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