Laser-Assisted Drug Delivery
What is laser-assisted drug delivery?
Laser-assisted drug delivery is a new and promising drug delivery technique that is used to improve the efficacy of local skin treatments. With laser pre-treatment followed by topical drug application, physicians can increase the amount of drug that reaches the skin and thus improve the efficacy of numerous topical treatments.
When should laser-assisted drug delivery be used?
Laser-assisted drug delivery has been shown to aid the efficacy of topical treatments for a range of conditions. Currently, the technique is primarily offered in conjunction with photodynamic therapy in patients with severe sun-damage or recurring solar keratosis, as well as in conjunction with corticosteroid treatment of various forms of scars. Laser-assisted drug delivery is not an FDA-approved treatment and other approved first-line therapies are often pursued before laser-assisted drug delivery is attempted.
What devices are used for laser-assisted drug delivery?
The most commonly used devices for laser-assisted drug delivery include the fractional ablative lasers, CO2 (wavelength 10,600 nm) and Er:YAG (wavelength 2940 nm).
How does it work?
In eligible patients, pretreatment with a fractional ablative laser device is conducted. The laser generates microscopic channels in the skin, penetrating its natural barrier and providing direct access to underlying skin layers. With the subsequent application of a topical drug, the laser channels facilitate drug delivery, providing a faster and greater drug deposition in the skin. The increased drug deposition intensifies the treatment, often resulting in greater efficacy when compared to conventional topical treatments conducted on intact skin.
Success rates, potential complications
The best evidence is available for laser-assisted drug delivery coupled with photodynamic therapy for the treatment of solar keratosis, where remission is improved and clearance rates increased from ~ 65% (conventional photodynamic therapy) to ~ 90% with laser-assistance. Less evidence is available for scars, although laser-assisted drug delivery of corticosteroids appears to offer clinical benefit regarding texture, volume, and discoloration.
Known side effects of the topical treatments are often exacerbated after laser delivery and patients undergoing laser-assisted photodynamic therapy may thus experience increased pain and inflammation during and after treatment. Due to a weakened skin barrier and the introduction of topical formulations in deeper skin layers, the risk of infection and hypersensitivity reactions may increase in patients undergoing the procedure.
What is the future of laser-assisted drug delivery?
Laser-assisted drug delivery is a fast and sterile pretreatment strategy to intensify a topical treatment, and can in theory be coupled with any topical agent. The prospect of laser-assisted drug delivery goes beyond solar keratosis and scars as clinical research has demonstrated improved efficacy for conditions including, actinic cheilitis, non-melanoma skin cancer, rhytides, photoaging, onychomycosis, warts, hemangiomas, and vitiligo. The use of laser-assisted drug delivery for these indications is promising, although further investigation is warranted before becoming clinically available.
UPDATED JANUARY 2018
Andres M. Erlendsson MD PhD, Emily Wenande MD, Merete Haedersdal MD, PhD, DMSc