- Dermatologists increasingly will use noninvasive devices for much more than fat treatments, clinicians say
- Dermatologists are beginning to use fractional CO2 lasers followed by photodynamic therapy to enhance treatment for skin cancer
and actinic keratosis
- Research may someday lead to a laser that is more selective in treating acne than the current devices are
Wailea, Hawaii — In coming years, the trend toward less invasive technologies will continue not only in fat removal and body sculpting treatments,
but also in new modalities for delivering a variety of drugs, according to physicians who spoke at MauiDerm 2012: Advances
in Cosmetic and Medical Dermatology in February.
“Some of the most exciting future technologies include using fractional laser technology to deliver drugs across the skin,”
says Omar Ibrahimi, M.D., assistant professor of dermatology, dermatologic and Mohs surgery and director of cutaneous laser
and cosmetic surgery at the University of Connecticut Health Center, Farmington.
Recent research from the Wellman Center has shown that “a single hole made by ablative fractional resurfacing (AFR) increases
the delivery of a drug logarithmically — it’s not just a two- or fourfold increase. It’s manyfold,” he says.
In a porcine model, investigators found that CO2 laser-ablated channels cut 1,850 m deep, facilitating significantly 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 found that treatment with an ablative fractional CO2 laser followed by topical MAL enhanced drug delivery, providing significantly higher porphyrin fluorescence of hair follicles
(P0.0011) and dermis (P0.0433) versus MAL alone at skin depths ranging from 120 m to 1,800 m (Haedersdal M, Sakamoto FH,
Farinelli WA, et al. Lasers Surg Med. 2010;42(2):113-122).
Other medical advances
“People are using fractional CO2 lasers followed by PDT to enhance therapies for skin cancers and actinic keratosis,” says Michael H. Gold, M.D., medical
director, Gold Skin Care Center and Tennessee Clinical Research Center, and clinical assistant professor, Division of Dermatology,
Vanderbilt University School of Medicine and Vanderbilt University School of Nursing, Nashville. “Those technologies are starting
to play a big role now.”
In a small case series, investigators have shown how AFR with a fractional CO2 laser improves MAL uptake and may intensify results of treatments for 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 ultrasound device (Alma), commercially available in Europe and Asia,
“You can create holes in the skin. Then you apply an active onto the skin and ‘hammer’ it with ultrasound into the skin. The
plan is to conduct U.S. trials on this device, which are expected to start within the next six to 12 months,” he says. “The
machine is doing very well outside the United States, and its results are pretty impressive.” Dr. Gold says he has submitted
an article on the device for publication.
One very recent study shows that investigators were able to vaccinate 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 study showed that it’s possible to deliver large molecules through
the skin, “whereas traditionally you couldn’t do that by topically applying large protein or peptide molecules.”
Also in a mouse model, researchers used a blue methylene dye and red 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 to diabetics so they won’t have to undergo needle sticks. This technology
has many promising applications,” Dr. Ibrahimi says.