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Labadie JG, Ibrahim SA, Worley B, Kang BY, Rakita U, Rigali S, Arndt KA, Bernstein E, Brauer JA, Chandra S, Didwania A, DiGiorgio C, Donelan M, Dover JS, Galadari H, Geronemus RG, Goldman MP, Haedersdal M, Hruza G, Ibrahimi OA, Kauvar A, Kelly KM, Krakowski AC, Miest R, Orringer JS, Ozog DM, Ross EV, Shumaker PR, Sobanko JF, Suozzi K, Taylor MB, Teng JMC, Uebelhoer NS, Waibel J, Wanner M, Ratchev I, Christensen RE, Poon E, Miller CH, Alam M. Evidence-Based Clinical Practice Guidelines for Laser-Assisted Drug Delivery. JAMA Dermatol 2022; 158:1193-1201. [PMID: 35976634 DOI: 10.1001/jamadermatol.2022.3234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Laser-assisted drug delivery (LADD) is used for various medical and cosmetic applications. However, there is insufficient evidence-based guidance to assist clinicians performing LADD. Objective To develop recommendations for the safe and effective use of LADD. Evidence Review A 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. Findings Of 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 Relevance This 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.
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Affiliation(s)
- Jessica G Labadie
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Uros Rakita
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Sarah Rigali
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Kenneth A Arndt
- SkinCare Physicians, Chestnut Hill, Massachusetts.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eric Bernstein
- Main Line Center for Laser Surgery, Ardmore, Pennsylvania
| | - Jeremy A Brauer
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Sunandana Chandra
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Aashish Didwania
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Mattias Donelan
- Shriners Hospital for Children-Boston, Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, Massachusetts.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Mitchel P Goldman
- Cosmetic Laser Dermatology, West Dermatology Company, San Diego, California
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark.,Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - George Hruza
- Departments of Dermatology and Otolaryngology, St Louis University-Laser and Dermatologic Surgery Center, St Louis, Missouri
| | | | - Arielle Kauvar
- New York Laser & Skin Care, New York.,New York University Grossman School of Medicine, New York, New York
| | - Kristen M Kelly
- Department of Dermatology, University of California Irvine School of Medicine, Irvine
| | - Andrew C Krakowski
- Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania
| | - Rachel Miest
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey S Orringer
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Peter R Shumaker
- Veterans Affairs San Diego Healthcare System and University of California, San Diego, California
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen Suozzi
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Mark B Taylor
- Gateway Aesthetic Institute & Laser Center, Salt Lake City, Utah
| | - Joyce M C Teng
- Department of Dermatology, School of Medicine, Stanford University, Stanford, California
| | | | - Jill Waibel
- Miami Dermatology and Laser Institute, Miami, Florida
| | - Molly Wanner
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ina Ratchev
- Section of Cutaneous Surgery, Northwestern Medical Group, Chicago, Illinois
| | - Rachel E Christensen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Corinne H Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Khalighi HR, Mojahedi M, Parandoosh A. Efficacy of Er,Cr:YSGG laser-assisted delivery of topical anesthesia in the oral mucosa. Clin Oral Investig 2020; 25:1055-1058. [PMID: 32556664 DOI: 10.1007/s00784-020-03399-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Lasers which can reduce epithelium thickness will enhance the penetration of topical drugs. To date, no study has assessed the efficacy of this technique in the oral mucosa. The aim of this study was the evaluation of efficacy of this technique in increasing the effect of topical anesthesia in the oral mucosa. MATERIALS AND METHODS On 20 volunteers, half of the lower lip mucosa was irradiated with Er,Cr:YSGG laser with 2780 nm wavelength and 1.3 J/cm2 energy for 1 min; then, topical lidocaine was applied on the entire lower lip mucosa. After 5 min, a 27-gauge needle was inserted to each half of the lip mucosa, and the length of the needle inserted into the mucosa without feeling pain was considered the depth of insertion. This measurement was repeated every 15 min for 1 h. RESULTS The mean depth of anesthesia at the control side was 6.95 ± 2.43, 8.45 ± 4.05, 6.5 ± 3.00, and 3.85 ± 2.08 mm at 5, 20, 35, and 60 min, respectively. These values at the test side were 12.25 ± 5.42, 13.25 ± 5.02, 11.4 ± 5.03, and 9.10 ± 5.84 mm, respectively. According to repeated-measures ANOVA, the effect of the type of the treatment on the depth of insertion was significant (P < 0.001). CONCLUSIONS The results showed that irradiation of Er,Cr:YSGG laser before the topical application of the anesthetic agents on the oral mucosa increases their efficacy. CLINICAL RELEVANCE Topical anesthesia is used to enhance dental procedures painlessly, but there is controversy in their efficacy. Laser-assisted drug delivery to the oral mucosa can enhance their efficacy.
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Affiliation(s)
- Hamid Reza Khalighi
- Oral Medicine Department, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Tehran, 1983963113, Iran.
| | - Massoud Mojahedi
- Laser Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Oni G, Brown SA, Kenkel JM. Can fractional lasers enhance transdermal absorption of topical lidocaine in an in vivo animal model? Lasers Surg Med 2012; 44:168-74. [PMID: 22302761 DOI: 10.1002/lsm.21130] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE It has been shown in vitro that pretreatment of skin with fractional lasers enhances transdermal delivery of drugs. The aim of this study is to demonstrate in vivo firstly that laser enhances transdermal drug absorption and secondly that this can be manipulated by altering laser settings. STUDY DESIGN/MATERIALS AND METHODS Four pigs were used in the IACUC approved animal study. On day 0, 5 g of 4% topical lidocaine was applied under occlusion for 60 minutes to a 400 cm(2) area on the abdomen. Blood was drawn at 0, 60, 90, 120, 180, and 240 minutes. On day 7, the Er:YAG laser was used at 500, 250, 50, and 25 µm ablative depth, respectively, over a 400 cm(2) area on the abdomen. Five grams of 4% topical lidocaine was applied immediately with occlusion for 60 minutes, and then removed. Blood was drawn at 0, 60, 90, 120, 180, and 240 minutes. The serum was extracted and analyzed for lidocaine and its metabolite monoethylglycinexylidide (MEGX). RESULTS Serum levels of lidocaine and MEGX were undetectable in untreated skin. Following laser treatment both lidocaine and MEGX were detectable. Peak levels of lidocaine were significantly higher (P = 0.0002) at 250 µm (0.62 mg/L), compared to 500 µm (0.45 mg/L), 50 µm (0.48 mg/L), and 25 µm (0.3 mg/L). Peak levels of MEGX were significantly higher (P ≤ 0.0001) at 250 µm (0.048 mg/L), compared to 500 µm (0.018 mg/L), 50 µm (0.036 mg/L), and 25 µm (0.0144 mg/L). CONCLUSIONS This study demonstrates that laser pretreatment significantly increases absorption of topical lidocaine so that it is detectable in the blood and that manipulating laser settings can affect drug absorption. Future work will look at translating this effect into clinical benefit.
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Affiliation(s)
- Georgette Oni
- Plastic Surgery Department, UT Southwestern Medical Center, Dallas, Texas, USA
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