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CO 2 fractional laser promotes micro-channel opening rates in vivo. The red fluorescence is labeled ethosomes permeate rabbit ear hypertrophic scar tissues 0 h (a), 6 h (b), 12 h (c), 24 h (d), 3 days (e), and 7 days (f) after CO 2 fractional laser treatment in vivo
Source publication
Objective:
This study is designed to explore permeability of ethosomes encapsulated with 5-florouracil (5-FU) mediated by CO2 fractional laser on hypertrophic scar tissues. Moreover, therapeutic and duration effect of CO2 fractional laser combined with 5-FU encapsulated ethosomes in rabbit ear hypertrophic scar model will be evaluated.
Methods:...
Contexts in source publication
Context 1
... SD; *p < 0.05, Particle size of 5-FU EG compared to 5-FU ES using one- way ANOVA; ** p < 0.01, PDI of 5-FU EG compared to 5-FU ES using one-way ANOVA; *** p < 0.001, EE(%) of 5-FU EG compared to 5-FU ES using one-way ANOVA , and 24 h. ****p value < 0.0001 was considered statistically highly extremely significant was determined immediately by CLSM (Fig. 4). Rho fluorescence was extensively visible and widely distributed in the dermis layer of the rabbit ear hypertrophic scars, which were closer to the ablative zone (Fig. 4a). These results may indicate Rho mixed with 5E primarily infiltrate through the porous channel after CO 2 fractional laser irradiation. Fluorescence can be detected ...
Context 2
... of 5-FU EG compared to 5-FU ES using one-way ANOVA , and 24 h. ****p value < 0.0001 was considered statistically highly extremely significant was determined immediately by CLSM (Fig. 4). Rho fluorescence was extensively visible and widely distributed in the dermis layer of the rabbit ear hypertrophic scars, which were closer to the ablative zone (Fig. 4a). These results may indicate Rho mixed with 5E primarily infiltrate through the porous channel after CO 2 fractional laser irradiation. Fluorescence can be detected in the ablative zone surrounding the dermal tissue after 6 h 5EL, even with a small distribution area (Fig. 4b). Fluorescence distribution area continues to shrink 12 h ...
Context 3
... rabbit ear hypertrophic scars, which were closer to the ablative zone (Fig. 4a). These results may indicate Rho mixed with 5E primarily infiltrate through the porous channel after CO 2 fractional laser irradiation. Fluorescence can be detected in the ablative zone surrounding the dermal tissue after 6 h 5EL, even with a small distribution area (Fig. 4b). Fluorescence distribution area continues to shrink 12 h after drug treatment, which indicates that microporous channels are gradually closed when the wound heals (Fig. 4c). After 24 h, 3 days, and 7 days treatment of CO 2 fractional laser irradiation, fluores- cence could only be found within the crust pore around openings and no ...
Context 4
... after CO 2 fractional laser irradiation. Fluorescence can be detected in the ablative zone surrounding the dermal tissue after 6 h 5EL, even with a small distribution area (Fig. 4b). Fluorescence distribution area continues to shrink 12 h after drug treatment, which indicates that microporous channels are gradually closed when the wound heals (Fig. 4c). After 24 h, 3 days, and 7 days treatment of CO 2 fractional laser irradiation, fluores- cence could only be found within the crust pore around openings and no penetration into the dermis (Fig. 4d-f), which suggests that CO 2 fractional laser penetration effect has disappeared with complete re-epithelialization of the epidermis. Our ...
Context 5
... distribution area continues to shrink 12 h after drug treatment, which indicates that microporous channels are gradually closed when the wound heals (Fig. 4c). After 24 h, 3 days, and 7 days treatment of CO 2 fractional laser irradiation, fluores- cence could only be found within the crust pore around openings and no penetration into the dermis (Fig. 4d-f), which suggests that CO 2 fractional laser penetration effect has disappeared with complete re-epithelialization of the epidermis. Our data suggested that micro-channel open- ing plays a critical role in drug penetration with 5EL treat- ment. Thereafter, we calculated micro-channel opening rates of 3 h, 6 h, 12 h, 24h, 3 days and 7 ...
Similar publications
Background:
Hypertrophic scars are skin fibrotic diseases, characterized by fibroblast hyperproliferation and excessive accumulation of extracellular matrix. However, topical drug application for hypertrophic scars are unsatisfactory. The purpose of this study was to explore the permeability of silk nanofiber hydrogels (SNFs) loaded with rhodamine...
Citations
... Thus, topical medications are less effective [34,35]. Scar tissue also has fewer hair follicles, adnexal glands, papillary dermis, and rete ridges than normal skin [36]. These conditions can hinder the penetration of drugs through the skin and lower water retention [37,38]. ...
Background
Keloid is a skin disorder that results from excessive fibrous tissue growth in the area of the initial trauma. Treating keloids can be challenging since the success of various treatments varies from one study to another. Triamcinolone acetonide injection, a standard treatment, can cause undesirable side effects. Meanwhile, the effectiveness of existing topical therapies for keloids is not always reliable. The pro-inflammatory, pro-proliferative, and pro-fibrotic effects of angiotensin II in human skin contribute to keloid formation. Losartan potassium, an angiotensin II blocker, has the potential to act as an anti-keloid agent. Due to the thicker skin structure of a keloid and ease of application, ethosome gel is chosen as a safe and comfortable carrier for losartan potassium, making it a good choice for treating keloids.
Methods
In this randomised clinical trial, 46 adults with keloids were divided into two treatment groups. One group of 23 participants received 5% losartan potassium loaded in ethosomal gel, while the other group of 23 participants received intralesional injections of 10% triamcinolone acetonide. Over 12 weeks, changes in POSAS 3.0 scores, degree of erythema and pigmentation, surface area, thickness, and pliability of the keloids will be measured at four different times: baseline, 4 weeks, 8 weeks, and 12 weeks. Statistical analysis will be conducted using SPSS software version 24, with a significance level of p < 0.05.
Discussion
Losartan potassium is believed to be beneficial for keloid management because it inhibits the angiotensin II receptor, which plays a role in inflammation, proliferation, and fibrosis. This study examines the efficacy of 5% losartan potassium loaded in ethosomal gel for human keloids.
Trial registration
Clinicaltrial.gov identifier NCT05893108. Registered on 7 June 2023.
... Thus topical medications are less effective (34,35). Scar tissue also has fewer hair follicles, adnexal glands, papillary dermis, and rete ridges than normal skin (36). These conditions can hinder the penetration of drugs through the skin and lower water retention (37,38). ...
Background: Keloid is a skin disorder that results from excessive fibrous tissue growth in the area of the initial trauma. Treating keloids can be challenging since the success of various treatments varies from one study to another. Triamcinolone acetonide injection, a standard treatment, can cause undesirable side effects. Meanwhile, the effectiveness of existing topical therapies for keloids is not always reliable. The pro-inflammatory, pro-proliferative, and pro-fibrotic effects of angiotensin II in human skin contribute to keloid formation. Losartan potassium, an angiotensin II blocker, has the potential to act as an anti-keloid agent. Due to the thicker skin structure of a keloid and ease of application, ethosome gel is chosen as a safe and comfortable carrier for losartan potassium, making it a good choice for treating keloids.
Methods: In this randomised clinical trial, 46 adults with keloids were divided into two treatment groups. One group of 23 participants received 5% losartan potassium loaded in ethosomal gel, while the other group of 23 participants received intralesional injections of 10% triamcinolone acetonide. Over 12 weeks, changes in POSAS 3.0 scores, erythema and pigmentation, surface area, thickness, and pliability of the keloids will be measured at four different times: baseline, four weeks, eight weeks, and twelve weeks. Statistical analysis will be conducted using SPSS software version 24, with a significance level of p<0.05.
Discussion: Losartan potassium is believed to be beneficial for keloid management because it inhibits the angiotensin II receptor, which plays a role in inflammation, proliferation, and fibrosis. This study aims to examine the efficacy of 5% losartan potassium loaded in ethosomal gel for human keloids.
Trial registration: Clinicaltrial.gov identifier NCT05893108. Registered on 7 June 2023.
... This effectively avoids thermal damage to the surrounding skin tissue, while its unique cooling technology effectively reduces thermal damage from the light. 19 However, it activates keratinocytes through thermal stimulation to promote collagen proliferation and repair rearrangement, thus improving skin texture and beautifying scarring. The fractional CO 2 laser acts on the treatment area through the photothermal reaction principle and has a good repair effect and large energy, but lacks good selectivity, which is easy to cause thermal damage to the normal tissue in the treatment area and has large adverse reactions. ...
Purpose
Laser and intense pulsed light (IPL) treatments are preferred over invasive procedures due to less pain. This study looked at the efficacy and safety of IPL and Erbium fractional laser for patients with striae gravidarum (SG).
Patients and Methods
All 60 patients with SG were successfully enrolled in the study. IPL treatment was followed by Erbium fractional laser (wavelength 2940 nm) treatment at 4-week intervals for a total of three treatments. SG elasticity was assessed with a SEM575 custom instrument and patients were scored for SG span with an Antera 3D multifunctional skin imaging analyzer. A 3D skin impact system was used to assess patients’ epidermal thickness. A visual analog scale (VAS) was used to assess patients’ pain scores during the treatment period. Improvement in stretch marks was assessed with the Global Aesthetic Improvement Scale (GAIS). The occurrence of adverse events was recorded at a follow-up of 3 months. Patient satisfaction with the outcome of the treatment was also recorded.
Results
Area of stretch marks decreased from 7.89 ± 0.49 cm² pre-treatment to 4.94 ± 1.16 cm² post-treatment (P < 0.001). The grayness values and atrophy of stretch marks were reduced after treatment. Furthermore, skin elasticity and thickness at the lesions of patients increased significantly after the treatment (P < 0.001), while the width of the stretch marks significantly decreased (P < 0.001). The VAS score was 5.45 ± 1.31, the incidence of adverse events was 25%, and patient satisfaction with the efficacy was 96.67%.
Conclusion
IPL combined with Erbium fractional laser improves the area and atrophy of SG, lightens the color, and increases the elasticity and thickness of the skin, with high treatment safety and remarkable clinical results.
... Fractional CO 2 laser is one of the most popular treatment approaches for hypertrophic scars and can be used alone or as an adjuvant in combination with other physical and surgical methods. 23,24 The mechanism of fractional CO 2 laser treatment of hypertrophic scars involves induction of small three-dimensional zones of thermal damage, referred to as "microscopic thermal zones," which cause collagen remodeling and ultimately lead to improvement in pliability. 25 In the present study, we used SVF gel plus laser to treat hypertrophic scars. ...
Background:
Treating hypertrophic scars remains challenging. Stromal vascular fraction (SVF) gel is produced by a purely mechanical process from lipoaspirates, rich in adipose-derived stem cells, and have showed therapeutic potential on scars. However, controversial effects on hypertrophic scars are emerging. This study aimed to assess the therapeutic effects of SVF gel combined with fractional CO2 laser on hypertrophic scars.
Methods:
A rabbit ear hypertrophic scar model was established. SVF gel combined with fractional CO2 laser was conducted for hypertrophic scars in rabbit. Scar alleviation in rabbits was observed based on the appearance and histology of scars, and the underlying mechanism was investigated by tissue immunological analyses and qRT-PCR. At last, six patients with hypertrophic scar were treated by SVF gel combined with fractional CO2 laser. Therapeutic effects were assessed using the Vancouver Scar Scale (VSS).
Results:
Following the treatments, hypertrophic scars became less apparent and softer, the dermis became thinner, and collagen fibers appeared looser and arranged in a more organized pattern. SVF gel plus fractional CO2 laser group showed the most obvious improvement. Besides, SVF gel combined with fractional CO2 laser increased adipogenesis in scar tissue, and adipose tissue regeneration was observed. Hypertrophic scars in patients were alleviated after the treatment of SVF gel combined with fractional CO2 laser.
Conclusions:
SVF gel transplantation combined with fractional CO2 laser showed encouraging therapeutic effects on hypertrophic scars. Although further investigation is necessary, this technique has great potential for clinical application to treat hypertrophic scars.
... Therefore, dynamic drug distribution over time has not been observed [22][23][24]. Additionally, due to rapid re-epithelialization [25], short drug penetration time intervals limit the use of CO 2 fractional laser-assisted drug delivery [15,26]. As such, the application of CO 2 fractional laser-assisted drug delivery for the treatment of scars deserves more research attention with regard to enhancing the penetration of drugs. ...
... In previous investigations, the effect of CO 2 fractional laser irradiation on increasing drug penetration began to fade after 24 h [26], which was mostly owing to the rapid re-epithelialization caused by the lateral migration of corneocytes [42]. Our findings were consistent with those of this prior study. ...
... The treatment of abnormal scar tissue remains a great challenge in clinical medicine since few carriers can penetrate scar tissue to enhance the biological function of the loaded drugs. Developing a transdermal carrier that can be loaded with drugs with distinct properties and penetrate scar tissue is critical for improving the efficacy of abnormal scar treatment [26]. SNF could be loaded with and immobilize both hydrophobic and hydrophilic cargos and achieve controllable and sustained release [31]. ...
Background:
Hypertrophic scars are skin fibrotic diseases, characterized by fibroblast hyperproliferation and excessive accumulation of extracellular matrix. However, topical drug application for hypertrophic scars are unsatisfactory. The purpose of this study was to explore the permeability of silk nanofiber hydrogels (SNFs) loaded with rhodamine 6G (R6G) and rhodamine 110 (R110) mediated by CO2 fractional laser irradiation into hypertrophic scar tissues.
Methods:
In this work, R6G and R110 were chosen as hydrophilic and hydrophobic model molecules. They were loaded inside SNFs. In vivo rabbit ear hypertrophic scars were treated with CO2 fractional laser irradiation and then R6G/R110-laden SNFs were applied to the scars to evaluate their synergetic effect on drug penetration efficiency. Their permeability was quantified by fluorescence intensity and measured by confocal laser scanning microscopy on days 1, 3, 5 and 7. More specifically, the thermal coagulation zone (CZ) and its surrounding area (peri-CZ) caused by the thermal coagulation of the laser were discussed separately.
Results:
Our data indicated that the SNFs promoted the penetration of R6G but not that of R110 in the peri-CZ on day 1 when combined with laser irradiation. Interestingly, both R6G and R110 were abundant in the CZ and remained stable on days 1, 3 and 5. Moreover, rapid re-epithelialization hindered the long-term permeability of both drugs.
Conclusion:
Combining CO2 fractional laser irradiation with SNF drug delivery could improve the efficiency of hydrophilic drug delivery within 24 h before total re-epithelialization.
... A further subgroup analysis was also performed which revealed that patients at the early stage could experience more significant improvement after the treatment of combined therapy. Ablative fractional CO 2 laser technology has been employed for many years; however, it is only in recent years that this technique has been applied to the treatment of hypertrophic scars (3,4,(13)(14)(15)(16)(17)(18)(19). Several case reports firstly reported the effectiveness of ablative fractional CO 2 laser treatment for hypertrophic scars (20,21), then Makboul et al. enrolled 40 patients with hypertrophic scars and confirmed ablative fractional CO 2 laser treatment as a feasible management for hypertrophic scarring (22). ...
Background:
Hypertrophic scars can be caused by various injuries and lead to a decrease in quality of life of those affected. This study was performed retrospectively in our center to investigate the safety and effectiveness of fractional micro-plasma radio-frequency treatment combined with ablative fractional carbon dioxide (CO2) laser treatment in patients with hypertrophic scar.
Methods:
This was a retrospective study performed in a single center between January 2019 and December 2020. All patients with hypertrophic scars receiving fractional micro-plasma radio-frequency treatment, ablative fractional CO2 laser treatment, or combined therapy of both were recruited to the study. The participants were then divided into a single therapy group or combined therapy group. The Vancouver scar scale was used to score and subsequently assess the effectiveness of scar treatment and the changes of scar thickness. Some adverse complications were also recorded to evaluate the safety of treatments. A subgroup analysis was then performed to investigate the differences of effectiveness and safety of combined therapy in scar patients at the early stage and late stage.
Results:
A total of 64 patients with hypertrophic scars were enrolled in this study, including 45 receiving combined treatment, and 19 receiving single treatment. There was no significant difference in demographic data between the two groups. Notably, combined therapy could more effectively reduce the score of Vancouver scar scale (P=0.026) without significantly increasing the incidence of adverse complications. However, no significant difference was observed in scar thickness between the two groups. Moreover, multiple treatments could further increase the effectiveness of combined therapy according to either the score of Vancouver scar scale or the thickness of scars. Subgroup analysis revealed that combined therapy could reduce the score of Vancouver scar scale and scar thickness in patients much more at the early stage than at the late stage (P=0.032 and 0.042, respectively).
Conclusions:
This study revealed that fractional micro-plasma radio-frequency treatment combined with ablative fractional CO2 laser treatment could be more effective in improving hypertrophic scars then single therapy. Also, multiple treatments could enhance the effectiveness of combined treatment, and patients should be encouraged to receive treatment as early as possible.
... Given that common anti-carring drugs are usually chemotherapy drugs, they are highly toxic to all cell types, and halt cellular proliferation indiscriminately. Zhang et al. studied the possibility of using gel with ethosomes to deliver the traditional antiscarring agent 5-fluorouracil (5-Fu) transdermal with a CO 2 fractional laser for the treatment of hypertrophic scarring [45]. The laser opened up microchannels in the skin, allowing for permeation of nano-scaled ethosomes (87.72 AE 9.27 nm) to permeate the dermal layer. ...
Scars affect millions of patients worldwide, yet their treatment efficacy and options clinically remain limited. In recent years, increased understanding of scar formation pathways leading to developments in nanotechnology have opened many opportunities for scar detection, prevention, and treatment due to the nanoscale features and therapeutic delivery capabilities of such technologies. Led by nanoparticles (NPs) and nanofibers, these novel strategies can aid in reducing scar contracture, improving wound-healing efficacy, and advancing progress towards scarless wound healing.
... AFR also enhances topical drug delivery, as ablated channels permit enhanced penetration into deeper layers of the dermis [4,36,37]. AFR combined with the immediate postoperative application of topical corticosteroids and/or 5-FU produces significant improvements in texture, hypertrophy, contractures, and dyschromia [4,36,38,39]. This approach may be superior to more traditional intralesional delivery, as injected corticosteroids are dispersed unevenly within dense scar tissue [17]. ...
Background and objectives:
This paper describes the laser techniques available for the treatment of surgical and trauma scars and develops recommendations for an algorithmic-based treatment approach based on extensive clinical experience and published data.
Study design/materials and methods:
We reviewed the literature regarding laser treatment of surgical and traumatic scars and incorporated the clinical experience of the authors to develop an algorithm for the treatment of surgical and trauma scars.
Results:
In order to develop treatment recommendations, scars were differentiated based on their clinical characteristics. Specific scar characteristics aid in determining the appropriate treatment strategy for different types of complex surgical and trauma scars.
Conclusion:
Laser therapy is first-line therapy for traumatic and surgical scars. The treatment approach should be guided by scar characteristics (e.g., anatomic location, type of injury, color, thickness, tension, scar age, and activity) and involves choosing the appropriate laser type and determining the benefit of combination therapy with surgical and nonsurgical treatment modalities to optimize treatment responses. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
... Its unique penetration mechanism allows it to be used in combination with other drugs to treat scarring with the effect of B1 + 1 > 2^. In a recent study, carbon dioxide fractional laser was combined with 5fluorouracil (5-FU) and the thermal decomposition effect of the former helped penetrate the pore channels of deep scar tissue, thereby improving the permeability and dispersion rate Yang Zizheng and LvYang contributed equally to this article. of 5-FU and achieving good therapeutic effect [4]. The possible mechanisms underlying the anti-scarring effects of silicone include hydration, electrostatic effect, and fibroblast inhibition. ...
To determine the combined therapeutic effect of fractional carbon dioxide laser and silicone gel on fresh traumatic scars using a rabbit ear hypertrophic scar (EHS) model, as well as on human subjects. The rabbit EHS model was established by punching four circular wounds in each ear and respectively treated with carbon dioxide laser, silicone gel, and the combination of both, while one wound was left untreated. In addition, a validation group of five rabbits was also included wherein the wounds were treated with triamcinolone, IFN-α, and normal saline, with one untreated control. The gross hyperplasic changes and the histological features were analyzed, and the scar elevation index (SEI) was calculated for each treatment group. In the rabbit model, the untreated control wounds showed hypertrophic growth, whereas triamcinolone or IFN-α showed an inhibitory effect, similar to that on hypertrophic scars in humans, thereby proving the feasibility of our animal model. The SEI peaked 2 months after treatment and was respectively 2.28 ± 0.56, 1.85 ± 0.33, 1.91 ± 0.34, and 1.45 ± 0.22 in the untreated control, and the silicone, laser, and combined treatment groups, clearly indicating a significant therapeutic effect of the combined treatment modality (p < 0.01). The fibroblast and microvascular counts also showed similar trends in each group. Early application of fractional carbon dioxide laser can prevent hypertrophic scars; the combined use of laser and silicone gel was more effective with less recovery time, thereby worthy of clinical promotion.
... 2/3 ulceration, [9] and because of the complexity of scarring mechanism and persistently evolving process [3]. So far, available clinical experiences and experimental-based data have suggested that a combination approach is more effective, using multiple modalities of therapy strategies (e.g., the combination of onion extract preparations and silicone gel sheet, [20] or triamcinolone acetonide, [14] CO2 fractional laser combined with 5-florouracil [21]. But the optimal combination therapy is still to be investigated and determined depending on the individual case. ...
