Comparative analysis of the effects of CO2 fractional laser and sonophoresis on human skin penetration with 5-aminolevulinic acid

Choi, Jin-Hwan; Shin, Euncheol; Jeong, Ki‐Heon; Shin, Min Kyung

doi:10.1007/s10103-017-2305-8

Cited by 17 publications

(9 citation statements)

References 25 publications

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“…The ability of TMFI pretreatment technology to prominently enhance ALA's percutaneous permeation using the compounded gel preparation resembles the performance of AFXL as reported by Choi et al at 10 and 20 mJ per micropore. Notably, TMFI applies 0.15 mJ per micropore at 6 milliseconds×400 µm.…”

Section: Discussionsupporting

confidence: 61%

“…The deep holes created by the laser serve as a channel for transport of the topical drug into the epidermis by eliminating the SC barrier, while the CZ may serve as a reservoir for small hydrophilic drugs, allowing slow release into the dermis . As reported by Choi et al , typical settings are 10–20 mJ per micropore using a 10,600 nm CO 2 fractional laser (eCO2®; Lutronic Co., Ltd., Seoul, Korea).…”

Section: Introductionmentioning

confidence: 99%

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A New Method for Percutaneous Drug Delivery by Thermo‐Mechanical Fractional Injury

Shavit¹,

Dierickx²

2019

Lasers Surg Med

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Background and Objectives: Percutaneous drug delivery (PDD) is a means of increasing the uptake of topically applied agents into the skin. Successful delivery of a photosensitizer into the skin is an important factor for effective photodynamic therapy. To evaluate the efficacy of pretreatment by thermomechanical fractional injury (TMFI) (Tixel ® , Novoxel ® , Israel) at low-energy settings in increasing the permeability of the skin to a known hydrophilic-photosensitizer medication, 5-amino-levulinic-acid hydrochloride (ALA) in compounded 20% ALA gel. To compare the effect of TMFI on ALA permeation into the skin in compounded gel to three commercial photosensitizing medications in different vehicles: ALA microemulsion gel, methyl-amino-levulinic-acid hydrochloride (MAL) cream, and ALA hydroalcoholic solution. Study Design/Materials and Methods: Five healthy subjects were treated in two separate experiments and on a total of 136 test sites, with four topical photosensitizer preparations as follows: compounded 20% ALA gel prepared in a good manufacturing practice (GMP)certified pharmacy (Super-Pharm Professional, Israel), 10% ALA microemulsion gel (Ameluz ® , Biofrontera Bioscience GmbH, Leverkusen, Germany), 16.8% MAL cream (Metvix ® , Galderma, Lausanne, Switzerland), and 20% ALA hydroalcoholic solution (Levulan Kerastick ® , DUSA Pharmaceuticals, Inc., Wilmington, MA, USA). The dermal sites were pretreated by Tixel ® (Novoxel ® Ltd., Israel) prior to topical drug application. One site was untreated to serve as control. Protoporphyrin IX (PpIX) fluorescence intensity readouts were taken immediately and 1, 2, 3, 4, and 5 hours posttreatment. Results: The highest average PpIX fluorescence intensity measurements were obtained for the compounded 20% ALA gel following pre-treatment by TMFI at 6 milliseconds pulse duration. After 2 and 3 hours, TMFI-treated sites exhibited an increased hourly rate in readouts of FluoDerm units, which were 156-176% higher than the control rates (P ≤ 0.004). TMFI pre-treatment did not enhance the percutaneous permeation of either ALA or MAL following the microemulsion gel, hydroalcoholic solution, and cream applications. Conclusions: Pretreatment with low-energy TMFI at a pulse duration of 6 milliseconds increased the percutaneous permeation of ALA linearly over the first 5 hours from application when the compounded 20% ALA gel was used. Formulation characteristics have substantial influence on the ability of TMFI pretreatment to significantly increase the percutaneous permeation of ALA and MAL. Lasers Surg. Med.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

A New Method for Percutaneous Drug Delivery by Thermo‐Mechanical Fractional Injury

Shavit¹,

Dierickx²

2019

Lasers Surg Med

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“…Waibel et al used a transdermal acoustic pressure wave device to enhance delivery of aminolevulinic acid in an in vivo study, showing increased penetration depth of aminolevulinic acid. In contrast, Choi et al did not find any additional effect of sonophoresis in AFXL assisted delivery of aminolevulinic acid. In one of the very first studies on the subject of AFXL assisted drug delivery skin massage did not seem to improve uptake of methyl aminolevulinate in the skin .…”

Section: Discussionmentioning

confidence: 81%

Drug penetration enhancement techniques in ablative fractional laser assisted cutaneous delivery of indocyanine green

et al. 2019

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Background and Objectives Topical drug delivery can be increased by pretreatment of the skin with ablative fractional laser (AFXL). Several physical penetration enhancement techniques have been investigated to further improve AFXL‐assisted drug delivery. This study investigated the influence of three of these techniques, namely massage, acoustic pressure wave treatment, and pressure vacuum alterations (PVP) on the distribution of the fluorescent drug indocyanine green (ICG) at different depths in the skin after topical application on AFXL pretreated skin. Materials and Methods In ex vivo human skin, test regions were pretreated with AFXL (10,600 nm, channel depth 300 μm, channel width 120 μm, density 15%). Subsequently, ICG was applied, followed by massage, acoustic pressure wave treatment or PVP. ICG fluorescence intensity (FI) was assessed after 1, 3, and 24 hours at several depths using fluorescence photography. Results FI was higher when using enhancement techniques compared to control (AFXL‐only) up to 3 hours application time (P < 0.05). After 3 hours, mean surface FI was highest after acoustic pressure wave treatment (61.5 arbitrary units; AU), followed by massage (57.5AU) and PVP (46.9AU), respectively (for comparison: AFXL‐only 31.6AU, no pretreatment 14.9AU). Comparable or higher FI was achieved already after 1 hour with enhancement techniques compared to 3–24 hours application time without. After 24 hours, no significant differences between enhancement techniques and AFXL‐only were observed (P = 0.31). Conclusion Penetration enhancement techniques, especially acoustic pressure wave treatment and massage, result in improved drug accumulation in AFXL‐pretreated skin and reduce the application time needed. Lasers Surg. Med. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

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“…This has led to increased efficacy of PDT treatment . Additional novel methods for enhancing the penetration of either ALA or MAL photosensitizers in human skin prior to PDT include the combination of sonophoresis with fractional CO 2 laser or sonophoresis with radiofrequency .…”

Section: Discussionmentioning

confidence: 99%

Split‐Sided Chest Study of Skin Rejuvenation Comparing Low‐Energy, 1,927‐nm Thulium Fractional Laser Treatment Prior to Photodynamic Therapy Versus Photodynamic Therapy Alone

et al. 2019

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Background and Objectives: Treatment of photoaging and intrinsic aging of the chest, with the associated concerns of skin roughness, uneven pigmentation, laxity, atrophy, and telangiectasias, can be problematic because of the potential for worsened esthetic outcomes with existing treatments. This study assessed the efficacy and safety of using nonablative fractional laser therapy (FLT) pretreatment with photodynamic therapy (PDT) versus PDT alone for chest rejuvenation. Study Design/Materials and Methods: In a randomized, evaluator-blinded, split-sided study, adult female patients with photodamage to the chest received three treatment courses over an 8-week period with follow-up visits at Weeks 12 and 20. FLT was applied to one side of the chest, randomly assigned at baseline, followed by aminolevulinic acid-based PDT, delivered using a thermal, short incubation, broad area technique, to both sides of the chest. In-person and photographic assessments were conducted using fivepoint scales to evaluate outcomes including rhytides, pigmentation, skin texture, and telangiectasias. Results: Eleven adults completed the study, of whom 11 had improved scores for rhytides and 10 had improved scores for skin texture at Week 20. There was no significant difference in any efficacy outcome between FLT and PDT and standard PDT alone. The severity of adverse events was rated significantly greater with the combined FLT-PDT treatment vs PDT alone. Conclusions: Significant improvements were observed vs baseline for both sides of the chest treated with FLT-PDT or standard PDT following three treatment sessions. No significant difference in efficacy was observed between treatment approaches, although adverse events were more severe on the FLT-pretreated side. This study was not registered as it qualified as a nonsignificant risk study. Lasers Surg. Med.

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Comparative analysis of the effects of CO2 fractional laser and sonophoresis on human skin penetration with 5-aminolevulinic acid

Cited by 17 publications

References 25 publications

A New Method for Percutaneous Drug Delivery by Thermo‐Mechanical Fractional Injury

A New Method for Percutaneous Drug Delivery by Thermo‐Mechanical Fractional Injury

Drug penetration enhancement techniques in ablative fractional laser assisted cutaneous delivery of indocyanine green

Split‐Sided Chest Study of Skin Rejuvenation Comparing Low‐Energy, 1,927‐nm Thulium Fractional Laser Treatment Prior to Photodynamic Therapy Versus Photodynamic Therapy Alone

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