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Vehiculización de fármacos asistida por láser
摘要： Absorption of topical products through the epidermis is limited by the skin's barrier function. Numerous techniques and agents such as microneedling, dermabrasion, radiofrequency, and lasers have been used to increase penetration within an approach known as transdermal drug delivery. One of these techniques is laser-assisted drug delivery (LADD), which often uses ablative fractional lasers (CO2 or erbium:YAG lasers) because of their capacity to produce microscopic ablated channels. The parameters in LADD need to be adjusted to the patient, the skin condition and its location, and the drug. LADD has been used with various topical products, such as corticosteroids, photosensitizers, and immunotherapy agents (imiquimod or 5-fluorouracil) to treat numerous conditions, including scars, nonmelanoma skin cancer, and photodamage. LADD is a promising technique that enhances the absorption of topical molecules while adding the synergic effect of the laser.
关键词： Laser-assisted drug delivery,CO2 laser,Ablative fractional laser,Hypertrophic scars,Keloid scars
更新于2025-09-23 15:23:52
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Evaluation of Fractional CO <sub/>2</sub> Versus Long Pulsed Nd:YAG Lasers in Treatment of Hypertrophic Scars and Keloids: A Randomized Clinical Trial
摘要： Background: Keloids and hypertrophic scars are challenging to both patients and physicians. They can be aesthetically disfiguring, functionally debilitating, and emotionally distressing. Lasers have introduced new mechanisms to improve scars both on aesthetic and symptomatic levels. Aim of Work: Comparing the efficacy of fractional CO2 laser, long‐pulsed Nd:YAG laser and their combination in the treatment of hypertrophic scars and keloids on clinical, histopathological, and biochemical basis. Patients and Methods: Thirty patients with hypertrophic scars and keloids were enrolled in the study. Three scars in each patient were randomly assigned to treatment modalities (i) Fractional CO2, (ii) Nd:YAG laser, (iii) Combined CO2 and Nd:YAG lasers. For each treatment area four sessions, 4–6 weeks apart were performed. Clinical evaluation was done before and 1 month following last session using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Routine hematoxylin and eosin, Masson's trichrome, and Orcein stains were used to evaluate the appearance and pattern of dermal collagen and elastic fibers. Image analysis was used to quantitatively assess the density of collagen and elastic fibers. Biochemical evaluation of tissue level of transforming growth factor‐β I (TGF‐β I) and TGF‐β III was performed using enzyme‐linked immunosorbent assay studies. Results: Both VSS and POSAS showed significant improvement following treatment with the three used modalities. Collagen fibers showed significant improvement as regards appearance and pattern while it was insignificant as regards density. Elastic fibers density improvement was only significant in fractional CO2 (treatment area A). Hypertrophic scars showed more significant improvement with fractional CO2 laser, while in keloids there was no significant difference between the three modalities regarding improvement. Level of TGF‐β I showed significant reduction after treatment in all treatment modalities, while TGF‐β III levels showed insignificant elevation in all treatment modalities. Side effects were significantly higher in treatment area C (combined treatment). Conclusion: Long pulsed Nd:YAG laser is effective and safe treatment of hypertrophic scars and keloids. Fractional CO2 laser yields better improvement in hypertrophic scars, while in keloids both fractional CO2 and Nd:YAG lasers achieve comparable improvement. Combination in the same session did not add significant additional benefit and the side effects profile was higher. Limitations: small sample size and short follow‐up period.
关键词： fractional CO2 laser,Nd:YAG laser,keloids,hypertrophic scars,RCT
更新于2025-09-23 15:19:57
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A novel technique for treating atrophic facial scars in Asians using ultraa??pulse CO <sub/>2</sub> laser
摘要： Background and Aims: Fractional lasers have become increasingly popular for treating atrophic scars, but their effectiveness is limited for deeper scars. We developed a novel technique (manual fractional thermal contraction technology, MFTCT) using an ultra-pulse CO2 laser and evaluated its efficacy and safety for treating atrophic facial scars. Methods: A total of 44 patients with atrophic facial scars were treated with MFTCT every 8 weeks for 1-4 times. Overall scar improvement was assessed by photographs taken at baseline and 3 months after the last treatment according to the 4-point global assessment scale (GAS) and ECCA grading scale. Improvements in color, distortion, and texture were assessed by the modified Manchester Scar Scale and scored individually from 1 to 4. Pain degrees and adverse reactions during and after treatment were recorded. Results: A total of 44 patients completed the treatment and follow-ups; of them, 89% reported at least 50% overall improvement after the last treatment. The mean ECCA scores fell from 67.50 ± 23.98 to 45.68 ± 18.57 (a 32% improvement), and the change was significant (P = .000). The average score for overall improvement was 3.48. The average scores for color, distortion, and texture were 3.07 ± 0.62, 3.27 ± 0.50, and 3.52 ± 0.51, respectively. Mean pain degree score was 4.27 ± 1.04, and mean erythema duration was 28.43 ± 6.58 days. Some patients developed pigmentation for a few months that resolved with topical treatment. Conclusion: Manual fractional thermal contraction technology has definite clinical efficacy in the treatment of atrophic facial scars with fewer adverse reactions and is worth using in the clinical setting.
关键词： thermal contraction,atrophic scars,manual fractional technology,ultra-pulse CO2 laser
更新于2025-09-23 15:19:57
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Clinical and histopathological comparison of microneedling combined with platelets rich plasma versus Fractional Erbium-Doped Yttrium Aluminium Garnet (Er: YAG) Laser 2940a??nm in treatment of atrophic post traumatic scar: A randomized controlled study.
摘要： Background: Different modalities have been tried for treating atrophic post traumatic scars. Objective: To compare the efficacy of microneedling combined with PRP with that of Fractional Er: YAG laser in treating post-traumatic atrophic scars. Methods: 45 patients with atrophic post traumatic scars were subdivided into three groups. Group I subjected to four sessions of skin microneedling followed by topical application of platelet rich plasma (PRP) immediately after each session. Group II subjected to the same protocol of treatment but for 6 sessions. Group III subjected to 4 sessions of Fractional Er: YAG laser at four weeks intervals for four sessions. Response to treatment was assessed clinically using the Quartile Grading Scale and histopathologicaly using H&E stain, trichrome and Orcein special stains. Results: All patients showed significant clinical improvement regardless of the treatment. There was a significant difference in clinical and histopathological improvement between group I and III, but there was no significant difference in improvement neither between group I and II nor between group II and III. Conclusion: microneedling could be as effective as fractional laser when combined with PRP and when used for more sessions.
关键词： Post traumatic scars,microneedling,Fractional laser,platelet rich plasma
更新于2025-09-23 15:19:57
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A Cross-sectional, Multi-center Study on Treatment of Facial Acne Scars With Low-Energy Double-Pass 1450-nm Diode Laser
摘要： Objective: Acne scars is the ultimate outcome of acne vulgaris, a prevalent skin disorder affecting the pilo-sebaceous unit. Laser resurfacing has been demonstrated to be an efficient therapy option for acne scars. Hence, we adopted this concept and conducted a study to evaluate the safety and efficacy of low-energy double-pass 1450-nm diode laser on acne scars. Methods: This study was conducted on forty-eight patients with acne scars, treated at 4-week interval with low-energy double-pass 1450-nm diode laser. Patients were evaluated clinically and with photographs, at day 0, 1st month and 3rd month post the final treatment and during follow-up visit. Results: Five treatment sessions were completed by all patients. Approximately 79.2% of patients showed around 30% improvement. At the end of 3rd month follow-up, 92.9% of the patients demonstrated >30% improvement. Vesicle formation was observed in two cases, with no post-inflammatory hyperpigmentation (PIH) and transient hyperpigmentation was observed in one case, which vanished within 2 months. Conclusion: Our study showed that 1450-nm diode laser treatment was efficient and well endured in facial acne scars when used with double-pass at low-energy.
关键词： Improvement,1450-nm diode laser,Facial acne scars,Low-energy double-pass
更新于2025-09-23 15:19:57
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Randomized, Controlled Early Intervention of Dynamic Mode Fractional Ablative CO <sub/>2</sub> Laser on Acute Burn Injuries for Prevention of Pathological Scarring
摘要： This study challenges the currently accepted treatment parameters of waiting 1 year following burn injury to treat the resultant scarring. It assesses the impact of treating burn and trauma wounds at less than 3 months of injury on scar formation, providing a new temporal paradigm to patients in the prevention and minimization of scar formation. This randomized clinical trial included 19 patients with moderate‐to‐severe acute burn injuries less than 3 months from injury. The treatment areas underwent three fractional ablative CO2 laser treatments at 8‐week intervals. The primary outcomes were improvement in the Manchester Scar Scale (MSS) and photography. Secondary outcomes were optical coherence tomography (OCT), treatment time, immediate post‐treatment response, and histology. Upon blinded evaluation, 100% of treatment areas were correctly identified when compared with control. MSS scores before and after treatment were totaled with an averaged sum of 13.33 per scar at baseline to 8.39 after treatment, a 63% average improvement versus control (P < 0.001). Histology and OCT demonstrated a re‐organization of the underlying skin structure. The average treatment time was 18 minutes. Immediate post‐treatment responses were limited to mild‐to‐moderate erythema. Early intervention with ablative fractional laser on acute traumatic wounds resulted in significant decrease of scar formation compared with untreated areas on the same wounds, providing an impactful new time course to treat severe burn and trauma injuries.
关键词： scar prevention,fractional ablative laser,burn scars,scars,wound healing
更新于2025-09-19 17:13:59
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Fractional laser and laser assisted corticosteroid delivery for hypertrophic scars in thermal burns
摘要： The unprecedented survival of individuals who sustain acute burns and other trauma has increased the necessity for effective modalities in the treatment and rehabilitation of patients. Hypertrophic scars and contractures are common following thermal burns injury. Cutaneous scars can be complex and thus the approach to therapy is often multimodal with only moderate success. Intralesional corticosteroids have long been a main treatment of hypertrophic and restrictive scars. Recent advance in laser technology and applications now provide additional options for improvements in function, symptoms, and cosmesis. The ablative zones created by fractional ablative lasers may also be used in the immediate post-operative period to enhance delivery of drugs and other substances. This case report shows the successful use of fractional laser assisted corticosteroid to treat burn scars. It is need more extensive clinical trial to prove this method can be a therapeutic option for the extensive cutaneous scarring in burn patients.
关键词： laser assisted corticosteroid delivery,thermal burns,hypertrophic scars,fractional laser,corticosteroid
更新于2025-09-19 17:13:59
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Treatment of Hypertrophic Scars Using Laser-Assisted Corticosteroid Versus Laser-Assisted 5-Fluorouracil Delivery
摘要： BACKGROUND As the mortality of individuals suffering severe cutaneous injuries decreases, there is an increased need to improve the methods by which physicians treat the resultant scars. Fractional lasers, which create zones of ablation at variable depths, provide a powerful tool in the management of scar complications and deformities. After disruption of the normal skin barrier, these zones may be used to deliver drugs that may enhance scar resolution. OBJECTIVE To determine the differences in clinical outcome for hypertrophic scars treated with laser-assisted corticosteroid delivery, as compared to laser-assisted 5-?uorouracil delivery. METHODS In this prospective, double-blinded, single-subject study of 20 individuals with hypertrophic scars, subjects underwent 3 treatment sessions at 1-month intervals consisting of fractional ablative laser treatment, followed by postoperative application of either topical triamcinolone acetonide (20 mg/mL) or topical 5-?uorouracil (50 mg/mL). RESULTS Three sessions of laser-assisted triamcinolone acetonide and 5-?uorouracil delivery both produced reductions in overall scar area. When compared with one another, there were no statistically signi?cant differences in area reduction between the 2 modalities (p = .603). However, scars treated with 5-?uorouracil were not associated with side effects seen with corticosteroid therapy, such as dermal atrophy or telangiectasia formation. CONCLUSION As 5-?uorouracil was associated with fewer adverse events, these ?ndings support the use of a nonsteroidal agent in the management of traumatic scars by laser-assisted therapy.
关键词： laser-assisted corticosteroid delivery,fractional ablative laser,scar treatment,laser-assisted 5-fluorouracil delivery,hypertrophic scars
更新于2025-09-12 10:27:22
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Effectiveness of Early Laser Treatment in Surgical Scar Minimization
摘要： BACKGROUND Studies investigating the ef?cacy of lasers to minimize early surgical scars are low powered and report variable results. To further examine the evidence, the authors performed a systemic review and meta-analysis. OBJECTIVE To present the evidence of randomized controlled trials investigating the ef?cacy of laser modalities in minimizing surgical scars when applied <1 month after operation. MATERIALS AND METHODS A literature search of PubMed, EMBASE, Northern Light Life Sciences Conference Abstracts, and Cochrane Library was performed between November 6, 2015, and November 20, 2015. After assessing for inclusion, data extraction used the PRISMA checklist. Assessment for quality, validity, and risk of bias applied a scale devised by Jadad and colleagues, the Oxford Pain Validity Scale, and the RevMan risk of bias assessment tool, respectively. The GRADEpro application graded overall quality, and statistical analysis was performed with RevMan. RESULTS Approximately 4,373/4,397 abstracts and 16/24 full articles were excluded using prede?ned criteria, leaving 8 articles in the systematic review and 4 in the meta-analysis. The primary outcome reached statistical signi?cance favoring the intervention group with standardized mean difference 0.39 (95% con?dence interval, 0.05–0.74) and p = .03. CONCLUSION The outcome supports the ef?cacy of lasers in minimizing primarily closed surgical scars when treated <1 month after surgery.
关键词： surgical scars,laser treatment,randomized controlled trials,meta-analysis,scar minimization
更新于2025-09-12 10:27:22
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Commentary on the Photomicrodebridement of Unstable Burn Scars Using Ablative Fractional CO2 Laser
摘要： Brown and colleagues describe a case of a 25% total body surface area burn patient with a course complicated by contractures, scar hypertrophy, and chronic skin breakdown despite grafts, multiple release procedures, and wound care. The authors treated her hypertrophic scars and open wounds with photomicrodebridement using ablative fractional (AF) carbon dioxide (CO2) laser (10,600 nm, UltraPulse; Lumenis, Ltd, DeepFx Hand Piece, 100 mJ/cm2, 3% density) followed by topical Kenalog 10 mg/ml and a bandage with betamethasone. Response was “dramatic” with evidence of almost complete wound closure by Day 10.
关键词： Photomicrodebridement,Laser-assisted drug delivery,Betamethasone,Kenalog,Unstable Burn Scars,Ablative Fractional CO2 Laser
更新于2025-09-12 10:27:22