Energy-based devices for enhanced transdermal drug delivery in pathological scars: A review

Although laser-assisted drug delivery (LADD) technology is well established, its clinical application has now expanded to include a broader range of energy-based devices (EBDs). This review aims to evaluate the use of energy-based device-assisted drug delivery (EADD) in the treatment of hypertrophic scars (HTS) and keloids. Following a comprehensive search of English and Chinese databases, 30 relevant studies were included. These studies evaluated the combined application of various EBDs-including ablative and non-ablative fractional lasers, micro-plasma radiofrequency (MPR), ultrasound, and thermomechanical fractional injury-with pharmacological agents such as corticosteroids, 5-fluorouracil (5-FU), verapamil, botulinum toxin type A (BTXA), and photosensitizers (5-aminolevulinic acid). The results indicate that for corticosteroids, EADD achieves efficacy comparable to that of intralesional injection while significantly reducing pain and lowering the risk of skin atrophy and telangiectasia, offering particular benefits for pediatric patients. The combination of EADD with 5-FU effectively improves scar thickness, whereas CO₂ AFL-assisted photosensitizers delivery shows an exceptionally low recurrence rate in the treatment of acne-induced HTS. In contrast, for keloids, intralesional BTXA injections remain superior to CO₂ AFL-assisted BTXA delivery. Furthermore, emerging strategies such as the triple-modality "light-light-sound" therapy, which combines intense pulsed light, CO₂ ablative fractional laser, and ultrasound, provide promising prospects for recalcitrant cases. In summary, EBDs enhance drug delivery through micropore formation or acoustic effects, establishing it as a key therapeutic strategy that balances efficacy with improved safety and patient compliance compared to monotherapy. However, standardized treatment protocols still require further validation through future research.