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Liu B, Sood R, Wang F, Zhang F, Sun L, Qiu X, Zhao D, Lineaweaver WC. Principles and clinical applications of transcutaneous laser-assisted drug delivery: A narrative review. Scars Burn Heal 2024; 10:20595131241234715. [PMID: 38505821 PMCID: PMC10949547 DOI: 10.1177/20595131241234715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Introduction Transcutaneous laser-assisted drug delivery (LADD) is recognized as a developing therapy for skin disorders. Method Current literature was reviewed to summarize current applications for LADD. Discussion 12 clinical applications for this therapy are currently reported. Conclusion LADD has potential for wide application in skin disorder treatment. Lay Summary Laser assisted drug delivery improves drug bioavailability for treatment of skin disorders. This technique is being assessed clinically in disorders ranging from skin cancers to alopecia.
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Affiliation(s)
- Baoyi Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Rajiv Sood
- Burn and Reconstruction Centers of America Augusta, Augusta, GA, USA
| | - Fuyang Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Feng Zhang
- Burn and Reconstruction Centers of America Augusta, Augusta, GA, USA
| | - Lu Sun
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Xing Qiu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
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Ng WHS, Smith SD. Laser-Assisted Drug Delivery: A Systematic Review of Safety and Adverse Events. Pharmaceutics 2022; 14:pharmaceutics14122738. [PMID: 36559233 PMCID: PMC9787022 DOI: 10.3390/pharmaceutics14122738] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Laser-assisted drug delivery (LADD) is an increasingly studied and applied methodology for drug delivery. It has been used in a wide variety of clinical applications. Given the relatively low barrier to entry for clinicians as well as ongoing research in this area, the authors aimed to review outcomes relating to safety in laser-assisted drug delivery. A systematic review was conducted, with the databases PubMed, Medline and Embase searched in September 2022. Included articles were those that mentioned laser-assisted drug delivery in human subjects that also reported adverse effects or safety outcomes. There were no language-based exclusions. Conference abstracts and literature reviews were excluded. The results were then tabulated and categorized according to the application of LADD. In total, 501 articles were obtained. Following deduplication, screening, and full text review 70 articles of various study designs were included. Common findings were erythema, oedema, pain, and crusting following LADD. Several notably more severe adverse effects such as generalized urticaria, infection, scarring and dyspigmentation were noted. However, these events were varied depending on the clinical use of LADD. Relevant negatives were also noted whereby no studies reported life-threatening adverse effects. Limitations included limited details regarding the adverse effects within the full texts, lack of follow-up, and risk of bias. In conclusion, there were multiple adverse effects that clinicians should consider prior to carrying out LADD, where treatment goals and patient tolerability should be considered. Further evidence is needed to quantitatively determine these risks.
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Affiliation(s)
| | - Saxon D. Smith
- ANU Medical School, ANU College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia
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Henning MAS, Bouazzi D, Jemec GBE. Treatment of Hyperhidrosis: An Update. Am J Clin Dermatol 2022; 23:635-646. [PMID: 35773437 DOI: 10.1007/s40257-022-00707-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
Hyperhidrosis is a dermatosis presenting as pathologically excessive focal or generalized sweating. The stigmatizing nature of hyperhidrosis may cause patients to feel embarrassment and apprehension about their symptoms and experience a significant decrease in well-being. Severe cases of hyperhidrosis can also increase the risk of developing psychiatric and somatic comorbidities. Conventional non-surgical treatments of hyperhidrosis include aluminum salts, iontophoresis, botulinum toxin injections, and oral glycopyrronium. In recent years, new topical anticholinergic medications and devices have emerged that may improve the patients' symptoms and even prevent the development of comorbidities. The treatment of hyperhidrosis can be a complex matter and may require the combination of several therapies. The purpose of this paper was to firstly review the literature on existing non-surgical treatment options for hyperhidrosis, and secondly provide a stepwise approach to investigating and treating patients with hyperhidrosis.
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Affiliation(s)
- Mattias A S Henning
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark
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Campanati A, Gregoriou S, Milia-Argyti A, Kontochristopoulos G, Radi G, Diotallevi F, Martina E, Offidani A. THE PHARMACOLOGICAL TREATMENT AND MANAGEMENT OF HYPERHIDROSIS. Expert Opin Pharmacother 2022; 23:1217-1231. [PMID: 35686667 DOI: 10.1080/14656566.2022.2083499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Idiopathichyperhidrosis is a dysfunctional disorder involving eccrine sweat glands and its impact on patients' daily quality of life is well-known. Unlike some years ago, when only poor effective and safe therapeutic alternatives were available, nowadays, several emerging pharmacological active substances have gained significant space as treatment options. AREAS COVERED The authors report on, in this narrative review, the emerging data from the literature focusing on the pharmacological treatments to draw up a drug treatments flow-chart for patients with idiopathic hyperhidrosis, taking into consideration specific differences among axillary, palmoplantar and craniofacial hyperhidrosis. EXPERT OPINION Idiopathic hyperhidrosis, regardless of the site of involvement, remains a functional disorder that places a significant burden on patients. After balancing efficacy against adverse events, systemic therapy, although off-label for all forms of hyperhidrosis can represent an additive therapeutic option for patients with insufficient response to topical treatment according to a step wise therapeutic approach. Until the pathophysiological mechanisms underlying hyperhidrosis are clear, and the etiological therapeutic approach become realistic, the greatest challenge in the therapeutic management of hyperhidrotic patients seems to be the search for the most convenient combination between different therapeutic modalities (topical and systemic agents, and botulinum toxins) to achieve long-term control of the disease symptoms.
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Affiliation(s)
- Anna Campanati
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Stamatis Gregoriou
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Adamantia Milia-Argyti
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - George Kontochristopoulos
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Giulia Radi
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Federico Diotallevi
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Emanuela Martina
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
| | - Annamaria Offidani
- National and Kapodistrian University of Athens, 1st department of Dermatology, Andreas Sygros Hospital.,Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic marche University, Ancona
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Efficacy and safety of 755-nm picosecond alexandrite laser with topical tranexamic acid versus laser monotherapy for melasma and facial rejuvenation: a multicenter, randomized, double-blinded, split-face study in Chinese patients. Lasers Med Sci 2022; 37:2879-2887. [PMID: 35501519 DOI: 10.1007/s10103-022-03566-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/22/2022] [Indexed: 02/05/2023]
Abstract
To compare the efficacy and safety of 755-nm picosecond alexandrite laser and topical tranexamic acid (TTA) combination therapy with laser monotherapy, for the treatment of melasma and facial rejuvenation. This multicenter, randomized, double-blinded, split-face study enrolled 37 patients who presented with melasma and photoaging. Facial halves were randomized to receive either laser and TTA combination therapy or laser monotherapy. Three treatments were delivered at 4-5 weeks intervals. Patients were followed up for 1, 3, and 6 months post-final treatment and evaluated by blinded investigators for hemi-Melasma Area and Severity Index (hemi-MASI), facial dyschromia, skin texture, laxity, and rhytids. Daily diaries rating healing progress for 7 days posttreatment and satisfaction grading were performed by all patients. Adverse events were recorded. Thirty-six patients completed the follow-up. Compared with the baseline, hemi-MASI, dyschromia, and skin texture on both halves improved significantly through the follow-up (p = 0.000). A significant difference in hemi-MASI and dyschromia between combination therapy halves and monotherapy halves was noticed at 1- and 3-month follow-ups (p < 0.05). The laser monotherapy halves displayed significantly less redness and sensitivity during the 7-day posttreatment recovery period (p < 0.05). Patients' satisfaction ratings for the combination therapy halves were higher than the monotherapy halves at 1-month follow-up (p < 0.05). No severe adverse events were observed. The picosecond alexandrite laser and TTA combination therapy demonstrated synergistic efficacy for hemi-MASI and dyschromia improvements over laser monotherapy. The optimization of the picosecond laser and TTA combination regimen needs further investigation.
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Efficacy and Safety of Using Noninsulated Microneedle Radiofrequency Alone versus in Combination with Polynucleotides for Treatment of Periorbital Wrinkles. Dermatol Ther (Heidelb) 2022; 12:1133-1145. [PMID: 35501660 PMCID: PMC9110589 DOI: 10.1007/s13555-022-00729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction A few studies have evaluated the efficacy and safety of noninsulated radiofrequency microneedling (RFMN) to treat periorbital wrinkles in Asian patients. Recently, wound healing accelerators, polynucleotides (PNs), have received attention in wound management. However, their efficacy and safety have not been fully elucidated following RFNM. This study aimed to evaluate the efficacy and safety of noninsulated RFMN for periorbital wrinkles and the synergistic effect of PNs after RFMN. Methods Thirty subjects with Fitzpatrick skin types III to V and facial wrinkles (Fitzpatrick grades I and II) were enrolled. All volunteers were treated over the entire face with noninsulated RFMN for three sessions at 2-week intervals. The left and right sides of each patient’s face were randomly assigned to receive PNs (treatment group) or normal saline solution (control group). The indentation and maximum depth of wrinkles were objectively measured using Antera 3D. Subjective self-evaluations were obtained at baseline, 2 weeks after the third treatment, and at 1, 2, 3, and 6 months after the final treatment. In addition, pain scores, immediate reactions, and other adverse effects were evaluated. Results Twenty-nine subjects completed the treatment protocol. Most presented with grade II wrinkling (69%). At 2-month follow-up, Antera 3D image analysis revealed faster improvement for the treatment group. At 6-month follow-up, the majority of subjects reported an improvement of 25–75% in their periorbital wrinkles. The average pain score was 2.2 out of 10. No serious adverse events (infection, pigmentary alteration, persistent erythema, or scarring) were observed. Conclusions Noninsulated RFMN is safe and effective for treating periorbital wrinkles and can be used as a modality for transdermal drug delivery. Topical polynucleotides as an adjunctive treatment provide additional benefits for periorbital wrinkle treatment. Trial Registration Number TCTR20201105007.
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A Practical Approach to the Diagnosis and Treatment of Palmar Hyperhidrosis. Plast Reconstr Surg Glob Open 2022; 10:e4172. [PMID: 35265447 PMCID: PMC8901220 DOI: 10.1097/gox.0000000000004172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
Palmar hyperhidrosis (PH), a condition characterized by excess sweating of the palms, is a common concern that presents to the plastic surgeon, which can have major impacts on patient confidence and quality of life. While several studies summarize treatment options for hyperhidrosis in general, few outline the therapeutic options available specifically for PH.
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Searle T, Ali FR, Al-Niaimi F. Lessons Learned from the First Decade of Laser-Assisted Drug Delivery. Dermatol Ther (Heidelb) 2021; 11:93-104. [PMID: 33464473 PMCID: PMC7858718 DOI: 10.1007/s13555-020-00478-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Indexed: 11/29/2022] Open
Abstract
Laser-assisted drug delivery augments the distribution and penetration of topically applied treatments, leading to enhanced delivery and bioavailability. We discuss the therapeutic application of laser-assisted drug delivery in clinical practice in cases of non-melanoma skin cancer, vitiligo, melasma, scarring, and alopecia (female pattern hair loss, male pattern hair loss, alopecia areata) as well as for vaccination, local anaesthesia, analgesia, viral warts, infantile haemangiomas and cosmetic uses, and we review clinical studies that have used this technique over the last decade. Our review shows that the application of laser-assisted drug delivery enhances topical agent efficacy, potentially reducing the agent concentration and duration of topical treatment required. Future research into the use of laser-assisted drug delivery before topical therapies is needed to establish the optimal techniques to enhance drug delivery and thus improve patient outcomes.
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Affiliation(s)
| | - Faisal R Ali
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Vernova Healthcare CIC, Macclesfield, UK
| | - Firas Al-Niaimi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK. .,Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark.
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Helou J, Korkomaz J, Stephan F, Soutou B. Searching predictive factors of efficacy and safety in a fractional CO 2 laser. Dermatol Ther 2020; 33:e13985. [PMID: 32639071 DOI: 10.1111/dth.13985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
A few studies discussed short outcomes in fractional CO2 laser. This study aimed to seek factors of medium-term efficacy and safety in patients treated for facial rejuvenation or acne scars. This single-center, prospective, single-arm, evaluator-blinded cohort study included patients of 18 years and older undergoing a fractional CO2 laser for facial skin rejuvenation or atrophic acne scars. One session of ultrapulsed fractional 10 600 nm CO2 laser was performed with the Deep FX TM mode in acne scars and the Active FX TM mode in facial rejuvenation and acne scars. Follow-up was carried out for 6 months. In the end, a patient self-satisfaction assessment was obtained. A blinded physician graded improvement based on pretreatment and 6-month photography. The study included 75 patients, of whom 88% were women. Forty-five had facial rejuvenation, and 30 had atrophic acne scars treatment. Half of the patients were satisfied. The physician-blinded evaluation indicated "good to very good" improvement in 46.7% of facial rejuvenation patients, and 30% of acne scars patients. Hyperpigmentation and folliculitis were recorded in 15 and 3 patients, respectively. This study did not find statistically significant factors to predict outcomes in a fractional CO2 laser. We could however note better results in acne scar patients of thicker skin, and facial rejuvenation patients of younger age and thinner skin. We counted more hyperpigmentation events in phototypes III and IV, and it was reversible in all cases.
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Affiliation(s)
- Josiane Helou
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Department of Dermatology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | | | - Farid Stephan
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Department of Dermatology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Boutros Soutou
- School of Medicine, Université Saint-Joseph, Beirut, Lebanon.,Department of Dermatology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
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