Provided herein is a device for altering a biological membrane in an individual comprising a means for delivering energy to the surface of the biological membrane, a means for monitoring a physiological state of the biological membrane during delivery of said energy, a means for modulating delivery of the energy to the biological membrane where the modulating is in response to a change in the monitored physiological state. Also provided is a device to control the permeation of substance across a biological membrane and methods for use of these devices.