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

Abstract

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.

The Past, Present, Future: Pathophysiology, Diagnosis, and Treatment of Human Skin Diseases

“…As for infections, it is not recommended for antibiotic or antifungal cases although antiviral when treating the face and genitalia; and antifungal prophylaxis is not recommended [129].…”

In vivo characterization of laser‐assisted delivery of hyaluronic acid using multiphoton fluorescence lifetime imaging

“…The depth of these vertical channels is determined by the fluence of the laser 7 . By partially destroying the outer epidermal and dermal layers in a controlled manner, these channels provide a pathway of increased permeability and penetration of various pharmaceuticals 5,7–10 …”

“…7 By partially destroying the outer epidermal and dermal layers in a controlled manner, these channels provide a pathway of increased permeability and penetration of various pharmaceuticals. 5,[7][8][9][10] Several studies demonstrated the efficacy of LADD for the treatment of photoaged skin. [10][11][12][13] In recent years, laser-assisted delivery of SQBs has gained tremendous popularity for facial skin remodelling.…”

Safety and Effectiveness of Fractional Ablative CO2 Laser-Assisted Delivery of Topical Poly-l-Lactic Acid for Rhytides and Scars

“…Such topicals have included analgesics, medications used in photodynamic therapy, 5fluorouracil, corticosteroids, hyaluronic acid, tranexamic acid, and PLLA, among others. 3,4 Cadaveric studies have confirmed that the microchannels created through fractional ablative laser treatment are sufficiently sized for larger-sized PLLA particles (sized 40-63 mm) to pass through the stratum corneum and penetrate the dermis, where they can exert their biologic effects. 1 Topical application of a PLLA suspension immediately following fractional ablative laser treatment has been shown to improve atrophic acne scars and rhytides of the upper lip in patients of FST I-III.…”