Laser-Assisted Drug Delivery in the Treatment of Scars, Rhytids, and Melasma: A Comprehensive Review of the Literature

Abstract

While 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. We conducted 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 using 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, we categorized relevant articles by scar type; hypertrophic/keloid, atrophic, and hypopigmented. LADD, with both ablative and non-ablative laser types, was studied in combination with corticosteroids, Botulinum Toxin-A (BTX-A), 5-Fluorouracil (5-FU), 5-Aminolevulinic acid (ALA) photodynamic therapy (PDT), stem-cells, Platelet-rich plasma (PRP), and prostaglandin analogs for the treatment of scars. Some randomized controlled trials demonstrated efficacy with LADD, while others showed no significant differences in clinical outcomes, but demonstrated reduced adverse effects. Regarding rhytids, laser has been combined with varying cosmeceuticals, Polylactic acid (PLLA), topical retinaldehyde, and topical BTX-A. The studies reviewed supported the use of LADD with these drugs compared to monotherapy. Some studies showed that LADD was effective for the absorption of drugs like PLLA 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.

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“…Laser-assisted drug delivery following fractional ablative laser may provide additional benefit beyond laser alone. Adjuvant application of 5-fluorouracil cream and intralesional solution to scars after treatment with fractional ablative CO 2 laser was shown to be more effective than either therapy alone [50,51]. Adjuvant topical steroids were superior to intralesional steroids but showed no significant improvement in scar flattening when compared with monotherapy with fractional ablative laser [52].…”