Update of Ablative Fractionated Lasers to Enhance Cutaneous Topical Drug Delivery.

Danielle M Nicolazzo,Ashley Rudnick,Jill S Waibel,Deborah R Shagalov

doi:10.1007/s12325-017-0516-9

Abstract

Ablative fractional lasers (AFXL) enhance uptake of therapeutics and this newly emerging field is called laser-assisted drug delivery (LAD). This new science has emerged over the past decade and is finding its way into clinical practice. LAD is poised to change how medicine delivers drugs. Topical and systemic application of pharmaceutical agents for therapeutic effect is an integral part of medicine. With topical therapy, the stratum corneum barrier of the skin impairs the ability of drugs to enter the body. The purpose of LAD is to alter the stratum corneum, epidermis, and dermis to facilitate increased penetration of a drug, device, or cell to its respected target. AFXL represents an innovative, non-invasive strategy to overcome the epidermal barrier. LAD employs three steps: (1) breakdown of the skin barrier with a laser, (2) optional use a laser for a therapeutic effect, (3) delivery of the medicine through laser channels to further enhance the therapeutic effect. The advantages of using lasers for drug delivery include the ease of accessibility, the non-invasive aspect, and its effectiveness. By changing the laser settings, one may use LAD to have a drug remain locally within the skin or to have systemic delivery. Many drugs are not intended for use in the dermis and so it has yet to be determined which drugs are appropriate for this technique. It appears this developing technology has the ability to be a new delivery system for both localized and systemic delivery of drugs, cells, and other molecules. With responsible development AFXL-assisted drug delivery may become a new important part of medicine.

Highlights

INTRODUCTIONDrug delivery is essential in the treatment of medical conditions. The efficacy of topical therapy is dependent on the ability of the therapeutic drug to reach its target
History of Laser-Assisted DeliveryDrug delivery is essential in the treatment of medical conditions
Drugs which are semi-lipophilic and small (\500 Da) may pass through the stratum corneum because the keratinocytes are embedded in a lipid matrix

Summary

INTRODUCTION

Drug delivery is essential in the treatment of medical conditions. The efficacy of topical therapy is dependent on the ability of the therapeutic drug to reach its target. Ablative fractional lasers (AFXLs), either carbon dioxide (CO2) or erbium:YAG (Er:YAG), provide a novel way to create a conduit in the stratum corneum, epidermal, and dermal layers, increasing penetration of topically applied molecules in a predictable and controlled pattern. AFXL creates vertical channels of ablation, opening a doorway into the human body Both CO2 and Er:YAG lasers are infrared lasers that heat skin tissue over 100 °C and cause vaporization. The CO2 laser has an absorption coefficient of 2 9 106/cm and takes higher energies to ablate tissue, resulting in increased thermal damage (coagulation zone) around the ablated channels compared to Er:YAG (Fig. 1). The objectives of a cutaneous delivery system include increasing access to therapeutic targets, decreasing the amount of drug needed, decreasing adverse events in other organs, and ease of use for patients. LAD is a new emerging concept bridging medicine with technology to improve health care [4]

Methodology of LAD

Findings

CONCLUSIONS