Wailea, Hawaii — In coming years, the trend toward less invasivetechnologies will continue not only in fat removal and bodysculpting treatments, but also in new modalities for delivering avariety of drugs, according to physicians who spoke at MauiDerm2012: Advances in Cosmetic and Medical Dermatology in February. "Some of the most exciting future technologies include usingfractional laser technology to deliver drugs across the skin," saysOmar Ibrahimi, M.D., assistant professor of dermatology,dermatologic and Mohs surgery and director of cutaneous laser andcosmetic surgery at the University of Connecticut Health Center,Farmington. Recent research from the Wellman Center has shown that "a singlehole made by ablative fractional resurfacing (AFR) increases thedelivery of a drug logarithmically — it's not just a two- orfourfold increase. It's manyfold," he says. |
In a porcine model, investigators found that CO 2 laser-ablated channels cut 1,850 deep, facilitatingsignificantly increased topical methyl aminolevulinate(MAL)-induced porphyrin fluorescence and photodynamic therapy (PDT)response, both superficially and deep, versus topical MAL alone(Haedersdal M, Katsnelson J, Sakamoto FH, et al. Lasers Surg Med . 2011;43(8):804-813). In an earlier porcine study, the same team of investigators foundthat treatment with an ablative fractional CO 2 laser followed by topical MAL enhanced drug delivery, providingsignificantly higher porphyrin fluorescence of hair follicles(P 0.0011) and dermis (P 0.0433) versus MAL alone at skindepths ranging from 120 to 1,800 (Haedersdal M, Sakamoto FH,Farinelli WA, et al.
Lasers Surg Med . 2010;42(2):113-122). Other medical advances "People are using fractional CO 2 lasers followed by PDT to enhance therapies for skin cancers andactinic keratosis," says Michael H. Gold, M.D., medical director,Gold Skin Care Center and Tennessee Clinical Research Center, andclinical assistant professor, Division of Dermatology, VanderbiltUniversity School of Medicine and Vanderbilt University School ofNursing, Nashville.
"Those technologies are starting to play a bigrole now." In a small case series, investigators have shown how AFR with afractional CO 2 laser improves MAL uptake and may intensify results of treatmentsfor basal cell carcinoma (Haedersdal M, Togsverd-Bo K, Paasch U. Lasers Med Sci . 2012 Jan 6. [Epub ahead of print]).
Likewise, Dr. Gold says that with the Legato iPixel plus ultrasounddevice (Alma), commercially available in Europe and Asia, "You cancreate holes in the skin. Then you apply an active onto the skinand 'hammer' it with ultrasound into the skin. The plan is toconduct U.S. trials on this device, which are expected to startwithin the next six to 12 months," he says.
"The machine is doingvery well outside the United States, and its results are prettyimpressive." Dr. Gold says he has submitted an article on thedevice for publication. One very recent study shows that investigators were able tovaccinate mice using AFR (Chen X, Shah D, Kositratna G, et al. J Control Release . 2012 Jan 9.
[Epub ahead of print]). Dr. Ibrahimi says this studyshowed that it's possible to deliver large molecules through theskin, "whereas traditionally you couldn't do that by topicallyapplying large protein or peptide molecules." Also in a mouse model, researchers used a blue methylene dye andred light to cure cutaneous Candida albicans infections (Dai T, Bil de Arce VJ, Tegos GP, Hamblin MR. Antimicrob Agents Chemother.
2011;55(12):5710-5717. Epub 2011 Sep 19). "AFR might ultimately be an ideal way to deliver insulin todiabetics so they won't have to undergo needle sticks. Thistechnology has many promising applications," Dr.
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