdermal delivery of TAC and 5-FU in the treatment of keloid scars. Methods Seven patients each received eight topical thermal ablations, with one ablation performed every 2–3 weeks. TAC and 5FU were applied after each ablation. Outcomes were evaluated using the Vancouver Scar Scale (VSS), and pain was assessed using the Visual Analog Scale (VAS). Results Mean keloid VSS reduced from 8.6 ± 1.2 to 5 ± 2.7 after the eight treatments. Mean treatment pain VAS score was 2.4 ± 0.7. Patients rated their satisfaction level as moderate–high. No severe adverse reactions were noted. Conclusion Thermomechanical drug delivery of TAC and 5-FU is safe and effective. This is a promising option for the treatment of keloid scars, particularly in the pediatric population.
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35
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Tawfik AA, Fathy M, Badawi A, Abdallah N, Shokeir H. Topical 5 fluorouracil cream vs combined 5 fluorouracil and fractional erbium YAG laser for treatment of severe hypertrophic scars. Clin Cosmet Investig Dermatol 2019; 12:173-180. [PMID: 30936735 PMCID: PMC6421878 DOI: 10.2147/ccid.s191137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Topical 5 fluorouracil (5-FU) has been reported as one of the standard treatments for hypertrophic scars (HTS). Ablative fractional laser was found to have promising results in the delivery of topical drugs into the skin by creating vertical channels through which the drugs can penetrate the skin. So far there have been no comparative studies performed to compare both modalities in the same patient and same anatomical region, especially in severe HTS. Objective The aim of this study was to compare the effectiveness of topical 5-FU and combined topical 5-FU and laser in treating severe HTS. Patients and methods Twenty-four severe HTS lesions were treated by 5-FU monotherapy and 5-FU combined with ablative fractional erbium YAG laser. Each lesion was divided into two parts. One part was treated with topical 5-FU twice weekly for 8 months. The other part was treated with combined topical 5-FU and ablative fractional erbium YAG laser once per month for 8 months. The scars’ improvement was evaluated by Vancouver scar scale (VSS) and skin analysis camera. Results The assessment by VSS showed a significant reduction in the mean height, pliability, and vascularity of the lesions which were treated with combined approaches compared to 5-FU monotherapy. Pain and ulceration occurred at a higher rate in the combination therapy group. Conclusion Treatment of severe HTS with combined 5-FU and ablative fractional erbium YAG laser is more effective than 5-FU alone.
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Affiliation(s)
- Abeer Attia Tawfik
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Maha Fathy
- Al-Houd Al Marsoud Hospital, Cairo, Egypt,
| | - Ashraf Badawi
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt, .,Dermatology and Allergology Department, University of Szeged, Szeged, Hungary
| | - Noha Abdallah
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Hisham Shokeir
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
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36
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Alegre-Sánchez A, Jiménez-Gómez N, Boixeda P. Laser-Assisted Drug Delivery. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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37
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Alegre-Sánchez A, Jiménez-Gómez N, Boixeda P. Vehiculización de fármacos asistida por láser. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:858-867. [DOI: 10.1016/j.ad.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 02/02/2023] Open
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38
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Braun SA, Schrumpf H, Buhren BA, Homey B, Gerber PA. Laser-assisted drug delivery: mode of action and use in daily clinical practice. J Dtsch Dermatol Ges 2018; 14:480-8. [PMID: 27119468 DOI: 10.1111/ddg.12963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Topical application of pharmaceutical agents is a basic principle of dermatological therapy. However, the effective barrier function of the skin significantly impairs the bioavailability of most topical drugs. Fractional ablative lasers represent an innovative strategy to overcome the epidermal barrier in a standardized, contact-free manner. The bioavailability of topical agents can be significantly enhanced using laser-assisted drug delivery (LADD). In recent years, the principle of LADD has become well established for various dermatological indications. Herein, we review the current literature on LADD and present potential future applications.
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Affiliation(s)
| | - Holger Schrumpf
- Department of Dermatology, Heinrich Heine University, Düsseldorf, Germany
| | | | - Bernhard Homey
- Department of Dermatology, Heinrich Heine University, Düsseldorf, Germany
| | - Peter Arne Gerber
- Department of Dermatology, Heinrich Heine University, Düsseldorf, Germany
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39
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40
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Badawi AM, Osman MA. Fractional erbium-doped yttrium aluminum garnet laser-assisted drug delivery of hydroquinone in the treatment of melasma. Clin Cosmet Investig Dermatol 2018; 11:13-20. [PMID: 29379308 PMCID: PMC5757209 DOI: 10.2147/ccid.s147413] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Melasma is a difficult-to-treat hyperpigmentary disorder. Ablative fractional laser (AFL)-assisted delivery of topically applied drugs to varied targets in the skin has been an area of ongoing study and research. Objective The objective of this study was to evaluate the efficacy and safety of fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser as an assisted drug delivery for enhancing topical hydroquinone (HQ) permeation into the skin of melasma patients. Patients and methods Thirty female patients with bilateral melasma were randomly treated in a split-face controlled manner with a fractional Er:YAG laser followed by 4% HQ cream on one side and 4% HQ cream alone on the other side. All patients received six laser sessions with a 2-week interval. The efficacy of treatments was determined through photographs, dermoscopic photomicrographs and Melasma Area Severity Index (MASI) score, all performed at baseline and at 12 weeks of starting therapy. The patient’s level of satisfaction was also recorded. Results Er:YAG laser + HQ showed significantly better results (p<0.005) with regard to decrease in the degree of pigmentation as assessed on the 4-point scale than HQ alone. There was a significant decrease in MASI scores on Er:YAG laser + HQ side vs HQ side. Minor reversible side effects were observed on both sides. Conclusion AFL-assisted delivery of HQ is a safe and effective method for the treatment of melasma.
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Affiliation(s)
- Ashraf M Badawi
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences (N.I.L.E.S.), Cairo University, Giza, Egypt.,Dermatology and Laser Applications, Szeged University, Szeged, Hungary.,European Society for Lasers and Energy Based Devices, Strasbourg, France.,European Society for Cosmetic and Aesthetic Dermatology, Paris, France
| | - Mai Abdelraouf Osman
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences (N.I.L.E.S.), Cairo University, Giza, Egypt
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41
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Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev 2018; 123:3-17. [PMID: 28941987 DOI: 10.1016/j.addr.2017.09.018] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
Severe burn injuries are the most traumatic and physically debilitating injuries affecting nearly every organ system and leading to significant morbidity and mortality. Early burn wound excision and skin grafting are common clinical practices that have significantly improved the outcomes for severe burn injured patients by reducing mortality rate and days of hospital stay. However, slow wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in burn research and management. In the present article, we review and discuss issues in the current treatment of burn injuries; the advances and novel strategies developed in the past decade that have improved burn management; and also, pioneer ideas and studies in burn research which aims to enhance burn wound care with a focus on burn wound infection, pain management, treatments for scarring and skin tissue engineering.
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42
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Ibrahim O, Wenande E, Hogan S, Arndt KA, Haedersdal M, Dover JS. Challenges to laser-assisted drug delivery: Applying theory to clinical practice. Lasers Surg Med 2017; 50:20-27. [DOI: 10.1002/lsm.22769] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Omer Ibrahim
- SkinCare Physicians; Chestnut Hill Massachusetts 02467
| | - Emily Wenande
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Copenhagen Denmark
| | - Sara Hogan
- Department of Dermatology; Cleveland Clinic; Cleveland Ohio 04195
| | | | - Merete Haedersdal
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Copenhagen Denmark
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43
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Srivastava S, Patil AN, Prakash C, Kumari H. Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil, and Their Combination for the Treatment of Keloids. Adv Wound Care (New Rochelle) 2017; 6:393-400. [PMID: 29098115 DOI: 10.1089/wound.2017.0741] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/19/2017] [Indexed: 11/12/2022] Open
Abstract
Objective: Despite the myriad options available, there is no universally accepted treatment for keloids. Our objective was to compare three regimens and establish superiority in terms of objective and subjective outcomes. Approach: In this randomized parallel group study, 60 patients were enrolled and randomly allocated to three groups. Patients received intralesional injections of triamcinolone acetonide (TAC) in Group TAC, 5-fluorouracil (5FU) in Group 5FU, and a combination in Group T + F every 3 weeks till 24 weeks or till the keloid resolved. Results: There was a reduction in all parameters at every successive assessment in all three groups. Improvement in terms of height, vascularity, and pliability was fastest with 5FU, TAC, and T + F group, respectively, which was statistically significant. Decrease in pigmentation was significantly faster with T+F. Reduction in pruritus, however, was significantly faster with 5FU than the other groups, but the difference in reduction of pain among the three groups was not significant. Telangiectasias and skin atrophy were seen most commonly in TAC group, while skin ulceration was a common problem in 5FU group. Conclusion: TAC, 5FU, and their combination are all effective in keloid scars. A combination of TAC +5FU seems to offer the balanced benefit of faster and more efficacious response with lesser adverse effects when compared to individual drugs.
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Affiliation(s)
- Sunil Srivastava
- Department of Plastic Surgery, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
| | - Aditya Nanasaheb Patil
- Department of Plastic Surgery, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
| | - Chaitra Prakash
- Department of Dermatology, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
| | - Hiranmayi Kumari
- Department of Plastic Surgery, Sawai Man Singh Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India
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44
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Forbat E, Ali FR, Al-Niaimi F. Treatment of keloid scars using light-, laser- and energy-based devices: a contemporary review of the literature. Lasers Med Sci 2017; 32:2145-2154. [PMID: 29047002 DOI: 10.1007/s10103-017-2332-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 09/19/2017] [Indexed: 01/28/2023]
Abstract
Keloid scars are common and have a predilection for young, ethnic skin often with a family history. Keloids can be painful and pruritic and cause significant emotional distress when particularly visible or prominent. In this article, we review the evidence underlying the use of laser- and energy-based devices for treatment of keloid scars, either as monotherapy or in conjunction with other therapies such as corticosteroids, surgery and silicone gel in the treatment of keloid scars.
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Affiliation(s)
- E Forbat
- Chelsea and Westminster Hospital, 369 Fulham Rd, London, SW10 9NH, UK
| | - F R Ali
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology,, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - F Al-Niaimi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology,, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
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45
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Issler-Fisher AC, Waibel JS, Donelan MB. Laser Modulation of Hypertrophic Scars. Clin Plast Surg 2017; 44:757-766. [DOI: 10.1016/j.cps.2017.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Gokalp H. Evaluation of nonablative fractional laser treatment in scar reduction. Lasers Med Sci 2017; 32:1629-1635. [DOI: 10.1007/s10103-017-2303-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 08/06/2017] [Indexed: 10/19/2022]
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47
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DeBruler DM, Blackstone BN, Baumann ME, McFarland KL, Wulff BC, Wilgus TA, Bailey JK, Supp DM, Powell HM. Inflammatory responses, matrix remodeling, and re-epithelialization after fractional CO 2 laser treatment of scars. Lasers Surg Med 2017; 49:675-685. [PMID: 28489283 DOI: 10.1002/lsm.22666] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Fractional CO2 laser therapy has been used to improve scar pliability and appearance; however, a variety of treatment protocols have been utilized with varied outcomes. Understanding the relationship between laser power and extent of initial tissue ablation and time frame for remodeling could help determine an optimum power and frequency for laser treatment. The characteristics of initial injury caused by fractional CO2 laser treatment, the rates of dermal remodeling and re-epithelialization, and the extent of inflammation as a function of laser stacking were assessed in this study in a porcine scar model. MATERIALS AND METHODS Full-thickness burn wounds were created on female Red Duroc pigs followed by immediate excision of the eschar and split-thickness autografting. Three months after injury, the resultant scars were treated with a fractional CO2 laser with 70 mJ of energy delivered as either a single pulse or stacked for three consecutive pulses. Immediately prior to laser treatment and at 1, 24, 96, and 168 hours post-laser treatment, transepidermal water loss (TEWL), erythema, and microscopic characteristics of laser injury were measured. In addition, markers for inflammatory cytokines, extracellular matrix proteins, and re-epithelialization were quantified at all time points using qRT-PCR. RESULTS Both treatments produced erythema in the scar that peaked 24 hours after treatment then decreased to basal levels by 168 hours. TEWL increased after laser treatment and returned to normal levels between 24 and 96 hours later. Stacking of the pulses did not significantly increase the depth of ablated wells or extend the presence of erythema. Interleukin 6 and monocyte chemoattractant protein-1 were found to increase significantly 1 hour after treatment but returned to baseline by 24 hours post laser. In contrast, expression of transforming growth factor β1 and transforming growth factor β3 increased slowly after treatment with a more modest increase than interleukin 6 and monocyte chemoattractant protein-1. CONCLUSIONS In the current study, the properties of the ablative zones were not directly proportional to the total amount of energy applied to the porcine scars with the use of triple stacking, resulting in only minor increases to microthermal zone (MTZ) depth and width versus a single pulse. Re-epithelialization and re-establishment of epidermal barrier function were observed in laser treated scars by 48 hours post therapy. Finally, many of the inflammatory genes up-regulated by the laser ablation returned to baseline within 1 week. As a whole, these results suggest that microthermal zones created by FXCO2 treatment re-epithelialize rapidly with the inflammatory response to the laser induced injury largely resolved within 1 week post treatment. Further study is needed to understand the relationship between laser stacking and MTZ properties in human scars in order to evaluate the clinical applicability of the stacking technique. Lasers Surg. Med. 49:675-685, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Danielle M DeBruler
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | - Britani N Blackstone
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | - Molly E Baumann
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Kevin L McFarland
- Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio
| | - Brian C Wulff
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Traci A Wilgus
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - J Kevin Bailey
- Department of Surgery, Division of Critical Care, Trauma and Burns, The Ohio State University, Columbus, Ohio
| | - Dorothy M Supp
- Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Heather M Powell
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
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48
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49
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Laser-assisted topical corticosteroid delivery for the treatment of keloids. Lasers Med Sci 2017; 32:601-608. [DOI: 10.1007/s10103-017-2154-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 01/16/2017] [Indexed: 11/26/2022]
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50
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Issler-Fisher AC, Fisher OM, Smialkowski AO, Li F, van Schalkwyk CP, Haertsch P, Maitz PKM. Ablative fractional CO 2 laser for burn scar reconstruction: An extensive subjective and objective short-term outcome analysis of a prospective treatment cohort. Burns 2016; 43:573-582. [PMID: 27707636 DOI: 10.1016/j.burns.2016.09.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The introduction of ablative fractional CO2 lasers (CO2-AFL) for burn scar management shows promising results. Whilst recent studies have focused on objective scar outcomes following CO2-AFL treatment, to date no data on patient subjective factors such as quality of life are available. METHODS A prospective study was initiated to analyze the safety and efficacy of the CO2-AFL. Various objective and subjective outcome parameters were prospectively collected from the date of first consultation and follow-up following treatment. Objective factors include the Vancouver Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS), and ultrasound measurements of the thickness of the scar. Subjective parameters included the assessment of neuropathic pain and pruritus, as well as the evaluation of improvement of quality of life following CO2-AFL with the Burns Specific Health Scale (BSHS-B). For treatment effect analysis, patients were stratified according to scar maturation status (> or <2 years after injury). RESULTS 47 patients with 118 burn scars completed at least one treatment cycle. At a median of 55 days (IQR 32-74) after CO2-AFL treatment all analyzed objective parameters decreased significantly: intra-patient normalized scar thickness decreased from a median of 2.4mm to 1.9mm (p<0.001) with a concomitant VSS-drop from a median of 7 to 6 (p<0.001). The overall POSAS patient scale decreased from a median of 9 to 5 (p<0.001) with similar effects documented in POSAS observer scales. Both pain and pruritus showed significant reduction. Quality of life increased significantly by 15 points (median 120 to 135; p<0.001). All of the identified changes following CO2-AFL were equally significant irrespective of scar maturation status. CONCLUSION Our preliminary results confirm significant improvement in thickness, texture, colour, and symptoms following treatment with CO2-AFL. Foremost, quality of life of patients with both immature and mature scars (up to 23 years after injury) improved significantly after just one treatment session. To our knowledge, this is the first study to document such holistic treatment effects in burn patients treated by CO2-AFL.
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Affiliation(s)
| | - Oliver M Fisher
- St. Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Frank Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
| | | | - Peter Haertsch
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
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