Younes, B., Mandour, E., Shoukr, T. (2025). Laser-Assisted Drug Delivery in Early Post-Burn Hypertrophic Scars: Review Article. The Egyptian Journal of Plastic and Reconstructive Surgery, 49(3), 241-248. doi: 10.21608/ejprs.2025.444136
Bassel Mohammed Younes; El Sayed Mandour; Tarek G Shoukr. "Laser-Assisted Drug Delivery in Early Post-Burn Hypertrophic Scars: Review Article". The Egyptian Journal of Plastic and Reconstructive Surgery, 49, 3, 2025, 241-248. doi: 10.21608/ejprs.2025.444136
Younes, B., Mandour, E., Shoukr, T. (2025). 'Laser-Assisted Drug Delivery in Early Post-Burn Hypertrophic Scars: Review Article', The Egyptian Journal of Plastic and Reconstructive Surgery, 49(3), pp. 241-248. doi: 10.21608/ejprs.2025.444136
Younes, B., Mandour, E., Shoukr, T. Laser-Assisted Drug Delivery in Early Post-Burn Hypertrophic Scars: Review Article. The Egyptian Journal of Plastic and Reconstructive Surgery, 2025; 49(3): 241-248. doi: 10.21608/ejprs.2025.444136
Laser-Assisted Drug Delivery in Early Post-Burn Hypertrophic Scars: Review Article
The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Tanta University
Abstract
Hypertrophic scars and keloids arise from an excessive healing process and frequently cause considerable distress to patients. Fractional ablative lasers generate tiny channels in the skin and penetrate scar tissue, prompting a natural regeneration reaction in the damaged areas. Laser-assisted drug delivery (LADD) is a promising therapeutic technique that involves the direct application of drugs that alter scars within the scar tissue via small channels. Burn injuries stem from numerous etiologies, with hot liquids, solids, and flames being the most common culprits. These injuries pose a significant source of morbidity and can impact on a patient’s quality of life, psychosocial well-being, and socioeconomic burden. While advances in burn management have reduced mortality rates, they have also led to a growing number of patients experiencing sequelae, notably hypertrophic scars (HTSs). An overly accelerated healing process might result in hypertrophic scars and keloids, which can sometimes cause significant patient issues. One cutting-edge technique for accurately distributing medications under the skin is laser-assisted drug delivery, or LADD. LADD has proven to be quite successful in treating burn injuries and scarring. They enable a speedy recovery, are minimally intrusive, and have a low risk of adverse consequences. Consequently, they are incorporated into certain therapy protocols with other conservative and surgical methods, which can be quite effective but also have a greater likelihood of complications.
1- Bernabe R.M., Choe D., Calero T., Lin J., Pham C., Dang J., et al.: Laser-Assisted Drug Delivery in the Treatment of Hypertrophic Scars and Keloids: A Systematic Review. J. Burn Care Res., 45: 590-600, 2024. 2- Karmisholt K.E., Haerskjold A., Karlsmark T., Waibel J., Paasch U. and Haedersdal M.: Early laser intervention to reduce scar formation - a systematic review. J. Eur. Acad Dermatol. Venereol., 32: 1099-110, 2018. 3- Kauvar A.N.B., Kubicki S.L., Suggs A.K. and Friedman P.M.: Laser therapy of traumatic and surgical scars and an algorithm for their treatment. Lasers Surg. Med., 52: 125-36, 2020. 4- James S.L., Lucchesi L.R., Bisignano C., Castle C.D., Dingels Z.V., Fox J.T., et al.: Epidemiology of injuries from fire, heat and hot substances: Global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study. Inj. Prev. 2020;26:i36-i45. 5- Klein M.B., Lezotte D.C., Heltshe S., Fauerbach J., Holavanahalli R.K., Rivara F.P., et al.: Functional and psychosocial outcomes of older adults after burn injury: Results from a multicenter database of severe burn injury. J. Burn Care Res., 32: 66-78, 2011. 6- A. El-Abbassy A., S. Elzyen E., I. El Berry K., Sobhy El Gendy R., Omar Taman R. and Mostafa Amer H.: Effect of Mindfulness Based Intervention on Alopecia Distress, Body Image Changes and Health Related Quality of Life among Women with Breast Cancer. Egyptian Journal of Health Care, 15: 1780-97, 2024. 7- Cartotto R., Cicuto B.J., Kiwanuka H.N., Bueno E.M. and Pomahac B.: Common postburn deformities and their management. Surg. Clin. North Am., 94: 817-37, 2014. 8- Jeschke M.G., Van baar M.E., Choudhry M.A., Chung K.K., Gibran N.S. and Logsetty S.: Burn injury. Nat. Rev. Dis. Primers, 6: 11, 2020. 9- Hemmati Maslakpak M., Ajoudani F., Lotfi M. and Alinejad V.: Burn self-stigma: A hybrid concept analysis. Burns, 48: 1405-16, 2022. 10- Slavinsky V., Wong J.H., Carney B.C., Lee D.T., Allely R., Shupp J.W., et al.: Addressing Burn Hypertrophic Scar Symptoms Earlier: Laser Scar Revision May Begin as Fig. (2): Laser channel morphology – definitions and impact on topical drug delivery [36]. Egypt, J. Plast. Reconstr. Surg., July 2025 247 Early as 3–6 Months After Injury. Lasers Surg. Med., 56: 632-41, 2024. 11- Yoshino Y., Ohtsuka M., Kawaguchi M., Sakai K., Hashimoto A., Hayashi M., et al.: The wound/burn guidelines–6: Guidelines for the management of burns. J. Dermatol., 43: 989-1010, 2016. 12- Altemir A. and Boixeda P.: [Translated article] Laser Treatment of Burn Scars. Actas Dermosifiliogr., 113: 938-44, 2022. 13- Anderson R.R., Donelan M.B., Hivnor C., Greeson E., Ross E.V., Shumaker P.R., et al.: Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: Consensus report. JAMA Dermatol., 150: 187-93, 2014. 14- Issler-Fisher A.C., Waibel J.S. and Donelan M.B.: Laser Modulation of Hypertrophic Scars: Technique and Practice. Clin. Plast. Surg., 44: 757-66, 2017. 15- Poetschke J., Dornseifer U., Clementoni M.T., Reinholz M., Schwaiger H., Steckmeier S., et al.: Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach. Lasers Med. Sci., 32: 1031-40, 2017. 16- Makboul M., Makboul R., Abdelhafez A.H., Hassan S.S. and Youssif S.M.: Evaluation of the effect of fractional CO2 laser on histopathological picture and TGF-β1 expression in hypertrophic scar. J. Cosmet Dermatol., 13: 169-79, 2014. 17- Le Qu A.L., Zhou L., He C., Grossman P.H., Moy R.L., Mi Q.S., et al.: Clinical and molecular effects on mature burn scars after treatment with a fractional CO2 laser. Lasers Surg. Med., 44: 517-24, 2012. 18- Azzam O., Bassiouny D., El-Hawary M., El Maadawi Z., Sobhi R. and El-Mesidy M.: Treatment of hypertrophic scars and keloids by fractional carbon dioxide laser: A clinical, histological, and immunohistochemical study. Lasers Med. Sci., 31: 9-18, 2016. 19- KRAKOWSKI A.C., GOLDENBERG A., EICHENFIELD L.F., MURRAY J-P. and SHUMAKER P.R.: Ablative fractional laser resurfacing helps treat restrictive pediatric scar contractures. Pediatrics, 134: 1700-5, 2014. 20- Klifto K.M., Asif M. and Hultman C.S.: Laser management of hypertrophic burn scars: A comprehensive review. Burns, 8: 2, 2020. 21- Taudorf E.H., Danielsen P.L., Paulsen I.F., Togsverd-Bo K., Dierickx C., Paasch U., et al.: Non-ablative fractional laser provides long-term improvement of mature burn scars–A randomized controlled trial with histological assessment. Lasers Surg. Med., 47: 141-7, 2015. 22- Carney B.C., McKesey J.P., Rosenthal D.S. and Shupp J.W.: Treatment strategies for hypopigmentation in the context of burn hypertrophic scars. Plastic and Reconstructive Surgery–Global Open, 6: e1642, 2018. 23- Begum J., Riyaz M. and Hyma P.: A Comprehensive Review on Laser-Assisted Drug Delivery. J. Adv. Sci. Res., 15: 1-6, 2024. 24- Issa M.C.A., Casabona G., Santos Torreão P. and Roale L.: Transepidermal Drug Delivery. In: Issa MCA, Tamura B, editors. Daily Routine in Cosmetic Dermatology. Cham: Springer International Publishing, p. 319-26, 2017. 25- Gowda A., Healey B., Ezaldein H. and Merati M.: A systematic review examining the potential adverse effects of microneedling. J. Clin. Aesthet Dermatol., 14: 45, 2021. 26- Napotnik T.B., Polajžer T. and Miklavčič D.: Cell death due to electroporation–a review. Bioelectrochemistry, 141: 107, 2021. 27- Jeong W.Y., Kwon M., Choi H.E. and Kim K.S.: Recent advances in transdermal drug delivery systems: A review. Biomater Res., 25: 24, 2021. 28- Ashar H. and Ranjan A.: Immunomodulation and targeted drug delivery with high intensity focused ultrasound (HIFU): Principles and mechanisms. Pharmacol. Ther., 244: 108, 2023. 29- Gaikwad S.S., Zanje A.L. and Somwanshi J.D.: Advancements in transdermal drug delivery: A comprehensive review of physical penetration enhancement techniques. Int. J. Pharm., 652: 123, 2024. 30- Wang X.Q., Liu Y.K., Qing C. and Lu S.L.: A review of the effectiveness of antimitotic drug injections for hypertrophic scars and keloids. Ann. Plast. Surg., 63: 688-92, 2009. 31- Haedersdal M., Sakamoto F.H., Farinelli W.A., Doukas A.G., Tam J. and Anderson R.R.: Fractional CO(2) laser- assisted drug delivery. Lasers Surg. Med., 42: 113-22, 2010. 32- Waibel J.S., Rudnick A., Shagalov D.R. and Nicolazzo D.M.: Update of ablative fractionated lasers to enhance cutaneous topical drug delivery. Adv. Ther., 34: 1840-9, 2017. 33- Khedr M., Elhefnawy A., Hussein Mahmoud W., Mostafa I. and Hantash S.: Laser-assisted delivery of tranexamic acid for the treatment of facial post-burn hyperpigmentation: A prospective clinico-histopathological study. European Journal of Plastic Surgery, 46, 2023. 34- Farkas J.P., Richardson J.A., Burrus C.F., Hoopman J.E., Brown S.A. and Kenkel J.M.: In vivo histopathologic comparison of the acute injury following treatment with five fractional ablative laser devices. Aesthet. Surg. J., 30: 457-64, 2010. 35- Meesters AA, Nieboer M.J., Kezic S., de Rie M.A. and Wolkerstorfer A.: Parameters in fractional laser assisted delivery of topical anesthetics: Role of laser type and laser settings. Lasers Surg. Med., 50: 813-8, 2018. 36- Wenande E., Anderson R.R. and Haedersdal M.: Fundamentals of fractional laser-assisted drug delivery: An indepth guide to experimental methodology and data interpretation. Adv. Drug Deliv. Rev., 153: 169-84, 2020. Vol. 49, No. 3 / Laser-Assisted Drug Delivery in Early Post-248 Burn Hypertrophic
37- Lee J. and Kim J.: Emerging Technologies in Scar Management: Laser-Assisted Delivery of Therapeutic Agents. In: Téot L., Mustoe T.A., Middelkoop E., Gauglitz G.G., editors. Textbook on Scar Management: State of the Art Management and Emerging Technologies. Cham: Springer International Publishing, p. 443-9, 2020. 38- Waibel J.S., Wulkan A.J. and Shumaker P.R.: Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg. Med., 45: 135-40, 2013. 39- Cavalié M., Sillard L., Montaudié H., Bahadoran P., Lacour J.P. and Passeron T.: Treatment of keloids with laser- assisted topical steroid delivery: A retrospective study of 23 cases. Dermatol. Ther., 28: 74-8, 2015.