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. 2022 Oct 1;158(10):1193-1201.
doi: 10.1001/jamadermatol.2022.3234.

Evidence-Based Clinical Practice Guidelines for Laser-Assisted Drug Delivery

Jessica G Labadie  1 , Sarah A Ibrahim  1 , Brandon Worley  1 , Bianca Y Kang  1 , Uros Rakita  2 , Sarah Rigali  2 , Kenneth A Arndt  3   4 , Eric Bernstein  5 , Jeremy A Brauer  6 , Sunandana Chandra  7 , Aashish Didwania  8 , Catherine DiGiorgio  9 , Mattias Donelan  10   11 , Jeffrey S Dover  3   4   12 , Hassan Galadari  13 , Roy G Geronemus  14 , Mitchel P Goldman  15 , Merete Haedersdal  16   17 , George Hruza  18 , Omar A Ibrahimi  19 , Arielle Kauvar  20   21 , Kristen M Kelly  22 , Andrew C Krakowski  23 , Rachel Miest  24 , Jeffrey S Orringer  25 , David M Ozog  26 , E Victor Ross  27 , Peter R Shumaker  28 , Joseph F Sobanko  29 , Kathleen Suozzi  12 , Mark B Taylor  30 , Joyce M C Teng  31 , Nathan S Uebelhoer  32 , Jill Waibel  33 , Molly Wanner  34 , Ina Ratchev  35 , Rachel E Christensen  1 , Emily Poon  1 , Corinne H Miller  36 , Murad Alam  1   37   38   39
Affiliations

Evidence-Based Clinical Practice Guidelines for Laser-Assisted Drug Delivery

Jessica G Labadie et al. JAMA Dermatol. .

Abstract

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.

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