Evidence-Based Clinical Practice Guidelines for Laser-Assisted Drug Delivery
Authors: Labadie Jessica G. , Ibrahim Sarah A. , Worley Brandon , Kang Bianca Y. , Rakita Uros , Rigali Sarah , Arndt Kenneth A. , Bernstein Eric , Brauer Jeremy A. , Chandra Sunandana , Didwania Aashish , DiGiorgio Catherine , Donelan Mattias , Dover Jeffrey S. , Galadari Hassan , Geronemus Roy G. , Goldman Mitchel P. , Haedersdal Merete , Hruza George , Ibrahimi Omar A. , Kauvar Arielle , Kelly Kristen M. , Krakowski Andrew C. , Miest Rachel , Orringer Jeffrey S. , Ozog David M. , Ross E. Victor , Shumaker Peter R. , Sobanko Joseph F. , Suozzi Kathleen , Taylor Mark B. , Teng Joyce M. C. , Uebelhoer Nathan S. , Waibel Jill , Wanner Molly , Ratchev Ina , Christensen Rachel E. , Poon Emily , Miller Corinne H. , Alam Murad 
Published: August 2022

Importance

Laser-assisted drug delivery (LADD) is used for various medical and cosmetic applications. However, there is insufficient evidence-based guidance to assist clinicians performing LADD.

Objective

To develop recommendations for the safe and effective use of LADD.

Evidence Review

A systematic literature review of Cochrane Central Register of Controlled Trials, Embase, and MEDLINE was conducted in December 2019 to identify publications reporting research on LADD. A multidisciplinary panel was convened to draft recommendations informed by the systematic review; they were refined through 2 rounds of Delphi survey, 2 consensus meetings, and iterative review by all panelists until unanimous consensus was achieved.

Findings

Of the 48 published studies of ablative fractional LADD that met inclusion criteria, 4 were cosmetic studies; 21, oncologic; and 23, medical (not cosmetic/oncologic), and 6 publications of nonablative fractional LADD were included at the request of the expert panel, producing a total of 54 studies. Thirty-four studies (63.0%) were deemed to have low risk of bias, 17 studies (31.5%) had moderate risk, and 3 (5.5%) had serious risk. The key findings that informed the guidelines developed by the expert panel were as follows: LADD is safe in adults and adolescents (≥12 years) with all Fitzpatrick skin types and in patients with immunosuppression; it is an effective treatment for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; it is useful for epidermal and dermal analgesia; drug delivery may be increased through the application of heat, pressure, or occlusion, or by using an aqueous drug solution; laser settings should be selected to ensure that channel diameter is greater than the delivered molecule; antibiotic prophylaxis is not recommended, except with impaired wound healing; antiviral prophylaxis is recommended when treating the face and genitalia; and antifungal prophylaxis is not recommended. The guideline’s 15 recommendations address 5 areas of LADD use: (I) indications and contraindications; (II) parameters to report; (III) optimization of drug delivery; (IV) safety considerations; and (V) prophylaxis for bacterial, viral, and fungal infections.

Conclusions and Relevance

This systematic review and Delphi consensus approach culminated in an evidence-based clinical practice guideline for safe and effective use of LADD in a variety of applications. Future research will further improve our understanding of this novel treatment technique.