Drugs and Lasers/IPLs
There has been a general trend within the industry to provide end-users of laser devices with guidance on which drugs to avoid to minimise the possibility of drug-induced photosensitivity reactions. This guidance has often, in the opinion of the authors, been largely based on an inappropriately rigid interpretation of what data exists.
Drugs & Lasers/IPLs
Guidance provided by the British Medical Laser Association.
Version 2 issued May 2017.
Important
This advice relates to non-essential aesthetic laser applications and reflects the best data available at the time of this report. It updates earlier advice issued in December 2009. Caution should be exercised in interpretation; the results of future studies may require alteration of the recommendations in this document.
The following is a consensus opinion of interested parties from the laser and light source world in the UK and takes into account:
a) Personal opinions
b) Theoretical perspectives
c) Evidence from practical use over very large numbers of clients/patients
d) Reporting of adverse events in clinical trials and in post-marketing surveillance studies.
Background
There has been a general trend within the industry to provide end-users of laser devices with guidance on which drugs to avoid to minimise the possibility of drug-induced photosensitivity reactions. This guidance has often, in the opinion of the authors, been largely based on an inappropriately rigid interpretation of what data exists.
Reports of photosensitivity reactions as a result of drug administration do occur, but we believe that these reactions have been reported to regulatory bodies with no indication of the wavelength of light that has been responsible. Accurate data are often lacking2.
Phototoxicity generally results from exposure to UVA (315-400nm) radiation with some drugs showing sensitivity into the visible region of the spectrum up to about 460nm. For laser/IPL (intense pulsed light) devices emitting wavelengths above 500nm there is very little likelihood of such a reaction for the vast majority of drugs. Despite this, some centres continue to deny treatment to a patient/client who is on any medication with a known photosensitivity3. This is not at all in accord with the original BMLA guidelines nor with the current revision which sets out the evidence on which the guidance is based.
Other drugs may have an effect on the skin’s healing ability without causing photosensitivity.
Practical Advice
Information regarding all drugs a patient/client is taking should be recorded including:
a) Over the counter drugs
b) Prescribed drugs
c) Herbal remedies
1. Photosensitising drugs that are CONTRAINDICATIONS to laser therapy
a. Drugs causing marked whole body sensitivity – wait 6 months. Drugs administered for systemic Photodynamic Therapy (PDT)4, e.g. Photofrin, Foscan.
b. Drugs causing marked localised light sensitivity – wait 6 weeks. Drugs administered for topical PDT5, e.g. Ameluz, Metvix.
2. Other drugs that may cause Photosensitivity
Any treatment should be performed with caution. Test and assess results carefully and treat small areas initially. If in doubt, do not treat.
If the client/patient wishes to proceed with treatment, the increased risk of hyperpigmentation/photosensitivity should be emphasised and documented.
a. Amiodarone – risk of hyperpigmentation and photosensitivity6,7
b. Minocycline (Minocin) – risk of hyperpigmentation8. Recommend stopping 4 weeks prior to treatment or consider change to an alternative. (It may be noted that lasers have been used successfully to treat minocycline-induced hyperpigmentation9.)
c. St John’s Wort – risk of photosensitivity10. Recommend stopping 4 weeks prior to treatment.
d. If taking other medications or herbal remedies of any sort then careful initial test patch, wait 4-7 days in the case of hair removal and 4-6 weeks in the case of vascular/pigmented treatments.
e. If a patient/client starts a BNF-named photosensitiser during a course of treatment then repeat test patch. It is likely, however, that the wavelength of laser / IPL will not induce a photosensitive response.
3. Drugs which may affect the healing of treated areas
Any treatment should be performed with caution. Test carefully and treat small areas initially. If in doubt, do not treat.
a. Oral Retinoids – There is some controversy around this. The British National Formulary (BNF) states that patients should be told to avoid laser skin treatments for 6 months, although it has been reported that many laser clinicians have treated within this time period without seeing any adverse effects11.
Examples: Isotretinoin (Roaccutane), acitretin (Neotigason), alitretinoin (Toctino)
b. Topical Retinoids – stop use 2 weeks prior to laser, recommence once area is healed.
Examples: Tretinoin (Retin-A, Aknemycin Plus), isotretinoin (Isotrexin), adapalene (Differin)
c. Oral Steroids – Wound healing impairment is dependent on potency, dose and duration of use. It is advisable to check with the prescribing physician if laser treatment can proceed safely. When possible, wait 4 weeks off drug and avoid use immediately following laser therapy. Recommence use once treated area is healed.
Examples: Betamethasone, cortisone, deflazacort, dexamethasone, hydrocortisone, methyl prednisolone, prednisolone, triamcinolone
d. Topical Steroids – Wound healing impairment is dependent on potency, dose and duration of use. It is advisable to check with the prescribing physician if laser treatment can proceed safely. Wait 1 week prior to treatment and avoid use immediately following laser therapy. Recommence use once treated area is healed.
References
1. http://www.bmla.co.uk/resources/ downloaded 10/04/2017
2. Kerstein RL, Lister T, Cole R (2014) Laser therapy and photosensitive medication: a review of the evidence. Lasers Med Sci 29(4):1449-52
3. Moseley H, Lanigan S, Martin R (2015) Drugs and lasers/IPLs. Lasers Med Sci 30(8):2223-4
4. Hopper C (2000) Photodynamic therapy: a clinical reality in the treatment of cancer. Lancet Oncol Dec;1:212-9.
5. Morton CA et al (2008) Photodynamic Therapy (PDT) Guidelines for topical photodynamic therapy: update. Br J Dermatol 159:1245-66
6. Ferguson J (2002) Photosensitivity due to drugs. Photodermatol Photoimmunol Photomed 18(5):262-9
7. Chalmers RJ, Muston HL, Srinivas V, Bennett DH (1982) High incidence of amiodarone-induced photosensitivity in North-west England. Br Med J 285:341
8. Dwyer CM, Cuddihy AM, Kerr REI, Chapman RR, Allam BF (1993) Skin pigmentation due to minocycline treatment of facial dermatoses. Br J Dermatol 129(2):158-62
9. Alster TS, Gupta SN (2004) Minocycline-induced hyperpigmentation treated with a 755-nm Q-switched alexandrite laser. Dermatol Surg 10:1201-4
10. Onoue S, Seto Y, Ochi M, Inoue R, Ito H, Hatano T Yamada S (2011) In vitro photochemical and phototoxicological characterization of major constituents in St. John’s wort (Hypericum perforatum) extracts. Phytochemistry 72 (14-15):1814-20
11. Prather HB, Alam M, Poon E, Arndt KA, Dover JS (2017) Laser safety in Isotretinoin use: A survey of expert opinion and practice. Dermatol Surg 43:357-363
Disclaimer
This should not be considered as an exclusive list of drugs that may interact with the laser treatment. It does not replace any advice or instruction issued by a registered medical practitioner, pharmacist or other registered health professional. The information provided is without any implied warranty of fitness for any purpose or use whatsoever.