Dermatopharmacology

In evidence-based clinical practice guidelines published online Aug. 17 in
 
 JAMA Dermatology
 
 , recommendations are presented for the safe and effective use of laser-assisted drug delivery (LADD).




 Jessica G. Labadie, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues developed recommendations for safe and effective use of LADD. Draft recommendations were informed by a systematic review and were refined through a Delphi survey, consensus meetings, and iterative review until unanimous consensus was achieved. A total of 48 published studies of ablative fractional LADD met inclusion criteria, and six publications of nonablative fractional LADD were included at the request of the expert panel.




 Thirty-four, 17, and three studies had low, moderate, and serious risk for bias, respectively. The researchers note that one of the key findings that informed the guidelines was that LADD is safe in adults and adolescents with all Fitzpatrick skin types and in immunosuppressed patients. LADD is effective for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; in addition, it is useful for epidermal and dermal analgesia. Application of heat, pressure, or occlusion or use of an aqueous drug solution may increase drug delivery. Laser settings should ensure that channel diameter is greater than the delivered molecule. Except with impaired wound healing, antibiotic prophylaxis is not recommended. When treating the face and genitalia, antiviral prophylaxis is not recommended; antifungal prophylaxis is not recommended.




 "As the standard of care continues to shift toward minimally invasive and individualized methods of drug delivery, LADD will play an important role," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




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Key findings that informed guidelines include that LADD is safe for adults, adolescents, immunosuppressed patients

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