Laser-assisted drug delivery

Laser-assisted drug delivery (LADD) is a relatively new method to increase the efficacy of topical agents used to treat many dermatoses. Performing a laser treatment on the area of the skin where the drugs are administered facilitates their penetration into the deeper layers of the skin, increases their absorption, resulting in better efficacy of the therapy. The technique is distinguished by its high degree of safety, sterility and efficacy.

Technology

The level of absorption, and therefore the effectiveness of topically applied drugs, is limited by the stratum corneum. The stratum corneum acts as a barrier protecting the skin from harmful external factors, which is an extremely important function, but its properties also limit the absorption of drugs and other substances whose absorbability is desirable for the efficacy of topical therapies.

Studies indicate that between 1 % and 5 % of the applied medicinal product is able to penetrate the skin and show a therapeutic effect. In the case of skin lesions, scars or keloids, the absorbability of therapeutic substances may be even lower. This problem has always been a challenge for doctors, and one way to minimise it is laser-assisted drug delivery. This technique is based on the use of an ablative fractional laser to make tubules in the skin that are evenly distributed throughout the treatment area. These tubules take the form of perpendicular depressions called microthermal treatment zones (MTZs). The micro-damage is thus surrounded by healthy skin, which accelerates healing. The controlled damage to the skin allows better absorption of the drug in question, as it has the chance to reach deep into the tissues where it can act most effectively.

Indications for treatment

Laser-assisted drug delivery is used in a number of dermatoses. The most common ones are listed below, but it is important to remember that it is the doctor who decides whether the patient is eligible for a particular treatment. Treatment may also be used in dermatoses not listed below.

• Skin tumours and precancerous lesions
• Benign skin lesions
• Hypertrophic scars, keloids and atrophic scars, including acne scars
• Pigmentation disorders, including melasma
• Excessive hair loss
• Androgenetic and alopecia areata
• Acne vulgaris
• Nail fungus
• Solar keratosis
• Sun exposure labial inflammation
• Acquired vitiligo
• Nail psoriasis
• Course of treatment

Each treatment is preceded by a detailed medical interview, during which the doctor rules out any contraindications, establishes the therapy schedule with the patient and answers questions. The area to be treated is cleaned and disinfected. Patients with a low pain threshold may opt for an anaesthetic, but the treatment itself is not very painful and the laser is equipped with a cooling system.  The doctor adjusts the laser parameters, such as the depth of penetration, depending on the dermatosis being treated and the drug being applied. The laser tip is directed at the area to be treated and the device emits light, which creates micro-damage in the skin thanks to its high energy. The resulting tubules close within 30 minutes, so before this time the doctor applies a dedicated medication to the treated area. In some cases, he or she may also perform a gentle massage, and during this time the active substances of the specific medicinal product get deep into the skin.

Effects

The results of a laser-assisted drug treatment include a variety of effects, depending on the dermatosis being treated. In each case, due to better drug absorption and more even distribution, the patient can expect an increase in efficacy. Depending on the disease being treated, the following results are observed:

• reduction of hair loss and acceleration of new hair regrowth,
• alleviation of acne vulgaris symptoms by reducing sebum secretion, narrowing pores and accelerating the healing of blemishes,
• brightening and reducing the appearance of hyperpigmentation, including that caused by the sun,
• support of nail fungus treatment,
• supporting the treatment of nail psoriasis,
• reducing the visibility of scars such as keloids, hypertrophic and acne scars,
• support for the treatment of cancerous and benign skin lesions.

Results may vary from patient to patient and the final outcome of treatments depends on a number of factors, including individual patient conditions and adherence to post-treatment recommendations.

Pre-treatment indications

One month before the treatment, one should refrain from sunbathing, exfoliating treatments (e.g. chemical peels), cosmetics, photosensitive drugs and herbs and not use acids in the treatment area. You should refrain from smoking 2 weeks before the treatment and you must not consume alcohol on the day of the treatment.

Indications after treatment

• No make-up should be applied until the treatment area has healed.
• No soothing or protective creams should be applied until the scabs fall off.
• Patients should avoid sunbathing for a minimum of one month prior to treatment and apply the highest sun protection to the post-treatment area for at least four months after treatment.
• Agents that could dilate blood vessels, such as alcohol or aspirin, should be avoided for about a week after laser therapy.
• Activities that could overheat the skin such as physical activity and swimming pool and sauna should be avoided for 7-14 days after the treatment.
• The skin after the procedure should be treated gently, flaky skin and scabs should not be ripped or scraped off.
• The patient should follow the post-treatment area care instructions set by the doctor.
• Factors that could potentially influence the appearance of infection should be avoided.

Recuperation

Recovery time depends on the problem being treated, the Patient's conditions, the medication used and many other factors. Immediately after the treatment, the Patient may feel warmth in the treated area. The skin is reddened, irritated and slightly swollen. Peeling of the epidermis and the formation of scabs may occur. These symptoms are natural and subside within a few hours or days. Full recovery takes about a week, while the skin peeling should resolve within 2 weeks. If a scab appears on the treated area, it should fall off spontaneously after a few/some days.

Contraindications

• pregnancy and breastfeeding
• certain chronic diseases
• taking anticoagulants
• implanted pacemakers
• active skin infections in the area to be treated
• vitiligo
• susceptibility to scarring

After consultation, the doctor decides whether a contraindication is an absolute obstacle to the procedure.

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