Efficacy of erbium:yttrium-aluminum-garnet laser-assisted delivery of topical anesthetic

Yun, Patricia Lee; Tachihara, Rieko; Anderson, R. R.

doi:10.1067/mjd.2002.124819

Cited by 62 publications

(47 citation statements)

References 16 publications

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“…Conventional Er:YAG laser ablation of stratum corneum and superficial epidermis enhanced PpIX accumulation in murine superficial skin layers and subcutaneous tumors as well as ALA penetration of in vivo porcine skin [19,20]. In addition, pre-treatment with conventional erbium:YAG laser improved the anesthetic efficacy of topically applied lidocaine [18,21]. Donnelly et al [36] evaluated microneedle-mediated intradermal delivery of 5-ALA, which enhanced ALA delivery to superficial regions of excised porcine skin, but not to deeper skin layers.…”

Section: Discussionmentioning

confidence: 96%

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Fractional CO₂ laser‐assisted drug delivery

et al. 2010

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Background and Objectives: Ablative fractional resurfacing (AFR) creates vertical channels that might assist the delivery of topically applied drugs into skin. The purpose of this study was to evaluate drug delivery by CO 2 laser AFR using methyl 5-aminolevulinate (MAL), a porphyrin precursor, as a test drug. Materials and Methods: Two Yorkshire swine were treated with single-hole CO 2 laser AFR and subsequent topical application of MAL (Metvix 1 , Photocure ASA, Oslo, Norway), placebo cream and no drug. MAL-induced porphyrin fluorescence was measured by fluorescence microscopy at skin depths down to 1,800 mm. AFR was performed with a 10.6 mm wavelength prototype CO 2 laser, using stacked single pulses of 3 millisecond and 91.6 mJ per pulse. Results: AFR created cone-shaped channels of approximately 300 mm diameter and 1,850 mm depth that were surrounded by a 70 mm thin layer of thermally coagulated dermis. There was no porphyrin fluorescence in placebo cream or untreated skin sites. AFR followed by MAL application enhanced drug delivery with significantly higher porphyrin fluorescence of hair follicles (P<0.0011) and dermis (P<0.0433) versus MAL alone at skin depths of 120, 500, 1,000, 1,500, and 1,800 mm. AFR before MAL application also enhanced skin surface (epidermal) porphyrin fluorescence. Radial diffusion of MAL from the laser-created channels into surrounding dermis was evidenced by uniform porphyrin fluorescence up to 1,500 mm from the holes (1,000, 1,800 mm depths). Skin massage after MAL application did not affect MAL-induced porphyrin fluorescence after AFR. Conclusions: Ablative fractional laser treatment facilitates delivery of topical MAL deeply into the skin. For the conditions of this study, laser channels approximately 3 mm apart followed by MAL application could produce porphyrins throughout essentially the entire skin. AFR appears to be a clinically practical means for enhancing uptake of MAL, a photodynamic therapy drug, and presumably many other topical skin medications. Lasers Surg.

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Section: Discussionmentioning

confidence: 96%

“…Erbium lasers in particular have been used for laser-assisted cutaneous drug delivery [18][19][20][21], but the potential for deep AFR-assisted drug delivery has not been studied. Whole skin in vitro is a well-accepted standard for measuring drug uptake by passive diffusion.…”

Section: Introductionmentioning

confidence: 99%

Fractional CO₂ laser‐assisted drug delivery

et al. 2010

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“…A single pulse of Er:YAG laser irradiation can remove an area of the stratum corneum, leading to enhanced uptake of topical agents such as lidocaine and epinephrine. 9 Recent studies have demonstrated that pretreatment of the skin with this laser device followed by a five-minute application of 4% liposomal lidocaine is an effective means of reducing the pain of venous cannulation in both patients 13 and volunteers. 12 The results of the current study demonstrate that laser irradiation of porcine skin results in temporary damage to the epidermis that is similar in histomorphologic appearance to a first-degree burn.…”

Section: Discussionmentioning

confidence: 99%

“…9 Several clinical trials evaluating a handheld Er:YAG laser device have demonstrated the ability of laser-assisted anesthesia to reduce the pain associated with intramuscular needle insertion 10,11 and intravenous cannulation. 12,13 However, because the laser ablates the stratum corneum, there are concerns that the associated cutaneous injury may result in adverse events such as infection and scarring.…”

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confidence: 99%

Histologic Effects of Laser‐assisted Topical Anesthesia in a Porcine Model

Singer

McClain

et al. 2005

Academic Emergency Medicine

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Objectives: A handheld laser device that removes the stratum corneum, the major barrier to transdermal absorption, has recently been approved to assist with topical anesthesia before painful procedures such as intravenous cannulation. The authors assessed the cutaneous histomorphologic effects of the laser device and the ability of the laser-treated skin to resist infection in a porcine model. Methods: This was a blinded, randomized animal experiment using isoflurane-anesthetized young domestic pigs. The ventral surface of the animals was irradiated multiple times with a lightweight, portable erbium yttrium-aluminum-garnet unit or a sham laser. One third of the wounds were inoculated with a Staphylococcus aureus suspension. The treated areas were then covered with a dry dressing, and full-thickness biopsy specimens of the treated areas were obtained immediately after treatment and at three, seven, ten, and 14 days for blinded histopathologic evaluation using hematoxylin and eosin staining and electron microscopy. Quantitative bacterial counts were obtained at three days in wounds exposed to bacteria. Main outcomes were quantitative bacterial counts, presence of cellular necrosis, epidermal integrity, and dermal scarring. Data analysis was conducted with descriptive statistics. Results: Laser irradiation resulted in immediate disruption of the cornified layer of the skin and necrosis of the stratum spinosum in all treated areas. There were also focal areas of vacuolar alteration of the basal one third of the epidermis. There was no evidence of any damage to the basement membrane or the underlying dermis. At three days, the epidermis had healed and there was evidence of epidermal hyperplasia and hyperkeratosis that was completely resolved by 14 days. There were no infections and no scarring. Sham laser had no histomorphologic effects on the skin. There was no bacterial growth from all sham laser-treated wounds challenged with bacteria. Three of 20 (15%; 95% confidence interval ¼ 0% to 31%) laser-irradiated wounds that were challenged with bacteria grew between 280,000 and 1,600,000 colony-forming units/g. Conclusions:Laser irradiation results in ablation of the stratum corneum and a superficial burn to the epidermis that heals by three to 14 days without any scarring or infection in pigs. Challenging laser-irradiated cutaneous wounds with a large bacterial inoculum resulted in bacterial growth in a minority of wounds.

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“…112 Laser-assisted drug delivery (LADD) was first introduced in 2002 with the use of the Er:YAG for the delivery of topical anesthetics. 113 Since that time, LADD has been used to synergistically treat scars and rhytides with corticosteroids, ascorbic acid, 5-FU, platelet-rich plasma (PRP), and various cosmeceuticals. 114 In general with LADD, the drug is immediately applied topically or injected in the treated area.…”

Section: Fractional Radiofrequencymentioning

confidence: 99%

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

2017

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I n recent decades, there has been a revolution in energy-based treatment options for skin scarring, rejuvenation, and tightening. One of the most promising developments has been the introduction of fractional photothermolysis, developed by Anderson and Manstein in 2004. Fractionated systems deliver laser energy in a grid-like pattern, creating microscopic columns of ablative and/or coagulative damage termed microthermal zones (MTZs), which stimulate collagen remodeling.1 The incorporation of fractional photothermolysis into energy-based devices has allowed less destruction to surrounding tissue, leading to desired results with the minimization of unwanted side effects, leading to both ablative and nonablative laser devices becoming desirable treatment options for cutaneous scarring and rejuvenation. Given their impressive results, newer fractional laser treatment options, including picosecond lasers, quality-switched (QS) lasers, and combined ablative and nonablative lasers, are being investigated for the treatment of these common skin conditions.The following review addresses the current and emerging topics on fractional laser treatment of skin scarring and rejuvenation based on the device type, including ablative, nonablative, QS, picosecond, and hybrid fractional lasers (HFLs). Additionally, newer energy-based fractional devices, such as radiofrequency (RF) with and without microneedling and the use of fractionated technology for drug delivery, are discussed in the context of these common skin conditions. Fractionated lasersTreatment options for cutaneous scars and skin rejuvenation have evolved significantly since the rise in popularity of ablative lasers in the 1990s. Newer treatment options, including ablative fractional lasers (AFL) and nonablative fractional lasers (NAFL), have garnered favor, given the milder side effect profile in comparison with traditional fully ablative lasers. Ablative fractional lasersAcne scarring AFLs were developed in an attempt to achieve the efficacy of traditional ablative lasers with the milder side effect profile of fractional technology. Although a single treatment produces less dramatic, albeit noticeable, results than traditional fully ablative lasers can, multiple treatments result in greater clinical improvement.2 Currently, there are 3 types of AFLs available for scar treatment: the 10600-nm carbon dioxide (CO2), the 2940-nm erbium:yttrium aluminum garnet (Er:YAG), and the 2740-nm yttrium scandium gallium garnet (YSGG) lasers. AFL is associated with the increased risk of both protracted erythema and postinflammatory hyperpigmentation (PIH) in darker skin types, which has led many clinicians to prefer a longer series of NAFL treatments over AFL treatments to achieve similar results with a lower risk of side effects.Multiple studies support the efficacy of the fractional CO2 laser in acne scars. The overwhelming majority of these studies investigate the utility of these lasers in atrophic facial scars. While NAFLs typically require multiple sessions to achieve modest ...

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Efficacy of erbium:yttrium-aluminum-garnet laser-assisted delivery of topical anesthetic

Cited by 62 publications

References 16 publications

Fractional CO₂ laser‐assisted drug delivery

Fractional CO₂ laser‐assisted drug delivery

Histologic Effects of Laser‐assisted Topical Anesthesia in a Porcine Model

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

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Efficacy of erbium:yttrium-aluminum-garnet laser-assisted delivery of topical anesthetic

Cited by 62 publications

References 16 publications

Fractional CO2 laser‐assisted drug delivery

Fractional CO2 laser‐assisted drug delivery

Histologic Effects of Laser‐assisted Topical Anesthesia in a Porcine Model

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

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Fractional CO₂ laser‐assisted drug delivery

Fractional CO₂ laser‐assisted drug delivery