title: Translational medicine in the field of ablative fractional laser (AFXL)-assisted drug delivery: A critical review from basics to current clinical status.
abstract: BACKGROUND
  Ablative fractional lasers enhance uptake of topical therapeutics and the concept of fractional laser-assisted drug delivery has now been taken into clinical practice.
  
  
  OBJECTIVE
  We systematically reviewed preclinical data and clinical evidence for fractional lasers to enhance drug uptake and improve clinical efficacy.
  
  
  METHODS
  We searched PubMed and Embase databases; 34 articles met the inclusion criteria. Studies were categorized into experimental preclinical studies and clinical trials, the latter graded according to level of evidence.
  
  
  RESULTS
  All preclinical trials (n = 16) documented enhanced topical drug uptake into skin after ablative fractional laser treatment. Clinical evidence encompassed 18 studies, of which 9 were randomized controlled trials and 2 were controlled trials, examining neoplastic lesions, photodamaged skin, scars, onychomycosis, and topical anesthetics. The highest level of evidence was reached for actinic keratoses treated with methylaminolevulinate for photodynamic therapy (level IB, 5 randomized controlled trials), substantiating superior and long-lasting efficacy versus conventional photodynamic therapy. No adverse events were reported, but ablative fractional laser-assisted drug delivery implies risks of systemic drug absorption, especially when performed over large skin areas.
  
  
  CONCLUSIONS
  Fractional laser-assisted drug delivery is beneficial in enhancing preclinical and clinical outcomes for certain skin conditions.
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: mhaedersdal@dadlnet.dk.
authors.forename: Merete
authors.initials: M
authors.lastname: Haedersdal
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Andrés M
authors.initials: AM
authors.lastname: Erlendsson
authors.affiliation: Departments of Dermatology, Venereology, and Allergology, University of Leipzig, Leipzig, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Paasch
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: R Rox
authors.initials: RR
authors.lastname: Anderson
mesh_terms: D000279:Administration, Cutaneous; D000622:Aminolevulinic Acid / Q000627:therapeutic use; D000777:Anesthetics / Q000008:administration & dosage; D000818:Animals; D002921:Cicatrix / Q000188:drug therapy / Q000473:pathology; D018849:Controlled Clinical Trials as Topic; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004195:Disease Models, Animal; D016503:Drug Delivery Systems / Q000379:methods* / Q000639:trends; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D014009:Onychomycosis / Q000175:diagnosis / Q000188:drug therapy; D061214:Patient Safety; D010778:Photochemotherapy / Q000379:methods*; D058996:Quality Improvement; D016032:Randomized Controlled Trials as Topic; D012871:Skin Diseases / Q000175:diagnosis / Q000188:drug therapy*; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology; D013552:Swine; D057170:Translational Research, Biomedical / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D003879:Dermatologic Agents; D000622:Aminolevulinic Acid
keywords: ablative fractional laser; cutaneous; drug delivery; laser; laser-assisted drug delivery; topical administration; transcutaneous