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Published in: Aesthetic Plastic Surgery 5/2021

01-10-2021 | Growth Factors | Original Article

Treatment of Scars with Laser-Assisted Delivery of Growth Factors and Vitamin C: A Comparative, Randomised, Double-blind, Early Clinical Trial

Authors: Barbara Helena Barcaro Machado, Jufen Zhang, James Frame, Mohammad Najlah

Published in: Aesthetic Plastic Surgery | Issue 5/2021

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Abstract

Background

Scarring can jeopardize the final result of plastic surgeries. Deep dermal injuries activate dermal fibroblasts that produce excessive amount of collagen and inflammatory cytokines and growth factors, which contributes to increased fibrous tissue and scarring tissue formation.

Objectives

The aim of this early study, double-blind, prospective, randomised clinical trial was to investigate the use of laser-assisted drug delivery (LADD) for scar improvement to support the establishment of LADD as standard therapy modality and to indicate suitable drugs for dermal administration.

Material and Methods

In total, 132 patients seeking scar treatment were consented and randomised. The control group (64 patients) received laser resurfacing immediately followed by skin surface application of Vitamin C and 68 patients received laser treatment followed by skin surface application of a cosmeceutical containing growth factors (GFs) and Vitamin C. Photographs were obtained before and three months after the procedure and submitted to three-dimensional reconstruction by the software Dermapix®. Objective measurements provided by the software were statistically analysed and established the differences in the treatment result between the two groups.

Results

There was a significant reduction in scar roughness and volume in both groups (p < 0.01). Mann-Whitney test confirmed that the group treated vitamin C and GFs presented significantly better results than the group treated with vitamin C alone (p < 0.01).

Conclusion

LADD has proven efficient as scars were reduced in both study groups. Furthermore, the addition of growth factors provided statistically significant better outcomes and resulted in more inconspicuous scars. No adverse reactions were observed.

Clinical Trial Registration

Plataforma Brasil under the number CAAE: 63710716.2.0000.5664.

Level of Evidence II

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.​springer.​com/​00266.
Literature
1.
go back to reference Boateng J, Matthews K, Stevens H, Eccleston G (2008) Wound healing dressings and drug delivery systems: a review. J Pharm Sci 97(8):2892–2923CrossRef Boateng J, Matthews K, Stevens H, Eccleston G (2008) Wound healing dressings and drug delivery systems: a review. J Pharm Sci 97(8):2892–2923CrossRef
2.
go back to reference Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG (2011) Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med 17(1–2):113–125CrossRef Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG (2011) Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med 17(1–2):113–125CrossRef
3.
go back to reference Amini-Nik S, Yousuf Y, Jeschke MG (2018) Scar management in burn injuries using drug delivery and molecular signalling: current treatments and future directions. Adv Drug Deliv Rev 123:135–54CrossRef Amini-Nik S, Yousuf Y, Jeschke MG (2018) Scar management in burn injuries using drug delivery and molecular signalling: current treatments and future directions. Adv Drug Deliv Rev 123:135–54CrossRef
4.
go back to reference Behm B, Babilas P, Landthaler M, Schreml S (2012) Cytokines, chemokines and growth factors in wound healing. J Eur Acad Dermatol Venereol 26(7):812–820CrossRef Behm B, Babilas P, Landthaler M, Schreml S (2012) Cytokines, chemokines and growth factors in wound healing. J Eur Acad Dermatol Venereol 26(7):812–820CrossRef
5.
go back to reference Verhaegen PD, Van Zuijlen PP, Pennings NM, Van Marle J, Niessen FB, Van Der Horst CM, Middelkoop E (2009) Differences in collagen architecture between keloid, hypertrophic scar, normotrophic scar, and normal skin: an objective histopathological analysis. Wound Repair Regen 17(5):649–656CrossRef Verhaegen PD, Van Zuijlen PP, Pennings NM, Van Marle J, Niessen FB, Van Der Horst CM, Middelkoop E (2009) Differences in collagen architecture between keloid, hypertrophic scar, normotrophic scar, and normal skin: an objective histopathological analysis. Wound Repair Regen 17(5):649–656CrossRef
6.
go back to reference Edwards J (2011) Scar therapy. J Commun Nurs 25(2):17–24 Edwards J (2011) Scar therapy. J Commun Nurs 25(2):17–24
7.
go back to reference Li K, Nicoli F, Xi WJ, Zhang Z, Cui C, Al-Mousawi A, Balzani A, Tong Y, Zhang Y (2019) The 1470 nm diode laser with an intralesional fiber device: a proposed solution for the treatment of inflamed and infected keloids. Burns Trauma 7(1):5PubMedPubMedCentral Li K, Nicoli F, Xi WJ, Zhang Z, Cui C, Al-Mousawi A, Balzani A, Tong Y, Zhang Y (2019) The 1470 nm diode laser with an intralesional fiber device: a proposed solution for the treatment of inflamed and infected keloids. Burns Trauma 7(1):5PubMedPubMedCentral
8.
go back to reference Park JW, Hwang SR, Yoon IS (2017) Advanced growth factor delivery systems in wound management and skin regeneration. Molecules 22(8):1259CrossRef Park JW, Hwang SR, Yoon IS (2017) Advanced growth factor delivery systems in wound management and skin regeneration. Molecules 22(8):1259CrossRef
9.
go back to reference Qu L, Liu A, Zhou L, He C, Grossman PH, Moy RL, Ozog D (2012) Clinical and molecular effects on mature burn scars after treatment with a fractional CO2 laser. Lasers Surg Med 44(7):517–524CrossRef Qu L, Liu A, Zhou L, He C, Grossman PH, Moy RL, Ozog D (2012) Clinical and molecular effects on mature burn scars after treatment with a fractional CO2 laser. Lasers Surg Med 44(7):517–524CrossRef
10.
go back to reference Haak CS, Bhayana B, Farinelli WA, Anderson RR, Haedersdal M (2012) The impact of treatment density and molecular weight for fractional laser-assisted drug delivery. J Control Release 163(3):335–341CrossRef Haak CS, Bhayana B, Farinelli WA, Anderson RR, Haedersdal M (2012) The impact of treatment density and molecular weight for fractional laser-assisted drug delivery. J Control Release 163(3):335–341CrossRef
11.
go back to reference Haedersdal M, Erlendsson AM, Paasch U, Anderson RR (2016) Translational medicine in the field of ablative fractional laser (AFXL)-assisted drug delivery: a critical review from basics to current clinical status. J Am Acad Dermatol 74(5):981–1004CrossRef Haedersdal M, Erlendsson AM, Paasch U, Anderson RR (2016) Translational medicine in the field of ablative fractional laser (AFXL)-assisted drug delivery: a critical review from basics to current clinical status. J Am Acad Dermatol 74(5):981–1004CrossRef
13.
go back to reference Lee KC, Dretzke J, Grover L, Logan A, Moiemen N (2016) A systematic review of objective burn scar measurements. Burns Trauma 4:14CrossRef Lee KC, Dretzke J, Grover L, Logan A, Moiemen N (2016) A systematic review of objective burn scar measurements. Burns Trauma 4:14CrossRef
14.
go back to reference Metcalfe A, Ferguson M (2007) Tissue engineering of replacement skin: the crossroads of biomaterials, wound healing, embryonic development, stem cells and regeneration. J R Soc Interface 4:413–437CrossRef Metcalfe A, Ferguson M (2007) Tissue engineering of replacement skin: the crossroads of biomaterials, wound healing, embryonic development, stem cells and regeneration. J R Soc Interface 4:413–437CrossRef
15.
go back to reference Hsiao CY, Huang CH, Hu S, Ko YS, Sung HC, Chen CC, Huang SY (2012) Fractional carbon dioxide laser treatment to enhance skin permeation of ascorbic Acid 2-Glucoside with minimal skin disruption. Dermatol Surg 38(8):1284–1293CrossRef Hsiao CY, Huang CH, Hu S, Ko YS, Sung HC, Chen CC, Huang SY (2012) Fractional carbon dioxide laser treatment to enhance skin permeation of ascorbic Acid 2-Glucoside with minimal skin disruption. Dermatol Surg 38(8):1284–1293CrossRef
16.
go back to reference Koria P (2012) Delivery of growth factors for tissue regeneration and wound healing. BioDrugs 26(3):163–175CrossRef Koria P (2012) Delivery of growth factors for tissue regeneration and wound healing. BioDrugs 26(3):163–175CrossRef
17.
go back to reference Bertin ACJ, Vilarinho A, Junqueira ALA (2018) Fractional non-ablative laser-assisted drug delivery leads to improvement in male and female pattern hair loss. J Cosmet Laser Ther 20(7–8):391–394CrossRef Bertin ACJ, Vilarinho A, Junqueira ALA (2018) Fractional non-ablative laser-assisted drug delivery leads to improvement in male and female pattern hair loss. J Cosmet Laser Ther 20(7–8):391–394CrossRef
18.
go back to reference Machado BHB, Zhang J, Frame JD, Najlah M, (2020) Comparative study on the outcome of periorbital wrinkles treated with laser-assisted delivery of vitamin c or vitamin c plus growth factors: a randomized double-blind clinical trial [epub ahead of print]. Aesthetic Plast Surg, 1: 2-6, https://doi.org/10.1007/s00266-020-02035-z Machado BHB, Zhang J, Frame JD, Najlah M, (2020) Comparative study on the outcome of periorbital wrinkles treated with laser-assisted delivery of vitamin c or vitamin c plus growth factors: a randomized double-blind clinical trial [epub ahead of print]. Aesthetic Plast Surg, 1: 2-6, https://​doi.​org/​10.​1007/​s00266-020-02035-z
19.
go back to reference Aldag C, Nogueira Teixeira D, Leventhal PS (2016) Skin rejuvenation using cosmetic products containing growth factors, cytokines, and matrikines: a review of the literature. Clin Cosmet Investig Dermatol 9:411–419CrossRef Aldag C, Nogueira Teixeira D, Leventhal PS (2016) Skin rejuvenation using cosmetic products containing growth factors, cytokines, and matrikines: a review of the literature. Clin Cosmet Investig Dermatol 9:411–419CrossRef
20.
go back to reference Husein el Hadmed H, Castillo RF (2016) Peptides, proteins, and growth factors. J Cosmet Dermatol 15:514–519CrossRef Husein el Hadmed H, Castillo RF (2016) Peptides, proteins, and growth factors. J Cosmet Dermatol 15:514–519CrossRef
21.
go back to reference Demidova-Rice TN, Hamblin MR, Herman IM (2012) Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 2: role of growth factors in normal and pathological wound healing: therapeutic potential and methods of delivery. Adv Skin Wound Care 25(8):349CrossRef Demidova-Rice TN, Hamblin MR, Herman IM (2012) Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 2: role of growth factors in normal and pathological wound healing: therapeutic potential and methods of delivery. Adv Skin Wound Care 25(8):349CrossRef
22.
go back to reference Bao P, Kodra A, Tomic-Canic M, Golinko MS, Ehrlich HP, Brem H (2009) The role of vascular endothelial growth factor in wound healing. J Surg Res 153:347–358CrossRef Bao P, Kodra A, Tomic-Canic M, Golinko MS, Ehrlich HP, Brem H (2009) The role of vascular endothelial growth factor in wound healing. J Surg Res 153:347–358CrossRef
23.
go back to reference Seidel R, Moy RL (2015) Improvement in atrophic acne scars using topical synthetic epidermal growth factor (EGF) serum: a pilot study. J Drug Dermatol 14:1005–1010 Seidel R, Moy RL (2015) Improvement in atrophic acne scars using topical synthetic epidermal growth factor (EGF) serum: a pilot study. J Drug Dermatol 14:1005–1010
24.
go back to reference Disphanurat W, Kaewkes A, Suthiwartnarueput W (2020) Comparison between topical recombinant human epidermal growth factor and Aloe vera gel in combination with ablative fractional carbon dioxide laser as treatment for striae alba: a randomised double-blind trial. Lasers Surg Med 52(2):166–175. https://doi.org/10.1002/lsm.23052CrossRefPubMed Disphanurat W, Kaewkes A, Suthiwartnarueput W (2020) Comparison between topical recombinant human epidermal growth factor and Aloe vera gel in combination with ablative fractional carbon dioxide laser as treatment for striae alba: a randomised double-blind trial. Lasers Surg Med 52(2):166–175. https://​doi.​org/​10.​1002/​lsm.​23052CrossRefPubMed
25.
go back to reference Kwon Y, Kim H, Roh D, Yoon S, Baek R, Kim J, Kweon H, Lee K, Park Y, Lee J (2006) Topical application of epidermal growth factor accelerates wound healing by myofibroblast proliferation and collagen synthesis in rat. J Vet Sci 7:105–109CrossRef Kwon Y, Kim H, Roh D, Yoon S, Baek R, Kim J, Kweon H, Lee K, Park Y, Lee J (2006) Topical application of epidermal growth factor accelerates wound healing by myofibroblast proliferation and collagen synthesis in rat. J Vet Sci 7:105–109CrossRef
26.
go back to reference Zhang Y, Wang T, He J, Dong J (2016) Growth factor therapy in patients with partial-thickness burns: a systematic review and meta-analysis. Int Wound J 13(3):354–366CrossRef Zhang Y, Wang T, He J, Dong J (2016) Growth factor therapy in patients with partial-thickness burns: a systematic review and meta-analysis. Int Wound J 13(3):354–366CrossRef
27.
go back to reference Barrientos S, Stojadinovic O, Golinko MS, Brem H, Tomic Canic M (2008) Growth factors and cytokines in wound healing. Wound Repair Regen 16:585–601CrossRef Barrientos S, Stojadinovic O, Golinko MS, Brem H, Tomic Canic M (2008) Growth factors and cytokines in wound healing. Wound Repair Regen 16:585–601CrossRef
29.
go back to reference Bertoncelj V, Pelipenko J, Kristl J, Jeras M, Cukjati M, Kockbek P (2014) Development and bioevaluation of nanofibers with blood-derived growth factors for dermal wound healing. Eur J Pharm Biopharm 88(1):64CrossRef Bertoncelj V, Pelipenko J, Kristl J, Jeras M, Cukjati M, Kockbek P (2014) Development and bioevaluation of nanofibers with blood-derived growth factors for dermal wound healing. Eur J Pharm Biopharm 88(1):64CrossRef
Metadata
Title
Treatment of Scars with Laser-Assisted Delivery of Growth Factors and Vitamin C: A Comparative, Randomised, Double-blind, Early Clinical Trial
Authors
Barbara Helena Barcaro Machado
Jufen Zhang
James Frame
Mohammad Najlah
Publication date
01-10-2021
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 5/2021
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-021-02232-4

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