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Objectives: The therapeutic efficacy of topical drugs is related to their ability to penetrate through the stratum corneum, which is a hydrophobic and brick and mortar barrier structure. To enhance drug bioavailability, several chemical or physical strategies have been recently advocated to enhance drug delivery at deeper skin layers so as to reach target cells

Introduction: In recent studies, for Mal or steroids, among all techniques, drug delivery was most enhanced after AFXL CO2 pretreatment, followed by sandpaper abrasion and microneedling (it seems that the coagulation zone thickness around microchannels impacts the degree of absorption).
Laser settings must be adapted to each specific indication: low fluence (5-10 mJ/MTZ) and low density (5%) are recommended for MAL laser CO2 assisted delivery on the face and the scalp.

Materials / method: In daily practice, optimal channel width, depth and density would vary according to various factors: indication, patient and area of the body being treated (thickness of the lesion or of the intact stratum corneum or nail…, age, gender, ethnicity…) & molecule being delivered (molecular weight, charges, hydrophily…). Other practical key points:
- vehicle of the drug: liquid and gel formulations penetrate laser channels more readily than cream formulations
- Timing of application: Skin uptake increases within the first 6 hours, and is greatest within 30 minutes after laser exposure

Results: Emergent risks can be expected and some have already been reported: Infection (non sterile preparation, occlusion, erosion as for 5-FU… ); systemic absorption and toxicity (poisoning with lidocaïne); intensified local cutaneous adverse effects of the drug (MAL: phototoxicity, delayed wound healing… , steroids: atrophy, hypochromia, 5-FU, IMQ, MTX : pain, erosion, hyperpigmentation, wounds, scars…); immunogenicity: local or systemic hypersensitivity reactions due to the introduction of immunogenic particles into the dermis, carcinogenicity (hydroquinone?, excipients?), teratogenicity

Conclusion: Our advice in 2019:
- Use of products suited for intradermal injections or topical products in as pure a formulation as possible
- Treat only localized body surface areas (respect contraindications of each drug delivered, ex. pregnancy or desire of pregnancy…)
- Use of drug doses not higher than those administered during intra-dermal injections
- Use only specific non allergenic care products after those procedures
Main reference
Pr Haedersdal M, Dover JS et al.
Challenges to Laser-Assisted Drug Delivery : Applying Theory to Clinical Practice
Lasers Surg Med 2018 Jan

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Objectives: Background: Melasma is a difficult-to-treat hyperpigmentary disorder. Ablative fractional laser (AFL)-assisted delivery of topically applied drugs to varied targets in the skin has been an area of ongoing study and research.

Introduction: The objective of this study was to evaluate the efficacy and safety of fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser as an assisted drug delivery for enhancing topical hydroquinone (HQ) permeation into the skin of melasma patients.

Materials / method: Thirty female patients with bilateral melasma were randomly treated in a split-face controlled manner with a fractional Er:YAG laser followed by 4% HQ cream on one side and 4% HQ cream alone on the other side. All patients received six laser sessions with a 2-week interval. The efficacy of treatments was determined through photographs, dermoscopic photomicrographs and Melasma Area Severity Index (MASI) score, all performed at baseline and at 12 weeks of starting therapy. The patient’s level of satisfaction was also recorded.

Results: Er:YAG laser + HQ showed significantly better results (p<0.005) with regard to decrease in the degree of pigmentation as assessed on the 4-point scale than HQ alone. There was a significant decrease in MASI scores on Er:YAG laser + HQ side vs HQ side. Minor reversible side effects were observed on both sides.

Conclusion: AFL-assisted delivery of HQ is a safe and effective method for the treatment of melasma.

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请注明名称（个人，公司，学会等等）: L'oreal, Skinceutical, ASDS grand,

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请注明日期: Non
和审阅情况: 2009

这项工作没有任何直接或间接的资金支持。由作者自己承担责任。