Skin development and permeability

Ablative fractional resurfacing in topical drug delivery: an update and outlook

BACKGROUND

The effective delivery of therapeutic molecules to varied targets in the skin and elsewhere has been an area of ongoing research and development.

OBJECTIVE

To review the structure of the skin with an emphasis on topical drug delivery and to present the rationale for the use of ablative and nonablative fractional resurfacing in assisted drug delivery.

METHODS AND MATERIALS

Review of the currently available scientific literature on laser-assisted drug delivery.

RESULTS

A number of strategies can be employed to enhance topical drug delivery. Ablative fractional resurfacing (AFR) has been demonstrated to be effective in enhancing drug delivery. Further studies are needed to assess the use of nonablative fractional resurfacing in assisted drug delivery.

CONCLUSION

AFR-assisted drug delivery is a promising tool for the future of dermatology. We expect to see a number of agents to be paired with AFR for enhanced drug delivery. Further investigation is necessary to evaluate appropriate drug specific channel density and depth parameters. Factors that must be considered include the physicochemical properties of the drug, the target tissue, skin wounding, and cost when evaluating the drugs and conditions that will most benefit from this promising new drug delivery system.

Percutaneous permeation enhancement by terpenes: mechanistic view

A popular approach for improving transdermal drug delivery involves the use of penetration enhancers (sorption promoters or accelerants) which penetrate into skin to reversibly reduce the barrier resistance. The potential mechanisms of action of penetration enhancers include disruption of intercellular lipid and/or keratin domains and tight junctions. This results in enhanced drug partitioning into tissue, altered thermodynamic activity/solubility of drug etc. Synthetic chemicals (solvents, azones, pyrrolidones, surfactants etc.) generally used for this purpose are rapidly losing their value in transdermal patches due to reports of their absorption into the systemic circulation and subsequent possible toxic effect upon long term application. Terpenes are included in the list of Generally Recognized As Safe (GRAS) substances and have low irritancy potential. Their mechanism of percutaneous permeation enhancement involves increasing the solubility of drugs in skin lipids, disruption of lipid/protein organization and/or extraction of skin micro constituents that are responsible for maintenance of barrier status. Hence, they appear to offer great promise for use in transdermal formulations. This article is aimed at reviewing the mechanisms responsible for percutaneous permeation enhancement activity of terpenes, which shall foster their rational use in transdermal formulations.

A novel foam vehicle for delivery of topical corticosteroids

Skin, particularly the uppermost layer--the stratum corneum--presents a formidable, largely impassable barrier to the entry of most compounds. Recently, a novel thermolabile, low-residue foam vehicle, VersaFoam (Connetics Corp, Palo Alto, Calif), has emerged that offers a number of clinical and cosmetic advantages for the delivery of therapeutic agents through the skin. Two corticosteroids--mid-potency betamethasone valerate and ultra-high-potency clobetasol propionate--are now available in this formulation, and other products are in development to deliver clindamycin and ketoconazole in the foam vehicle. A series of in vitro studies have demonstrated that the new foam has the ability to deliver the active drug at an increased rate compared with other vehicles. These findings suggest that the new foam utilizes a nontraditional "rapid-permeation" pathway for the delivery of drugs. It is likely that components within the foam (probably the alcohols) act as penetration enhancers, and reversibly alter the barrier properties of the outer stratum corneum, thus driving the delivered drug across the skin membrane via the intracellular route. This is in contrast to traditional topical delivery vehicles, which must first rely on hydration of the intercellular spaces in the stratum corneum to achieve drug delivery. The latter mechanism reflects a hydration-dependent process, which may result in comparatively slower drug permeation.

Chemical enhancement of percutaneous absorption in relation to stratum corneum structural alterations

The outermost layer of the skin, stratum corneum (SC), provides an outstanding barrier against the external environment and is also responsible for skin impermeability toward most solutes. The barrier function is related to the unique composition of the SC lipids and their complex structural arrangement. The lipoidal matrix of the SC, therefore, is a target of penetration enhancer action. The literature on the skin barrier structure and function and on the mechanisms of action of some well established permeation promoters, with a focus on their impact on SC structural alterations, is reviewed. Data obtained from infrared, thermal, and fluorescence spectroscopic examinations of the SC and its components imply enhancer improved permeation of solutes through the SC is associated with alterations involving the hydrocarbon chains of the SC lipid components. Data obtained from electron microscopy and X-ray diffraction reveals that the disordering of the lamellar packing is also an important mechanism for increased permeation of drugs induced by penetration enhancers.

Ultrasonically enhanced transdermal drug delivery. Experimental approaches to elucidate the mechanism

The effect of therapeutic range ultrasound on skin permeability was studied in vitro. Permeating molecule ionization state, pH, ultrasound duration, reversibility of the enhancement phenomenon, and skin structural alterations were evaluated. It was found that ultrasound affects the permeability of both ionized and unionized molecules. No irreversible structural alterations due to the ultrasound exposure were detected in the stratum corneum. Ultrasound enhancing mechanism was discussed.

Enhanced permeation and stratum corneum structural alterations in the presence of dithiothreitol

Stratum corneum protein biochemical and biophysical structural contributions to the barrier properties of human epidermis were determined in the presence of the reducing agent dithiothreitol (DTT). Mannitol and sucrose permeation through human epidermis in the presence of 0 to 50 mM DTT in PBS (pH 7.4) was measured in symmetric, side-by-side diffusion cells (32 degrees C). DTT enhancement ratios, KP(DTT)/KP(PBS), ranging from 1.6 to 32, were dependent on skin donor and DTT concentrations. DTT did not alter stratum corneum uptake of mannitol or sucrose nor mannitol solubility in DTT/PBS solutions. Stratum corneum biophysical structure was ascertained by FTIR in solvent replacement experiments. DTT-induced protein conformational alterations were apparent in the emergence of an Amide I band near 1615 cm-1, which is generally associated with beta-sheet-like conformers. Therefore, DTT alters stratum corneum biophysical structure through interactions with proteins. After exposure of stratum corneum protein sheets to DTT/PBS solutions, the free thiol concentration increased from < 1 nmol SH/mg protein sheet to approx. 130 nmol/mg. The enhanced permeation which increased with increasing concentrations of DTT, was associated with diffusion mechanisms involving the cornified cells of the stratum corneum. These results indicate that corneocyte protein integrity does contribute to barrier function of the skin and influences the transport of polar solutes.

Transdermal delivery and intramuscular injection of trimethoprim/sulphadiazine in sucking piglets

The pharmacokinetics of a combination of trimethoprim (TMP) and sulphadiazine (SDZ) after topical application to sucking piglets was compared with the pharmacokinetics after intramuscular injection. A long-lasting and fairly constant SDZ/TMP concentration ratio in plasma was obtained after topical application. The mean plasma concentration of TMP ranged from 0.091 to 0.17 micrograms/ml and that of SDZ from 0.72 to 1.1 micrograms/ml for at least 24 h. TMP and SDZ had different half-lives after intramuscular injection. Transdermal delivery of a combined preparation of TMP/SDZ may be usable for colibacillosis of sucking piglets, although the bioavailability of the drugs is poor.

The water permeability of primary mouse keratinocyte cultures grown at the air-liquid interface

In order to study the development of the epidermal permeability barrier in vitro, tritiated water (HTO) flux was measured across murine keratinocytes cultured at the air-liquid interface. Using a micro-diffusion technique, it was shown that air-liquid cultures form areas where the water diffusion is comparable to that of intact neonatal mouse skin. When water permeability is measured over a large area of the culture surface, however, significantly higher flux is obtained. These results show that under the culture conditions used, areas of water barrier comparable to intact neonatal mouse skin coexist with regions of less complete barrier formation.