Ablative fractional laser intensifies treatment outcome of scalp actinic keratoses with ingenol mebutate: a case report

Karmisholt, Katrine; Hædersdal, Merete

doi:10.1111/jdv.13021

Cited by 15 publications

(14 citation statements)

References 10 publications

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“…In a trial looking at the effects of AFXL pre-treatment on field treatment of AKs on the face and scalp, 15 patients had conventional PDT applied to one area of skin and on the symmetrical corresponding area of skin received AFXL-PDT (10 mJ per pulse, 0.12-mm spot, 5 % density) [16]. At 3-month follow-up, AFXL-PDT was more effective than conventional PDT, with complete lesion response of 88 and 59 % respectively, with AFXL-PDT exhibiting fewer new AKs and improved photoageing.…”

Section: Actinic Keratosismentioning

confidence: 99%

“…As observed in cases of PDT, AFXL pre-treatment intensified the inflammation seen after ingenol mebutate therapy, such that the inflammation persisted for 3 weeks following therapy. A second case series of three males with AKs on the hairless scalp utilised a split-scalp study [16]. On one side of the scalp, ingenol mebutate was applied in the conventional manner (once daily for 3 days); the other side of the scalp was pre-treated with CO 2 -AFXL (pulse energy 10 mJ, density 5 %) prior to a single application of ingenol mebutate.…”

Section: Actinic Keratosismentioning

confidence: 99%

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Laser-assisted drug delivery in dermatology: from animal models to clinical practice

Ali

Al‐Niaimi

2015

Lasers Med Sci

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Topical medicaments are the mainstay of the dermatologists' therapeutic arsenal. Laser-assisted drug delivery enhances the ability of topically applied medicaments to penetrate the skin. We discuss the mechanisms of laser-assisted drug delivery and animal models that have informed clinical practice. We review clinical studies that have employed laser-assisted drug delivery for a range of indications to date including non-melanoma skin cancer, vitiligo, scarring, vaccination, local anaesthesia, analgesia, viral warts, infantile haemangiomas and cosmetic uses. Studies thus far suggest that laser pre-treatment improves transepidermal absorption of topical agents and allows for a much deeper penetration of drugs than is possible with topical medicaments alone. This may allow more efficacious action of current treatments, such that conventional duration of treatment can be shortened or lower concentrations of active agents be used, potentially obviating side effects of treatment. The prospect of using laser technologies to facilitate transdermal vaccination and as an adjunct for inflammatory dermatoses and cosmetic indications remains in its infancy. As larger trials are published, involving greater numbers of patients and utilising various laser and topical medicament parameters, we will enhance our understanding of this nascent modality of treatment delivery.

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Section: Actinic Keratosismentioning

confidence: 99%

Section: Actinic Keratosismentioning

confidence: 99%

Laser-assisted drug delivery in dermatology: from animal models to clinical practice

Ali

Al‐Niaimi

2015

Lasers Med Sci

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“…Pretreatment with AFL has been shown to significantly improve clinical treatment outcomes for selected topical treatments of AKs, in particular photodynamic therapy . A case report suggested a single AFL‐assisted IM treatment of AKs on the scalp advantageous over conventional IM triple self‐application and provided good cosmetic outcome . Literature on AFL pretreatment of BCCs is limited, and further investigations are required to establish optimal conditions for AFL‐assisted drug delivery for BCCs, including combined treatment with IM.…”

Section: Introductionmentioning

confidence: 99%

Basal cell carcinoma treated with combined ablative fractional laser and ingenol mebutate – an exploratory study monitored by optical coherence tomography and reflectance confocal microscopy

Banzhaf

Phothong

Suku

et al. 2019

Acad Dermatol Venereol

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Background Basal cell carcinomas (BCCs) have previously been treated off‐label with ingenol mebutate (IM). Ablative fractional laser (AFL) may improve efficacy of IM by increasing drug uptake in the tumour. Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) detect BCC non‐invasively. Our aim was to investigate BCC response and tolerability after combined AFL and IM treatment of low‐risk BCCs. Methods Twenty patients with histologically verified superficial (n = 7) and nodular (n = 13) BCCs were treated with combined fractional CO2‐laser (10 600 nm) and IM 0.015% or 0.05%, the concentration depending on anatomical location. BCC response was evaluated clinically, by OCT and RCM at day 29 and 90 after first treatment, and histologically at day 90. Treatment was repeated at day 29 if BCC persisted. Local skin reactions (LSRs) were assessed using LSR scale at all visits. Results At day 29, 18/20 patients received a second treatment due to residual BCC detected clinically, by OCT or RCM. OCT and RCM presented subclinical BCCs in five of 20 cases (25%). At day 90, overall histological cure rate was 70%, corresponding to clinical (65%) and OCT/RCM (60%) cure rates, and agreement between evaluation methods was substantial (kappa ≥ 0.796, P < 0.0001). Clearance rates were similar for sBCCs and nBCCs (P = 0.354) and for lesions treated with IM 0.015% and 0.05% (P = 0.141). LSRs were tolerable, but scarring was observed in the majority of cleared patients. Conclusion Two treatments of combined AFL and IM show potential to treat low‐risk BCCs with acceptable tolerability. OCT and RCM show promise to detect subclinical BCCs at short‐term follow‐up.

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“…Our own group has been able to demonstrate that combination therapy consisting of AFXL and IM results in a more pronounced inflammatory response, and that hyperkeratotic and often recalcitrant AKs on the dorsal aspects of hands and feet may be treated successfully (Figure a–c). Similar to PDT, combined therapy may possibly also shorten the treatment duration from three days to a single session . Future studies might also address the question as to whether the deeper penetration of IM caused by laser pretreatment may expand the spectrum of indications to include more deeply infiltrating skin tumors such as squamous cell carcinoma.…”

Section: Ingenol Mebutatementioning

confidence: 99%

Laser‐assisted drug delivery: mode of action and use in daily clinical practice

Braun

Schrumpf

Buhren

et al. 2016

J Deutsche Derma Gesell

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Summary Topical application of pharmaceutical agents is a basic principle of dermatological therapy. However, the effective barrier function of the skin significantly impairs the bioavailability of most topical drugs. Fractional ablative lasers represent an innovative strategy to overcome the epidermal barrier in a standardized, contact‐free manner. The bioavailability of topical agents can be significantly enhanced using laser‐assisted drug delivery (LADD). In recent years, the principle of LADD has become well established for various dermatological indications. Herein, we review the current literature on LADD and present potential future applications.

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Ablative fractional laser intensifies treatment outcome of scalp actinic keratoses with ingenol mebutate: a case report

Cited by 15 publications

References 10 publications

Laser-assisted drug delivery in dermatology: from animal models to clinical practice

Laser-assisted drug delivery in dermatology: from animal models to clinical practice

Basal cell carcinoma treated with combined ablative fractional laser and ingenol mebutate – an exploratory study monitored by optical coherence tomography and reflectance confocal microscopy

Laser‐assisted drug delivery: mode of action and use in daily clinical practice

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