Enhancement of topical 5-aminolaevulinic acid delivery by erbium:YAG laser and microdermabrasion: a comparison with iontophoresis and electroporation

Jy, Fang; Lee, William R.; Sc, Shen; Fang, YP; Ch, Hu

doi:10.1111/j.1365-2133.2004.06051.x

Cited by 137 publications

(101 citation statements)

References 26 publications

(27 reference statements)

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“…Among others, these include iontophoresis, ultrasound, microneedle puncture, temperature elevation as well as removal of hyperkeratosis and stratum corneum with curettage, tape stripping, microdermabrasion and laser ablation [17,23]. 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].…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

“…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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“…Our hypothesis was: if the main limiting factor is tumor depth of not more than 2 mm, we will reduce the tumor to a depth less than 2 mm with another laser method, then eradicating the remainder of the tumor (if any) with PDT. By reference to a study demonstrating greater ALA penetration after surface treatment with an Er:YAG laser, it is also expected that greater saturation of the pathological tissue can be achieved with aminolevulinate [6][7]. Er:YAG laser (same as CO2) is itself an effective tool for the ablation of nonmalign, pre-malign, and malign tumors [8,9].…”

Section: Introductionmentioning

confidence: 99%

Combination of Er:YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinoma

Smucler

Vlk

2008

Lasers Surg Med

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Backgrounds and Objectives: Photodynamic therapy (PDT), via topical aminolevulinic acid (ALA) is an effective treatment for basal cell carcinomas not exceeding a depth of 2 mm. This limits the treatment of basal cell carcinoma (non-melanoma skin cancer) to superficial forms and nodular therapy (only in aesthetically desired locations). This paper addresses the effectiveness of reducing tumor mass via initial Er:YAG laser ablation to depths that are therapeutically responsive to PDT with ALA. Study Design/Materials and Methods: This study compared three methods for the treatment of recurring nodular basal cell carcinomas (r nBCC). Method A utilized PDT with topical application of ALA methyl ester, method B with solitary Er:YAG laser ablation, and method C combined Er:YAG laser ablation reducing tumor size below 2 mm (method B) with subsequent ALA methyl ester PDT (method A). All three methods were used to treat to each patient, all subjects presenting with three or more basal cell carcinomas in order to eliminate differences in patient responsiveness to treatment. Patients were monitored and interviewed at 3, 6, and 12 month intervals to examine the progress of tumor elimination, aesthetic results as well as the patient's preference of treatment method. In all, 286 patients were treated, of whom 194 were checked at the prescribed intervals and then evaluated. Results: Statistically, the combination therapy demonstrated the most effective treatment at all time intervals, with a final efficacy of 98.97% versus 94.85% (PDT only) and 91.75% (Er:YAG laser only). The combined method also provided the best aesthetic results (scale: 1-best; 4-worst) of 1.23 AE 1.23, compared to 1.67 AE 0.76 (PDT only) and 1.83 AE 0.95 (Er:YAG laser only). Conclusions: Although 67% patients preferred solitary Er:YAG laser treatment over the PDT method (20%) and the combined treatment (13%), because of the simplicity of the treatment, the combination therapy has proven to be both clinically and aesthetically superior. Solitary Er:YAG laser ablation will remain however a fast, effective, and economical treatment alternative for simple manifestations of superficial basal cell carcinoma and has replaced PDT for uncomplicated cases at our facility. The combination of Er:YAG laser ablation and ALA-PDT aspires to be therapy of choice for BCC. Lasers Surg. Med. 40:153-158, 2008. ß

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“…According to the literature data, access of 5-aminolevulinic acid (ALA) to the cells can be augmented 2 times with the help of electric impulses (17), and the production of photofrin IX can be increased by almost 3 times in comparison with passive diffusion of ALA (18). In this study, the lifetime of the pores was measured, and it was found that lifetime of electropores varied within an interval of milliseconds depending on electroporation parameters.…”

Section: Discussionmentioning

confidence: 99%

“…In that way, electroporation could help: a) to reduce accumulation duration of a photosensitizer, b) to minimize the effective dose of the photodrug, c) to reduce the phototoxic effect of photosensitized damage on the organism. Few recent studies performed in vitro and in vivo have shown that electroporation could increase the effectiveness of PDT (17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Enhancement of photodynamic tumor therapy effectiveness by electroporation in vitro

et al. 2009

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Enhancement of topical 5-aminolaevulinic acid delivery by erbium:YAG laser and microdermabrasion: a comparison with iontophoresis and electroporation

Abstract: This basic study has encouraged the further investigation of ALA permeation by laser or microdermabrasion.

Cited by 137 publications

References 26 publications

Fractional CO₂ laser‐assisted drug delivery

Fractional CO₂ laser‐assisted drug delivery

Combination of Er:YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinoma

Enhancement of photodynamic tumor therapy effectiveness by electroporation in vitro

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Enhancement of topical 5-aminolaevulinic acid delivery by erbium:YAG laser and microdermabrasion: a comparison with iontophoresis and electroporation

Abstract: This basic study has encouraged the further investigation of ALA permeation by laser or microdermabrasion.

Cited by 137 publications

References 26 publications

Fractional CO2 laser‐assisted drug delivery

Fractional CO2 laser‐assisted drug delivery

Combination of Er:YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinoma

Enhancement of photodynamic tumor therapy effectiveness by electroporation in vitro

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Fractional CO₂ laser‐assisted drug delivery

Fractional CO₂ laser‐assisted drug delivery