title: Fractional Ablative Laser Followed by Transdermal Acoustic Pressure Wave Device to Enhance the Drug Delivery of Aminolevulinic Acid: In Vivo Fluorescence Microscopy Study.
abstract: BACKGROUND
  Topical drug delivery is the foundation of all dermatological therapy. Laser-assisted drug delivery (LAD) using fractional ablative laser is an evolving modality that may allow for a greater precise depth of penetration by existing topical medications, as well as more efficient transcutaneous delivery of large drug molecules. Additional studies need to be performed using energy-driven methods that may enhance drug delivery in a synergistic manner. Processes such as iontophoresis, electroporation, sonophoresis, and the use of photomechanical waves aid in penetration. This study evaluated in vivo if there is increased efficacy of fractional CO2 ablative laser with immediate acoustic pressure wave device.
  
  
  METHODS
  Five patients were treated and biopsied at 4 treatment sites: 1) topically applied aminolevulinic acid (ALA) alone; 2) fractional ablative CO2 laser and topical ALA alone; 3) fractional ablative CO2 laser and transdermal acoustic pressure wave device delivery system; and 4) topical ALA with transdermal delivery system. The comparison of the difference in the magnitude of diffusion with both lateral spread of ALA and depth diffusion of ALA was measured by fluorescence microscopy.
  
  
  RESULTS
  For fractional ablative CO2 laser, ALA, and transdermal acoustic pressure wave device, the protoporphyrin IX lateral fluorescence was 0.024 mm on average vs 0.0084 mm for fractional ablative CO2 laser and ALA alone. The diffusion for the acoustic pressure wave device was an order of magnitude greater.
  
  
  CONCLUSIONS
  We found that our combined approach of fractional ablative CO2 laser paired with the transdermal acoustic pressure wave device increased the depth of penetration of ALA.
authors.forename: Jill S
authors.initials: JS
authors.lastname: Waibel
authors.forename: Ashley
authors.initials: A
authors.lastname: Rudnick
authors.forename: Carlos
authors.initials: C
authors.lastname: Nousari
authors.forename: Dhaval G
authors.initials: DG
authors.lastname: Bhanusali
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D016503:Drug Delivery Systems / Q000379:methods*; D006801:Humans; D054020:Lasers, Gas; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D011312:Pressure; D014464:Ultrasonic Therapy
chemical_list: D000622:Aminolevulinic Acid