A comparison of the efficacy of ablative fractional laser-assisted photodynamic therapy according to the density of the ablative laser channel in the treatment of actinic keratosis: A prospective, randomized, controlled trial

Cho, Yeo-Rye; Seo, Jeong-Wan; Kim, Ho-Jin; Song, Ki‐Hoon

doi:10.1016/j.jaad.2019.10.037

Cited by 4 publications

(7 citation statements)

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“…In total, 48 published studies of AF LADD met inclusion criteria (eFigure in the Supplement): 4 cosmetic studies,, 21 oncologic, and 23 medical (not cosmetic/oncologic) . In addition, 6 publications of NAF LADD were included at the request of the expert panel, for a total of 54 studies.…”

Section: Resultsmentioning

confidence: 99%

“…Although there are many indications for LADD as identified through the systematic review and as reported by members of the expert panel from their own clinical experience (Table 3), there was sufficient evidence to strongly recommend that LADD is safe and effective for the treatment of actinic keratoses, actinic cheilitis, and cutaneous squamous cell carcinoma in situ . In general, it was found that LADD is most effective for treating these indications, with this typically performed with laser followed by photodynamic therapy (PDT).…”

Section: Resultsmentioning

confidence: 99%

“…Abbreviation: GRADE, Grading of Recommendations Assessment, Development and Evaluation. a These are provided for illustrative purposes and are based on published reports b Level of evidence and strength of recommendation were determined by the guideline panel for the specific indication, but not necessarily for a particular technique or topical agent.…”

Section: Resultsmentioning

confidence: 99%

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Evidence-Based Clinical Practice Guidelines for Laser-Assisted Drug Delivery

et al. 2022

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ImportanceLaser-assisted drug delivery (LADD) is used for various medical and cosmetic applications. However, there is insufficient evidence-based guidance to assist clinicians performing LADD.ObjectiveTo develop recommendations for the safe and effective use of LADD.Evidence ReviewA systematic literature review of Cochrane Central Register of Controlled Trials, Embase, and MEDLINE was conducted in December 2019 to identify publications reporting research on LADD. A multidisciplinary panel was convened to draft recommendations informed by the systematic review; they were refined through 2 rounds of Delphi survey, 2 consensus meetings, and iterative review by all panelists until unanimous consensus was achieved.FindingsOf the 48 published studies of ablative fractional LADD that met inclusion criteria, 4 were cosmetic studies; 21, oncologic; and 23, medical (not cosmetic/oncologic), and 6 publications of nonablative fractional LADD were included at the request of the expert panel, producing a total of 54 studies. Thirty-four studies (63.0%) were deemed to have low risk of bias, 17 studies (31.5%) had moderate risk, and 3 (5.5%) had serious risk. The key findings that informed the guidelines developed by the expert panel were as follows: LADD is safe in adults and adolescents (≥12 years) with all Fitzpatrick skin types and in patients with immunosuppression; it is an effective treatment for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; it is useful for epidermal and dermal analgesia; drug delivery may be increased through the application of heat, pressure, or occlusion, or by using an aqueous drug solution; laser settings should be selected to ensure that channel diameter is greater than the delivered molecule; antibiotic prophylaxis is not recommended, except with impaired wound healing; antiviral prophylaxis is recommended when treating the face and genitalia; and antifungal prophylaxis is not recommended. The guideline’s 15 recommendations address 5 areas of LADD use: (I) indications and contraindications; (II) parameters to report; (III) optimization of drug delivery; (IV) safety considerations; and (V) prophylaxis for bacterial, viral, and fungal infections.Conclusions and RelevanceThis systematic review and Delphi consensus approach culminated in an evidence-based clinical practice guideline for safe and effective use of LADD in a variety of applications. Future research will further improve our understanding of this novel treatment technique.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Evidence-Based Clinical Practice Guidelines for Laser-Assisted Drug Delivery

et al. 2022

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“…The density may need to be increased to 3% or 5%, or even higher. In reported work in other disease states, increasing the density improved drug penetrance and primary outcomes 38 …”

Section: Discussionmentioning

confidence: 95%

“…In reported work in other disease states, increasing the density improved drug penetrance and primary outcomes. 38 It was hypothesized that not only did hypopigmented scars lack α-MSH, but they also lacked the starting reactant for melanogenesis: tyrosine. 39 Therefore, the drug was dissolved in L-tyrosine.…”

Section: Future Workmentioning

confidence: 99%

Laser‐assisted drug delivery of synthetic alpha melanocyte stimulating hormone and L‐tyrosine leads to increased pigmentation area and expression of melanogenesis genes in a porcine hypertrophic scar model

et al. 2023

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Objectives: One symptom of hypertrophic scar (HTS) that can develop after burn injury is dyschromia with hyper-and hypopigmentation. There are limited treatments for these conditions. Previously, we showed there is no expression of alpha melanocyte stimulating hormone (α-MSH) in hypopigmented scars, and if these melanocytes are treated with synthetic α-MSH in vitro, they respond by repigmenting. The current study tested the same hypothesis in the in vivo environment using laser-assisted drug delivery (LADD). Methods: HTSs were created in red Duroc pigs. At Day 77 (pre), they were treated with CO 2 fractional ablative laser (FLSR). Synthetic α-MSH was delivered as a topical solution dissolved in L-tyrosine (n = 6, treated). Control scars received LADD of L-tyrosine only (n = 2, control). Scars were treated and examined weekly through Week 4. Digital images and punch biopsies of hyper, hypo-, and normally pigmented scar and skin were collected. Digital pictures were analyzed with ImageJ by tracing the area of hyperpigmentation. Epidermal sheets were obtained from punch biopsies through dispase separation and RNA was isolated. qRT-PCR was run for melanogenesis-related genes: tyrosinase (TYR), tyrosinase-related protein-1 (TYRP1), and dopachrome tautomerase (DCT). Two-way ANOVA with multiple comparisons and Dunnett's correction compared the groups. Results: The areas of hyperpigmentation were variable before treatment. Therefore, data is represented as fold-change where each scar was normalized to its own pre value. Within the LADD of NDP α-MSH + L-tyrosine group, hyperpigmented areas gradually increased each week, reaching 1.3-fold over pre by Week 4. At each timepoint, area of hyperpigmentation was greater in the treated versus the control (1.04 ± 0.05 vs. 0.89 ± 0.08, 1.21 ± 0.07 vs. 0.98 ± 0.24, 1.21 ± 0.08 vs. 1.04 ± 0.11, 1.28 ± 0.11 vs. 0.94 ± 0.25; fold-change from pre-). Within the treatment group, pretreatment, levels of TYR were decreased −17.76 ± 4.52 below the level of normal skin in hypopigmented scars. After 1 treatment, potentially due to laser fractionation, the levels decreased to −43.49 ± 5.52. After 2, 3, and 4 treatments, there was ever increasing levels of TYR to almost the level of normally pigmented skin Week 4]). This pattern was also observed for TYRP1 (pre = −12.

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